Coronary artery disease
Coronary artery disease | |
---|---|
Other names | Atherosclerotic heart disease, |
Frequency | 110 million (2015)[11] |
Deaths | 8.9 million (2015)[12] |
Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD),
A common symptom is
Risk factors include
Ways to reduce CAD risk include eating aIn 2015, CAD affected 110 million people and resulted in 8.9 million deaths.
Signs and symptoms
The most common symptom is chest pain or discomfort that occurs regularly with activity, after eating, or at other predictable times; this phenomenon is termed stable angina and is associated with narrowing of the arteries of the heart. Angina also includes chest tightness, heaviness, pressure, numbness, fullness, or squeezing.[28] Angina that changes in intensity, character or frequency is termed unstable. Unstable angina may precede myocardial infarction. In adults who go to the emergency department with an unclear cause of pain, about 30% have pain due to coronary artery disease.[29] Angina, shortness of breath, sweating, nausea or vomiting, and lightheadedness are signs of a heart attack, or myocardial infarction, and immediate emergency medical services are crucial.[28]
With advanced disease, the narrowing of coronary arteries reduces the supply of oxygen-rich blood flowing to the heart, which becomes more pronounced during strenuous activities during which the heart beats faster and has an increased oyxgen demand.[30] For some, this causes severe symptoms, while others experience no symptoms at all.[4]
Symptoms in females
Symptoms in females can differ from those in males, and the most common symptom reported by females of all races is shortness of breath.[31] Other symptoms more commonly reported by females than males are extreme fatigue, sleep disturbances, indigestion, and anxiety.[32] However, some females do experience irregular heartbeat, dizziness, sweating, and nausea.[28] Burning, pain, or pressure in the chest or upper abdomen that can travel to the arm or jaw can also be experienced in females, but it is less commonly reported by females than males.[32] On average, females experience symptoms 10 years later than males.[33] Females are less likely to recognize symptoms and seek treatment.[28]
Risk factors
Coronary artery disease is characterized by heart problems that result from atherosclerosis.
Job stress appears to play a minor role accounting for about 3% of cases.
Blood fats
The consumption of different types of fats including trans unsaturated, saturated and trans in a diet "influences the level of cholesterol that is present in the bloodstream".[49] Unsaturated fats originate from plant sources (such as oils). There are two types of unsaturated fats, cis and trans isomers. Cis unsaturated fats are bent in molecular structure and trans are linear in structure. Saturated fats originate from animal sources (such as animal fats) and are also molecularly linear in structure.[50] The linear configurations of unsaturated trans and saturated fats allow them to easily accumulate and stack at the arterial walls when consumed in high amounts (and other positive measures towards physical health are not met).
- Fats and cholesterol are insoluble in blood and thus are amalgamated with proteins to form lipoproteins for transport. Low density lipoproteins (LDL) transport cholesterol from the liver to the rest of the body and therefore raise blood cholesterol levels. The consumption of "saturated fats increases LDL levels within the body, thus raising blood cholesterol levels".[49]
- High density lipoproteins (HDL) are considered 'good' lipoproteins as they search for excess cholesterol in the body and transport it back to the liver for disposal. Trans fats also "increase LDL levels whilst decreasing HDL levels within the body, significantly raising blood cholesterol levels".[49]
High levels of cholesterol in the bloodstream lead to atherosclerosis. With increased levels of LDL in the bloodstream, "LDL particles will form deposits and accumulate within the arterial walls, which will lead to the development of plaques, restricting blood flow".[49] The resultant reduction in the heart's blood supply due to atherosclerosis in coronary arteries "causes shortness of breath, angina pectoris (chest pains that are usually relieved by rest), and potentially fatal heart attacks (myocardial infarctions)".[36]
Genetics
The
Transcriptome
Transcripts associated with CAD (TRACs) - FoxP1, ICOSLG, IKZF4/Eos, SMYD3, TRIM28, and TCF3/E2A that are likely markers of regulatory T cells (Treg), consistent with known reductions in Tregs in CAD.[53]
The RNA changes are mostly related to ciliary and endocytic transcripts, which in the circulating immune system would be related to the immune synapse. The immune synapse is the contact-dependent mode of communication between T cells and B cells, on one side, and a variety of antigen-presenting and immunomodulating cells on the other side.) are known elements of the Wnt signaling pathway, which is major determinant of Treg differentiation.
