The use of a year ASCVD risk score for blood pressure is used to guide the therapy for hypertension management.
For stage 2 hypertension, the clinician should initiate pharmacological therapy, along with non-pharmacological interventions. Non-pharmacological interventions are lifestyle modifications that include changes in diet and exercise.
A heart-healthy diet like the DASH diet pattern that is rich in fruits, vegetables, whole grains, and low-fat dairy products with reduced content of saturated fat would lower the systolic BP by approximately 11 mm Hg. Weight loss also has a positive impact on lowering blood pressure. Reduction of one kg in body weight for overweight adults can reduce the systolic BP by one mm Hg. For those who prefer dynamic resistance training, a weekly total of 90 to minutes of six exercises, three sets and 10 repetitions per exercises, would lower the systolic BP by approximately 5 to 8 mm Hg.
Other forms of exercises like isometric resistance e. Reducing alcohol consumption also has blood-pressure-lowering effects. Current recommendations are for men to drink no more than two drinks per day and for women to drink no more than one drink per day. This would help lower the systolic BP by approximately 4 mm Hg.
Type 2 diabetes mellitus is categorized when hemoglobin A1c HbA1c is greater than 6. Type 2 diabetes mellitus is strongly related to a sedentary lifestyle, dietary habits, physical activity, and body weight. It is one of the major cardiovascular risk factors. Additionally, weight loss is recommended if the individual is overweight or obese. Metformin can also be considered as first-line therapy for type 2 DM to improve the glycemic index and reduce cardiovascular risk.
A moderate-intensity statin is recommended to any patient aged between 40 to 75 years with type 2 DM, regardless of cholesterol levels and ASCVD risk. In this age group, for patients with low-density lipoprotein LDL exceeding , high or maximum tolerable intensity statin is recommended.
For intermediate-risk 7. Coronary artery calcium CAC scoring should be used to further guide the decision, in case a decision cannot be reached based on a year ASCVD risk assessment, especially for patients at borderline or intermediate risk.
If the CAC score is less than 0, with no risk conditions, then holding statin therapy is reasonable and if the CAC score is above , then starting statin therapy is reasonable. A CAC score 1 to 99 favors the use of statin, especially if the patient is aged 55 or above. For patients older than 75 years, discussions between patient and physician, assessment of risk factors, and side effects should be all looked at for initiation or continuation of statin therapy.
Aspirin is anti-thrombotic and reduces the risk of cardiovascular disease by irreversibly binding with the platelets. However, the use of low-dose aspirin 75 to mg orally for primary prevention is getting more controversial recently. Previous U. The strength of recommendation is comparatively weaker, and a thorough evaluation with risk versus benefit assessment is necessary. Secondary prevention is the therapy to prevent further damage and progression of the disease after the patient has a diagnosis of cardiovascular disease, including coronary artery, cerebrovascular, or peripheral arterial disease.
The guidelines are somewhat similar to that of primary prevention, including diet, exercises, and smoking cessation as discussed above. A large part of secondary prevention also includes pharmacological therapy. In contrast to primary prevention, anti-thrombotic therapy low dose aspirin is strongly recommended unless contraindicated. The daily strength of 75 mg of clopidogrel is recommended for people who are intolerant or allergic to aspirin.
Blood pressure should be lowered in all patients with coronary artery disease and stage 1 hypertension using both non- pharmacological and pharmacological therapies. Metformin remains the first-line therapy in diabetic patients for secondary prevention. High intensity or maximally tolerated statin is part of secondary prevention, independent of the lipid levels in as long as the patient can tolerate, and the goal is to achieve LDL less than Differential diagnosis is made based on the presenting signs and symptoms.
Other conditions presenting as chest pain and mimicking CAD could be musculoskeletal pains, pleural inflammation, diaphragmatic symptoms, GERD, dysphagia, panic attacks, and neuralgia from neck and shoulder. Prognosis depends on adherence to the prevention program. Prevention of coronary artery disease best starts with the initial evaluation of risk factors to prevent or halt the disease progression.
