Coronary artery disease
Coronary artery disease (CAD), also known asischemic heart disease (IHD), is
a group of diseases that includes: stable
angina, unstable angina, myocardial infarction, and sudden cardiac death. It
is within the group of cardiovascular diseases of which it is
the most common type. A
common symptom is chest pain or discomfort which may travel into the
shoulder, arm, back, neck, or jaw. Occasionally
it may feel like heartburn. Usually symptoms occur with exercise or
emotional stress, last less than a few minutes, and
get better with rest. Shortness of breath may also occur and
sometimes no symptoms are present. The
first sign is occasionally a heart attack. Other
complications include heart failure or an irregular
heartbeat.
Risk factors
include: high blood pressure, smoking, diabetes,
lack of exercise, obesity, high blood cholesterol, poor diet, and
excessive alcohol,
among others. Other
risks include depression. The
underlying mechanism involves atherosclerosis of
the arteries of the heart. A
number of tests may help with diagnoses including: electrocardiogram, cardiac stress testing, coronary computed tomographic
angiography, and coronary angiogram, among others.
Prevention
is by eating a healthy diet, regular exercise, maintaining a healthy weight and
not smoking. Sometimes
medication for diabetes, high cholesterol, or high blood pressure are also
used. There
is limited evidence for screening people who are at low risk and do not have
symptoms. Treatment
involves the same measures as prevention. Additional
medications such as antiplatelets including aspirin, beta
blockers, or nitroglycerin may be recommended. Procedures
such as percutaneous coronary intervention (PCI)
or coronary artery bypass surgery(CABG)
may be used in severe disease. In
those with stable CAD it is unclear if PCI or CABG in addition to the other
treatments improve life expectancy or decreases heart attack
risk.
In 2013 CAD
was the most common cause of death globally,
resulting in 8.14 million deaths (16.8%) up from 5.74 million deaths (12%) in
1990. The
risk of death from CAD for a given age has decreased between 1980 and 2010
especially in developed countries. The
number of cases of CAD for a given age has also decreased between 1990 and
2010. In
the United States in 2010 about 20% of those over 65
had CAD, while it was present in 7% of those 45 to 64, and 1.3% of those 18 to
45. Rates
are higher among men than women of a given age.
Signs and
symptoms
Chest pain that
occurs regularly with activity, after eating, or at other predictable times is
termed stable angina and
is associated with narrowings of the arteries of
the heart.
Angina that
changes in intensity, character or frequency is termed unstable. Unstable
angina may precede myocardial infarction. In adults who go to the
emergency department with an unclear cause of pain, about 30% have pain due to
coronary artery disease.
Risk factors
Coronary
artery disease has a number of well determined risk factors. The most common
risk factors include smoking, family history, hypertension, obesity, diabetes, lack
of exercise, stress, and high
blood lipids. Smoking
is associated with about 36% of cases and obesity 20%. Lack
of exercise has been linked to 7–12% of cases. Exposure
to the herbicide Agent
orange may increase risk. Both rheumatoid arthritis and systemic lupus erythematosus are
independent risk factors as well.
Job stress
appears to play a minor role accounting for about 3% of cases.
In one
study, women who were free of stress from work life saw an increase in the
diameter of their blood vessels, leading to decreased progression of
atherosclerosis. In
contrast, women who had high levels of work-related stress experienced a
decrease in the diameter of their blood vessels and significantly increased
disease progression. Having
a type A behavior pattern, a group of personality
characteristics including time urgency, competitiveness, hostility, and
impatience is
linked to an increased risk of coronary disease.
Blood fats
- High blood cholesterol (specifically, serum LDL concentrations). HDL (high density lipoprotein) has a protective effect over development of coronary artery disease.
- High blood triglycerides may play a role.
- High levels of lipoprotein(a), a compound formed when LDL cholesterol combines with a protein known as apolipoprotein(a).
- Dietary cholesterol does not appear to have a significant effect on blood cholesterol and thus recommendations about its consumption may not be needed. Saturated fat is still a concern.
Other
- Endometriosis in women under the age of 40
- It is unclear if type A personality affects the risk of coronary artery disease. Depression and hostility do appear to be risks however.
- The number of categories of adverse childhood experiences (psychological, physical, or sexual abuse; violence against mother; or living with household members who were substance abusers, mentally ill, suicidal, or incarcerated) showed a graded relationship to the presence of adult diseases including coronary artery (ischemic heart) disease.
- Hemostatic factors: High levels of fibrinogen and coagulation factor VII are associated with an increased risk of CAD. Factor VII levels are higher in individuals with a high intake of dietary fat. Decreased fibrinolytic activity has been reported in patients with coronary atherosclerosis.
- Low hemoglobin
- Men over 45; Women over 55. (Read more >>)
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