Coronary Artery Disease Risk Factors
Many things can make you more likely to have coronary artery disease. Some you can change, and some you canât. They include:
Age, especially being older than 65
Being overweight or obese
Family history, especially if one of your close relatives got heart disease at a young age
Gender. Men have a greater risk of heart attack and have them earlier, compared with women, until the risk evens out at age 70.
High blood pressure and high cholesterol
Lack of physical activity
Race. African Americans have a higher risk than people of other races because they tend to have higher blood pressure. Higher rates of obesity and diabetes in some Asian and Hispanic people may also put them at higher risk of heart disease.
Smoking or breathing secondhand smoke
Unhealthy diet, including a lot of food that has high saturated fat, trans fat, salt, and sugar
The Struggle To Rebound
Depression can also complicate the aftermath of a heart attack, stroke, or invasive procedure such as open-heart surgery. The immediate shock of coming so close to death is compounded by the prospect of a long recuperation, as well as the fear that another, potentially more serious event could occur without warning.
The result is often feelings of depression, anxiety, isolation, and diminished self-esteem. According to the National Institutes of Mental Health , up to 65 percent of coronary heart disease patients with a history of heart attack experience various forms of depression. Though such emotions are not unusual, they should be addressed as quickly as possible. Major depression can complicate the recovery process and actually worsen your condition. Prolonged depression in patients with cardiovascular disease has been shown to contribute to subsequent heart attacks and strokes.
High Blood Cholesterol Levels
The Framingham Heart Study results demonstrated that the higher the cholesterol level, the greater the risk of coronary artery disease alternatively, CAD was uncommon in people with cholesterol levels below 150 mg/dL. In 1984, the Lipid Research Clinics-Coronary Primary Prevention Trial revealed that lowering total and LDL or bad cholesterol levels significantly reduced CAD. More recent series of clinical trials using statin drugs have provided conclusive evidence that lowering LDL cholesterol reduces the rate of myocardial infarction , the need for percutaneous coronary intervention and the mortality associated with CAD-related causes.
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Treatment For Coronary Heart Disease
Treatment may include:
Modification of risk factors. Risk factors that you can change include smoking, high cholesterol levels, high blood glucose levels, lack of exercise, poor dietary habits, being overweight, and high blood pressure.
Medicines. Medicine that may be used to treat coronary artery disease include:
Antiplatelets. These decrease blood clotting. Aspirin, clopidogrel, ticlopidine, and prasugrel are examples of antiplatelets.
Antihyperlipidemics. These lower lipids in the blood, particularly low density lipid cholesterol. Statins are a group of cholesterol-lowering medicines, and include simvastatin, atorvastatin, and pravastatin, among others. Bile acid sequestrants–colesevelam, cholestyramine and colestipol–and nicotinic acid are other medicines used to reduce cholesterol levels.
Antihypertensives. These lower blood pressure. Several different groups of medicines work in different ways to lower blood pressure.
Coronary angioplasty. With this procedure, a balloon is used to create a bigger opening in the vessel to increase blood flow. Although angioplasty is done in other blood vessels elsewhere in the body, percutaneous coronary intervention refers to angioplasty in the coronary arteries to permit more blood flow into the heart. PCI is also called percutaneous transluminal coronary angioplasty . There are several types of PCI procedures, including:
Balloon angioplasty. A small balloon is inflated inside the blocked artery to open the blocked area.
Monocytes Tissue Macrophages And Myocardial Infarction
The immune response to acute myocardial infarction includes an inflammatory phase at days 14 and a healing phase from days 4 to 15. In a seminal study, identified two subsets of monocytes, Ly6CHi and Ly6CLow, that were recruited sequentially via CCR2 and CX3CR1, respectively. In the early phase, Ly6CHi monocytes removed necrotic tissue exhibiting phagocytic, proteolytic, and inflammatory properties. Ly6CLow monocytes indeed promote tissue healing via myofibroblast maturation, the deposition of collagen fibers, and vascular angiogenesis through increased endothelial growth factor expression. Monocyte recruitment in the human heart depends on innate B cells, which drive monocyte expansion in a CCL7-dependent fashion once they are recruited into ischaemic cardiac tissue.