Prognosis of coronary artery disease is discussed in detail other topics. Prevention is intended to prevent a cardiovascular complication due to the chronic reduction of blood flood to the heart muscle cells.
Arrhythmias, chest pain, heart attack, related arterial diseases, sudden death, heart failure are complications of coronary artery disease discussed in detail in other topics. Patient education programs are fundamental to the prevention of cardiovascular diseases and their complications.
They are designed to allow people with chronic conditions to actively participate in managing their condition, promoting self-care behavior, and modifying risk factors. The goals are to improve health outcomes and decrease the incidence of complications for patients by supporting, not replacing, medical care. Educational interventions in cardiac care have been shown to increase physical activity, healthier dietary habits, and smoking cessation.
The delivery of patient education programs can vary substantially: locations can be in clinics, classrooms, or homes; the target could be an individual or groups, and content could be tailored or generic. Common topics include nutrition, exercise, risk factor modification, psychosocial well-being, and medications.
Coronary artery disease is a multifaceted health problem. It comprises of modifiable and non-modifiable risk factors, physical and emotional imbalances, and private and social relationships. Therefore, it needs an interprofessional approach, mainly an efficacious interprofessional team.
Prevention of cardiovascular diseases might provide a general framework for improving follow-up for patients with chronic diseases by targeting many domains for quality improvement: e.
Interactive approaches have to be used to engage clinicians in simultaneously developing and implementing the interventions. The optimal approach to managing coronary artery disease utilizes an interprofessional healthcare team approach. Doctors, nurses, physiotherapists, dietitians, physical trainers, psychologists, patients, and family members should all have involvement.
Cardiac specialty pharmacists will be the experts on the medications used to address coronary artery disease, and its underlying conditions are comorbidities. They will monitor agent selection, dosing, and perform medication reconciliation to preclude drug interactions, reporting any adverse findings to the healthcare team. They are also involved in patient counseling. Nurses are crucial to this process, particularly those with cardiovascular specialty training. They can monitor patient compliance, treatment progression, provide counseling, and answer questions from the patient and their family, as well as administering medication for inpatients.
Nursing also acts as a direct extension of the treating clinician on a properly functioning healthcare team. As mentioned above, dieticians or nutritionists, as well as exercise trainers may also play a role in the management of coronary artery disease and associated comorbidities, and when they are involved, they also need to be plugged in to the healthcare team structure, so they can operate from the same paradigm for the patient's case.
Only through a fully collaborative, interprofessional team approach can coronary artery disease cases achieve optimal results for the patient. This book is distributed under the terms of the Creative Commons Attribution 4. Turn recording back on. National Center for Biotechnology Information , U. StatPearls [Internet]. Search term. Affiliations 1 Southern Illinois University. Continuing Education Activity In the United States, cardiovascular disease is one of the leading causes of mortality, morbidity, and increased healthcare cost.
Introduction Coronary artery disease CAD is the most common form of heart disease. Etiology Risk factors of coronary artery disease are as follows [2] [3] : Non-Modifiable Age.
Epidemiology Coronary artery disease is a leading cause of death worldwide. Pathophysiology The beginning of coronary artery disease is generally attributed to a chronic inflammatory process, from the earliest formation of the fatty streak to the final formation of a fibrous-atheroma.
Although data suggest that revascularization of viable myocardium in patients with LV dysfunction and symptoms of congestive heart failure may improve survival, this benefit has not yet been definitively proven and awaits the results of the ongoing STICH Surgical Treatment for Ischemic Heart Failure trial.
Revascularization vs medical therapy as a function of percentage of ischemic myocardium. From Circulation , 99 with permission from Wolters Kluwer Health.
Not all apparently significant stenoses on visual inspection are hemodynamically relevant, and a recent small trial showed the benefits of targeted revascularization on the basis of an objective measurement of hemodynamic severity. The search for the location of future plaque ruptures or erosions leading to MI so-called vulnerable plaques is an important area of cardiovascular research and could potentially change drastically how CAD is diagnosed and treated.
