Heart Disease

Causes

Damage to blood vessel walls causes CAD. The most common sources of damage are:

• Smoking, high blood pressure, and inflammation
• Plaque build-up on the vessel walls—from certain types of fat and cholesterol in the blood

Plaque is a sticky substance. When it hardens it can tear blood vessel walls and cause bleeding. A blood clot will form to help the area heal. However, it can also add to plaque and further shrink paths for blood flow.

Risk Factors

The risk for CAD is greater in:

• Men (mostly those who are over 45 years of age)
• Women who are over 55 years of age

Things that raise the risk of CAD include:

• Strong family history of heart disease
• Obesity and being overweight
• Certain habits, such as:
• Smoking
• Not being physically active often
• High blood pressure
• High cholesterol—especially low-density lipoprotein (LDL) (bad) cholesterol
• Low high-density lipoprotein (HDL) (good) cholesterol
• Diabetes
• Metabolic syndrome—having a mix of at least 3 of these conditions:
• High blood pressure
• High cholesterol
• Too much belly fat
• Insulin resistance

Other things that may raise the risk of CAD are:

• Drinking too much alcohol
• Mental health conditions such as depression and anxiety
• A food plan that is high in saturated fat, trans fat, cholesterol, and/or calories
• Having sugary drinks often
• Shift work and altered sleeping patterns

Symptoms

CAD itself may not have any signs or symptoms. Often the first sign is a problem with the heart. Weak or blocked blood flow to the heart can cause:

• Angina—chest pain caused by low blood flow to heart muscle
• Heart attack—loss of blood flow that has caused severe damage to heart muscle
• Heart failure—the heart muscle is permanently harmed after years of poor blood flow

Call for medical help right away if you think you may be having a heart attack. Early care can stop further harm.

Diagnosis

The doctor may suspect CAD based on family and health history. People with a high risk of CAD may have these tests:

• Electrocardiogram (ECG)—shows electrical action in the heart
• Exercise stress test—tests the heart under stress
• Echocardiogram—image of the heart
• Coronary angiography—exam of blood vessels
• CT scan

Blood tests to check:

• Cholesterol levels
• Glucose levels
• Signs of inflammation

CAD may not be found until after angina appears or a heart attack occurs.

Treatment

The goals of treatment include:

• Slow or stop growth of plaque in blood vessels. Decrease build-up if possible.
• Decrease risk of problems like blood clots or heart attack.
• Relieve symptoms if there are any.

Options to help reach these goals include:

Lifestyle Habits

Diet and exercise can play a role in heart and blood vessel healthy. Goals may include

• Heart healthy diet:
  • Limit saturated and trans fats, red meat, and processed meats.
  • Increase fruits, vegetables, fish, and fiber.
• Limit or avoid alcohol. This means no more than:
• 2 drinks per day for men
• 1 drink per day for women.
• 30 to 60 minutes of physical activity on most days.
• Reach and keep a healthy weight.

Smoking can also make plaque worse. It also increases risk of heart disease. There are many tools to help quit.

Medicine

Medicine can help to manage issues that can make CAD worse. It can also help decrease the risk of complications. Options include:

• Statin therapy—to help manage cholesterol
• Ace inhibitors or Beta blockers—may help to prevent angina and lower the risk of heart attack
• Antiplatelet (aspirin or other)—to decrease risk of blood clots

Medical Care

Early care may decrease damage to the heart. Routine follow-up care will be part of the care plan. Other steps that may be advised include:

• Control of high blood pressure—may include medicine
• Diabetes care plan—high blood glucose can damage blood vessels
• Flu shot every year

Surgery

Surgery may be needed to remove very bad blocks. Options include:

• Percutaneous coronary interventions (PCI)—A tube is passed to the blockage. A wire mesh may also be used to hold the artery open.
• Coronary artery bypass grafting (CABG)—Part of a blood vessel is taken from other areas of the body. It is then placed near the blockage. The blood can then flow around the block through this new path.

Prevention

The risk of CAD may be lower with:

• A healthy weight
• A heart healthy diet
• Regular physical activity
• Never smoking or vaping—or quitting smoking or vaping
• Stress management