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Coronary Artery Disease

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What Is Coronary Artery Disease?

Coronary artery disease (CAD) occurs when the arteries that supply blood to the heart muscle (coronary arteries) become hardened and narrowed. The arteries harden and become narrow due to the buildup of plaque on the inner walls or lining of the arteries (atherosclerosis). Blood flow to the heart is reduced as plaque narrows the coronary arteries. This decreases the oxygen supply to the heart muscle. CAD is the most common type of heart disease. It is the leading cause of death in the U.S. in both men and women. When blood flow and oxygen supply to the heart are reduced or cut off, you can develop:
  • Angina. Angina is chest pain or discomfort that occurs when your heart is not getting enough blood.
  • Heart attack. A heart attack happens when a blood clot suddenly cuts off most or all blood supply to part of the heart. Cells in the heart muscle that do not receive enough oxygen-carrying blood begin to die. This can cause permanent damage to the heart muscle.
Over time, CAD can weaken your heart muscle and contribute to:
  • Heart failure. In heart failure, the heart is not able to pump blood to the rest of the body effectively. Heart failure does not mean that your heart has stopped or is about to stop working. But it does mean that your heart is failing to pump blood the way that it should.
  • Arrhythmias. Arrhythmias are changes in the normal rhythm of the heartbeats. Some can be quite serious.

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What Causes Coronary Artery Disease?

CAD is caused by atherosclerosis, the thickening and hardening of the inside walls of arteries. Some hardening of the arteries occurs normally as you grow older. In atherosclerosis, plaque deposits build up in the arteries. Plaque is made up of fat, cholesterol, calcium, and other substances from the blood. Plaque buildup in the arteries often begins in childhood. Over time, plaque buildup in the coronary arteries can:
  • Narrow the arteries so that less blood can flow to the heart muscle
  • Completely block the arteries and the flow of blood
  • Cause blood clots to form and block the arteries.
Heart Image

Plaque in the arteries can be:
  • Hard and stable. Hard plaque causes the artery walls to thicken and harden. This condition is associated more with angina than with a heart attack, but heart attacks frequently occur with hard plaque.
  • Soft and unstable. Soft plaque is more likely to break open or apart and cause blood clots. This can lead to a heart attack.

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What Makes Coronary Artery Disease More Likely?

About 13 million people in the U.S. have CAD. It is the number one killer of both men and women. Each year, more than half a million Americans die from CAD. There are factors that make it more likely that you will develop CAD. These are called risk factors. Risk factors that you cannot do anything about are:
  • Age. As you get older, your risk for CAD increases.
    • In men, risk increases after age 45
    • In women, risk increases after age 55.
  • Family history of early heart disease:
    • Heart disease diagnosed before age 55 in father or brother
    • Heart disease diagnosed before age 65 in mother or sister.
Risk factors that you can do something about include:
  • High blood cholesterol
  • High blood pressure
  • Cigarette smoking
  • Diabetes
  • Being overweight or obese
  • Lack of physical activity.
The more risk factors you have, the greater your chance for developing CAD. Promising Research Scientists continue to study the cause and the risk factors for CAD.
  • Some recent studies show that having high levels of a substance called C-reactive protein (CRP) in your blood appears to be associated with an increased risk of developing CAD and having a heart attack. CRP levels in the blood rise when there is inflammation, a body process that is a response to injury. The inflammatory process appears to contribute to the growth of plaque in the artery. Inflammation can occur as a result of an infection.

  • Research is under way to find out if reducing inflammation and lowering CRP levels can also reduce the risk for CAD and heart attack.

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What Are the Signs and Symptoms of Coronary Artery Disease?

The most common symptoms of CAD are:
  • Chest pain or chest discomfort (angina), or pain in one or both arms, the left shoulder, neck, jaw or back.
  • Shortness of breath.
The severity of symptoms varies widely. Your symptoms may become more severe as your coronary arteries become narrower due to the buildup of plaque (atherosclerosis). In some people, the first sign of CAD is a heart attack. A heart attack occurs when plaque in a coronary artery breaks apart, causing a blood clot or clots to form and block the artery.

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How is Coronary Artery Disease Treated?