Only Percutaneous coronary intervention includes percutaneous balloon angioplasty, introduced in , and stenting with bare metal stents BMSs , in use since , or drug-eluting stents DESs , in use since Of an estimated 1.
During the past 30 years, multiple trials have attempted to find the preferred method of revascularization for patients with stable CAD. In all these trials, no difference in the incidence of death or nonfatal MI was observed between these methods of revascularization.
Patients with multivessel disease who undergo CABG have been shown to require less additional revascularization than those undergoing PCI , ; however, no survival advantage has been demonstrated, except for diabetic patients in the BARI trial. The rate of stroke was higher in the CABG group, perhaps because of the decreased use of antiplatelet agents. From N Engl J Med , with permission.
Thus, the method of choice for revascularization depends on the angiographic characteristics of the lesions causing ischemia, LV dysfunction, comorbid conditions and suitability of the patient for surgery, likelihood of technical success with PCI, quality-of-life expectations, and patient preference.
The advantages of PCI include lesser invasiveness, no need for general anesthesia, less postprocedural morbidity, and a shorter hospital stay. In current practice, CABG is often the preferred method of revascularization in patients with high-risk left main, 3-vessel, or 2-vessel disease with substantial especially proximal LAD involvement and LV dysfunction, particularly in patients with diabetes.
When PCI is the chosen method of revascularization, DESs are usually preferred because of the decreased rate of in-stent restenosis and need for target lesion revascularization compared with BMS. However, in patients in whom long-term dual platelet therapy may be problematic because of bleeding or financial issues , BMS may be the stent of choice.
Revascularization of future culprit lesions with coronary artery bypass grafting CABG. From Lancet , with permission from Elsevier. Some patients have CAD with intractable angina despite maximum medical therapy and may not be candidates for revascularization. One option for these patients is spinal cord stimulation, in which an electrode is inserted into the epidural space at the C7-T1 level.
This electrode stimulates axons in the spinal cord that do not transmit pain so as to reduce input to the brain of axons that do transmit pain gate theory. Another technique used to treat patients with refractory angina is enhanced external counterpulsation. This technique involves the use of a series of cuffs wrapped around the patient's legs, which are inflated with compressed air in sequence distally to proximally during diastole so as to propel blood back to the heart.
Enhanced external counterpulsation is administered as 35 one-hour treatment sessions over the course of 7 weeks. The proposed mechanisms of action are reduced myocardial demand, improved myocardial perfusion, and improved endothelial function. Another technique that has been used for refractory angina is transmyocardial laser revascularization, which creates small channels from the epicardial to endocardial surfaces of the heart with a laser using a surgical approach.
The mechanism of action of laser therapy is incompletely understood, and multiple randomized trials have failed to demonstrate an increase in survival. The lack of survival benefit for transmyocardial laser revascularization highlights the important role of the placebo effect in reducing angina with this now rarely used technique. Intramyocardial bone marrow stem cell injection is currently being investigated as a new therapeutic option for patients with chronic ischemia who are ineligible for revascularization.
This technique is still in the experimental stages, and further studies are required to assess long-term results and efficacy for reducing mortality and morbidity. All patients with stable CAD require comprehensive and aggressive control of risk factors. An initial trial of medical therapy alone is appropriate in most patients with chronic stable angina and is the cornerstone of treatment for chronic CAD.
Persistent symptoms, the magnitude of the ischemic burden, or drug intolerance should drive decision making regarding subsequent revascularization. Ischemia should be established with a noninvasive stress test before angiography. In patients undergoing angiography without a previous noninvasive stress test, FFR may be used to make appropriate decisions regarding revascularization, but the technique requires experience and is not widely used in many catheterization laboratories.
The method of choice for revascularization depends on the angiographic characteristics of the lesions causing ischemia, LV dysfunction, comorbid conditions, suitability of the patient for surgery, and likelihood of technical success. The physician's ultimate decisions regarding patient care must incorporate current evidence-based medicine as well as the patient's preferences and quality-of-life expectations.