Other
- Endometriosis in females under the age of 40.[55]
- Depression and hostility appear to be risks.[56]
- The number of categories of adverse childhood experiences (psychological, physical, or sexual abuse; violence against mother; or living with household members who used substances, mentally ill, suicidal, or incarcerated) showed a graded correlation with the presence of adult diseases including coronary artery (ischemic heart) disease.[57]
- Hemostatic factors: High levels of fibrinogen and coagulation factor VII are associated with an increased risk of CAD.[58]
- Low hemoglobin.[59]
- In the Asian population, the b fibrinogen gene G-455A polymorphism was associated with the risk of CAD.[60]
- Patient-specific vessel ageing or remodelling determines endothelial cell behaviour and thus disease growth and progression. Such 'hemodynamic markers' are thus patient-specific risk surrogates.[61]
Pathophysiology
Limitation of blood flow to the heart causes
Typically, coronary artery disease occurs when part of the smooth, elastic lining inside a
Diagnosis
The diagnosis of CAD depends largely on the nature of the symptoms. The first investigation when CAD is suspected is an
For stable patient but who are symptomatic there are several non-invasive tests to diagnose CAD depending on pre assessment of the risk profile. Non invasive imaging include;
The diagnosis of microvascular angina (previously known as cardiac syndrome X – the rare coronary artery disease that is more common in females, as mentioned, is a diagnosis of exclusion. Therefore, usually, the same tests are used as in any person with the suspected of having coronary artery disease:[73]
Stable angina
In minor to moderate cases, nitroglycerine may be used to alleviate acute symptoms of stable angina or may be used immediately prior to exertion to prevent the onset of angina. Sublingual nitroglycerine is most commonly used to provide rapid relief for acute angina attacks and as a complement to anti-anginal treatments in patients with refractory and recurrent angina.[76] When nitroglycerine enters the bloodstream, it forms free radical nitric oxide, or NO, which activates guanylate cyclase and in turn stimulates the release of cyclic GMP. This molecular signaling stimulates smooth muscle relaxation, ultimately resulting in vasodilation and consequently improved blood flow to regions of the heart affected by atherosclerotic plaque.[77]
Stable coronary artery disease (SCAD) is also often called stable ischemic heart disease (SIHD).[78] A 2015 monograph explains that "Regardless of the nomenclature, stable angina is the chief manifestation of SIHD or SCAD."[78] There are U.S. and European clinical practice guidelines for SIHD/SCAD.[79][80][70] In patients with non-severe asymptomatic aortic valve stenosis and no overt coronary artery disease, the increased troponin T (above 14 pg/mL) was found associated with an increased 5-year event rate of ischemic cardiac events (myocardial infarction, percutaneous coronary intervention, or coronary artery bypass surgery).[81]
Acute coronary syndrome
Diagnosis of
Risk assessment
There are various risk assessment systems for determining the risk of coronary artery disease, with various emphasis on different variables above. A notable example is
Polygenic score is another way of risk assessment. In one study the relative risk of incident coronary events was 91% higher among participants at high genetic risk than among those at low genetic risk.[83]
Prevention
Up to 90% of cardiovascular disease may be preventable if established risk factors are avoided.[84][85] Prevention involves adequate physical exercise, decreasing obesity, treating high blood pressure, eating a healthy diet, decreasing cholesterol levels, and stopping smoking. Medications and exercise are roughly equally effective.[86] High levels of physical activity reduce the risk of coronary artery disease by about 25%.[87] Life's Essential 8 are the key measures for improving and maintaining cardiovascular health, as defined by the American Heart Association. AHA added sleep as a factor influencing heart health in 2022.[88]
Most guidelines recommend combining these preventive strategies. A 2015 Cochrane Review found some evidence that counseling and education to bring about behavioral change might help in high-risk groups. However, there was insufficient evidence to show an effect on mortality or actual cardiovascular events.[89]
In
Diet
A diet high in fruits and vegetables decreases the risk of cardiovascular disease and death.
The consumption of trans fat (commonly found in hydrogenated products such as margarine) has been shown to cause a precursor to atherosclerosis[98] and increase the risk of coronary artery disease.[99]
Evidence does not support a beneficial role for
Secondary prevention
Secondary prevention is preventing further sequelae of already established disease. Effective lifestyle changes include:
- Weight control
- Smoking cessation
- Avoiding the consumption of trans fats (in partially hydrogenated oils)
- Decreasing psychosocial
- Exercise
Aerobic exercise, like walking, jogging, or swimming, can reduce the risk of mortality from coronary artery disease.[105] Aerobic exercise can help decrease blood pressure and the amount of blood cholesterol (LDL) over time. It also increases HDL cholesterol.[106]
Although exercise is beneficial, it is unclear whether doctors should spend time counseling patients to exercise. The
Psychological symptoms are common in people with CHD, and while many psychological treatments may be offered following cardiac events, there is no evidence that they change mortality, the risk of revascularization procedures, or the rate of non-fatal myocardial infarction.[104]
Antibiotics for secondary prevention of coronary heart disease
Antibiotics may help patients with coronary disease to reduce the risk of heart attacks and strokes.[109] However, the latest evidence suggests that antibiotics for secondary prevention of coronary heart disease are harmful with increased mortality and occurrence of stroke.[109] So, the use of antibiotics is not currently supported for preventing secondary coronary heart disease.
