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"

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.

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Coronary Artery Disease

General Information

NEWS:

Calcium Intake and Vascular Calcification(2005)

Calcium curious: How much is enough?

Calcium Supplements May Increase Heart Attacks In Older Women

Genetic Factors May Predict Depression In Heart Disease Patients “According to the study, published in the April issue of the American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, the genes are related to the vascular system, suggesting that vascular health – which includes the body's network of blood vessels, arteries and veins – may be a predictor of depression in individuals with heart disease. This is the first large-scale genetic study of depressive symptoms in cardiac patients. "Depression can significantly impact quality of life for heart disease patients and can increase the risk for additional cardiac events or even death," said lead author Jeanne M. McCaffery, PhD, of The Miriam Hospital's Weight Control and Diabetes Research Center. "Although it's too early to begin to speculate about the possible clinical implications of these findings, it's intriguing to think that there may be a genetic explanation as to why people with heart disease are more susceptible to depression." “

Heart Disease: The World's Number One Killer “Heart disease is the number one killer in the world. By 2010, India's population is expected to account for 60 percent of the world's heart disease cases. One percent of the world's population has a genetic mutation that makes them almost guaranteed to have heart trouble, but in South Asia, the frequency of the mutation reaches four percent. The mutation on the heart protein gene MYBPC3 was discovered five years ago in two Indian families with cardiomyopathy, but its significance was not realized until a broader study including almost 1,500 people across India was done. "The mutation leads to the formation of an abnormal protein," Kumarasamy Thangaraj, study leader of the Centre for Cellular and Molecular Biology in Hyderabad, India, was quoted as saying. "Young people can degrade the abnormal protein and remain healthy, but as they get older it builds up and eventually results in the symptoms we see."”

IQ Explains Some Of The Difference In Heart Disease Between People Of High And Low Socio-economic Status

Largest-Ever Meta-Analysis Finds CRP Is Unlikely to Be Causal for CVD “In the largest and most comprehensive meta-analysis to date looking at C-reactive-protein (CRP) levels and risk of coronary heart disease (CHD) and stroke, British researchers conclude that CRP is unlikely to be a causal factor for cardiovascular disease [1]. Although CRP concentration was linearly associated with CHD, stroke, and vascular mortality, as well as nonvascular mortality, statistical adjustment for conventional cardiovascular risk factors "resulted in considerable weakening of associations," note the scientists of the Cambridge-based Emerging Risk Factors Collaboration (ERFC), who report their findings online December 21, 2009 in the Lancet. In an editorial accompanying the paper [2], Drs S Matthijs Boekholdt and John JP Kastelein (Academic Medical Center, Amsterdam, the Netherlands) say the UK authors "are to be commended for this impressive data set." Although the findings "add weight to the evidence of noncausality" for a role of CRP in the development of cardiovascular disease, "the debate can be resolved only by randomized trials with agents that specifically target CRP, and such compounds are currently under development," say the Dutch doctors.”

Men with angina 'at greater risk' “Men with angina are much more likely than women to develop further serious heart problems, a study suggests. Researchers found male patients were twice as likely to have a heart attack and almost three times as likely to suffer a heart disease-related death. Angina, a type of chest pain, is common and can be the first sign of heart disease - but the risks are unclear. The study of UK patients, led by the National University of Ireland, Galway, appears in the British Medical Journal. Angina is caused by insufficient supply of blood to the heart muscle. Recent estimates suggest that 4.8% of men and 3.4% of women aged over 16 in England have angina. In Scotland, the figures are higher: 6.6% of men and 5.6% of women. “

Neck Size Linked to Heart Risk

Phosphorus Levels May Predict Heart Disease

Younger Men With Erectile Dysfunction At Double Risk Of Heart Disease

ARTICLES:

Heart Disease and Angina (Chest Pain)

Heart Disease: Angina “The most common symptom of coronary artery disease is angina or "angina pectoris," also known as chest pain. Angina can be described as a discomfort, heaviness, pressure, aching, burning, fullness, squeezing or painful feeling. Often, it can be mistaken for indigestion. Angina is usually felt in the chest, but may also be felt in the shoulders, arms, neck, throat, jaw or back. If you have this symptom, take notice. If you've never been diagnosed with heart disease, you should seek treatment immediately. If you've had angina before, use your angina medications as directed by your doctor and try to determine if this is your regular pattern of angina or if the symptoms are worse. (This is called unstable angina, see below.)”

JOURNAL ARTICLES:

25-Hydroxyvitamin D Levels Inversely Associate with Risk for Developing Coronary Artery Calcification.. (J Am Soc Nephrol. 2009) “In conclusion, lower 25-hydroxyvitamin D concentrations associate with increased risk for incident CAC. Accelerated development of atherosclerosis may underlie, in part, the increased cardiovascular risk associated with vitamin D deficiency.”

APOE Genotype, Lipids, and Coronary Heart Disease Risk: A Prospective Population Study “Conclusions: In the largest prospective cohort study to date, CHD risk was not associated with APOE genotype after controlling for a variety of cardiovascular risk factors, particularly the ratio of low- to high-density lipoprotein cholesterol. Perspective: APOE plays an important role in cholesterol and triglyceride metabolism. Common polymorphisms in APOE affect binding of lipoprotein particles to receptors involved in clearance, and these polymorphisms have been associated with variation in plasma lipoproteins, C-reactive protein (CRP) levels, and risk for cardiovascular disease. The degree to which APOE polymorphisms affect vascular risk, independent of circulating lipid levels, is controversial. Although CRP levels were not measured in the current study, this relatively large prospective study reveals that three common APOE polymorphisms do not have major effects on CHD risk after adjustment for plasma lipid levels.”

Omega-6 Fatty Acids and Risk for Cardiovascular Disease (Circulation 2009)

Oral calcium supplements do not affect the progression of aortic valve calcification or coronary artery calcification. (J Am Board Fam Med. 2009)

Persistent chest pain and no obstructive coronary artery disease. (JAMA. 2009) “Two underdiagnosed cardiac causes for persistent chest pain include microvascular coronary disease and abnormal cardiac nociception. Microvascular coronary disease is associated with an increased risk of adverse cardiovascular events such as myocardial infarction, congestive heart failure, and sudden cardiac death, and treatment directed at improving endothelial function can improve outcomes. Abnormal cardiac nociception is also a cause for persistent chest pain caused by heightened coronary pain perception. Coronary reactivity testing allows for direct measurement of blood flow characteristics in response to vasoactive agents for the diagnoses of microvascular coronary disease and can be a useful tool to differentiate causes of chest pain.”

The association between cardiac calcification and coronary artery disease. (Acta Cardiol. 2009)

Usefulness of diabetes mellitus to predict long-term outcomes in patients with unstable angina pectoris. (Am J Cardiol. 2009)

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