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Coronary Artery Disease

(CAD; Coronary Atherosclerosis; Silent MI; Coronary Heart Disease; Ischemic Heart Disease; Atherosclerosis of the Coronary Arteries)

Definition    TOP

Coronary arteries bring oxygen rich blood to the heart muscle. Coronary artery disease (CAD) is narrowing of these arteries. If the blockage is complete, areas of the heart muscle may be damaged. In a severe case, the heart muscle dies. This can lead to a heart attack, also known as a myocardial infarction (MI).

Coronary artery disease is the most common form of heart disease. It is the leading cause of death worldwide.

Coronary Artery Disease

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Copyright © Nucleus Medical Media, Inc.

Causes    TOP

Causes include:

  • Thickening of the walls of the arteries that feed the heart muscle
  • Build up of fatty plaques within the coronary arteries
  • Sudden spasm of a coronary artery
  • Narrowing of the coronary arteries
  • Inflammation within the coronary arteries
  • Development of a blood clot within the coronary arteries that blocks blood flow

Risk Factors    TOP

Major risk factors include:

  • Sex: male—men have a greater risk of heart attack than women
  • Age: 45 and older for men, 55 and older for women
  • Heredity: strong family history of heart disease
  • Obesity and being overweight
  • Smoking
  • High blood pressure
  • Inactive lifestyle
  • High cholesterol, specifically, high LDL cholesterol and low HDL cholesterol
  • Diabetes
  • Metabolic syndrome —a combination of high blood pressure, abdominal obesity, and insulin resistance

Other risk factors may include:

  • Stress
  • Excessive alcohol use
  • Depression
  • A diet that is high in saturated fat, trans fat, cholesterol, and/or calories
  • Drinking sugary beverages on a regular basis may increase your risk of CAD.

Symptoms    TOP

CAD may progress without any symptoms.

Angina is chest pain that comes and goes. It often has a squeezing or pressure-like quality. It may radiate into the shoulder(s), arm(s), or jaw. Angina usually lasts for about 2-10 minutes. It is often relieved with rest. Angina can be triggered by:

  • Exercise or exertion
  • Emotional stress
  • Cold weather
  • A large meal

Chest pain may indicate more serious unstable angina or a heart attack if it includes the following:

  • It is unrelieved by rest or nitroglycerin
  • Severe angina
  • Angina that begins at rest
  • Angina that lasts more than 15 minutes

Accompanying symptoms may include:

  • Shortness of breath
  • Sweating
  • Nausea
  • Weakness

Immediate medical attention is needed for unstable angina. CAD in women may not cause typical symptoms. It is likely to start with shortness of breath and fatigue.

Diagnosis    TOP

If you go to the emergency room with chest pain, some tests will be done right away. The tests will attempt to see if you are having angina or a heart attack. If you have a stable pattern of angina, other tests may be done to determine the severity of your disease.

The doctor will ask about your symptoms and medical history. A physical exam will be done.

Tests may include:

Treatment    TOP

Treatment may include:

Nitroglycerin

This medicine is usually given during an attack of angina. It can be given as a tablet that dissolves under the tongue or as a spray. Longer-lasting types can be used to prevent angina before an activity known to cause it. These may be given as pills or applied as patches or ointments.

Blood-Thinning Medications

A small, daily dose of aspirin has been shown to decrease the risk of heart attack. Ask your doctor before taking aspirin daily.

Other blood-thinning medicines include:

  • Warfarin
  • Ticlopidine
  • Clopidogrel
  • Prasugrel

Beta-Blockers, Calcium-Channel Blockers, and ACE-Inhibitors    TOP

These may help prevent angina. In some cases, they may lower the risk of heart attack.

Medications to Lower Cholesterol    TOP

Medicines, like statins, are often prescribed to people who have CAD. Statins lower cholesterol levels, which can help to prevent CAD events.