Neuropsychological Assessment
A thorough systematic review found that indeed there is a link between a CHD condition and brain dysfunction in females.[110] Consequently, since research is showing that cardiovascular diseases, like CHD, can play a role as a precursor for dementia, like Alzheimer's disease, individuals with CHD should have a neuropsychological assessment.[111]
Treatment
There are a number of treatment options for coronary artery disease:[112]
- Lifestyle changes
- Medical treatment – beta-blockers, nitroglycerin, calcium channel blockers, etc.);
- Coronary interventions as angioplasty and coronary stent;
- Coronary artery bypass grafting(CABG)
Medications
- Statins, which reduce cholesterol, reduce the risk of coronary artery disease[113]
- Nitroglycerin[114]
- Calcium channel blockers and/or beta-blockers[115]
- Antiplatelet drugs such as aspirin[115][116]
It is recommended that blood pressure typically be reduced to less than 140/90 mmHg.[117] The diastolic blood pressure however should not be lower than 60 mmHg. Beta blockers are recommended first line for this use.[117]
Aspirin
In those with no previous history of heart disease, aspirin decreases the risk of a myocardial infarction but does not change the overall risk of death.
Anti-platelet therapy
Surgery
Revascularization for
Epidemiology
As of 2010, CAD was the leading cause of death globally resulting in over 7 million deaths.[129] This increased from 5.2 million deaths from CAD worldwide in 1990.[129] It may affect individuals at any age but becomes dramatically more common at progressively older ages, with approximately a tripling with each decade of life.[130] Males are affected more often than females.[130]
It is estimated that 60% of the world's cardiovascular disease burden will occur in the South Asian subcontinent despite only accounting for 20% of the world's population. This may be secondary to a combination of genetic predisposition and environmental factors. Organizations such as the Indian Heart Association are working with the World Heart Federation to raise awareness about this issue.[131]
Coronary artery disease is the leading cause of death for both males and females and accounts for approximately 600,000 deaths in the United States every year.[132] According to present trends in the United States, half of healthy 40-year-old males will develop CAD in the future, and one in three healthy 40-year-old females.[133] It is the most common reason for death of males and females over 20 years of age in the United States.[134]
After analysing data from 2 111 882 patients, the recent meta-analysis revealed that the incidence of coronary artery diseases in breast cancer survicors was 4.29 (95% CI 3.09-5.94) per 1000 person-years.[135]
Society and culture
Names
Other terms sometimes used for this condition are "hardening of the arteries" and "narrowing of the arteries".[136] In Latin it is known as morbus ischaemicus cordis (MIC).
Support groups
The Infarct Combat Project (ICP) is an international
Industry influence on research
In 2016 research into the archives of the [
Research
Research efforts are focused on new
A more controversial link is that between
Myeloperoxidase has been proposed as a biomarker.[148]
Plant-based nutrition has been suggested as a way to reverse coronary artery disease,[149] but strong evidence is still lacking for claims of potential benefits.[150]
Several immunosuppressive drugs targeting the chronic inflammation in coronary artery disease have been tested.[151]
See also
References
- ^ "Coronary heart disease – causes, symptoms, prevention". Southern Cross Healthcare Group. Archived from the original on 3 March 2014. Retrieved 15 September 2013.
- PMID 15173041.
- ^ MedlinePlus Encyclopedia: Coronary heart disease
- ^ a b c d e "What Are the Signs and Symptoms of Coronary Heart Disease?". 29 September 2014. Archived from the original on 24 February 2015. Retrieved 23 February 2015.
- ^ a b c d "Coronary Artery Disease (CAD)". 12 March 2013. Archived from the original on 2 March 2015. Retrieved 23 February 2015.
- ^ ISBN 978-92-4-156437-3.
- ^ PMID 25453985.
- ^ a b "How Is Coronary Heart Disease Diagnosed?". 29 September 2014. Archived from the original on 24 February 2015. Retrieved 25 February 2015.
- ^ a b c "How Can Coronary Heart Disease Be Prevented or Delayed?". Archived from the original on 24 February 2015. Retrieved 25 February 2015.
