Coronary Artery Disease
- Diagnosis, Imaging, Screening
- General Information
- Guidelines
- Internet Sites
- Risk Factors
- Risk Reduction
- Treatment
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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"
NHS – Coronary Heart Disease (Videos) “The main symptom of coronary heart disease is angina. Angina can be a mild, uncomfortable feeling similar to indigestion. In severe cases, it causes a feeling of extreme pressure on the chest, breathlessness, trapped air and belching. It is usually triggered by physical exercise or stressful situations, and tends to go away when you stop what you're doing, when you rest or when you take medication. Other symptoms include: Heart palpitations When you become aware of your heart beating irregularly or harder than normal. Heart attack If your arteries become completely blocked, you will have a heart attack. … Heart failure Heart failure occurs when the heart gradually gets too weak to pump blood around the body. This can cause fluid to build up in the lungs, making it increasingly difficult to breathe. Heart failure can happen suddenly (acute heart failure) or over a period of time (chronic heart failure).”
Highlighted Articles
Positive and negative affect and risk of coronary heart disease: Whitehall II prospective cohort study. (BMJ. 2008) “Smoking, hypertension, hypercholesterolaemia, and diabetes are established risk factors for coronary heart disease, a leading cause of morbidity and mortality in Western industrialised countries.1 2 However, psychological factors, such as emotions, may also have a role in the development of coronary heart disease.3 4 Several prospective studies have found anxiety, hostility/anger, and depression to be associated with an increased risk of coronary heart disease in healthy participants.3 5 As the relative importance of these three negative emotions on risk of coronary heart disease remains largely undefined,6 7 they have been hypothesised to be the components of a single underlying factor, labelled negative affect. Negative affect refers to “stable and pervasive individual differences in mood and self-concept characterised by a general disposition to experience a variety of aversive emotional states.”5 8 High negative affect has been described as a general tendency to report “distress, discomfort, dissatisfaction, and feelings of hopelessness over time and regardless of the situation,” and low negative affect is characterised by “calmness and serenity.”8 9 Supporting this conceptualisation, a considerable neurobiological and psychological overlap between anxiety, hostility/anger, and depression has previously been shown.10 11 As attempts to link psychological factors to heart disease have focused on negative emotions, mostly depression,7 whether positive emotions might also have a role in the development of coronary heart disease remains unclear.“
[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."
Visit InfoMedSearch's Home Page for all InfoMedLinks Cardiovascular Topics: Atherosclerosis, Atrial Fibrillation, Coronary Artery Disease, Cholesterol - Lipids, General Cardiovascular, Heart Failure, Hypertension, Myocardial Infarction (Heart Attack), Peripheral Artery Disease, and Stroke.
Notes
The Guidelines section will contain 2008 and some 2007 updated published guidelines. To view Guidelines from previous years, view the Guideline sections or the Article sections or our Monthly Online Newsletter (under the Guidelines section).
Coronary Artery Disease
Daily Treatment Report
Cognitive Therapy-CBT-Psychotherapy
Device Therapy
[Severe myocardial infarction due to late and very late stent thrombosis after coronary artery stenting with drug-eluting stents] (Dtsch Med Wochenschr. 2008)
Carotid angioplasty and stenting in octogenarians: is it safe? (Catheter Cardiovasc Interv. 2008)
Drug Side-Effects and Interactions
Incidence of Bleeding in 'Real-Life' Acute Coronary Syndrome Patients Treated with Antithrombotic Therapy. (Cardiology. 2008)
Drugs
Wider cholesterol drug use may save lives “People with low cholesterol and no big risk for heart disease dramatically lowered their chances of dying or having a heart attack if they took the cholesterol pill Crestor, a large study found. The results, reported Sunday at an American Heart Association conference, were hailed as a watershed event in heart disease prevention. Doctors said the study might lead as many as 7 million more Americans to consider taking cholesterol-lowering statin drugs, sold as Crestor, Lipitor, Zocor or in generic form. … However, some doctors urged caution. Crestor gave clear benefit in the study, but so few heart attacks and deaths occurred among these low-risk people that treating everyone like them in the United States could cost up to $9 billion a year — "a difficult sell," one expert said. About 120 people would have to take Crestor for two years to prevent a single heart attack, stroke or death, said Stanford University cardiologist Dr. Mark Hlatky. He wrote an editorial accompanying the study published online by the New England Journal of Medicine. "Everybody likes the idea of prevention. We need to slow down and ask how many people are we going to be treating with drugs for the rest of their lives to prevent heart disease, versus a lot of other things we're not doing" to improve health, Hlatky said.”
