by Curtis Hamburg MD FACC

Coronary Artery Disease (CAD)

is the number-one killer of men and women in the United States. Nearly 17 million people have it—and many of them will not know it until it is too late.

MANY patients are familiar with the term “heart attack.” What they may not know is that an early diagnosis of coronary artery disease—and follow-through with treatment recommendations—can give them a new lease on life and prevent heart damage. This is good news, considering that each year nearly 800,000 people in the United States suffer a cardiovascular episode. To reduce the risk of this devastating event, HeartWell physicians are diligently talking to their patients about coronary artery disease, including the symptoms, causes, and treatment options.

What Patients Should Know About Coronary Artery Disease

Patients need to understand the cause of heart disease—a buildup of plaque (fatty debris) in the coronary arteries (atherosclerosis) resulting in blockages that restrict blood flow to the heart.  As a result, the heart is starved of oxygen and the vital nutrients it needs to pump efficiently.

The classic symptom of coronary artery disease is chest pain, or angina pectoris. The patient who experiences angina or anginal equivalents (such as shortness of breath) can be classified as having predictable stable angina, usually brought on by exertion and lasting just minutes, or unstable angina, often occurring unexpectedly, and with increasing frequency.

Obviously, unstable angina is the more serious of the two and can be a prelude to a heart attack (death of heart muscle). However, this does not mean that stable angina should be treated lightly. The patient should realize that stable angina can eventually turn into unstable angina, occurring at unpredictable times, with increasing severity,
and lasting longer. Either type of angina is a cause for concern and needs to be addressed.

The severity of angina does not always indicate the severity of the problem, as even mild chest pain may indicate severe ischemia. Regardless of the severity on a symptomatic level, a heart attack occurs when there is a complete blockage of blood to the heart muscle for an extended period. When angina lasts for more than five minutes or becomes increasingly frequent, emergency help is needed.

What Patients Should Know About Risk

The risk of coronary artery disease increases with age. In fact, about 85 percent of those who die from heart disease are over 65. Nevertheless, the prognosis for stable coronary artery disease is good when patients follow through on treatment recommendations. According to American Family Physician, “although CAD caused one out of five deaths in 2005, improved management of the disease has achieved a 34 percent decline in CAD mortality since 1995.” Still, vigilance is necessary. “All patients with stable coronary artery disease require medical therapy to prevent disease progression and recurrent cardiovascular events,” American Family Physician adds.

Men are more at risk for coronary artery disease than women. Although after menopause the risk of coronary artery disease increases significantly in women. Those especially at risk include men or women with a history of diabetes or high blood pressure. High cholesterol levels through genetic mechanisms or diet are a major risk factor.  Family history is important in assigning risk. Other factors related to lifestyle include:

Smoking. Tobacco use may be responsible for a fifth of all deaths from heart disease. Patients should know that while smoking is one of the most significant risk factors, it is also one of the most reversible.

Alcohol. While drinking in moderation can have health benefits, excessive consumption of alcohol (more than one or two drinks per day) can lead to blood clots. Not surprisingly, heart disease is the leading cause of death in alcoholics.

Inactivity. A sedentary lifestyle makes a person twice as likely to have a heart attack than those who engage in a regular program of exercise.

Diet. Excess body fat (especially abdominal fat) can lead to high blood pressure and diabetes—conditions that are associated with heart disease.

What Patients Should Know About Treatment

In some cases, surgery (balloon angioplasty, stent placement, or bypass) can treat coronary artery disease, and medication can help the heart pump more efficiently. Much, however, falls on the patient to address his or her lifestyle. Patients should realize that while surgery may increase the efficiency of blood flow, that alone will not cure
coronary artery disease. It may, however, give the patient a new platform from which to make lifestyle changes. Just as lifestyle factors can be the cause of coronary artery disease, they can also be key to treatment.

HeartWell physicians strive to help patients to reduce risk factors. Cutting out high-cholesterol foods and adhering to a low-fat diet will help maintain a healthy body weight and help keep cholesterol under control.  Patients should also quit smoking and drink only in moderation. It is never too late to start a daily exercise regimen that is tailored to the patient’s specific condition and needs.  However, before starting a vigorous exercise program consultation with a physician is essential.

HeartWell physicians are among the most accomplished and respected in their fields. Each patient of a HeartWell physician receives an accurate, thorough evaluation and diagnosis. This is followed by the most advanced available solutions to manage cardiovascular diseases through medical therapies, mechanical interventions if necessary, and the timely application of lifestyle changes.