- ^ a b c d e "How Is Coronary Heart Disease Treated?". 29 September 2014. Archived from the original on 24 February 2015. Retrieved 25 February 2015.
- ^ PMID 27733282.
- ^ PMID 27733281.
- ISBN 978-1-4419-6920-0. Archivedfrom the original on 10 January 2017.
- ^ "Myocardial ischemia - Symptoms and causes". Mayo Clinic. Retrieved 5 February 2022.
- ^ "Ischemic Heart Disease". National Heart, Lung, and Blood Institute (NHLBI). Retrieved 2 February 2019.
- PMID 25530442.
- S2CID 9327889.
- ^ PMID 24274053.
- PMID 37622654.
- S2CID 53303792.
- S2CID 39392260.
- PMID 24844736.
- PMID 24240936.
- PMID 25685763.
- PMID 24573352.
- PMID 24573351.
- ^ PMID 21993341.
- ^ a b c d "Coronary Artery Disease Symptoms: Types, Causes, Risks, Treatment". Cleveland Clinic.
- PMID 20194155.
- ^ "Coronary artery disease - Symptoms and causes". Mayo Clinic. Retrieved 27 June 2020.
- PMID 20045850.
- ^ PMID 14597589.
- ^ "Women & Cardiovascular Disease". Cleveland Clinic.
- ^ (Institute of Medicine (US) Committee on Social Security Cardiovascular Disability Criteria. (2010). Cardiovascular Disability: Updating the Social Security Listings. NCBI, National Academies Press (US). www.ncbi.nlm.nih.gov/books/NBK209964/#:~:text=Ischemic%20means%20that%20an%20organ,blood%20to%20the%20heart%20muscle)
- ^ (Tenas, M. S. & Torres, M. F. (2018) What is Ischaemic Heart Disease? Clinic Barcelona. www.clinicbarcelona.org/en/assistance/diseases/ischemic-heart-disease/definition)
- ^ a b (Nordestgaard, B. G. & Palmer, T. M. & Benn, M. & Zacho, J & Tybjærg-Hansen, A. & Smith, G. D. & Timpson, N. J. (2012). The Effect of Elevated Body Mass Index on Ischemic Heart Disease Risk: Causal Estimates from a Mendelian Randomisation Approach. PLoS Medicine vol. 9,5 e1001212. https://doi.org/10.1371/journal.pmed.1001212)
- PMID 26839654.
- ^ PMID 22981903.
- PMID 29367388.
- PMID 22818936.
- ^ "Agent Orange presumptive conditions". US Department of Veterans Affairs, Veterans Health Administration.
- PMID 11665973.
- S2CID 8419145.
- PMID 25561362.
- S2CID 4630668.
- ^ S2CID 38337323.
- ^ Andreassi JL (2000). Psychophysiology: human behavior and physiological response. Mahwah, NJ: L. Erlbaum. p. 287.
- ISBN 978-0-08-036128-4.
- ^ a b c d "Lipid Health Risks | BioNinja". ib.bioninja.com.au. Archived from the original on 19 October 2023. Retrieved 12 December 2023.
- ^ "Types of Fatty Acids | BioNinja". ib.bioninja.com.au. Archived from the original on 19 October 2023. Retrieved 12 December 2023.
- PMID 26892958.
- PMID 29212778.
- PMID 34479557.
- S2CID 257761467.
- PMID 27025928.
- S2CID 25144107.
- S2CID 26055600.
- S2CID 20395787.
- Gale A261829143.
- .
- PMID 35725256.
- PMID 25705391.
- PMID 15919653.
- PMID 16399854.
- PMID 34950242.
- PMID 23026403.
- PMID 25454903.
- S2CID 18216111.
- ^ "Coronary Artery Disease Diagnosis and Treatment". Mayo Clinic.
- ^ PMID 31504439.
- ^ American Society of Echocardiography (20 December 2012). "Five Things Physicians and Patients Should Question". Choosing Wisely: An Initiative of the ABIM Foundation. Archived from the original on 26 February 2013. Retrieved 27 February 2013., citing
- Douglas PS, Garcia MJ, Haines DE, Lai WW, Manning WJ, Patel AR, et al. (March 2011). "ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance Endorsed by the American College of Chest Physicians". Journal of the American College of Cardiology. 57 (9): 1126–66. PMID 21349406.
- Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, et al. (January 2003). "ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on the Management of Patients With Chronic Stable Angina)". Journal of the American College of Cardiology. 41 (1): 159–68. PMID 12570960.
- Greenland P, Alpert JS, Beller GA, Benjamin EJ, Budoff MJ, Fayad ZA, et al. (December 2010). "2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Journal of the American College of Cardiology. 56 (25): e50-103. PMID 21144964.