On completion of this article, you should be able to: 1 integrate the information obtained from a history, physical examination, and a stress test to diagnose and stratify the risk of patients with chronic coronary artery disease; 2 apply evidence-based management strategies to improve survival in patients with chronic coronary artery disease; and 3 determine when revascularization is indicated in a patient with chronic coronary artery disease, and, if indicated, choose the preferred method for each patient.
For CME credit, see the link on our Web site at mayoclinicproceedings. National Center for Biotechnology Information , U. Journal List Mayo Clin Proc v. Mayo Clin Proc. Rihal , MD, and Bernard J. Author information Copyright and License information Disclaimer. Address correspondence to Bernard J. Individual reprints of this article and a bound reprint of the entire Symposium on Cardiovascular Diseases will be available for purchase from our Web site www. This article has been cited by other articles in PMC.
Abstract Coronary artery disease CAD is the single most common cause of death in the developed world, responsible for about 1 in every 5 deaths. TABLE 1. Open in a separate window. TABLE 2. TABLE 3. TABLE 4. TABLE 5. Risk Stratification on the Basis of Noninvasive Testing. Cardiac Ct and Mri Coronary artery calcium scanning with CT is a screening tool that has no role in patients with established CAD in whom the presence of coronary artery calcification is a given.
TABLE 6. Indications for Coronary Revascularization The indications for coronary revascularization continue to evolve as scientific and technological advances improve both the outcomes obtained with OMT and the techniques of revascularization. Alternative Therapies for Refractory Angina Some patients have CAD with intractable angina despite maximum medical therapy and may not be candidates for revascularization.
Notes On completion of this article, you should be able to: 1 integrate the information obtained from a history, physical examination, and a stress test to diagnose and stratify the risk of patients with chronic coronary artery disease; 2 apply evidence-based management strategies to improve survival in patients with chronic coronary artery disease; and 3 determine when revascularization is indicated in a patient with chronic coronary artery disease, and, if indicated, choose the preferred method for each patient.
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The utility of clinical, electrocardiographic, and roentgenographic variables in the prediction of left ventricular function. Prognostic implications of baseline electrocardiographic features and their serial changes in subjects with left ventricular hypertrophy.
Circulation ; 90 4 [ PubMed ] [ Google Scholar ]. Frequency of stress testing to document ischemia prior to elective percutaneous coronary intervention. Fox KA. Revascularisation in patients with stable coronary artery disease [letter]. Application of appropriateness criteria to stress single-photon emission computed tomography sestamibi studies and stress echocardiograms in an academic medical center. Circulation ; 9 [ PubMed ] [ Google Scholar ]. Diagnostic and prognostic value of non-invasive imaging in known or suspected coronary artery disease.
Cardiac outcomes after screening for asymptomatic coronary artery disease in patients with type 2 diabetes: the DIAD study: a randomized controlled trial. Identification of severe coronary artery disease using simple clinical parameters.
The result is coronary artery disease. The blood flow may eventually be completely blocked in one or more of the three large coronary arteries. In nonobstructive coronary artery disease, the large arteries may be narrowed by plaque, but not as much as they are in obstructive disease. Small plaques can also develop in the small blood vessels in the heart, causing coronary microvascular disease. For example, the blood vessels may not respond to signals that the heart needs more oxygen-rich blood.
Normally, the blood vessels widen to allow more blood flow when a person is physically active or under stress. But if you have coronary heart disease, the size of these blood vessels may not change, or the blood vessels may even narrow. In nonobstructive coronary artery disease, damage to the inner walls of the coronary arteries can cause them to spasm suddenly tighten.
This is called vasospasm. The spasm causes the arteries to narrow temporarily and blocks blood flow to the heart. These problems can also happen in the tiny blood vessels in the heart, causing coronary microvascular disease sometimes called coronary syndrome X. Coronary microvascular disease can happen with or without obstructive or nonobstructive coronary artery disease. Plaque can attract platelets and white blood cells to the area of buildup in the large coronary arteries, causing inflammation.
