Coronary artery disease
Coronary artery disease (CAD), also known as coronary heart disease (CHD) or ischemic heart disease (IHD),[13] involves the reduction of blood flow to the heart muscle due to build-up of plaque in the arteries of the heart.[5][14][6] It is the most common of the cardiovascular diseases.[ Types include stable angina, unstable angina, myocardial infarction, and sudden cardiac death.[16] A common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw.[4] Occasionally it may feel like heartburn. Usually symptoms occur with exercise or emotional stress, last less than a few minutes, and improve with rest.[4] Shortness of breath may also occur and sometimes no symptoms are present.[4] In many cases, the first sign is a heart attack.[5] Other complications include heart failure or an abnormal heartbeat.[5]
Risk factors include high blood pressure, smoking, diabetes, lack of exercise, obesity, high blood cholesterol, poor diet, depression, and excessive alcohol.[6][7][17] A number of tests may help with diagnoses including: electrocardiogram, cardiac stress testing, coronary computed tomographic angiography, and coronary angiogram, among others.[8]
Ways to reduce CAD risk include eating a healthy diet, regularly exercising, maintaining a healthy weight, and not smoking.[9] Medications for diabetes, high cholesterol, or high blood pressure are sometimes used.[9] There is limited evidence for screening people who are at low risk and do not have symptoms.[18] Treatment involves the same measures as prevention.[10][19] Additional medications such as antiplatelets (including aspirin), beta blockers, or nitroglycerin may be recommended.[10] Procedures such as percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) may be used in severe disease.[10][20] 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.[21]
In 2015, CAD affected 110 million people and resulted in 8.9 million deaths.[11][12] It makes up 15.6% of all deaths, making it the most common cause of death globally.[12] The risk of death from CAD for a given age decreased between 1980 and 2010, especially in developed countries.[22] The number of cases of CAD for a given age also decreased between 1990 and 2010.[23] 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;[24] rates were higher among men than women of a given age
Risk factors include high blood pressure, smoking, diabetes, lack of exercise, obesity, high blood cholesterol, poor diet, depression, and excessive alcohol.[6][7][17] A number of tests may help with diagnoses including: electrocardiogram, cardiac stress testing, coronary computed tomographic angiography, and coronary angiogram, among others.[8]
Ways to reduce CAD risk include eating a healthy diet, regularly exercising, maintaining a healthy weight, and not smoking.[9] Medications for diabetes, high cholesterol, or high blood pressure are sometimes used.[9] There is limited evidence for screening people who are at low risk and do not have symptoms.[18] Treatment involves the same measures as prevention.[10][19] Additional medications such as antiplatelets (including aspirin), beta blockers, or nitroglycerin may be recommended.[10] Procedures such as percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) may be used in severe disease.[10][20] 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.[21]
In 2015, CAD affected 110 million people and resulted in 8.9 million deaths.[11][12] It makes up 15.6% of all deaths, making it the most common cause of death globally.[12] The risk of death from CAD for a given age decreased between 1980 and 2010, especially in developed countries.[22] The number of cases of CAD for a given age also decreased between 1990 and 2010.[23] 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;[24] rates were higher among men than women of a given age
Risk factors
Coronary artery disease has a number of well determined risk factors. These include high blood pressure, smoking, diabetes, lack of exercise, obesity, high blood cholesterol, poor diet, depression, family history, and excessive alcohol.[6][7][17] About half of cases are linked to genetics.[26] Smoking and obesity are associated with about 36% and 20% of cases, respectively.[27] Smoking just one cigarette per day about doubles the risk of CAD.[28] Lack of exercise has been linked to 7–12% of cases.[27][29] Exposure to the herbicide Agent Orange may increase risk.[30] Rheumatologic diseases such as rheumatoid arthritis, systemic lupus erythematosus, psoriasis, and psoriatic arthritis are independent risk factors as well.