- Douglas PS, Garcia MJ, Haines DE, Lai WW, Manning WJ, Patel AR, et al. (March 2011). "ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance Endorsed by the American College of Chest Physicians". Journal of the American College of Cardiology. 57 (9): 1126–66.
- ABIM Foundation, American College of Cardiology, archivedfrom the original on 17 December 2013, retrieved 10 February 2014
- PMID 25091971.
- ^ "Angina - Symptoms and causes". Mayo Clinic.
- ^ "Coronary Angiography". National Heart, Blood, and Lung Institute. Retrieved 10 December 2017.
- PMID 23472498.
- ^ "Nitrostat® (Nitroglycerin Sublingual Tablets, USP)" (PDF). United States Food and Drug Administration. Archived (PDF) from the original on 19 April 2014.
- ^ ISBN 978-0-470-91537-0.
- PMID 25070666.
- ^ "ESC Guidelines on Chronic Coronary Syndromes (Previously titled Stable Coronary Artery Disease)". European Society of Cardiology.
- PMID 36915288.
- PMID 17584558.
- PMID 27959714.
- PMID 18316498.
- S2CID 37833889.
- PMID 24473061.
- PMID 27510511.
- ^ "Life's Essential 8". www.heart.org. Retrieved 3 July 2022.
- PMID 21249647.
- ^ Norman J (7 October 2019). "Managing Diabetes with Blood Glucose Control". Endocrineweb.
- PMID 25073782.
- PMID 23965907.
- PMID 22677895.
- PMID 19166134.
- PMID 19378874.
- PMID 24355537.
- S2CID 58632705.
- PMID 15735094.
- PMID 16611951.
- PMID 22968891.
- PMID 22493407.
- S2CID 205828596.
- PMID 8615707.
- ^ PMID 28452408.
- PMID 22520533.
- ^ "Coronary Heart Disease (CHD)". Penguin Dictionary of Biology. 2004.
- S2CID 38338385.
- PMID 12821592.
- ^ PMID 33704780.
- S2CID 235245540.
- PMID 28886155.
- OCLC 54501403. Archived from the originalon 19 February 2014. Retrieved 26 October 2015.
- PMID 22732744.
- ^ MedlinePlus Encyclopedia: Nitroglycerin Sublingual
- ^ PMID 27007960.
- S2CID 9841653.
- ^ PMID 25829340.
- PMID 27064410.
- PMID 11790071.
- PMID 29240976.
- ^ "FDA Drug Safety Communication: FDA review finds long-term treatment with blood-thinning medicine Plavix (clopidogrel) does not change risk of death". FDA. 6 November 2015. Archived from the original on 4 February 2016. Retrieved 25 January 2016.
- PMID 25467565.
- PMID 12356647.
- PMID 24296791.
- PMID 24296767.
- PMID 28231944.
- PMID 30113498.
- ^ "WHO Disease and injury country estimates". World Health Organization. 2009. Archived from the original on 11 November 2009. Retrieved 11 November 2009.
- ^ S2CID 1541253.
- ^ PMID 23218570.
- ^ Indian Heart Association Why South Asians Facts Archived 18 May 2015 at the Wayback Machine, 29 April 2015; accessed 26 October 2015.
- PMID 24974587.
- PMID 17194875.
- ^ "Heart Disease and Stroke Statistics | American Heart Association (AHA)". 2007. Archived from the original on 20 December 2008. Retrieved 12 December 2023.
- PMID 37499186.
- ^ "Other Names for Coronary Heart Disease". 29 September 2014. Archived from the original on 13 February 2015. Retrieved 23 February 2015.
- ^ "Our Mission". Infarct Combat Project.
- ^ O'Connor, Anahad, "How the Sugar Industry Shifted Blame to Fat" Archived 28 February 2017 at the Wayback Machine, The New York Times, 12 September 2016. Retrieved 12 September 2016.
- PMID 27618496.
- PMID 27617709.
- ^ Ifill G (13 September 2016). "How the sugar industry paid experts to downplay health risks". PBS NewsHour. Archived from the original on 20 August 2017.
- PMID 16710446.
- PMID 22015375.
- PMID 20386763.
- S2CID 21496102.
- PMID 25854002.
- PMID 15928286.
- PMID 18382609.
- PMID 25198208.
- PMID 28254181.
- S2CID 248589827.
External links
- Risk Assessment of having a heart attack or dying of coronary artery disease, from the American Heart Association.
- "Coronary Artery Disease". MedlinePlus. U.S. National Library of Medicine.
- Norman J (7 October 2019). "Managing Diabetes with Blood Glucose Control". Endocrineweb.