What is Coronary Artery Disease (CAD)? 

Globally, cardiovascular illnesses are one of the most leading cause of death. Among its various forms, coronary artery disease (CAD) is the most prevalent form and the leading cause of death in developed countries. In addition to its high prevalence, CAD has high morbidity and high costs for health systems. Studies suggest that, for a 40-year-old adult, the lifetime risk of developing CAD is 49% for men and 32% for women. 

Coronary artery disease (CAD) is a consequence of the atherosclerosis process, in which there is gradual or sudden obstruction of the coronary arteries by fatty plaques and clots. With this, there is insufficiency of the coronary arteries (blood vessels responsible for irrigating the heart itself), to provide the heart muscle (myocardium), the nutrients and oxygen it needs to maintain its normal activity. 

Importance of the coronary 

Because the coronary arteries supply blood to the heart muscle, any coronary artery disorder or disease can have serious implications by reducing the flow of oxygen and nutrients to the heart muscle. This has the potential to cause a heart attack and even death. Atherosclerosis (a buildup of plaque on the inner lining of an artery causing it to narrow or become blocked) is the most common cause of heart disease.

Causes of coronary artery disease 

Coronary artery disease is caused by atherosclerosis.Plaque accumulation inside of your arteries is known as atherosclerosis. Plaque consists of cholesterol, fatty substances, waste products, calcium, and the clot-forming substance fibrin. 

As plaque continues to build up on artery walls, your arteries narrow and harden.Your arteries may get blocked or damaged by plaque, which will restrict or halt blood flow to your heart muscle. If your heart doesn't get enough blood, it can't get the oxygen and nutrients it needs to function properly. 

This condition is called ischemia. Not getting enough blood supply to the heart muscle can lead to chest discomfort or chest pain (called angina).

CAD is favored by a series of inappropriate habits, behaviors and lifestyles, such as unbalanced diet, obesity (mainly abdominal obesity), smoking, sedentary lifestyle and stress. No less important are risk factors for atherosclerosis, such as: arterial hypertension (“high blood pressure”), high cholesterol (mainly LDL, the so-called “bad cholesterol”) and diabetes. 

How does plaque build up in arteries? 

Coronary artery disease happens to everyone. The speed with which it develops differs from person to person. When you are very young, the process typically begins. Before adolescence, the walls of blood vessels begin to show streaks of fat. 

As plaque builds up on the artery's inner walls, your body fights this ongoing process by sending white blood cells to attack cholesterol, but the attack causes more inflammation. This triggers even more cells in the artery wall to form a soft layer over the plaque. 

This thin cover over the plaque can break open (due to blood pressure or other causes). Fragments of blood cells called platelets stick to the “injury” site, causing a clot to form. The clot further narrows the arteries. Sometimes a blood clot breaks down on its own. Other times, the clot blocks blood flow through the artery, depriving the heart of oxygen and causing a heart attack.

What are the symptoms of coronary heart disease? 

Coronary disease can be manifested by a transient chest pain related to efforts or stress, called angina pectoris or angina pectoris, which results from a transient deficit in myocardial irrigation, resulting from a partial obstruction of the coronary artery, where there is an imbalance between supply and demand for blood and oxygen in the “clogged” region. 

Chest pain related to coronary artery disease may have the following characteristics: 

– Feeling of tightness in the heart; 

– Pain that spreads throughout the body, in regions such as the back, neck, neck, shoulders and arms (especially the left);

– Recurrent pain, which lasts for a few minutes, disappears and returns, always varying in intensity and 

- It can come along with shortness of breath, dizziness, nausea. 

In the presence of these sensations, it is extremely important to seek specialized help as soon as possible. As time passes, the pain subsides, but the damage becomes more extensive and irreversible.

What are the risk factors? 

The main risks of coronary artery disease are: 

– Angina pectoris (pain on exertion that can progress to pain at rest), reducing quality of life; 

– Acute myocardial infarction which can lead to weakening of the heart muscle (heart failure); 

– Sudden death “heart attack”, due to arrhythmias originating from necrotic (dead) muscle or under ischemia (low oxygenation) and 

- Cardiac insufficiency. 