Management of hypertension in patients with cardiac disease: use of renin-angiotensin blocking agents. (Am J Med. 2008)
Meta-Analysis of the Efficacy and Safety of Clopidogrel Plus Aspirin as Compared to Antiplatelet Monotherapy for the Prevention of Vascular Events (The American Journal of Cardiology 2008) "In conclusion, combining aspirin and clopidogrel significantly reduces the odds of major cardiovascular events in patients with acute coronary syndromes or those who undergo percutaneous coronary intervention but at the expense of significant increases in the risk for bleeding."
Low-dose aspirin in patients with stable cardiovascular disease: a meta-analysis. (Am J Med. 2008)
The use of different evidence-based medications and 5-year survival after an acute coronary syndrome: An observational study. (Int J Cardiol. 2008)
Exercise
Exercise Gives Longer Life For People With Heart Disease “Exercising once a week can help prolong life expectancy for people with heart disease according to a new study from the Norwegian University of Science and Technology (NTNU) in Trondheim, Norway.”
Training, Detraining and Retraining Effects after a Water-Based Exercise Program in Patients with Coronary Artery Disease (Cardiology 2008)
Aerobic and Resistance Training in Coronary Disease: Single versus Multiple Sets (Med Sci Sports Exerc. 2008) “Conclusions: Combined AT + RT yields more pronounced physiological adaptations than AT alone and appears to be superior in producing improvements in V·O2peak, muscular strength and endurance, and body composition. The data support the use of multiple set RT for patients desiring an increased RT stimulus which may further augment parameters that affect V·O2peak, VAT, lower body endurance, and muscle mass in a cardiac population.”
Aerobic Plus Resistance Training May Improve Coronary Artery Disease Outcomes “"Combined...AT and...RT rehabilitation programs are rapidly becoming standard treatments for individuals with coronary artery disease," write Susan Marzolini, from the University of Toronto in Ontario, Canada, and colleagues. "Although recommendations for the AT prescription are widely known, the RT prescription when combined with AT remains unclear. Recently established RT practice guidelines for patients with CAD [coronary artery disease] advocate the use of one set of six to ten exercises." “
Importance of exercise training session duration in the rehabilitation of coronary artery disease patients. (European Journal of Cardiovascular Prevention & Rehabilitation. 2008) “Conclusions: In the early rehabilitation of CAD patients, 40-min exercise training sessions seem to be at least as effective for improving body anthropometrics, blood plasma lipid profile and exercise capacity, as compared with 60-min exercise training sessions.”
High-intensity aerobic exercise improves diastolic function in coronary artery disease “Conclusions. Aerobic treadmill exercise improves early diastolic relaxation in patients with stable coronary artery disease, measured by the mean LV early diastolic strain rate.”
Tai chi training for patients with coronary heart disease. (Med Sport Sci. 2008)
Effects of high frequency exercise in patients before and after elective percutaneous coronary intervention. (Eur J Cardiovasc Nurs. 2008)
Better exercise counseling needed for CHD patients "They suggest that many CHD patients may have a lack of confidence in their ability to engage in physical activity and they may also be unaware of the benefits of physical activity. They also point out that exercise counseling by healthcare providers or practitioners has been effective in promoting physical activity, but overall, the rate of physician counseling about exercise remains low nationally (25% to 34%)."
General Information
Frequency of Stress Testing to Document Ischemia Prior to Elective Percutaneous Coronary Intervention (JAMA. 2008) “Conclusion The majority of Medicare patients with stable coronary artery disease do not have documentation of ischemia by noninvasive testing prior to elective PCI.”
Symptoms of chest pain and dyspnea and factors associated with chest pain and dyspnea 10 years after coronary artery bypass grafting. (Am Heart J. 2008) “CONCLUSION: During 10 years after CABG, one third died. After 10 years, 54% of the survivors were free from chest pain and 31% were free from dyspnea. Predictors for chest pain and dyspnea could be defined and reflected age, history, sex, obesity, preoperative complications, and symptom severity.”
