Coronary Artery Disease

General

Coronary artery disease (CAD) is the most common form of heart disease in America and Europe and is a serious health problem worldwide. The incidence of CAD is lower in Asian countries, particularly Japan, where diets are low in saturated fat and cholesterol.

CAD occurs from atherosclerosis, when arteries become narrow and hardened due to cholesterol plaque build-up. Further narrowing may occur from thrombi (blood clots) that form on the surfaces of plaques. Angina (chest pain) or dyspnea (shortness of breath) may be present.

X-section of a Normal healthy coronary artery

Diseased coronary showing severe stenosis

Statistics show CAD to be the leading cause of death among both men and women in the United States and in Europe. For example, approximately 12,400,000 Americans suffer from CAD and nearly 500,000 Americans die annually from heart attacks caused by CAD. Over 12 million Americans have a history of myocardial infarction or angina or both (Source : American Heart Association).

Risk factors for CAD include to major categories:

• Controllable factors
• Uncontrollable factors

Controllable risk factors for CAD include high blood cholesterol, hypertension, smoking, diabetes, obesity, lack of physical activity, and stress. Uncontrollable risk factors for CAD include gender, family history, race, and genetics.

Tests used to detect/diagnose CAD include physical exam, blood cholesterol tests, blood pressure measurements, electrocardiogram, exercise testing, chest X-ray, coronary angiography, echo cardiogram, cardiac magnetic resonance imaging, sub-second/multi-slice CT, and nuclear medicine imaging.

Treatment of CAD depends on severity. Invasive treatment options for severe CAD include coronary angioplasty and coronary artery bypass graft.

Detection

Approximately 50% of men and 63% of women who die suddenly from CAD show no previous signs of the disease.
Typically, CAD detection occurs during routine office visits, even if the patient has no symptoms of CAD. In some cases, angina (chest pain) and dyspnea (shortness of breath) may accompany CAD.

Other symptoms may include:

• Tightness, heaviness, burning sensation, pressure, squeezing, or pain behind the breastbone or less commonly also in the arms, neck or jaws
• Nausea and vomiting
• Fatigue
• Sweating
• Weakness

Tests to detect CAD:

• Blood cholesterol
  

  Total cholesterol (mg/dL)	LDL cholesterol (mg/dL)	HDL cholesterol (mg/dL)
  Ideal: Less than 200	Ideal: less than 130	Ideal: 35 or higher
  High risk: 240 and over	High risk: 160 or higher	–

   

• Blood pressure
  

  (mm Hg)	Ideal	Normal	High Normal	Hypertension
  Systolic (top number)	Less than 120	Less than 130	130-139	140 or higher
  Diastolic (bottom number)	Less than 80	Less than 85	85-89	90 or higher

• Chest X-ray
• Electrocardiogram (ECG)
• Exercise Testing
• Ambulatory Monitoring (Holter Monitoring)

Treatment

Treatment of coronary artery disease (CAD) will depend on its severity.

Lifestyle changes:

• Change to a diet low in saturated fat and cholesterol
• Exercise regularly
• Lose weight if overweight or obese
• Quit smoking
• Minimize stress
• Lowering cholesterol
• Lowering blood pressure
• Coronary angioplasty
• Coronary artery bypass graft