Job stress appears to play a minor role accounting for about 3% of cases.[27] In one study, women who were free of stress from work life saw an increase in the diameter of their blood vessels, leading to decreased progression of atherosclerosis.[35] In contrast, women who had high levels of work-related stress experienced a decrease in the diameter of their blood vessels and significantly increased disease progression.[35] Having a type A behavior pattern, a group of personality characteristics including time urgency, competitiveness, hostility, and impatience,[36] is linked to an increased risk of coronary disease.[37]
Blood fats
High blood cholesterol (specifically, serum LDL concentrations). HDL (high density lipoprotein) has a protective effect over development of coronary artery disease.[38]
High blood triglycerides may play a role.[39]
High levels of lipoprotein(a),[40][41][42] a compound formed when LDL cholesterol combines with a protein known as apolipoprotein(a).
Dietary cholesterol does not appear to have a significant effect on blood cholesterol and thus recommendations about its consumption may not be needed.[43] Saturated fat is still a concern.[43]
Genetics
The heritability of coronary artery disease has been estimated between 40% and 60%.[44] Genome-wide association studies have identified over 160 genetic susceptibility loci for coronary artery disease.[45]
Other
Endometriosis in women under the age of 40.
Coronary artery disease has a number of well determined risk factors. These include high blood pressure, smoking, diabetes, lack of exercise, obesity, high blood cholesterol, poor diet, depression, family history, and excessive alcohol.[6][7][17] About half of cases are linked to genetics.[26] Smoking and obesity are associated with about 36% and 20% of cases, respectively.[27] Smoking just one cigarette per day about doubles the risk of CAD.[28] Lack of exercise has been linked to 7–12% of cases.[27][29] Exposure to the herbicide Agent Orange may increase risk.[30] Rheumatologic diseases such as rheumatoid arthritis, systemic lupus erythematosus, psoriasis, and psoriatic arthritis are independent risk factors as well.
Job stress appears to play a minor role accounting for about 3% of cases.[27] In one study, women who were free of stress from work life saw an increase in the diameter of their blood vessels, leading to decreased progression of atherosclerosis.[35] In contrast, women who had high levels of work-related stress experienced a decrease in the diameter of their blood vessels and significantly increased disease progression.[35] Having a type A behavior pattern, a group of personality characteristics including time urgency, competitiveness, hostility, and impatience,[36] is linked to an increased risk of coronary disease.[37]
Blood fats
High blood cholesterol (specifically, serum LDL concentrations). HDL (high density lipoprotein) has a protective effect over development of coronary artery disease.[38]
High blood triglycerides may play a role.[39]
High levels of lipoprotein(a),[40][41][42] a compound formed when LDL cholesterol combines with a protein known as apolipoprotein(a).
Dietary cholesterol does not appear to have a significant effect on blood cholesterol and thus recommendations about its consumption may not be needed.[43] Saturated fat is still a concern.[43]
Genetics
The heritability of coronary artery disease has been estimated between 40% and 60%.[44] Genome-wide association studies have identified over 160 genetic susceptibility loci for coronary artery disease.[45]
Other
Endometriosis in women under the age of 40.
Depression and hostility appear to be risks.
The number of categories of adverse childhood experiences (psychological, physical, or sexual abuse; violence against mother; or living with household members who were substance abusers, mentally ill, suicidal, or incarcerated) showed a graded correlation with the presence of adult diseases including coronary artery (ischemic heart) disease.[48]
Hemostatic factors: High levels of fibrinogen and coagulation factor VII are associated with an increased risk of CAD.[49]
Low hemoglobin.[50]
In the Asian population, the b fibrinogen gene G-455A polymorphism was associated with the risk of CA
Hemostatic factors: High levels of fibrinogen and coagulation factor VII are associated with an increased risk of CAD.[49]
Low hemoglobin.[50]
In the Asian population, the b fibrinogen gene G-455A polymorphism was associated with the risk of CA
0 Comments