Coronary Heart Disease
What is coronary heart disease?
If the human body were a machine, it would have been recalled by now. A case in point is the heart. The muscle itself is a marvel of engineering, a tireless pump that moves 75 gallons of blood every hour. But there's a glaring flaw in the system. The arteries that carry blood to the heart often become clogged, a condition called coronary heart disease or coronary artery disease. It's as if a car company designed the perfect engine but forgot to look at the fuel lines.
About 16 million Americans have coronary heart disease (CHD), and many of them will pay a high price. If the coronary arteries become too narrow, the heart won't get the oxygen or nutrients it needs to stay healthy. And if an artery becomes completely clogged, part of the heart will shut down. Doctors call this a myocardial infarction, but it's better known as a heart attack. Over 450,000 people with CHD die of heart disease every year.
How does coronary heart disease occur?
The bloodstream is a highway for many substances, including cholesterol and other fats. Usually, these fats are harmless. But all too often, they can start sticking to the walls of the arteries, leaving less and less room for blood to flow. This condition is called atherosclerosis or hardening of the arteries. Atherosclerosis often gets its start when there's too much cholesterol in the blood. Anything that damages or inflames the arteries can also help set the disease in motion. Damaged arteries often become "stickier," which speeds the buildup of plaque.
What are the symptoms of coronary heart disease?
In its earliest stages, CHD is a silent disease. Some people never have symptoms, even as their arteries become dangerously clogged. Most people, however, will notice some warning signs. The symptoms may be subtle or severe, but they should never be taken lightly.
As the arteries feeding your heart become narrower and narrower, you may become short of breath. You may also feel chest pain, often called angina. Angina isn't just an ache; you'll probably also have a heavy, tight, burning, squeezing sensation right behind your sternum (breastbone). The pain may also spread to your jaw, throat, or one arm. The attacks usually come on during exertion or emotional stress, and they go away when you rest or calm down. If the attacks suddenly become more frequent or if they start arriving while you're resting, a heart attack may be around the corner.
Symptoms are often different in women than men. If you are a woman and you experience fatigue, sleep disturbance, shortness of breath, indigestion, cold sweats, dizziness, or anxiety -- even in the absence of chest pain -- you may have heart disease and could even be experiencing a heart attack.
What raises the risk of coronary heart disease?
Coronary heart disease doesn't strike at random. People with CHD often have one or more traits that make them likely targets.
Three risk factors stand far above the rest: high cholesterol, high blood pressure, and smoking. Any one of these traits roughly doubles your chances for developing CHD. Combine all three, and you'll be eight times more likely to develop CHD.
These "big three" all threaten your heart in different ways. The hazards of high cholesterol are obvious -- put enough sludge in a pipe, and it's bound to get backed up. High blood pressure damages the walls of the arteries, making it easier for cholesterol to stick. Nicotine from tobacco smoke also damages the arteries, but it doesn't stop there. The addictive compound in cigarettes lowers the levels of HDL cholesterol, the "good" cholesterol that helps clear artery-clogging LDL "bad" cholesterol from the blood. Obesity, a lack of exercise, and diabetes can also make you vulnerable to CHD. Extra fat -- especially in the midsection -- can set off a cascade of chemical changes in the body that encourage CHD. A sedentary lifestyle aggravates all the previous risk factors. Diabetes damages arteries and, like smoking, is especially likely to cause CHD in women.
Some risk factors, such as age, family history, and gender are completely beyond your control. Fortunately, CHD rarely develops in men younger than 40 or women younger than 50. You're more likely to have CHD if a close family member had the condition, especially if it developed at an early age. Because estrogen helps keep the arteries healthy, premenopausal women are much less likely than men their age to develop heart disease. After menopause, however, women can be just as vulnerable as men to CHD.
Scientists are still trying to uncover other possible threats to the heart. A growing number of studies suggest that depression, stress, and loneliness can increase a person's risk for CHD. People with aggressive, type-A personalities also seem to be at greater-than-average risk.
How can I protect myself from coronary heart disease?