The pro-inflammatory subset of monocytes in humans express CD14++CD16, and pro-healing monocytes express CD14+CD16++ .
MHC-IIHi and MHC-IILow macrophages phagocytize apoptotic cells, promote angiogenesis and render neonatal cardiomyocytes more responsive to proliferative stimuli through minimal inflammation and more efficient than non-embryonic macrophages, although data on adult cells are less definitive . In adult myocardial infarction, there are large numbers of CCR2+ macrophages and monocyte expansion that drives inflammatory responses through inflammasome activation and oxidative damage, thus impacting cell healing.
Risk Factors You Cant Control
Its important to be aware of risk factors you cant control, because you may be able to monitor their effects.
Age and gender
Your risk of CAD increases as you age. This is because plaque builds up over time. According to the National Heart, Lung, and Blood Institute , the risk for women increases at age 55. The risk for men increases at age 45.
CAD is the most common kind of heart disease among both men and women in the United States. White men between the ages of 35 and 44 are about 6 times more likely to die of CAD than white women in that same age group, according to a 2016 overview. The difference is less among people who arent white.
The death rate among women increases after menopause. A womans risk of death from CAD is equal to or greater than the same risk for a man by age 75.
Some degree of cardiovascular disease at the level of the heart muscle and coronary arteries often occurs as people age. The condition is identifiable in more than 80 percent of adults over age 80, according to a 2007 review .
Changes that occur in the body as you age create conditions that make it easy for heart disease to develop. For example, the smooth artery vessel walls can naturally develop rough surfaces with abnormal blood flow that attract plaque deposits and cause stiffening of the arteries.
In the United States, heart disease is the leading cause of death for most ethnicities. According to the , heart disease is second only to cancer as a cause of death among:
Smoking And Cardiovascular Disease Risk
Smoking increases your risk of heart attack, stroke and peripheral vascular disease â which can lead to gangrene and limb amputation).
Smoking makes your blood âstickierâ, causing blood cells to clump together. This slows blood flow through your arteries and makes blockages more common. Blockages may cause heart attack and stroke.
Smoking also makes your artery walls sticky, causing them to become clogged with fatty material called plaque or atheroma. Smokers often have cold hands or feet as a result of clogged arteries, which may also lead to serious problems such as gangrene.
If your coronary artery becomes clogged, it can cause angina. If a blood clot forms in the narrowed coronary artery and completely blocks the blood supply to a part of your heart, it can cause a heart attack.
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Who Gets Coronary Artery Disease
You have an increased risk of coronary artery disease if you:
- Have a high cholesterol level .
- Are a man over 45 years of age or a post-menopausal woman.
- Are overweight.
- Are physically inactive.
- Are an African American, Mexican American, Native American, Native Hawaiian or an Asian American. The increased risks are caused by higher rates of high blood pressure, obesity and diabetes in these populations.
If you have these risk factors, talk with your healthcare provider. They may want to test you for coronary artery disease.
Quantification Of Myocardial Stress: Mental Stress
Mental Stress-Induced Myocardial Ischaemia is a corollary of different validated techniques used to assess the effects of stress on cardiac function .
In contrast to exercise and pharmacologic stress-induced ischaemia, MSIMI is a provocative test that provides psychological rather than physical stimuli, leading to reversible myocardial ischaemic damage. Different mental stressors are used to recreate behavioral challenges experienced in everyday life .
Many different instrumental resources have been tested: ECG recording, echocardiography, ventriculography, myocardial scintigraphy, positron-emission tomography, and coronary angiography .
