coronary artery disease
ABBR: CAD
Narrowing of the coronary arteries, usually as a result of atherosclerosis. It is the single most common cause of death in industrialized nations. In the U.S., about 600,000 people die of coronary artery disease each year.
SEE: illus. ; angina pectoris; ischemic heart disease; myocardial infarction .
Stenoses within the coronary circulation most commonly occur in people who smoke or who have diabetes mellitus, hypertension, adverse lipid profiles, or a familial predisposition to coronary heart disease. CAD tends to worsen as people age and is more common in men than in women. A person's risk for coronary artery disease can be estimated, e.g., with on-line tools such as the Framingham calculator available at http://cvdrisk.nhlbi.nih.gov. If blockages within the coronary arteries limit the flow of oxygenated blood to the myocardium, ischemia or infarction of the heart muscle may occur.
Risk-Factors: Risk factors for CAD include advancing age, chronic kidney disease, diabetes mellitus, family history of CAD before the age of 55, a prior history of heart disease or stroke, hyperlipidemia, hypertension, male gender, sedentary lifestyle, and smoking, among others.
Symptoms: Typically, patients who experience symptoms due to CAD report pain, burning, or pressure in the chest (angina pectoris) that begins or worsens with exertion, emotion, exposure to cold air, or the eating of a large meal. The pain may be described as a suffocating feeling or may be experienced as shortness of breath. It is often located beneath the sternum and can radiate to the upper chest, neck, jaw, shoulders, back, or arms. It may cause bloating, nausea, vomiting, or perspiration. However, many patients may not recognize the symptoms of coronary artery disease, a condition called “silent ischemia,” or they may attribute their symptoms to another cause, e.g., indigestion.
Treatment: A low-fat, low-cholesterol diet, a regular program of sustained exercise, and smoking cessation all help patients to limit CAD. Medications to control hypertension, lipids, and ischemia (such as beta blockers, statins, and nitrates) also alleviate symptoms. Invasive approaches to reopen narrowed arteries are helpful in some patients. These include coronary angioplasty, stent placement, atherectomy, and coronary artery bypass surgery.
SEE: Coronary Artery Disease
