CAD remains the leading cause of death globally. It represents a spectrum of diseases, including stable angina, unstable angina, myocardial infarction (heart attack), and sudden cardiac death.

Definition

Coronary artery disease (CAD), also known as coronary heart disease (CHD), is a condition characterized by the buildup of plaque inside the coronary arteries. These arteries supply oxygen-rich blood to the heart muscle. Over time, this plaque buildup, comprising fat, cholesterol, and other substances, can narrow or block the coronary arteries, leading to reduced blood flow to the heart, potentially causing chest pain or a heart attack.

 Symptoms

• Angina (chest pain): This discomfort can feel like squeezing, fullness, pressure, or pain in the chest. It can also be felt in the arms, neck, jaw, shoulder, or back.
• Shortness of breath: Especially during exertion.
• Fatigue: Feeling unusually tired, especially during physical activities.
• Heart palpitations: Irregular heart rhythms or skipped beats.

If plaque ruptures, it can lead to a heart attack, presenting as severe chest pain, nausea, vomiting, and profuse sweating.

 Causes

The primary cause of CAD is atherosclerosis, a process whereby plaque accumulates on the artery walls. Factors include:

• Cholesterol circulation: LDL (low-density lipoprotein) cholesterol can get deposited on arterial walls.
• Inflammation: Chronic inflammation can expedite plaque buildup and rupture.

Risk Factors

Understanding and controlling risk factors is crucial:

• High LDL cholesterol and low HDL cholesterol
• High blood pressure
• Smoking
• Diabetes
• Obesity
• Physical inactivity
• High-stress levels
• Unhealthy diet
• Family history of CAD
• Aging: Especially after 65
• Gender: Males have a slightly higher risk.
• High alcohol consumption

Prevention: How to Avoid CAD

• Healthy Diet: Opt for a diet low in saturated fats, trans fats, cholesterol, and sodium. Increase intake of fresh fruits, vegetables, and whole grains.
• Physical Activity: Engage in at least 150 minutes of moderate aerobic activity weekly.
• Maintain a Healthy Weight: Aim for a BMI between 18.5 and 24.9.
• Regular Check-ups: Monitor cholesterol, blood pressure, and blood sugar regularly.
• No Smoking: If you smoke, quit. Avoid second-hand smoke too.
• Limit Alcohol: Consume alcohol in moderation or not at all.
• Manage Stress: Explore stress-reducing techniques like meditation, deep breathing, and physical activity.

When to See a Doctor

Immediate medical attention is required if:

• Experiencing severe chest pain or discomfort: Could indicate a heart attack.
• Symptoms worsen: If previously diagnosed with CAD and symptoms worsen, consult immediately.

Regular check-ups are essential for those at risk. Early diagnosis can lead to more effective treatment and better outcomes.

Additional Information

• Diagnosis: Besides physical exams and understanding medical history, doctors use tests like ECG, echocardiogram, stress tests, cardiac catheterization, and CT scans.
• Treatment: Depending on severity, treatments range from lifestyle changes, medications, and potential procedures like angioplasty or coronary artery bypass grafting.
• CAD in Women: CAD symptoms can differ in women, including atypical chest pain or fatigue. They might also experience symptoms without chest pain, making diagnosis challenging.
• Impact of Mental Health: Chronic stress or depression can increase CAD risk due to raised cortisol levels or unhealthy coping mechanisms like smoking or poor diet.

The Underlying Mechanisms of CAD

1. Endothelial Dysfunction: The inner layer of our arteries, known as the endothelium, has essential functions, including modulating blood vessel tone and ensuring smooth blood flow. When this function is impaired (often due to factors like smoking, high cholesterol, and diabetes), it sets the stage for atherosclerosis.
2. Platelet Aggregation: Platelets in our blood start to gather at the site where the endothelium is damaged, leading to a cascade of events where different types of cells move to the site.
3. Smooth Muscle Proliferation: The smooth muscle cells in the arterial wall can multiply and migrate toward the inner layers of the arteries, contributing to the growing plaque.

Complications of CAD

• Heart Failure: If a significant portion of the heart muscle is damaged due to reduced blood supply over time, the heart may not pump blood efficiently, leading to heart failure.
• Arrhythmias: Impaired blood flow can lead to abnormal heart rhythms, which might be life-threatening.

Understanding Angina Further

1. Stable Angina: Triggered by physical exertion or stress and is relatively predictable. It’s the most common form and can be relieved by rest or medication.
2. Unstable Angina: Occurs suddenly and unpredictably and is more intense. It might last longer and isn’t easily relieved by rest or medication, signaling a higher risk of heart attack.
3. Variant (Prinzmetal’s) Angina: Caused by a spasm in a coronary artery, which temporarily narrows the artery. It can occur at rest and is usually relieved by medication.

Modern Diagnostic Innovations

• Coronary Calcium Scoring: A specialized X-ray test that provides pictures of the heart to detect and measure calcium-containing plaque in the arteries.
• Magnetic Resonance Angiography (MRA): A type of MRI that uses a magnetic field and radio wave energy to provide pictures of the inside of the body.

Emerging Treatments

• Biodegradable Stents: Unlike traditional stents that remain in the body permanently, these newer stents gradually dissolve over time.
• Genetic Testing and Personalized Medicine: By understanding one’s genetic predisposition to CAD, personalized prevention and treatment plans can be designed.

The Influence of Genetics

There’s increasing evidence suggesting a strong genetic component to CAD. If a first-degree relative (parent or sibling) had CAD before age 55 for a male relative or before age 65 for a female relative, you might be at increased risk.

Holistic Approaches and Complementary Therapies

• Yoga and Tai Chi: These practices can enhance cardiovascular health by reducing stress, lowering blood pressure, and improving heart function.
• Nutraceuticals and Herbal Therapies: Some natural substances, like omega-3 fatty acids, coenzyme Q10, and certain herbs, may offer heart benefits. However, they should be taken under a healthcare provider’s guidance.

Environmental Factors and CAD:

Air pollution, especially fine particulate matter, has been linked to higher CAD rates. Those living in polluted urban areas might have a slightly elevated risk.