Inflammation can also prevent the small arteries of the heart from responding to the physical, electrical, and chemical signals that tell the arteries when the heart needs more oxygen-rich blood.
This can lead to coronary microvascular disease. There are many risk factors for coronary heart disease. Your risk of coronary heart disease goes up with the number of risk factors you have and how serious they are. Some risk factors—such as high blood pressure and high blood cholesterol —can be changed through heart-healthy lifestyle changes. Other risk factors, such as sex, older age, family history and genetics , and race and ethnicity, cannot be changed.
Genetic or lifestyle factors cause plaque to build up in your arteries as you age. In men, the risk for coronary heart disease starts to increase around age Before menopause, women have a lower risk of coronary heart disease than men.
This is likely because women make less estrogen a female hormone after menopause. Also, changes in the small blood vessels of the heart as you age raise the risk for coronary microvascular disease.
Air pollution in the environment can put you at higher risk of coronary heart disease. The increase in risk may be higher in older adults, women, and people who have diabetes or obesity. Air pollution may cause or worsen other conditions, such as atherosclerosis and high blood pressure, which are known to increase your risk for coronary heart disease. A family history of early heart disease is a risk factor for coronary heart disease.
This is especially true if your father or brother was diagnosed before age 55, or if your mother or sister was diagnosed before age Research shows that some genes are linked with a higher risk for coronary heart disease.
Unhealthy lifestyle habits that are risk factors include the following:. Learn about steps you can take to improve your heart health in our Heart-Healthy Living topic. Coronary heart disease is the leading cause of death for people of most racial and ethnic groups in the United States, including African Americans, Hispanics, and whites.
People of South Asian ancestry are at higher risk of developing coronary heart disease and serious complications than other Asian Americans. Coronary heart disease affects men and women. Obstructive coronary artery disease is more common in men. However, nonobstructive coronary artery disease is more common in women. Since the nonobstructive type is harder to diagnose, women may not be diagnosed and treated as quickly as men.
If you are a woman having chest discomfort or shortness of breath during physical activity, ask your doctor about tests to check for nonobstructive coronary artery disease or coronary microvascular disease.
Women may have a higher than normal risk for developing coronary heart disease if they have one of the following conditions. You should start getting screening tests and risk assessments for coronary heart disease around age 20 if you do not have any risk factors for coronary heart disease.
Children may need screening if they have risk factors, such as obesity, low levels of physical activity, or a family history of heart problems. Afterward, your doctor may recommend preventive treatments such as heart-healthy lifestyle changes to help you lower your risk of coronary heart disease.
Screening usually occurs in a doctor's office, but sometimes screenings are done at health fairs, drugstores, or other places. Blood samples might be collected at your doctor's office, a hospital, or a laboratory. Ask your doctor or nurse whether you need to fast not eat or drink anything besides water before the blood tests.
Your doctor may use a risk calculator to estimate your risk of having a heart attack, having a stroke, or dying from a heart or blood vessel disease in the next 10 years or throughout your lifetime. It also factors in whether you smoke or take medicines to manage your high blood pressure or cholesterol. Ask about your risk during your annual check-up. Knowing your risk will help you and your doctor decide on healthy lifestyle changes and possibly medicines to lower your risk.
Risk assessments should be repeated every 4 to 6 years in adults 20 to 79 years of age who do not have heart or blood vessel disease. No single risk calculator is appropriate for all people. Calculators can give you and your doctor a good idea about your risk, but your doctor might have to consider other factors to estimate your risk more accurately.
Commonly used risk calculators might not accurately estimate risk in certain situations, such as if you:. In these cases, your doctor may suggest other tests for coronary heart disease even if the ASCVD Risk Estimator says you are not at high risk. Studies show that heart-healthy living —never smoking, eating healthy, and being physically active—throughout life can prevent coronary heart disease and its complications.
Work with your doctor to set up a plan that works for you based on your lifestyle, your home and neighborhood environments, and your culture. Working with a team of healthcare providers may help with making changes in your diet, being physically active, managing other medical conditions, and helping you quit smoking.