The treatments for CAD include lifestyle changes, medications, and special procedures. The goals of treatment are to:
  • Relieve symptoms
  • Slow or stop atherosclerosis by controlling or reducing the risk factors
  • Lower the risk for blood clots forming, which can cause a heart attack
  • Widen or bypass clogged arteries
  • Reduce cardiac events.
Lifestyle Changes Everyone with CAD needs to make some lifestyle changes:
  • Eat a healthy diet to prevent or reduce high blood pressure and high blood cholesterol, and maintain a healthy weight. New research has shown that pomegranate seeds offer health benefits for coronary heart disease patients and drinking a cup (240 mL) of pomegranate juice per day helped reduce stress-induced myocardial ischemia, poor blood flow to the heart muscle brought on by stress or exercise. Patients who took a cup of pomegranate juice per day for three months experienced a 17% improvement in blood flow to the heart muscle. This benefit may be due to pomegranate’s high levels of polyphenols, a group of vegetable chemical substances that act as antioxidants.
  • Take Magnesium supplements but only under your doctor's advice. People with severe heart disease should not take magnesium or any other supplement except on the advice of a physician. Some Naturopathic doctors have proposed the use of Magnesium for treatment or risk reduction of a range of coronary health conditions including: Angina; Atherosclerosis; Congestive Heart Failure; Coronary Artery Disease; Fatigue; Fibromyalgia; Mitral Valve Prolapse and Stroke.
  • Take Ribose supplement with your doctor's advice. Individuals with severe coronary artery disease suffer from reduced blood flow to the heart (ischemia) during exercise will feel angina pain. One small study examined 20 men with severe coronary artery disease who walked on a treadmill until signs of ischemia prevented them from walking any longer. It was found that men who took 60 mg per day of oral ribose for just three days were able to walk longer on the treadmill before developing EKG signs of ischemia as copmpared to their own time three days earlier. Those taking placebo had no such improvement.
  • Take Mesoglycan supplements under your doctor's advice. A double-blind comparative study looked at men with atherosclerosis (coronary artery disease). They were given either 200 mg of mesoglycan per day or no extra treatment. After 18 months, the layering of the vessel lining was 7.5 times greater in the untreated group than in the mesoglycan-taking group which is a significant difference. There is also some evidence to show that Mesoglycan reduces cholesterol levels and have a blood thinning effect.
  • Take Melatonin supplements with your doctor's advice to reduce the risks of developing coronary heart disease.
  • Taking Motherwort supplements can help manage irregular or rapid heartbeat but you should only do so with your doctor's advice. Germany's Commission E recommends a dose of 4.5 g of dried herb daily, or the equivalent. Please note that irregular or rapid heartbeat can be a symptom of serious heart disease requiring urgent medical attention. Do not combine motherwort with other heart medications, as they might interact.
  • Taking N-Acetyl Cystein (NAC) supplements has been shown effective in managing angina pectoris (a squeezing chest pain or discomfort caused by inadequate blood supply to the heart). Angina pectoris can be a warning sign of a an impending heart attack and physicians use the drug nitroglycerin to relieve symptoms of Angina pectoris. In a 4-month long double-blind, placebo-controlled study of about 200 people with heart disease, researchers found that the combination of NAC and nitroglycerin can reduce the number of heart attacks and other severe heart problems. Used alone, NAC and nitroglycerin were not as effective. Use of Nitroglycerin can cause severe headaches in patients, the combination of nitroglycerin and NAC caused severe headaches in many of the research patients. NAC may also help with nitroglycerin tolerance (a condition in which the patient derives a decreasing level of benefits from Nitroglycerin).
  • Naturopaths propose the use of Quercetin supplements can prevent heart disease.
  • Taking Reservatrol supplements has been proposed as an effective treatmnent for coronary heart disease.
  • If you smoke, quit.
  • Exercise as directed by your doctor.
  • Lose weight if you are overweight or obese
  • Reduce stress.
For some people, these changes may be the only treatment needed.

Medications

Medications may be needed in addition to making lifestyle changes. Some medications decrease the workload on your heart and relieve your symptoms. Others decrease your chance of having a heart attack or sudden death, and prevent or delay the need for a special procedure (angioplasty or bypass surgery). Some common medications used to treat CAD are:
  • Cholesterol-lowering medications.

