Coronary Artery Disease

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Coronary Artery Disease

NIH - Medical Encyclopedia Coronary heart disease

"Coronary heart disease (CHD) is a narrowing of the small blood vessels that supply blood and oxygen to the heart. CHD is also called coronary artery disease. Coronary heart disease is usually caused by a condition called atherosclerosis, which occurs when fatty material and a substance called plaque builds up on the walls of your arteries. This causes them to get narrow. As the coronary arteries narrow, blood flow to the heart can slow down or stop, causing chest pain (stable angina), shortness of breath, heart attack, and other symptoms. Coronary heart disease (CHD) is the leading cause of death in the United States for men and women. … Chest pain or discomfort (angina) is the most common symptom. You feel this pain when the heart is not getting enough blood or oxygen. How bad the pain is varies from person to person.

There are two main types of chest pain:

• Atypical chest pain -- often sharp and comes and goes. You can feel it in your left chest, abdomen, back, or arm. It is unrelated to exercise and not relieved by rest or a medicine called nitroglycerin. Atypical chest pain is more common in women.

• Typical chest pain -- feels heavy or like someone is squeezing you. You feel it under your breast bone (sternum). The pain usually occurs with activity or emotion, and goes away with rest or a medicine called nitroglycerin. Adults with typical chest pain have a higher risk of CHD than those with atypical chest pain.

Other symptoms include: • Shortness of breath • Heart attack -- in some cases, the first sign of CHD is a heart attack…

Tips for preventing CHD or lowering your risk of the disease: • Avoid or reduce stress as best as you can. • Don't smoke. • Eat well-balanced meals that are low in fat and cholesterol and include several daily servings of fruits and vegetables. • Get regular exercise. If your weight is considered normal, get at least 30 minutes of exercise every day. If you are overweight or obese, experts say you should get 60 to 90 minutes of exercise every day. • Keep your blood pressure, blood sugar, and cholesterol under control"

Highlighted Articles

[Heart disease and stroke] (Tidsskr Nor Laegeforen. 2007)

"Most cases of heart disease and stroke are caused by atherosclerosis, and the two diseases have much in common with regards to risk factors, treatment and prognosis. Heart disease may also be a direct cause of stroke. About one in four cerebral infarctions are due to embolism from the heart to the brain, mainly because of atrial fibrillation, but also because of diseases such as acute myocardial infarction, dilated cardiomyopathy and prosthetic heart valves (cardioembolic stroke). Stroke can also be caused by a cardiogenic fall in blood pressure in patients with stenoses in pre- or intracerebral arteries (haemodynamic stroke). Patients with symptoms of atherosclerosis in one artery system should be treated as if they have a high risk of developing symptoms from other artery systems. The possibility of a cardiac embolic source should always be considered in patients with acute brain infarctions."

Optimal Medical Therapy with or without PCI for Stable Coronary Disease (NEJM 2007)

"Background In patients with stable coronary artery disease, it remains unclear whether an initial management strategy of percutaneous coronary intervention (PCI) with intensive pharmacologic therapy and lifestyle intervention (optimal medical therapy) is superior to optimal medical therapy alone in reducing the risk of cardiovascular events. … Conclusions As an initial management strategy in patients with stable coronary artery disease, PCI did not reduce the risk of death, myocardial infarction, or other major cardiovascular events when added to optimal medical therapy."

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Coronary Artery Disease

General Information

NEWS:

Study Links Coronary Disease, Colon Cancer "People newly diagnosed with coronary artery disease had nearly double the normal incidence of colorectal tumors and cancers, a study by Hong Kong researchers found. Both the tumors and the heart disease 'probably develop through the mechanism of chronic inflammation,' said the report by researchers at the University of Hong Kong that's published in the Sept. 26 issue of the Journal of the American Medical Association. But U.S. experts said the risk factors for both diseases are remarkably similar. 'A high-fat diet, a high-protein diet, a sedentary lifestyle,' said Dr. Randall W. Burt, director of prevention and outreach at the University of Utah Huntsman Cancer Institute. 'We know that the same factors that are important for coronary artery disease are important for colon cancer risk. What they [the Hong Kong researchers] have done is put the two together.' "

ARTICLES:

Acute Coronary Syndromes "The term ACS is used to describe a spectrum of myocardial ischemia or injury.2 ACS results primarily from diminished myocardial blood flow secondary to an occlusive or partially occlusive coronary artery thrombus.3 Patients with ACS include those with clinical presentations that cover the following range of diagnoses: UA, non–ST-segment elevation MI (NSTEMI), and ST-segment elevation MI (STEMI). 2 Risk factors for the development of ACS include smoking, family history of premature coronary events, adverse lipid profiles, elevated blood pressure, diabetes, physical inactivity, and obesity.4 "

Acute Coronary Syndromes "Acute coronary syndromes (ACS) is a term used to describe a group of conditions resulting from acute myocardial ischemia (insufficient blood flow to heart muscle) and ranging from unstable angina (increasing, unpredictable chest pain) to myocardial infarction (heart attack). The conditions are related to varying degrees of narrowing or blockage of single or multiple coronary arteries that provide blood, oxygen, and nutrients to the heart. This life-threatening disorder is a major cause of emergency medical care and hospitalization. Coronary artery disease (CAD) remains the leading cause of death in the United States."

