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Coronary Heart Disease is narrowing or even blockage of the arteries of the Heart.

It is often caused by a build-up of plaque in arteries called Arthersclerosis.

It is often referred to as Coronary Artery Disease [CAD] and/or Arteriosclerotic Heart Disease

It is the #1 cause of death worldwide and this  is especially true in the United States.

Every 1 minute there is another death in the US as a result of CHD

This means that there are 700,000 deaths every year.

For women, 10 times more deaths are attributed to CHD than to Breast Cancer.

Plaque fills the inner pipes of arteries that supply oxygen to the Heart.

Smoking is the #1 preventable risk factor

Coronary arteries supply the muscle of the heart with oxygen.

Plaque can fill or line the arteries of the heart

Rupture or tearing of the arteries can occur causing serious consequences.

Risk factors

• Family history
• Blood lipid abnormality
• Obesity
• Inactivity
• Diabetes Mellitus
• Smoking
• Hypertension
• Cigarette smoking
• Metabolic Syndrome

Cholesterol

• Increased LDL – bad cholesterol – is an important risk factor that can be modified.
• HDL –  good cholesterol – is important to have and can be a buffer.
• LDL = Low-density lipoprotein
• HDL = High-density lipoprotein

 

Metabolic Syndrome

3 or more of the following

• Abdominal obesity
• Hypertension
• Triglycerides greater than 150
• HDL lower than 40 – Men
• HDL lower than 50 – Women
• Fasting glucose more than 110
  – Numbers are identified as mg/dL

Artersclerosis

• Lipid accumulation in the arteries
• Starts with a Fatty Streak
• LDL is the major player
• HDL protects by reversing transport of cholesterol
• The streaks cause an increase in thickness of the arteries
• Calcification may occur narrowing the lumen of the artery
• Blood flow than is affected
• If oxygen is compromised – noted as Ischemic heart disease [link]
• Myocardial Infarction [Heart attack] is often a complication

Diagnosis:

Cardiac Stress testing is often done with those who begin to have cardiac symptoms or have a large amount of risk factors.

Coronary angiography can also help determine severity of blockage or narrowing

EKG is helpful

Echocardiography, Ultrasound, and MRI can be useful

Symptoms

• No symptoms initially
• Chest pain
• Chest discomfort
• Angina
• Shortness of breath
• Edema
• Perfuse sweating
• Weakness
• Fatigue

Treatment

1.)  Smoking cessation

2.) Exercise

3.)  Lipid lowering medications

• HMG-CoA reductase inhibitors [Statins]

1.  Atorvastatin (Lipitor)
2.  Fluvastatin (Lescol)
3.  Lovastatin (Mevacor)
4.  Pravastatin (Pravachol)
5.  Rosuvastatin (Crestor)
6.  Simvastatin (Zocor)
7.  Simvastatin + Ezetimibe (Vytorin)
8.  Lovastatin + Niacin ER (Advicor)
9.  Atorvastatin + Amlodipine (Caduet)

Organic Compounds and Vitamin

1. Niacin
2.  Omega-3 fatty acid
3.  Fish oils

Fibrates

1.  Gemfibrozil (Lopid)  * most commonly used
2.  Benzafibrate (Bezalip)
3. Ciprofibrate (Modalism)
4.  Fenofibrate (TriCor)

Bile Acid Sequestrants

1.  Colestyramine (Questran)
2.  Colestipol (Colestid)
3. Colextran
4.  Colesevelam  (WelcholTM in the USA, Cholestagel in Europe)

4.) Antiplatelet Therapy

• Aspirin
• Clopidogrel (Plavix)
• Ticlopidine (Ticlid)
• Coumadin (Warfirin)

5.)  Beta Blockers

• Bisoprolol
• Carvedilol (Coreg)
• Metoprolol – a Sustained release (Lopressor, Toprol-XL)

6.)  ACE Inhibitors

7.)  Diuretics