Coronary artery disease (CAD) is the leading cause of death in the United States in men and women, according to the Centers for Disease Control and Prevention. Additionally, CAD is the most common heart disease among all others.
CAD is caused by plaque buildup in the walls of the arteries (coronary arteries) that supply blood to the heart. Plaque consists of cholesterol and other materials, which causes the inside of the arteries to narrow over time, resulting in partially or completely blocking blood flow to the heart.
Risk factors for CAD
Perhaps one of the biggest risk factors for heart problems is age, particularly for men over age 55 years and women age 65 and older. “Estrogen protects women pre-menopause which may delay the disease in them for additional 10 years,” said Dr. Mohammad Diaa Alaoua, Marshfield Clinic Health System cardiologist.
Family history of CAD, particularly if at a premature age is another important risk factor.
Smoking is a big factor when it comes to developing CAD. Inhaling tobacco causes artery linings to become shaggy and coarse, which allows cholesterol to easily break apart and clog artery walls.
“Diabetes, high cholesterol, and high blood pressure also are common risk factors,” Alaoua said.
Uncommon but possible causes of CAD are radiation exposure and cocaine use.
How is CAD diagnosed?
Once you know you have a family history or health condition that makes you more susceptible to CAD, cardiology providers have several ways to diagnose it:
- Electrocardiograms: Measure the electrical activity and regularity of your heartbeat. Learn more
- Echocardiogram and stress test: An echocardiogram uses ultrasound to create a picture of the heart, while a stress test (using exercise or medication) displays if blood flow problems may occur. Learn more
- Calcium scoring: A test to detect how much calcium (as a plaque advocate) buildup is in coronary arteries. Learn more
Based on the above tests, other definitive tests include a coronary CT angiogram, where dye is injected in the arm to scan the heart quickly via X-rays, and a heart catheterization, where a soft heart catheter is inserted in the body up the heart to inject a dye through it. Providers can see dye filling arteries where the blockages are and can assess the extent of the blockages.
Acute vs. chronic CAD
CAD also may be classified as acute or chronic. When you have acute CAD, there is sudden reduced blood flow to the heart.
Acute coronary syndrome often causes severe chest pain or discomfort, and medical attention is needed. This is what often occurs during a heart attack. For many, a heart attack is the first sign of CAD. Alaoua explains that in Wisconsin, this sometimes happens when we are shoveling snow or doing other infrequent strenuous exercise in cold weather.
Even just 40 to 50 percent blockage, can cause the acute event if it breaks inside the blood vessel” he said. “Coupled with the cold weather, which already causes the arteries to constrict causing reduced blood flow a heart attack can occur.”
Chronic CAD occurs when there’s a gradual plaque buildup. At about a 70 percent or more blockage, symptoms will show up like chest pain and shortness of breath, most notably during exercise. “During exercise, the heart muscle needs more blood. While normal blood vessels can provide up to five times more blood flow, the blocked blood vessels cannot.”
Treatments for CAD
Although CAD could be a fatal condition, Alaoua said three common treatments (medical, angioplasty and surgery) and lifestyle changes are available.
Medication can help with risk factors including high blood pressure, cholesterol control and diabetes. In addition, medications can reduce the symptoms of the CAD and prevent clotting.
Your provider may recommend a coronary angiogram with angioplasty to place a stent in the artery to open heart blockages.
Additionally, bypass surgery can restore normal blood flow to an obstructed coronary artery.
Preventive measures against CAD
Beyond medical intervention, you can take some simple steps to improve your health and prevent CAD. Alaoua recommends that if you smoke, quit. Smoking increases your chances for CAD.
“Studies show that after three years of you quitting smoking, your risk comes close to risk of those individuals who never smoked,” Alaoua said.
Alaoua also recommends a healthy diet. Because of what individuals eat today, Alaoua said obesity and cases of type 2 diabetes is starting as early as five years old. By eating healthy, you can prevent risk factors from manifesting early, he said. Alaoua also encourages you to contact your provider for a regular physical.
“Early detection is key,” he said. “It’s better to be early than wait.”