Revascularization    TOP

Patients with severe blockages in their coronary arteries may benefit from procedures to immediately improve blood flow to the heart muscle:

  • Percutaneous coronary interventions (PCI)—such as balloon angioplasty, in some cases, a wire mesh stent is placed to hold the artery open
  • Coronary artery bypass grafting (CABG) —segments of vessels are taken from other areas of the body and are sewn into the heart arteries to reroute blood flow around blockages

Options for Refractory Angina    TOP

For patients who are not candidates for revascularization procedures, but have continued angina despite medicine, options include:

  • Enhanced external counterpulsation (EECP)—large air bags are inflated around the legs in tune with the heart beat. The patient receives 5 one-hour treatments per week for seven weeks. This has been shown to reduce angina and may improve symptom-free exercise duration.
  • Transmyocardial revascularization (TMR)—surgical procedure done with laser to reduce chest pain

Prevention    TOP

To reduce your risk of getting coronary artery disease:

  • Maintain a healthy weight.
  • Eat a heart healthy diet that is low in saturated fat, red meat and processed meats, and rich in whole grains, fruits, vegetables, and nuts.
  • Begin a safe exercise program with the advice of your doctor.
  • If you smoke, quit.
  • Treat your high blood pressure and/or diabetes.
  • Treat high cholesterol or triglycerides.
  • Ask your doctor about taking a low-dose aspirin every day.
  • Find ways to reduce stress.

RESOURCES:

American Heart Association
http://www.heart.org
National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov

CANADIAN RESOURCES:

Heart and Stroke Foundation of Canada
http://www.heartandstroke.com
Public Health Agency of Canada
http://www.phac-aspc.gc.ca

References:

Arora RR, Chou TM, et al. The multicenter study of enhanced external counterpulsation (MUST-EECP): effect of EECP on exercise-induced myocardial ischemia and anginal episodes. J Am Coll Cardiol . 1999;33:1833-1840.
Boden WE, O'Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med . 2007;356:1503-1516.
Coronary artery disease. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Cad/CAD_WhatIs.html . Updated August 23, 2012. Accessed February 8, 2013.
Coronary artery disease (CAD). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated January 29, 2013. Accessed February 8, 2013.
Coronary artery disease–Coronary heart disease. American Heart Association website. Available at: http://www.heart.o... . Accessed February 8, 2013.
What is coronary heart disease? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/cad/ . Updated August 23, 2012. Accessed February 8, 2013.
4/10/2007 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Boden WE, O'Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med . 2007 Mar 26.
11/7/2007 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Bravata DM, Gienger AL, McDonald KM, et al. Systematic Review: The comparative effectiveness of percutaneous coronary interventions and coronary artery bypass graft surgery. Ann Intern Med . 2007 Nov 20.
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6/5/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Sinha R, Cross AJ, Graubard BI, Leitzmann MF, Schatzkin A. Meat intake and mortality: a prospective study of over half a million people. Arch Intern Med . 2009;169:562-571.
7/6/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Kodama S, Saito K, Tanaka S, et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA . 2009;301:2024-2035.
7/6/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Fung TT, Malik V, Rexrode KM, Manson JE, Willett WC, Hu FB. Sweetened beverage consumption and risk of coronary heart disease in women. Am J Clin Nutr . 2009;89:1037-1042.
2/12/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : FDA approves new indication for Crestor. US Food and Drug Administration website. Available at: http://www.fda.gov... . Published February 9, 2010. Accessed February 12, 2010.
11/26/2012 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Kivimaki M, Nyberg S, Batty G, et al. Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data. Lancet . 2012 Oct 27;380(9852):1491-7.
7/21/2014 DynaMed's Systematic Literature Surveillance
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Afshin A, Micha R, et al. Consumption of nuts and legumes and risk of incident ischemic heart disease, stroke, and diabetes: a systematic review and meta-analysis. Am J Clin Nutr. 2014 June 4;100(1):278-288.
Last reviewed September 2013 by Michael J. Fucci, DO
Last Updated: 7/21/2014