Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), myocardial ischemia, or simply heart disease, involves the reduction of blood flow to the heart muscle due to build-up of atherosclerotic plaque in the arteries of the heart. It is the most common of the cardiovascular diseases. Types include stable angina, unstable angina, myocardial infarction, and sudden cardiac death. A common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw. Occasionally it may feel like heartburn. Usually symptoms occur with exercise or emotional stress, last less than a few minutes, and improve with rest. Shortness of breath may also occur and sometimes no symptoms are present. In many cases, the first sign is a heart attack. Other complications include heart failure or an abnormal heartbeat.
Risk factors include high blood pressure, smoking, diabetes, lack of exercise, obesity, high blood cholesterol, poor diet, depression, and excessive alcohol consumption. A number of tests may help with diagnoses including: electrocardiogram, cardiac stress testing, coronary computed tomographic angiography, and coronary angiogram, among others.
Ways to reduce CAD risk include eating a healthy diet, regularly exercising, maintaining a healthy weight, and not smoking. Medications for diabetes, high cholesterol, or high blood pressure are sometimes used. There is limited evidence for screening people who are at low risk and do not have symptoms. Treatment involves the same measures as prevention. Additional medications such as antiplatelets (including aspirin), beta blockers, or nitroglycerin may be recommended. Procedures such as percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) may be used in severe disease. In those with stable CAD it is unclear if PCI or CABG in addition to the other treatments improves life expectancy or decreases heart attack risk.
In 2015, CAD affected 110 million people and resulted in 8.9 million deaths. It makes up 15.6% of all deaths, making it the most common cause of death globally. The risk of death from CAD for a given age decreased between 1980 and 2010, especially in developed countries. The number of cases of CAD for a given age also decreased between 1990 and 2010. In the United States in 2010, about 20% of those over 65 had CAD, while it was present in 7% of those 45 to 64, and 1.3% of those 18 to 45; rates were higher among men than women of a given age.
The rise of coronary heart disease has been traced to the 1940's in western Europe and the 1920's in the US, reaching its peak in the 1970's in western Europe and the 1960's in the US. It has been associated by medical doctors with frequent consumption of meat, refined foods, and artificial ingredients; also with certain inflammatory diseases caused by infections, which may in turn cause inflammation of the arteries and plaque build up.
Coronary heart disease (CHD) kills about two million people every year in the West, more people than any other disease or illness. Death rates in most industrialized countries are stationary or rising. According to a 1991 UK report, an estimated 480 Britons die every day from coronary heart disease, the leading cause of death in the country. About 15 times as many people have coronary heart disease as are killed by it; in the USA 13 million people had it in 1996, of whom 500,000 died of a heart attack. < In developing countries such as Malaysia, Singapore and Sri Lanka, the incidence has reached very high levels. In some developing countries, CHD has already emerged as a prominent public health problem afflicting especially men in the prime of life when their productivity and social and family responsibilities are greatest. In others, CHD poses a serious potential threat to health, and the probability is that, unless this threat can be averted or contained, it will soon reach proportions approaching those of the industrial countries.
63% of coronary heart disease has an inherited component. The gene ApoE 4 increases the absorption of cholesterol from food. This is obviously an advantage in times of famine and with some of the more irregular diets of human ancestors. The level of homocysteine (a protein that affects blood clotting) is also genetically determined, and can be countered with folic acid to reduce the clotting risk.
1. A low-fat mainly vegetarian diet could prevent 1.25 million heart attacks per year in the USA.
2. All alcoholic drinks taken in moderation reduce the chance of a heart attack.
3. Taking vitamin E reduces the risk of a heart attack by 75%.
4. The odds of surviving bypass surgery have improved since the operation was introduced, but the risk of experiencing a decline in mental function afterwards has remained steady since the 1980s. Signs of this decline may include trouble following directions, mood swings and short tempers.