Coronary artery disease is the most common form of heart disease and is the leading cause of death of both men and women in the U.S., according to the American Heart Association.
Coronary artery disease is caused by the gradual buildup of cholesterol-rich fatty deposits, called plaque, within the walls of the coronary arteries, which supply oxygenated blood to your heart muscle. These plaque deposits decrease the space through which the blood can flow, and the arteries become narrowed or blocked. Poor blood flow within the coronary arteries can "starve" the heart muscle by limiting the oxygen, which can lead to chest pain, heart attacks and other complications. A heart attack results if the artery becomes severely restricted or blocked completely, usually by a blood clot forming over an area of plaque that has ruptured.
What Causes the Buildup of Plaque in the Arteries?
Plaque is made up of excess cholesterol, calcium and other substances that float in your blood and eventually become lodged on the walls of the arteries, causing the lining to become thickened and roughened by these fatty deposits. This process is called atherosclerosis, or hardening of the arteries. High cholesterol, high blood pressure and smoking also contribute to coronary artery disease.
How Do I Know if I Have Coronary Artery Disease?
Because the disease develops very slowly over time, most people do not know they have it until they begin to experience symptoms, such as chest pain and/or shortness of breath. If your physician suspects that you have the disease, a number of tests can be taken to confirm the diagnosis. In addition to a complete physical exam, the most common initial tests are blood tests, chest x-ray, an electrocardiography (EKG), a stress EKG, exercise electrocardiography, an Ultrafast CT scan and a nuclear stress test.
What Are the Risk Factors for Coronary Artery Disease?
There are a number of risk factors that increase your chances of developing the disease. They include:
- Smoking
- High blood pressure
- High cholesterol
- Diabetes
- Obesity
- Physical inactivity
- Stress
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Other risk factors are family history, race and gender. The rates of coronary artery disease in women after menopause are two to three times those of women the same age before menopause. Although many women still consider heart disease to be a male risk factor, coronary artery disease is the leading cause of death in women.
How is Coronary Artery Disease Treated?
By making lifestyle changes and/or taking medication, patients can slow or halt the damage to their arteries. Lifestyle changes include making dietary modifications, exercising regularly and quitting smoking.
Medications are prescribed according to the nature of the patient's coronary artery disease. The most common of these are aspirin and Plavix (platelet inhibitors), ACE inhibitors, beta-blockers, nitrates, calcium-channel blockers and statins. Beta-blockers are used to slow the heart rate and reduce the power of contractions, to allow the heart to function with less oxygen. Nitrates and calcium-channel blockers are used to relax and dilate the coronary arteries. Statins are prescribed to help reduce cholesterol by interfering with cholesterol production in the liver and boosting the removal of LDL (low-density lipoprotein) cholesterol from the blood.
The preferred methods for treating coronary artery diseases are angioplasty with stent placement or atherectomy because they are less invasive procedures that do not require major surgery. However, these treatment methods may not be appropriate in all instances and coronary artery bypass surgery may be necessary. Coronary artery bypass surgery and valve surgery are the two most common types of heart surgery.
Cardiologists at Saint John's often use stents to unblock clogged arteries. Saint John's Heart Institute offers the most state-of-the-art treatments for coronary artery disease, including bypass surgery, balloon angioplasty and angioplasty with drug-eluting stents (please click on Treatment Options for more information). Stents are small, wire-mesh tubes that are inserted via a catheter into a blocked section of the coronary artery to open it up and improve blood flow. Drug-eluting stents are coated with time-released medications that prevent the growth of cells that would clog the stent and are more effective than conventional stents in keeping the artery from becoming blocked again.