The following heterogenic haemodynamic features associated with MSIMI result in myocardial transient ischaemia: increased resistance of vascular walls, coronary vasospasm, reduced endothelial function, elevated heart rate and/or blood pressure, anomalies in the electrical repolarization phase, ventricular kinetics and myocardial perfusion. Moreover, mental stress-induced activation of the stress-response system increases catecholamine release, leading to cardiac electrical instability . Subjects with an exaggerated cardiovascular response during mental stress were also more likely to present pathologic findings in a classic exercise/pharmacologic stress test .
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Risk Factors Of Cad Development By Logistic Regression
Table 2 shows the results of LR analysis between the subject’s factors and CAD risk. For clinical factors, male , older age , BMI , smoking , drink , hypertension , and diabetes mellitus are identified as CAD risk factors. For blood lipids, LDLC-3 , LDLC-4 , and LDLC-5 are identified as risk factors for CAD development.
Table 2. Logistic regression analysis for independent association between subjects’ variables and the risk of CAD.
Study Design Patient Population And Ethical Approval
Plasma samples of 132 statin users at intermediate/high risk of obstructive CAD according to ESC guidelines on chronic coronary syndrome participating to the clinical study of H2020-SMARTool project, were collected together with clinical, demographic characteristics and clinical biochemistry. All patients referred to Radiology Departments for CCTA. No substantial differences in statin type were present, but there was a predominant use of Atorvastatin . Statins were administered 6.3 ± 1.4 years before their enrollment with a medium-high dosage 10 mg/die, Rosuvastatin \ 5 mg/die, Simvastatin \ 20 mg/die) for the 84% of the population.
The study was conducted according to the Declaration of Helsinki and its later amendments. The Ethical Commitee of Area Vasta Nord Ovest approved the Multicentric European Study under Coordination of Fondazione Toscana Gabriele Monasterio Hospital in Pisa . Written informed consent was obtained from all individual participants included in the study.
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Psychosocial Factors As Independent Risk Factors For Cardiac Diseases
Chronic stressors such as negative psychosocial factors represent modifiable risk factors that could be linked to adverse cardiac prognosis and the mortality rate worldwide. The international INTERHEART case control study proved that psychosocial factors were significantly related to acute myocardial infarction, with an odds ratio of 2.67 .
Social inequalities and behavioral factors as determinants of CV morbidity and mortality were also investigated by M. Marmot and colleagues in a cohort of British civil servants who worked in the late 1960s and in 198588 . The results from these long-term prospective studies, initially considered platforms for studying age-related diseases, for the first time linked lower socioeconomic status and lower employment grade with a higher incidence of metabolic syndrome stigmata and a higher coronary mortality rate among male employers. Other combined variables associated with increased risk of CVD mortality were high-strain work and low social support. In the same cohort, the presence of financial difficulties in lower employment grades was a risk factor for weight gain and metabolic alterations, in particular in female workers. Findings derived from these large cohort studies clearly show the direct correlation between social conditions and metabolic disturbances, coronary disease onset and the mortality rate .
What Should I Expect If I Have Coronary Artery Disease Can It Be Cured
Technically coronary artery disease cant be cured. If youve been diagnosed with coronary artery disease, follow your healthcare providers treatment plan to help prevent your condition from getting worse. Your treatment plan may include procedures and surgery to increase the blood supply to your heart, lifestyle changes to target your risk factors and medications.
If your coronary artery disease has led to a heart attack, your healthcare provider can recommend a cardiac rehabilitation program to reduce your risk of future heart problems, regain strength and improve the quality of your life.
It is important to keep all follow-up appointments and have all tests ordered by your healthcare provider. These are needed to keep track of your condition, monitor how well your treatment plan is working and make adjustments if needed.
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Coping With Life’s Pressures
Heart disease has many other mind-body connections that you should consider. Prolonged stress due to the pressures at home, on the job, or from other sources can contribute to abnormally high blood pressure and circulation problems. As with many other diseases, the effects vary from person to person. Some people use stress as a motivator while others may “snap” at the slightest issue.
How you handle stress also influences how your cardiovascular system responds. Studies have shown that if stress makes you angry or irritable, you’re more likely to have heart disease or a heart attack. In fact, the way you respond to stress may be a greater risk factor for heart problems than smoking, high blood pressure, and high cholesterol.