Some people have severe symptoms of coronary heart disease. Others have no symptoms at all. Women are somewhat less likely than men to experience chest pain.
Instead, they are more likely to experience:. The symptoms may get worse as the buildup of plaque continues to narrow the coronary arteries. Chest pain or discomfort that does not go away or happens more often or while you are resting might be a sign of a heart attack. If you do not know whether your chest pain is angina or a heart attack, call right away. All chest pain should be checked by a doctor. Your doctor will diagnose coronary heart disease based on your symptoms , your medical and family history, your risk factors , and the results from tests and procedures.
It is important to seek care right away if you have symptoms of coronary heart disease. Your doctor will ask about your eating and physical activity habits, your medical history, your family history, and risk factors for coronary heart disease. Your doctor may ask whether you have any other signs or symptoms. This information can help your doctor determine whether you have complications or other conditions that may cause coronary heart disease. If you have coronary heart disease risk factors , your doctor may recommend diagnostic tests even if you do not have symptoms.
Nonobstructive coronary artery disease and coronary microvascular disease can be missed because patients or doctors may not recognize the warning signs. Diagnosing these types often requires more invasive tests or specialized tests, such as cardiac PET scans, that are not widely available. Your treatment plan depends on how severe your disease is, the severity of your symptoms, and any other health conditions you may have.
Possible treatments for coronary heart disease include heart-healthy lifestyle changes, medicines, or procedures such as coronary artery bypass grafting or percutaneous coronary intervention.
Your doctor will consider your year risk calculation when deciding how best to treat your coronary heart disease. Learn more about heart-healthy living. Your doctor may recommend medicines to manage your risk factors or treat underlying causes of coronary heart disease. Some medicines can reduce or prevent chest pain and manage other medical conditions that may be contributing to your coronary heart disease.
You may need a procedure or heart surgery to treat more advanced coronary heart disease. If you have been diagnosed with coronary heart disease, it is important that you continue your treatment plan. Get regular follow-up care to control your condition and prevent complications. It is important to get routine medical care and to take all medicines regularly, as your doctor prescribes. Do not change the amount of your medicine or skip a dose unless your doctor tells you to.
Talk with your doctor about how often you should schedule office visits and blood tests. Between visits, call your doctor if you have any new symptoms, if your symptoms worsen, or if you have problems with your blood pressure or blood sugar. Return to Treatment to review possible treatment options for coronary heart disease. You may be referred for exercise-based cardiac rehabilitation , also called cardiac rehab, to manage symptoms and reduce the chances of future problems such as heart attack.
Studies have shown that cardiac rehabilitation lowers the risk of hospitalization and death. It can also improve your quality of life. Your doctor will work with you to manage medical conditions that can raise your risk of heart problems and complications. Your doctor will likely suggest heart-healthy lifestyle changes, such as eating heart-healthy foods, being physically active, and quitting smoking.
Your doctor may refer you to other professionals, such as a registered dietitian or exercise physiologist. Your healthcare team can help you set up a personal plan to meet your health goals. There are benefits to quitting smoking no matter how long or how much you have smoked. Coronary heart disease risk associated with smoking begins to decrease soon after you quit, and it generally continues to decrease over time. In addition:. Living with heart disease may cause fear, anxiety, depression, and stress.
You may worry about having heart problems or making lifestyle changes that are necessary for your health. Talk with your healthcare team about how you feel. Your doctor may talk to you about:. Coronary heart disease can lead to heart attack or stroke. If you think that you are or someone else is having the following symptoms, call right away.
Every minute matters. Coronary heart disease is the leading cause of death for women. Learn more about how the causes, risk factors, symptoms, diagnosis, and treatment of coronary heart disease may be different for women than for men.
Read Advancing Women's Heart Health to learn more. Coronary heart disease is different for women than men because of hormonal and anatomical differences. Women are more likely than men to have medical conditions or life issues that raise their risk for coronary heart disease.
