Coronary artery disease (CAD), also known as ischemic heart disease (IHD), is a group of diseases that includes stable angina, unstable angina, myocardial infarction, and sudden cardiac death. It is the most common type of heart disease and is the leading cause of death globally. CAD occurs when the arteries that supply blood to the heart muscle (coronary arteries) become hardened and narrowed due to the buildup of plaque on their inner walls. This process is called atherosclerosis.
The narrowing reduces blood flow to the heart, which can result in chest pain (angina), shortness of breath, or other coronary artery disease signs and symptoms. A complete blockage can cause a heart attack (myocardial infarction).
Causes and Risk Factors
The exact cause of CAD is complex and multifactorial. Risk factors include:
- Age: The risk increases with age.
- Sex: Males are generally at higher risk than females, though the risk for females increases and may surpass males after menopause.
- Family history: A family history of heart disease increases the risk.
- Smoking: Smoking and long-term exposure to secondhand smoke damage the interior walls of arteries.
- High blood pressure: High blood pressure can damage arteries over time, making them more susceptible to atherosclerosis.
- High cholesterol levels: High levels of cholesterol in the blood can increase the formation of plaques and atherosclerosis.
- Diabetes: Diabetes increases the risk of CAD, partly because it is associated with other conditions like obesity, high blood pressure, and high cholesterol.
- Obesity: Obesity is linked with high blood cholesterol levels, high triglyceride levels, high blood pressure, and diabetes.
- Physical inactivity: Lack of exercise is associated with CAD and its risk factors.
Symptoms
CAD may be asymptomatic for a long time. When symptoms do appear, they may include:
- Chest pain or discomfort (angina), often triggered by physical or emotional stress
- Shortness of breath
- Fatigue with activity
- Heart attacks, which can manifest as chest pain, upper body discomfort, sweating, nausea, and shortness of breath
Diagnosis
The diagnosis of CAD involves a combination of clinical evaluation, non-invasive tests, and invasive procedures. These may include:
- Electrocardiogram (ECG or EKG): Measures the electrical activity of the heart.
- Echocardiogram: Uses ultrasound to visualize the heart.
- Stress testing: Assesses how the heart works during physical stress.
- Coronary angiography: Involves using dye and X-rays to show the inside of the coronary arteries.
- Blood tests: To measure levels of certain fats, cholesterol, sugar, and proteins in the blood.
Treatment and Management
Treatment of CAD involves lifestyle modifications, medications, and potential procedures like angioplasty and coronary artery bypass grafting (CABG).
- Lifestyle changes: Include quitting smoking, eating a heart-healthy diet, exercising regularly, and maintaining a healthy weight.
- Medications: These may include statins to lower cholesterol, blood pressure medications, antiplatelets to prevent clots and nitroglycerin for chest pain.
- Surgical and procedural interventions: Such as angioplasty (with stent placement) to open narrowed arteries, or coronary artery bypass grafting (CABG) to create new pathways for blood flow to the heart.
Prevention
Preventing CAD involves managing risk factors through lifestyle changes, such as eating a healthy diet, exercising regularly, avoiding tobacco, and controlling high blood pressure, cholesterol, and diabetes. Regular health check-ups are important for detecting potential risk factors early.
Coronary artery disease represents a significant public health challenge worldwide. Early detection, comprehensive management of risk factors, and adherence to treatment plans can significantly reduce the impact of CAD and improve the quality of life for individuals affected by this disease.
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