  • Anticoagulants prevent clots from forming in your arteries and blocking blood flow.

  • Aspirin, an antiplatelet medication to prevent clots from forming in your arteries and blocking blood flow. Aspirin may not be appropriate for some people because it increases the risk of bleeding. Discuss the benefits and risk with your doctor before starting aspirin therapy.

  • Other antiplatelet medications stop platelets from clumping together to form clots. These medications may be given to people who have had a heart attack, have angina, or who experience angina after angioplasty.

  • ACE inhibitors lower blood pressure and reduce the strain on your heart. They also may reduce the risk for a future heart attack and heart failure.

  • Beta-blockers slow your heart rate and lower your blood pressure to decrease the workload on your heart. Beta-blockers are used to relieve angina and may also reduce the risk of a future heart attack.

  • Calcium channel blockers relax blood vessels and lower your blood pressure. These medications can reduce your heart's workload, help coronary arteries open, and relieve and control angina.

  • Nitroglycerin to prevent or relieve chest pain.

  • Long-acting nitrates open up the arteries to the heart, increasing blood flow to the heart muscle and relieving chest pain. Long-acting nitrates can limit the occurrence of chest pain when used regularly over a long period.

  • Glycoprotein IIb-IIIa inhibitors are very strong antiplatelet medications that are used in the hospital during and after angioplasty or to treat angina.

  • Thrombolytics dissolve the clots that can occur during heart attacks. You need to get to the hospital as soon as possible if you think you are having a heart attack to get thrombolytic therapy.
Special (Invasive) Procedures
  • Angioplasty. This procedure is used to open blocked or narrowed coronary arteries. It can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack. Sometimes a stent is placed in the artery to keep it propped open after the procedure.

  • Coronary artery bypass surgery. This surgery uses arteries or veins from other areas in your body to bypass your diseased coronary arteries. It can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack.
Angioplasty or bypass surgery may be used to treat CAD if:
  • Medications and lifestyle changes have not improved your symptoms
  • Your symptoms are worsening.
Some people may need to have angioplasty or bypass surgery on an emergency basis during a heart attack to limit damage to the heart. Cardiac Rehabilitation (Rehab) Your doctor may prescribe cardiac rehab for angina or after bypass surgery, angioplasty, or a heart attack. Together with medical and surgical treatments, cardiac rehab can help you recover faster, feel better, and develop a healthier lifestyle. Almost everyone with CAD can benefit from rehab. Cardiac rehab often begins in the hospital after a heart attack, heart surgery, or other heart treatment. Rehab continues in an outpatient setting after you leave the hospital. The cardiac rehab team may include:
  • Doctors
    • Your family doctor
    • A heart specialist
    • A surgeon
  • Nurses
  • Exercise specialists
  • Physical therapists and occupational therapists
  • Dietitians
  • Psychologists or other behavior therapists.
Rehab has two parts:
  • Exercise training to help you learn how to exercise safely, strengthen your muscles, and improve your stamina. Your exercise plan will be based on your individual ability, needs, and interests.

  • Education, counseling, and training to help you understand your heart condition and find ways to reduce your risk of future heart problems. The cardiac rehab team will help you learn how to cope with the stress of adjusting to a new lifestyle and to deal with your fears about the future.

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How Can I Prevent or Delay Coronary Artery Disease?

Preventing CAD begins with knowing which risk factors you have and taking action. Remember, your chance of developing CAD increases with the number of risk factors you have. Know your family history of health problems related to CAD. If you or someone in your family has CAD, be sure to tell your doctor. Make sure everyone in your family is getting enough exercise and maintaining a healthy body weight. By controlling your risk factors with lifestyle changes and medications, you may prevent or slow the development of CAD. CAD can cause serious complications, but by following your doctor's advice and changing your habits, you can prevent or reduce the chance of:
  • Sudden cardiac death
  • A heart attack and permanent damage to your heart muscle
  • Reduced oxygen to your heart causing damage
  • Irregular heartbeats (arrhythmia).
If you have any other health conditions, it is important that you follow your doctor's directions to treat these conditions. By staying as healthy as possible, you can lower your risk for CAD and its complications.

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Coronary Artery Disease