First of all, see your doctor for a checkup and an evaluation of your risk. The American Heart Association has advised that doctors evaluate patients for their general risk of cardiovascular disease starting at age 20. As part of the assessment, your doctor should check your blood pressure, body mass index, waist measurement, and pulse, and repeat the assessment at least every two years. Your cholesterol and glucose levels should be monitored every five years. If you're 40 or over or have multiple risk factors, the AHA recommends that your doctor calculate what the chances are that you'll develop cardiovascular disease in the next 10 years. You can also calculate your own risk online by using the AHA's risk assessment tool.
Next, make a list of everything that puts you at risk, then work on crossing as many things off that list as you can. With a healthy lifestyle -- and a little help from your doctor -- you may be able to slow down coronary heart disease or even avoid it altogether. Medical treatment for high blood pressure, high cholesterol, and even smoking cessation is highly effective. In short, you may be able to turn America's number-one killer into a minor-league threat.
Eating a low-fat diet rich in fruits, vegetables, and whole grains; exercising 30 to 60 minutes at least 5 days a week (enough to break a sweat); not smoking; drinking only in moderation; keeping your blood pressure and cholesterol under control; and maintaining a good support network: all this will work wonders for your heart. If you have high cholesterol and are unable to bring it down through diet and exercise, you should talk to your doctor about statins or other cholesterol-lowering drugs. And to be on the safe side, check with your doctor before beginning a new exercise regimen.
The AHA recommends statin therapy for people 40 to 75 with a 7.5% risk of a stroke within 10 years; for people who've had a heart attack, stroke or serious arterial condition; for people over 21 with unusually high "bad" LDL cholesterol (190 mg/dL) or more; and people 40 to 75 who have type 1 or type 2 diabetes.
If you're feeling depressed, anxious, or stressed-out, seek out help from a psychologist or other therapist. The results can be dramatic: A study from Duke University Medical Center found that a stress-management program cut the chances that a heart patient would suffer a heart attack or need surgery by 74 percent.
If you have diabetes, you can lower your risk of CHD by keeping your blood pressure and cholesterol under control. You should also be sure to give up cigarettes and avoid second-hand smoke, get regular exercise, and do anything else you can to protect your heart. Combining diabetes with any other risk factor for CHD can be dangerous -- and even deadly.
Can aspirin protect my heart?
Daily aspirin therapy can help lower the risk of a heart attack in many people. One study found that an aspirin per day cut the risk of a heart attack by more than 40 percent. However a study reported in the March 7, 2005 edition of the New England Journal of Medicine suggests that women may not benefit much from aspirin therapy. The Women's Health Study found that 100 mg of aspirin every other day didn't significantly reduce women's risk of a first heart attack or death due to heart problems. The same dose did reduce women's risk of stroke by 17 percent.
The American Heart Association recommends a daily dose of aspirin for people who have had a heart attack. However, aspirin can cause stomach problems, and you shouldn't take regular doses unless your doctor says it's okay. A recent review by Duke University Medical Center found that a dose of 50 mg per day was as effective as a dose of 325 mg per day. (Also, if you drink alcohol regularly, be sure to tell your physician when discussing aspirin therapy.)
If your doctor decides a daily aspirin is advisable, she may want to monitor its effectiveness with a blood test to measure your platelet function, or clotting ability. Also, a recent study suggests that naproxen may hamper the cardiac benefits of aspirin, so check with your doctor about pain relievers if you take them regularly.
How is coronary heart disease treated?
If one or more of your coronary arteries is severely clogged, you may need treatment to restore the flow of blood to your heart. One option is coronary artery bypass surgery. Using a blood vessel from another part of your body, a surgeon can create a detour around the blocked artery. Another option is angioplasty, a procedure that involves threading a catheter through the clogged artery. Once the catheter is in place, it can widen the artery when the doctor inflates a small balloon, fires a laser, rotates a tiny blade, or inserts a small metal scaffold called a stent.
If your arteries aren't severely blocked but you're still bothered by angina, your doctor may prescribe beta-blockers, nitroglycerin, or other medications to ease your symptoms. With proper self-care, there's little reason that you can't lead a rich, active life.
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