Diagnostic Exams 

There are several options and your doctor will evaluate which one to recommend based on the risks and benefits. The most used tests are: 

– Electrocardiogram; 

– Echocardiogram; 

– Exercise test; 

– Myocardial scintigraphy; 

– Angiotomography and 

– Coronariography (“catheterization”)

Other diagnostic imaging tests may include: 

-Nuclear Imaging: This test produces images of the heart after administration of a radioactive tracer. 

-Computed tomography angiography: uses computed tomography and contrast dye to view 3D images of the moving heart and detect blockages in the coronary arteries.

How is the treatment of coronary disease? 

The treatment has two objectives: to combat atherosclerotic plaque and to improve blood flow through the coronary artery. Like all diseases in cardiology, the first step is changing habits, the most recommended being: 

– Diet with less fat and simple sugar, and higher fiber, nuts, fruits and vegetables; 

– Maintain normal weight; 

– Practice regular physical activity 

- Stop smoking. 

In medications, the doctor will evaluate your case and decide, from the options below, the most suitable for you. He will assess the benefit of the medicine and the risk of side effects. The most used medications are: 

– Acetylsalicylic acid (ASA) and clopidogrel: 

medications that reduce platelet activity, reducing the risk of blood “clogging, obstructing” the illness.

– Statins (simvastatin, rosuvastatin, atorvastatin etc): 

reduction of cholesterol and reduction of inflammation and growth of fat plaque. This last effect occurs even if your cholesterol is normal and reduces the risk of plaque clogging and rupture, decreasing the chance of heart attack and stroke. 

In addition to these remedies to treat atherosclerosis, it will be necessary to combat risk factors, with medications for blood pressure and diabetes. 

On the other hand, if there is an atherosclerotic plaque causing major obstruction in the coronary arteries, it may be necessary to “unobstruct” the lesion. This can be done in two ways: by a catheter, similar to catheterization, called angioplasty, or by myocardial revascularization surgery, the so-called “saphenous bypass”.

Prevention of coronary artery disease 

You can reduce your risk of heart disease and other heart problems by making lifestyle changes. These changes include: 

*Reduce stress 

*Maintain a healthy weight 

*Doing physical activity 

*Limit alcohol consumption 

*Eat nutritious foods 

*Quitting smoking (or not starting to smoke)

If you've had a heart attack or stroke in the past, these changes may reduce your risk of having another. Also, stick to your healthcare professional's plans for managing your heart disease or condition. 

Limit alcohol consumption 

Limit alcohol consumption to: 

• two glasses a day maximum for women 

• three glasses a day maximum for men 

One equal glass: 

• 341 ml (12 oz) beer, cider or cooler (containing 5% alcohol) 

• 142 ml (5 oz) wine (containing 12% alcohol) 

• 43 ml (1.5 oz) distilled alcohol (containing 40% alcohol)

Reduce stress 

Find out when you feel stressed and find ways to avoid those situations. Do something enjoyable, such as: 

• to read a book 

• watch a movie 

• visit a friend 

You can also try to: 

• learn to say no to requests for your time • doing regular breathing exercises or something that relaxes you 

• being active by taking a walk or cycling to help reduce tension

Physical activity 

Being physically active can help reduce your risk of heart disease and other heart conditions, but it depends on your current health. Ask your healthcare professional for advice on high-intensity exercise first. Your diet and way of life will be examined if you: 

- are older, as if you are: 

•a man aged 45 or over 

•a woman aged 55 or over

- are overweight 

- are not physically fit 

- have a family history of heart disease 

If your health is poor, the physical demands of intense exercise can be fatal. 

This risk also increases in cold weather. For example, shoveling snow can be dangerous.

Consume nutritious foods 

Adopt healthy eating habits by choosing a variety of: 

• fruits and vegetables 

• cereals products 

• milk and alternatives 

• meats and substitutes

Maintain a healthy weight 

Ask your healthcare professional to determine your healthy weight and develop a plan to achieve and maintain it. Even losing a little excess weight can help reduce your risk of heart disease. 

Carefully manage your diet if you have diabetes and take your medications as directed by your healthcare professional.