Health

Heart Attack
Coronary Artery Disease

Highlights

Build-up of cholesterol rich plaque in the wall of the arteries (hardening or blockages) causes Coronary artery disease (CAD). This can also occur in the arteries outside of the heart. CAD is the most important cause for death in adults. Despite major advances in cardiology in the last 2 decades, apparently healthy adults still die from sudden cardiac death. If the plaque ruptures it causes a heart attack or even sudden death. Angina or pain from the heart occurs if the blockages partially compromise the blood flow to the heart muscle. Depending on the severity of obstruction, it can occur at various levels of physical activity.

Introduction

The risk factors for CAD can be broadly divided into modifiable and non-modifiable. Modifiable factors include high blood sugar or diabetes, high cholesterol, smoking, high blood pressure or hypertension (HTN), metabolic syndrome, physical inactivity, obesity and lack of dietary consumption of fruits and vegetable. Non-modifiable risk factors include age, male sex, family history of premature CAD and race. Modifiable risk factors are known to attribute to about 90% of the total burden of CAD.

Prevention Strategies (Risk factor modification)

Diabetes: Diabetes is by far the strongest risk factor for CAD. Studies have showed that diabetics have the same risk of heart attack and death as patients with established CAD. It is imperative that diabetics take it seriously and be treated aggressively to achieve good glucose control. Hemoglobin A1c, a measure of diabetes control should be targeted to level less than 7. In addition, all diabetic should have their cholesterol controlled to the level desirable for patient with established heart problems.

Hypertension or High BP: One in three adults in the United States has high BP (HTN). Anyone with BP more than or equal to 140/90 is considered to have HTN. However, one-third of them do not know it, as there are usually no symptoms. HTN is the most important risk factor for Stroke. It is also a risk factor for heart attack, heart failure and death. In spite of treatment, in two thirds of individuals BP is not well controlled. Majority will require two or three medications. Compliance is an issue as there are patient have no symptoms from HTN and patients are afraid of perceived or real side effects.

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