Although men and women can experience the same symptoms of coronary heart disease, women often experience no symptoms or have different symptoms than men do. Tests and procedures for diagnosing coronary heart disease are very similar for women and men.
But women may experience delays in diagnosis or treatment. Learn about important diagnostic tests and treatment options.
We are committed to advancing science and translating discoveries into clinical practice to promote the prevention and treatment of heart, lung, blood, and sleep disorders, including coronary heart disease. Learn about current and future NHLBI efforts to improve health through research and scientific discovery. Learn about the following ways the NHLBI continues to translate current research into improved health for people with heart disease. Learn about some of the pioneering research contributions we have made over the years that have improved clinical care.
In support of our mission , we are committed to advancing coronary heart disease research in part through the following ways. We lead or sponsor many studies on coronary heart disease. See if you or someone you know is eligible to participate in our clinical trials and observational studies. To learn more about clinical trials at the NIH Clinical Center or to talk to someone about a study that might fit your needs, call the Office of Patient Recruitment Learn more about participating in a clinical trial.
View all trials from ClinicalTrials. After reading our Coronary Heart Disease Health Topic, you may be interested in additional information found in the following resources. Coronary heart disease is a type of heart disease that develops when the arteries of the heart cannot deliver enough oxygen-rich blood to the heart. It is the leading cause of death in the United States. Coronary heart disease is often caused by the buildup of plaque, a waxy substance, inside the lining of larger coronary arteries.
This buildup can partially or totally block blood flow in the large arteries of the heart. Some types of this condition may be caused by disease or injury affecting how the arteries work in the heart.
Coronary microvascular disease is another type of coronary heart disease. Symptoms of coronary heart disease may be different from person to person even if they have the same type of coronary heart disease. However, because many people have no symptoms, they do not know they have coronary heart disease until they have chest pain, a heart attack, or sudden cardiac arrest.
If you have coronary heart disease, your doctor will recommend heart-healthy lifestyle changes, medicines, surgery, or a combination of these approaches to treat your condition and prevent complications. Explore this Health Topic to learn more about coronary heart disease, our role in research and clinical trials to improve health, and where to find more information. Causes - Coronary Heart Disease. Plaque buildup.
Normal versus a blocked artery. The image shows a normal coronary artery with normal blood flow and a blocked coronary artery narrowed by plaque. The buildup of plaque limits the flow of oxygen-rich blood through the artery.
Problems affecting the blood vessels. The cause of these problems is not fully clear. But it may involve: Damage or injury to the walls of the arteries or tiny blood vessels from chronic inflammation , high blood pressure , or diabetes. Molecular changes that are part of the normal aging process. Molecular changes affect the way genes and proteins are controlled inside cells. Spasm and plaque buildup can cause your arteries to narrow. Top left: image of a heart showing the coronary arteries.
Top right: This artery does not have plaque buildup but has a vasospasm, causing it to narrow. This is a type of nonobstructive coronary artery disease. However, the vasospasm causes severe narrowing. Coronary microvascular disease in small arteries and obstructive coronary artery disease in large arteries.
Figure A shows the small coronary artery network, which includes a normal artery and an artery with coronary microvascular disease. Figure B shows a large coronary artery with plaque buildup. Read more. Read less. Risk Factors - Coronary Heart Disease. Environment and occupation. Your work life can also raise your risk if you: Come into contact with toxins, radiation, or other hazards Have a lot of stress at work Sit for long periods Work more than 55 hours a week, or work long, irregular, or night shifts that affect your sleep.
Family history and genetics. Lifestyle habits. Unhealthy lifestyle habits that are risk factors include the following: Being physically inactive , which can worsen other heart disease risk factors, such as high blood cholesterol and triglyceride levels, high blood pressure, diabetes and prediabetes, and overweight and obesity. Not getting enough good quality sleep, including waking up often throughout the night, which may raise your risk of coronary heart disease.
While you sleep, your blood pressure and heart rate fall. Your heart does not work as hard as it does when you are awake. As you begin to wake up, your blood pressure and heart rate increase to the usual levels when you are awake and relaxed.
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