An in-depth report on the causes, diagnosis, treatment, and prevention of coronary artery disease (CAD).
Coronary Artery Disease
Coronary artery disease (CAD), also called heart disease, is a condition in which fatty deposits, called plaque, build up in the heart's arteries. These deposits cause arteries to become narrow and blocked, which restricts blood and oxygen flow to the heart muscle. CAD is the leading cause of death for both men and women in the United States.
The most important factors that increase the risk for CAD are:
- Unhealthy cholesterol and lipid levels
- High blood pressure
- Lack of exercise
- Advancing age
Angina is the primary symptom of CAD. Angina feels like gripping pain or pressure in the chest area.
- Stable angina is predictable chest pain that lasts a few minutes or less and is usually relieved by rest or medication. It is often triggered by physical exertion or emotional stress.
- Unstable angina is unpredictable chest pain and may occur at rest. When patients with stable angina have symptoms that are more severe or occur with less and less activity it is called unstable angina. It is a more serious condition than stable angina and can be a warning sign of a heart attack.
Some patients with CAD have few or no symptoms. Often a heart attack or an episode of unstable angina is the first sign that a person has CAD.
Lifestyle changes (such as a healthy diet and regular physical activity) are essential for preventing and treating CAD.
Medications for preventing and treating CAD include aspirin and related drugs, cholesterol-lowering drugs (statins), and high blood pressure medications (such as beta-blockers, calcium channel blockers and angiotensin converting enzyme [ACE] inhibitors). Some patients take nitrate drugs such as nitroglycerin or other medications (including some blood pressure medications) to treat angina.
Procedures may be needed to open a blocked or narrowed coronary artery and improve blood flow to the heart. These approaches are known as reperfusion therapy. Percutaneous coronary intervention (PCI), also called angioplasty (usually with stenting), uses a small balloon to open the blood vessel. Coronary artery bypass graft (CABG) is a more invasive procedure that is generally recommended for patients with multiple severe blockages. It uses grafts in the form of arteries or veins to reroute blood flow to the heart.
Heart Disease Guidelines
The American College of Cardiology, American Heart Association, and other professional organizations' guidelines recommend:
- For patients with heart disease, controlling blood pressure and lipids is very important, as is the regular use of antiplatelet therapy (usually aspirin).
- Patients deciding between CABG and PCI should meet with an interdisciplinary medical team that includes both a cardiac surgeon and an interventional cardiologist. CABG is a more invasive procedure. But it may work better than PCI for certain patients, depending on the location and number of blockages as well as other factors such as how well the heart is functioning and other medical problems the patient might have, such as diabetes.
- Cardiac rehabilitation is strongly recommended, especially for patients who have undergone bypass surgery. Heart disease patients should also be screened for depression.
- Sexual activity is safe for most patients with stable CAD. But patients with severe heart disease should abstain until their condition stabilizes.