Being Overweight And Cardiovascular Disease Risk
Being overweight or obese increases your risk of a number of health problems, including:
Carrying extra weight around your middle is more of a health risk, so it is especially important for you to lose weight if this is the case.
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Coronary Artery Bypass Grafting
Coronary artery bypass grafting is also called bypass surgery or coronary artery bypass surgery. In the procedure, doctors take an artery or vein from another part of the body to connect the aorta to a coronary artery past the point of its blockage. Blood flow is thus rerouted, skipping over the narrowed or blocked area. Veins are usually taken from the leg. Arteries are usually taken from beneath the breastbone or from the forearm. Artery grafts rarely develop coronary artery disease, and more than 97% of them still work properly 10 years after the bypass surgery. However, vein grafts may gradually become narrowed by atheroma. After 1 year about 15% are completely blocked, and after 5 years, one third or more may be completely blocked.
The operation takes 2 to 4 hours, depending on the number of blood vessels to be grafted. A numeric modifier before bypass refers to the number of arteries that are bypassed. The person is given a general anesthetic. Then, an incision is made down the center of the chest from the neck to the top of the stomach, and the breastbone is parted. This type of surgery is called open-heart surgery. Sometimes special equipment that permits the use of smaller incisions that do not split the breastbone is used.
Some people develop changes in thinking or behavior after a CABG procedure. The changes may be mild or very severe and some may last for weeks to years. Older people are at greater risk. Risk may decrease if a heart-lung machine is not used.
Search Strategy And Selection Criteria
We searched 16 electronic databases for published and grey literature published up until May 2015: MEDLINE, EMBASE, CINAHL Plus, PsycINFO, ASSIA, Web of Science, Cochrane Library, Social Policy and Practice, National Database of Ageing Research, Open Grey, HMIC, ETHOS, NDLTD, NHS Evidence, SCIE and National Institute for Health and Care Excellence . Thesaurus and free text terms were combined with filters for observational study designs and tailored to each database. The search strategy included no health terms, as it aimed to capture all disease outcomes, rather than focus on CHD and stroke. For the full electronic strategy used to search MEDLINE, see online 1.
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The Heart As An Immune Organ
According to the most recent research, the heart can respond to acute tissue injury through complex inflammatory and reparative cascades, acting as an immune organ .
Several types of immune cells, such as macrophages, dendritic cells, mast cells and a small number of B and T lymphocytes, reside in the heart. Irrespective of the origin of cell injury, acute tissue damage promotes an inflammatory response, mainly characterized by the involvement of innate immune cells, followed by a reparative/remodeling phase, with a prevalence of adaptive immune cells and angiogenic/fibrotic events .
New Vision Of Coronary Heart Disease: Beyond The Concept Of Cholesterol
Although Rudolf Virchow had already recognized the inflammatory nature of atherosclerotic plaques in the nineteenth century , coronary artery disease was traditionally considered a cholesterol storage disorder characterized by the progressive accumulation of cholesterol and thrombotic debris in the artery wall. A considerable number of published clinical and epidemiologic studies linked high cholesterol levels to increased risk of cardiovascular events. In particular, a metanalysis of clinical trials investigating the effects of inhibitors of cholesterol synthesis established a reduced risk of coronary heart disease with reductions in the LDL cholesterol concentration .
In a large clinical trial it was observed that serum high-sensitivity C-reactive protein , the principle marker of underlying systemic inflammation, was a significant predictor of cardiovascular risk, even in a subgroup of women with low LDL cholesterol .
Epidemiological studies and prospective clinical trials have also shown an increased risk of cardiovascular events in patients with high levels of CRP irrespective of cardiovascular risk assessment and lipid profiles, highlighting a key role for inflammation in atherosclerotic disease.
Specifically, assessment of CRP may be helpful in those patients at intermediate risk over 10 years) to guide further clinical evaluations and start a therapeutic programme.
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