By: Myra Drake
Coronary Artery Disease
Coronary artery disease is thought to begin with damage or injury to the inner layer of a coronary artery, sometimes as early as childhood. The damage may be caused by various factors, including:
- High blood pressure
- High cholesterol
- Diabetes or insulin resistance
- Sedentary lifestyle
Chest pain (angina). You may feel pressure or tightness in your chest, as if someone were standing on your chest. This pain, referred to as angina, usually occurs on the middle or left side of the chest. Angina is generally triggered by physical or emotional stress.
The pain usually goes away within minutes after stopping the stressful activity. In some people, especially women, this pain may be fleeting or sharp and felt in the neck, arm or back.
- Shortness of breath. If your heart can't pump enough blood to meet your body's needs, you may develop shortness of breath or extreme fatigue with exertion.
Heart attack. A completely blocked coronary artery may cause a heart attack. The classic signs and symptoms of a heart attack include crushing pressure in your chest and pain in your shoulder or arm, sometimes with shortness of breath and sweating.
Women are somewhat more likely than men are to experience less typical signs and symptoms of a heart attack, such as neck or jaw pain. Sometimes a heart attack occurs without any apparent signs or symptoms.
- Age. Simply getting older increases your risk of damaged and narrowed arteries.
- Sex. Men are generally at greater risk of coronary artery disease. However, the risk for women increases after menopause.
- Family history. A family history of heart disease is associated with a higher risk of coronary artery disease, especially if a close relative developed heart disease at an early age. Your risk is highest if your father or a brother was diagnosed with heart disease before age 55 or if your mother or a sister developed it before age 65.
- Smoking. People who smoke have a significantly increased risk of heart disease. Exposing others to your secondhand smoke also increases their risk of coronary artery disease.
- High blood pressure. Uncontrolled high blood pressure can result in hardening and thickening of your arteries, narrowing the channel through which blood can flow.
- High blood cholesterol levels. High levels of cholesterol in your blood can increase the risk of formation of plaques and atherosclerosis. High cholesterol can be caused by a high level of low-density lipoprotein (LDL), known as the "bad" cholesterol. A low level of high-density lipoprotein (HDL), known as the "good" cholesterol, can be a sign of atherosclerosis.
- Diabetes. Diabetes is associated with an increased risk of coronary artery disease. Type 2 diabetes and coronary artery disease share similar risk factors, such as obesity and high blood pressure.
- Overweight or obesity. Excess weight typically worsens other risk factors.
- Physical inactivity. Lack of exercise also is associated with coronary artery disease and some of its risk factors, as well.
- High stress. Unrelieved stress in your life may damage your arteries as well as worsen other risk factors for coronary artery disease.
Making a commitment to the following healthy lifestyle changes can go a long way toward promoting healthier arteries:
- Quit smoking.
- Eat healthy foods.
- Exercise regularly.
- Lose excess weight.
- Reduce stress.
Various drugs can be used to treat coronary artery disease, including:
- Cholesterol-modifying medications. By decreasing the amount of cholesterol in the blood, especially low-density lipoprotein (LDL, or the "bad") cholesterol, these drugs decrease the primary material that deposits on the coronary arteries. Your doctor can choose from a range of medications, including statins, niacin, fibrates and bile acid sequestrants.
Aspirin. Your doctor may recommend taking a daily aspirin or other blood thinner. This can reduce the tendency of your blood to clot, which may help prevent obstruction of your coronary arteries.
If you've had a heart attack, aspirin can help prevent future attacks. There are some cases where aspirin isn't appropriate, such as if you have a bleeding disorder or you're already taking another blood thinner, so ask your doctor before starting to take aspirin.
- Beta blockers. These drugs slow your heart rate and decrease your blood pressure, which decreases your heart's demand for oxygen. If you've had a heart attack, beta blockers reduce the risk of future attacks.
- Nitroglycerin. Nitroglycerin tablets, sprays and patches can control chest pain by temporarily dilating your coronary arteries and reducing your heart's demand for blood.
- Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). These similar drugs decrease blood pressure and may help prevent progression of coronary artery disease.
Procedures to restore and improve blood flow
Sometimes more aggressive treatment is needed. Here are some options:
Angioplasty and stent placement (percutaneous coronary revascularization). Your doctor inserts a long, thin tube (catheter) into the narrowed part of your artery. A wire with a deflated balloon is passed through the catheter to the narrowed area. The balloon is then inflated, compressing the deposits against your artery walls.
A stent is often left in the artery to help keep the artery open. Some stents slowly release medication to help keep the artery open.
- Coronary artery bypass surgery. A surgeon creates a graft to bypass blocked coronary arteries using a vessel from another part of your body. This allows blood to flow around the blocked or narrowed coronary artery. Because this requires open-heart surgery, it's most often reserved for cases of multiple narrowed coronary arteries.
Omega-3 fatty acids are a type of unsaturated fatty acid that's thought to reduce inflammation throughout the body, a contributing factor to coronary artery disease. However, recent studies have not shown them to be beneficial. More research is needed.
- Fish and fish oil. Fish and fish oil are the most effective sources of omega-3 fatty acids. Fatty fish — such as salmon, herring and light canned tuna — contain the most omega-3 fatty acids and, therefore, the most benefit. Fish oil supplements may offer benefit, but the evidence is strongest for eating fish.
- Flax and flaxseed oil. Flax and flaxseed oil also contain beneficial omega-3 fatty acids, though studies have not found these sources to be as effective as fish. The shell on raw flaxseeds also contains soluble fiber, which can help lower blood cholesterol.
- Other dietary sources of omega-3 fatty acids. Other dietary sources of omega-3 fatty acids include canola oil, soybeans and soybean oil. These foods contain smaller amounts of omega-3 fatty acids than do fish and fish oil, and evidence for their benefit to heart health isn't as strong.
Other supplements may help reduce your blood pressure or cholesterol level, two contributing factors to coronary artery disease. These include:
- Alpha-linolenic acid (ALA)
- Beta-sitosterol (found in oral supplements and some margarines, such as Promise Activ)
- Blond psyllium
- Coenzyme Q10
- Oat bran (found in oatmeal and whole oats)
- Sitostanol (found in oral supplements and some margarines, such as Benecol)