Risk Factors for Coronary Artery Disease
Risk factors for heart disease development can be distinguished
by whether they are within our control and differ from a gender
perspective. Your risk factor profile should be discussed as part
of your regular check-up with your physician.
Uncontrollable Risk Factors
Gender
Men are still at higher risk for heart disease than women. However,
once women are post-menopausal, their risk level starts to catch
up with that of men. Research has shown that generally women have
a degree of protection against development of heart disease prior
to menopause. However, we know that some women can and do develop
heart disease prior to menopause, and it has been documented in
women at increasingly younger ages.
Increasing Age
Advancing age increases the risk for heart disease development
in both men and women.
Genetics and Heredity
Having immediate family members with coronary artery disease that
developed before age 60 increases the risk for its occurrence.
African-Americans, Native Americans, native Hawaiians, and some
Asian-Americans generally demonstrate a higher risk for heart disease.
Post-Menopausal State
Prior to the onset of menopause, women have a reduced incidence
of heart disease. Further research into the nature of this protective
factor is ongoing. Hormone replacement therapy research outcomes
now demonstrate that the choice for the use of hormone replacement
must be discussed on an individual basis by each woman and her
physician.
Controllable Risk Factors
High Blood Pressure
Because elevated blood pressure levels significantly contribute
to the development of coronary artery disease, it is essential
to monitor and control blood pressure. Hypertension or high blood
pressure is often a silent condition and is an important factor
to be monitored at regular health screenings and physician check-ups.
Smoking
If you smoke and wish to decrease your heart disease risk, it
is imperative to stop at once.
Second-hand smoke can also affect your health. If you are continuously
exposed to cigarette smoke in your environment, this poses a risk
to your lung and heart health.
Diabetes
Diabetes, especially the insulin-dependent type, greatly increases
your risk of coronary
artery disease development. The more poorly controlled your diabetes,
the greater the
chance for aggressive advancement of heart disease.
Elevated Cholesterol Levels
Studies continue to show a correlation between elevated blood
cholesterol and the development of heart disease. It is not enough
to know only your total cholesterol. Evaluation of your LDL, HDL,
and triglycerides is essential to accurately assess your risk.
Obesity
Excess weight causes the heart to work harder. Obesity elevates
blood pressure, increases cholesterol, and predisposes for the
development of diabetes. Recent research studies have shown that
people who gain weight especially in the waist and abdominal areas
are even more prone to heart disease development. Talk with your
physician about your healthy target weight and consult with him
or her about a safe diet and exercise plan to lose and then maintain
your optimal weight.
Sedentary Lifestyle
Research studies continue to indicate that the more inactive the
lifestyle the greater the likelihood for heart disease occurrence.
Because exercise is a physical stressor and can challenge the heart’s
capability to do its work, it is important to undergo a physical
examination with your physician before undertaking a change in
your activity level. Exercise also affects other health conditions
such as blood pressure and diabetes management.
Stress
Stressful situations in our lives can trigger both physical and
emotional responses that in turn may contribute to the possibility
of coronary artery disease development. Stress can elevate blood
pressure and glucose levels. The physical mechanism of stress-related
experiences may over time contribute to heart disease. It also
can cause us to overeat and distract us from undertaking positive
behaviors that assist in health maintenance.
Symptoms of Coronary Artery Disease
The symptoms of heart disease are variable, and patients may experience
only one symptom or any combination of them. Some patients can
have significant coronary artery disease and not demonstrate symptoms
for some time. Coronary artery disease symptoms include the following:
- Chest pain or angina
- Shortness of breath
- Weakness or fatigue
- Pain or pressure in the shoulders, arms, neck, jaw, throat or back
- Nausea or indigestion
- Perspiration
- Palpitations or fluttery sensation in the chest
Women are less likely to experience the same presentation of typical
chest pain as men do in the development of heart disease. Women,
for example, may have only a single symptom of their heart disease,
and it may be back pain, fatigue, or shortness of breath.
Women must be alert for possible symptoms of heart disease. Early
diagnosis and treatment remain key to successful outcomes.
Diagnosis of Coronary Artery Disease
The diagnosis of heart disease is achieved through review of the
patient’s health history and symptoms as well as diagnostic
testing. When coronary artery disease is suspected, your physician
will evaluate this possibility through a combination of studies.
He or she will examine your electrocardiogram (EKG) for indications
of myocardial ischemia (lack
of adequate blood supply to the heart). This tracing of the heart’s
electrical impulse pattern may reveal the existence of heart disease.
You may also undergo an echocardiogram to determine the effectiveness
of the heart’s ability to act as a pump as well as the nature
of the action of the heart valves. Stress testing, often with a
nuclear imaging component, is used to challenge the heart under
exercise conditions to verify adequate cardiac response and determine
whether blood supply to the heart muscle is compromised by blockages.
The stress test either involves walking on a treadmill or receiving
an intravenous drug that simulates exercise.
Depending on the outcome of these studies, your physician may
recommend that you undergo a cardiac catheterization (also known
as coronary angiography). This study
allows actual visualization of the coronary artery anatomy. A special
catheter is passed from a major vessel in the arm or the leg through
which dye is introduced and pictures are taken with a special camera.
The physician then examines these images to determine the presence
and extent of artery blockage.
Treatment of Coronary Artery Disease
Your physician will determine treatment of your coronary artery
disease on an individual basis. The recommendations will involve
treatment of the disease already present as well as actions to
aid in prevention of further disease progression. Attention will
be given to individual controllable risk factors so that they may
be effectively addressed as part of your treatment plan.
The medications that will be prescribed will depend on multiple
factors including the severity of your symptoms, your age and lifestyle,
the extent and severity of your coronary artery disease, and the
presence of disease in other organs such as the kidney,
lungs, and brain. Coronary artery angioplasty can be an effective
choice for opening blockages in the coronary arteries. Stent placement
at the time of the angioplasty procedure involves placing a very
small mesh tube at the site of the blockage to help prevent reoccurrence.
Your treatment recommendation will be based in part on the location
and extent of the blockages within the coronary arteries.
Your physician will carefully consider the presence of those risk
factors within your health history that promote occurrence and
progression of heart disease. Cholesterol, diabetes, and blood
pressure control will all be paramount in the effective treatment
of your heart disease.
When extensive and multiple blockages of the coronary arteries
is determined, the recommendation may be for coronary artery bypass
surgery (also known as CABG and
pronounced “cabbage” amongst health care professionals).
In this surgical procedure, the cardiac surgeon will use vessels
removed from the legs or chest to reroute blood flow around significant
blockages in the coronary artery anatomy.