JOURNAL ARTICLES:

Acute coronary syndromes and their presentation in Asian and Caucasian patients in Britain. (Heart. 2007) "CONCLUSION: Asian patients were younger, more likely to be diabetic and tended to report a higher intensity of pain and over a greater area of their body, and more frequent discomfort over the rear of their upper thorax than Caucasian patients."

Association between aortic calcification and total and cardiovascular mortality in older women (Journal of Internal Medicine 2007) "Conclusions. Abdominal aortic calcification in older women is associated with increased mortality."

Blood omega-3 and trans Fatty acids in middle-aged acute coronary syndrome patients. (Am J Cardiol. 2007)

Calorie Restriction or Exercise: Effects on Coronary Heart Disease Risk Factors. A Randomized Controlled Trial. (Am J Physiol Endocrinol Metab. 2007)

Clinical course of isolated stable angina due to coronary heart disease. (Eur Heart J. 2007) "Conclusion Patients with stable isolated angina have low rates of death and major cardiac events, but relatively high rates of chest pain requiring hospitalization despite contemporary management. Since the majority of deaths and major CV clinical events are not preceded by clear warning symptoms, the main clinical implication is that measures to prevent such events must target all patients."

Coffee, caffeine, and coronary heart disease. (Curr Opin Lipidol. 2007) "Coffee is a complex mixture of compounds that may have either beneficial or harmful effects on the cardiovascular system. Randomized controlled trials have confirmed the cholesterol-raising effect of diterpenes present in boiled coffee, which may contribute to the risk of coronary heart disease associated with unfiltered coffee consumption. A recent study examining the relationship between coffee and risk of myocardial infarction incorporated a genetic polymorphism associated with a slower rate of caffeine metabolism and provides strong evidence that caffeine also affects risk of coronary heart disease. Several studies have reported a protective effect of moderate coffee consumption, which suggests that coffee contains other compounds that may be beneficial. SUMMARY: Diterpenes present in unfiltered coffee and caffeine each appear to increase risk of coronary heart disease. A lower risk of coronary heart disease among moderate coffee drinkers might be due to antioxidants found in coffee."

Coronary heart disease (CHD) - one or several diseases? Changes in the prevalence and features of CHD. (Perspect Biol Med. 2007) "We suggest instead that CHD cases may comprise at least two distinct populations: those associated with hypercholesterolemia, and those associated with insulin resistance. The epidemic of CHD was due primarily to changes in the incidence of the hypercholesterolemia subgroup."

Coronary ischemic events after first atrial fibrillation: risk and survival. (Am J Med. 2007) "CONCLUSIONS: First AF marks a high risk for new coronary ischemic events in both men and women. AF conferred additional risk for coronary events beyond conventional risk prediction in women only. The excess mortality risk associated with the development of coronary events was significantly greater in women."

C-reactive protein, diastolic dysfunction, and risk of heart failure in patients with coronary disease: Heart and Soul Study (European Journal of Heart Failure 2007) “Among outpatients with stable CHD, elevated CRP levels predict hospitalisation for heart failure, independent of baseline heart failure, medication use, CHD severity, and subsequent MI events. This relationship appears to be at least partly explained by abnormal diastolic function in patients with elevated CRP levels. “

Decline in Rates of Death and Heart Failure in Acute Coronary Syndromes, 1999-2006 (JAMA. 2007) "Conclusions In this multinational observational study, improvements in the management of patients with ACS were associated with significant reductions in the rates of new heart failure and mortality and in rates of stroke and mycoardial infarction at 6 months."

Depression, C-reactive Protein and Two-year Major Adverse Cardiac Events in Men after Acute Coronary Syndromes. (Biol Psychiatry. 2007) " CONCLUSIONS: In men assessed 2 months after ACS, depression and CRP are overlapping prognostic risks. Patients with either risk may benefit from similar therapies."

Effect of Hyponatremia (<135 mEq/L) on Outcome in Patients With Non–ST-Elevation Acute Coronary Syndrome (The American Journal of Cardiology 2007) "In conclusion, hyponatremia on admission is associated with 30-day adverse outcome in patients presenting with suspected acute coronary syndrome/non-STEMI."

