Coronary artery disease is the most common type of heart disease. Also known as coronary heart disease, it affects about 13 million Americans. The cause of coronary artery disease is atherosclerosis — the gradual buildup of plaques in blood vessels that feed your heart (your coronary arteries).
Over time, these plaques — deposits of fat, cholesterol, calcium and other cellular sludge from your blood — can narrow your coronary arteries, so less blood flows to your heart muscle. Diminished blood flow to your heart can cause chest pain (angina). A sudden, complete blockage can lead to a heart attack. Each year, more than 500,000 Americans die of complications of coronary artery disease.
The problem is that many people who have this form of heart disease aren’t aware they have it. Coronary artery disease develops slowly and silently over decades. It can go virtually unnoticed until it produces a heart attack.
You can prevent or slow coronary artery disease by taking steps to improve the health of your heart and blood vessels. Drugs and surgical techniques can repair narrowed coronary arteries, but the best long-term solution is to make lifestyle choices that can help control the risk factors for coronary artery disease.
Coronary artery disease varies both in signs and symptoms and in severity. It may produce no symptoms, or it can produce chest pain of varying degrees as well as shortness of breath. It may also result in a heart attack.
Like any muscle, your heart needs a steady supply of oxygen-rich and nutrient-rich blood to function. Your coronary arteries encircle your heart like a crown and branch off into your heart muscle, supplying it with blood.
If your coronary arteries become narrowed, they can’t supply enough oxygenated blood to your heart when it’s beating hard, as when you exert yourself. An insufficient blood supply to the heart or other organs is called ischemia. When it affects the heart, it is known as cardiac ischemia. Cardiac ischemia can result in:
Arteries are blood vessels that carry oxygen-rich blood away from your heart, to all of the tissues of your body — including your heart itself.
Healthy arteries — including healthy coronary arteries — are clean, smooth and slick. The artery walls are flexible and can expand to let more blood through when necessary. Artery disease is thought to begin with an injury to the lining of the walls of arteries. This injury makes them susceptible to atherosclerosis.
Atherosclerosis is the slow, progressive buildup of deposits called plaques on the inner walls of your arteries. Plaques are deposits of fat, cholesterol, calcium and other cellular material from your blood.
These plaques both narrow and harden arteries. Plaques alone can significantly block your coronary arteries and arteries throughout your body. They can also become fragile and rupture, forming blood clots that can block blood flow to your heart or elsewhere in your body.
Atherosclerosis is a complex disease that starts in childhood and usually progresses as you age. In some people, atherosclerosis progresses rapidly, especially those with risk factors such as smoking, high blood pressure, diabetes and high cholesterol. Obesity and physical inactivity are other factors that can contribute to this disease.
A high blood level of low-density lipoprotein (LDL) cholesterol — so-called “bad” cholesterol — can lead to atherosclerosis. High blood cholesterol can be an inherited problem, but it’s also typically a byproduct of poor health habits — such as eating a high-fat, high-cholesterol diet, which is common in Western societies. When the level of LDL cholesterol in your blood is high, there’s a greater chance that it will be deposited onto your artery walls. Higher levels of the “good” cholesterol, high-density lipoprotein (HDL), seem to protect against heart disease.
Some research suggests that a bacterium, such as Chlamydia pneumoniae, may play a role in the narrowing of coronary arteries. But whether infectious agents play an important role in this process isn’t well-defined because other research has failed to confirm this link. It’s also unclear whether inflammation of the arteries caused by an infection or other factor underlies coronary artery disease or accelerates it.
How can you know whether you have this silent, potential killer? Your doctor can help answer that question based on test results and your level of risk.
If you have risk factors for coronary artery disease, your doctor may want to test you for coronary artery disease, even if you don’t have signs or symptoms of narrowed arteries. You may be referred to a cardiologist, a doctor who specializes in diagnosing and treating cardiovascular problems. The term cardiovascular refers to your body’s circulatory system — your heart, arteries and veins.
In addition to a physical examination, taking your medical history and routine blood tests, your doctor may recommend these tests to diagnose coronary artery disease:
If your doctor finds that you have coronary artery disease, several treatment approaches are possible, depending on the seriousness of the disease. Many people are able to manage coronary artery disease with lifestyle changes and medications. Other people with severe coronary artery disease may need coronary angioplasty or surgery.
Although great advances have been made in treating coronary artery disease, changing your habits remains the single most effective way to stop the disease from progressing. Here are the most beneficial changes you can make:
In addition to lifestyle changes, your doctor may recommend drug therapy to treat coronary artery disease. Medications to prevent or treat coronary artery disease include:
You may need to take drugs for your heart indefinitely, or you may take medications temporarily until a risk factor for coronary artery disease is better under control.
Types of procedures to improve coronary blood flow (revascularization) include:
Research into new ways to treat coronary artery disease is yielding possibilities. Here are some areas of current research:
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