Mortality and Cardiovascular Events in Patients Treated With Homocysteine-Lowering B Vitamins After Coronary Angiography (JAMA 2008) “Conclusions This trial did not find an effect of treatment with folic acid/vitamin B12 or vitamin B6 on total mortality or cardiovascular events. Our findings do not support the use of B vitamins as secondary prevention in patients with coronary artery disease.”
A meta-analysis update: percutaneous coronary interventions. (Am J Manag Care. 2008) “CONCLUSION: Recent RCTs comparing PCIs with conservative MT in stable CAD increase confidence in previous findings that the use of PCIs does not offer marginal benefit over that of the use of MT alone for mortality risk, cardiac death or MI, and nonfatal MI.”
Drugs often rival angioplasty, study finds “People with chronic chest pain who are not in big danger of a heart attack now may have even less reason to rush into an artery-opening angioplasty: There's more evidence drugs should be tried first and often are just as effective. The slim early advantage for angioplasty at relieving pain in these nonemergency cases starts to fade within six months and vanishes after three years, according to a new report from a landmark heart study. That is sooner than the five years doctors estimated last year after their first analysis of the study. The new information comes from patients' own reports of how they fared after treatment. Results are in today's New England Journal of Medicine. "This study should be enlightening and practice-changing for doctors and patients alike," and should lead more to try drugs before resorting to the $40,000 heart procedure, said Duke University's Dr. Eric Peterson, who co-authored an editorial in the medical journal.“
Effect of PCI on Quality of Life in Patients with Stable Coronary Disease “Conclusions Among patients with stable angina, both those treated with PCI and those treated with optimal medical therapy alone had marked improvements in health status during follow-up. The PCI group had small, but significant, incremental benefits that disappeared by 36 months.”
[Therapy of chronic stable angina.] (Internist (Berl). 2008)
Guidelines
GWTG Works: New Study Shows Adherence to CAD Guidelines Reaps Benefits
Immunotherapy
Internet Sites
Treatment Information
Drug-Food-Supplement Information
DrugDigest (drug interactions)
FDA - Drug Interactions: What You Should Know
NIH - Botanical Dietary Supplements: Background Information
NIH - Drug, Supplements, and Herbal Information
NIH - Herbal Supplements: Consider Safety, Too
NIH - Vitamin and Mineral Supplement Fact Sheets
Nutrition
Fish and n-3 fatty acids for the prevention of fatal coronary heart disease and sudden cardiac death. (Am J Clin Nutr. 2008)
Supplementation with orange and blackcurrant juice, but not vitamin E, improves inflammatory markers in patients with peripheral arterial disease. (Br J Nutr. 2008)
Historical overview of n-3 fatty acids and coronary heart disease. (Am J Clin Nutr. 2008) "These studies demonstrate that fish oil fatty acids have beneficial effects on coronary heart disease."
Nutritional management of coronary heart disease (JCN 2008)
Majority Have Poor Diets a Year After CHD Diagnosis
Other
Other Treatments
Experimental
Radiotherapy
Supplements-Vitamins-CAM
Intakes of long-chain omega-3 fatty acid associated with reduced risk for death from coronary heart disease in healthy adults. (Curr Atheroscler Rep. 2008)
The Role of Oral Coenzyme Q10 in Patients Undergoing Coronary Artery Bypass Graft Surgery. (J Cardiothorac Vasc Anesth. 2008)
Antioxidant vitamins intake and the risk of coronary heart disease: meta-analysis of cohort studies. (European Journal of Cardiovascular Prevention & Rehabilitation 2008) "Conclusions: Our findings in this meta-analysis suggest that an increase in dietary intake of antioxidant vitamins has encouraging prospects for possible CHD prevention."
Fish-oil supplementation in patients with implantable cardioverter defibrillators: a meta-analysis (CMAJ 2008) "Conclusion: These data indicate that there is heterogeneity in the response of patients to fish-oil supplementation. Caution should be used when prescribing fish-oil supplementation for patients with ventricular tachycardia."
Should patients with cardiovascular disease take fish oil?
Surgery
Cognitive Outcomes Three Years After Coronary Artery Bypass Surgery: Relation to Diffusion-Weighted Magnetic Resonance Imaging. (Ann Thorac Surg. 2008)
Transplantation
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