Emergency Duties and Deaths from Heart Disease among Firefighters in the United States (NEJM 2007)

Estimating the incidence of the acute coronary syndrome: data from a Danish cohort of 138 290 persons. (Eur J Cardiovasc Prev Rehabil. 2007)

Heart disease and single-vitamin supplementation. (m J Clin Nutr. 2007)

[Heart disease and stroke] (Tidsskr Nor Laegeforen. 2007) "Most cases of heart disease and stroke are caused by atherosclerosis, and the two diseases have much in common with regards to risk factors, treatment and prognosis. Heart disease may also be a direct cause of stroke. About one in four cerebral infarctions are due to embolism from the heart to the brain, mainly because of atrial fibrillation, but also because of diseases such as acute myocardial infarction, dilated cardiomyopathy and prosthetic heart valves (cardioembolic stroke). Stroke can also be caused by a cardiogenic fall in blood pressure in patients with stenoses in pre- or intracerebral arteries (haemodynamic stroke). Patients with symptoms of atherosclerosis in one artery system should be treated as if they have a high risk of developing symptoms from other artery systems. The possibility of a cardiac embolic source should always be considered in patients with acute brain infarctions."

Hostility and serum homocysteine as cardiovascular risk factors in Korean patients with coronary artery disease. (J Clin Nurs. 2007) "Conclusions. This result suggests that high level of hostility may increase cardiovascular risk by elevated serum homocysteine concentration."

Importance of collateral circulation in coronary heart disease. (Eur Heart J. 2007) "Coronary collateral arteries may prevent myocardial ischaemia in healthy subjects and in patients with CHD. A functional collateral circulation may lead to reduced ischaemia, preservation of ventricular function, and an improved prognosis."

Information given to postmenopausal women on coronary computed tomography may influence cardiac risk reduction efforts. (J Clin Epidemiol. 2007) "OBJECTIVE: Cardiovascular disease (CVD) is largely preventable through appropriate risk-factor modification. We sought to compare effects of comprehensive cardiac risk factor screening with and without computed tomography (CT) imaging of the coronary arteries on behavior change related to cardiac risk in postmenopausal women. … CONCLUSIONS: CVD risk-screening programs can facilitate cardiac risk reduction in women, but these data do not support an independent benefit of coronary CT imaging in a low-to-moderate risk group. The possibility of a deleterious effect of imaging on patient commitment to lifestyle changes is suggested."

Living alone and atypical clinical presentation are associated with higher mortality in patients with all components of the acute coronary syndrome. (Eur J Cardiovasc Prev Rehabil. 2007) "RESULTS: The 1-year case-fatality proportion was 9.8%. Positive predictors of mortality were living alone, Q waves and diabetes. Negative predictors were chest pain, ST elevation and treatment with angioplasty or thrombolysis."

[Mortality after acute coronary syndrome - a study of a local cohort.] (Tidsskr Nor Laegeforen. 2007)

Mortality of patients with acute coronary syndromes still remains high: a follow-up study of 1188 consecutive patients admitted to a university hospital. (Ann Med. 2007) "CONCLUSIONS: In an unselected patient cohort, short-term mortality of MI patients, especially those classified as NSTEMI, still was high despite increasing use of proven treatment modalities."

Prevalence of Heart Disease --- United States, 2005 (MMWR 2007)

Resting heart rate in cardiovascular disease. (J Am Coll Cardiol. 2007)

[Relationship between coronary artery disease and periodontal disease. What the cardiologist must know.] (Ann Cardiol Angeiol (Paris). 2007)

Serum Antioxidants, Inflammation, and Total Mortality in Older Women (American Journal of Epidemiology 2006)

Survival in relation to angina symptoms and diagnosis among men aged 70-90 years: the Whitehall Study. (Eur J Cardiovasc Prev Rehabil. 2007) "CONCLUSIONS: Both angina symptoms and diagnosis have a significant adverse effect on survival among men aged 70-90 years highlighting the importance of diagnosis and appropriate treatment of angina in old age."

The role of heart rate in the development of cardiovascular disease. (Clin Res Cardiol. 2007) "These studies demonstrated detrimental effects of increased heart rate on the function and structure of the cardiovascular system."

Usefulness of Atherogenic Dyslipidemia for Predicting Cardiovascular Risk in Patients With Angiographically Defined Coronary Artery Disease. (Am J Cardiol. 2007) "This study was conducted to assess the predictive value of atherogenic dyslipidemia (defined as high triglycerides and low high-density lipoprotein [HDL] cholesterol) for long-term outcomes in patients with CAD. … In conclusion, these data provide evidence that atherogenic dyslipidemia is an independent predictor of cardiovascular risk in patients with CAD, even stronger than isolated high triglycerides or low HDL cholesterol."

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