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Coronary artery disease

Coronary artery disease
Other namesArteriosclerotic heart disease, atherosclerotic heart disease,[1] atherosclerotic vascular disease,[2] coronary heart disease[3]
Illustration depicting atherosclerosis in a coronary artery
SpecialtyCardiology, cardiac surgery
SymptomsChest pain, shortness of breath[4]
ComplicationsHeart failure, abnormal heart rhythms, heart attack, cardiogenic shock, cardiac arrest[5]
CausesAtherosclerosis of the arteries of the heart[6]
Risk factorsHigh blood pressure, smoking, diabetes, lack of exercise, obesity, high blood cholesterol[6][7]
Diagnostic methodElectrocardiogram, cardiac stress test, coronary computed tomographic angiography, coronary angiogram[8]
PreventionHealthy diet, regular exercise, maintaining a healthy weight, not smoking[9]
TreatmentPercutaneous coronary intervention (PCI), coronary artery bypass surgery (CABG)[10]
MedicationAspirin, beta blockers, nitroglycerin, statins[10]
Frequency110 million (2015)[11]
Deaths8.9 million (2015)[12]

Coronary artery disease (CAD), also called coronary heart disease (CHD), or ischemic heart disease (IHD),[13] is a type of heart disease involving the reduction of blood flow to the cardiac muscle due to a build-up of atheromatous plaque in the arteries of the heart.[5][6][14] It is the most common of the cardiovascular diseases.[15] CAD can cause stable angina, unstable angina, myocardial ischemia,[16] and myocardial infarction.[17]

A common symptom is angina, which is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw.[4] Occasionally it may feel like heartburn. In stable angina, 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 consumption.[6][7][18] A number of tests may help with diagnosis including: electrocardiogram, cardiac stress testing, coronary computed tomographic angiography, biomarkers (high-sensitivity cardiac troponins) and coronary angiogram, among others.[8][19] Ways to reduce CAD risk include eating a healthy diet, regularly exercising, maintaining a healthy weight, and not smoking.[20][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.[21] Treatment involves the same measures as prevention.[10][22] 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][23] 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.[24]

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.[25] The number of cases of CAD for a given age also decreased between 1990 and 2010.[26] 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;[27] rates were higher among males than females of a given age.[27]

Clogged artery
  1. ^ "Coronary heart disease – causes, symptoms, prevention". Southern Cross Healthcare Group. Archived from the original on 3 March 2014. Retrieved 15 September 2013.
  2. ^ Faxon DP, Creager MA, Smith SC, Pasternak RC, Olin JW, Bettmann MA, et al. (June 2004). "Atherosclerotic Vascular Disease Conference: Executive summary: Atherosclerotic Vascular Disease Conference proceeding for healthcare professionals from a special writing group of the American Heart Association". Circulation. 109 (21): 2595–604. doi:10.1161/01.CIR.0000128517.52533.DB. PMID 15173041.
  3. ^ MedlinePlus Encyclopedia: Coronary heart disease
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  7. ^ a b Mehta PK, Wei J, Wenger NK (February 2015). "Ischemic heart disease in women: a focus on risk factors". Trends in Cardiovascular Medicine. 25 (2): 140–51. doi:10.1016/j.tcm.2014.10.005. PMC 4336825. PMID 25453985.
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  10. ^ a b c d e "How Is Coronary Heart Disease Treated?". 29 September 2014. Archived from the original on 24 February 2015. Retrieved 25 February 2015.
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  12. ^ a b c Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, et al. (GBD 2015 Mortality and Causes of Death Collaborators) (October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/S0140-6736(16)31012-1. PMC 5388903. PMID 27733281.
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  16. ^ "Myocardial ischemia – Symptoms and causes". Mayo Clinic. Retrieved 5 February 2022.
  17. ^ Wong ND (May 2014). "Epidemiological studies of CHD and the evolution of preventive cardiology". Nature Reviews. Cardiology. 11 (5): 276–89. doi:10.1038/nrcardio.2014.26. PMID 24663092. S2CID 9327889.
  18. ^ Charlson FJ, Moran AE, Freedman G, Norman RE, Stapelberg NJ, Baxter AJ, et al. (November 2013). "The contribution of major depression to the global burden of ischemic heart disease: a comparative risk assessment". BMC Medicine. 11: 250. doi:10.1186/1741-7015-11-250. PMC 4222499. PMID 24274053.
  19. ^ Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, et al. (October 2023). "2023 ESC Guidelines for the management of acute coronary syndromes". Eur Heart J. 44 (38): 3720–3826. doi:10.1093/eurheartj/ehad191. PMID 37622654.
  20. ^ Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, Braun LT, de Ferranti S, Faiella-Tommasino J, Forman DE, Goldberg R, Heidenreich PA, Hlatky MA, Jones DW, Lloyd-Jones D (25 June 2019). "2018 Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines". Journal of the American College of Cardiology. 73 (24): e285–e350. doi:10.1016/j.jacc.2018.11.003. hdl:20.500.12749/1738. ISSN 0735-1097. PMID 30423393. S2CID 53303792.
  21. ^ Desai CS, Blumenthal RS, Greenland P (April 2014). "Screening low-risk individuals for coronary artery disease". Current Atherosclerosis Reports. 16 (4): 402. doi:10.1007/s11883-014-0402-8. PMID 24522859. S2CID 39392260.
  22. ^ Boden WE, Franklin B, Berra K, Haskell WL, Calfas KJ, Zimmerman FH, Wenger NK (October 2014). "Exercise as a therapeutic intervention in patients with stable ischemic heart disease: an underfilled prescription". The American Journal of Medicine. 127 (10): 905–11. doi:10.1016/j.amjmed.2014.05.007. PMID 24844736.
  23. ^ Deb S, Wijeysundera HC, Ko DT, Tsubota H, Hill S, Fremes SE (November 2013). "Coronary artery bypass graft surgery vs percutaneous interventions in coronary revascularization: a systematic review". JAMA. 310 (19): 2086–95. doi:10.1001/jama.2013.281718. PMID 24240936.
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  25. ^ Moran AE, Forouzanfar MH, Roth GA, Mensah GA, Ezzati M, Murray CJ, Naghavi M (April 2014). "Temporal trends in ischemic heart disease mortality in 21 world regions, 1980 to 2010: the Global Burden of Disease 2010 study". Circulation. 129 (14): 1483–1492. doi:10.1161/circulationaha.113.004042. PMC 4181359. PMID 24573352.
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  27. ^ a b Centers for Disease Control and Prevention (CDC) (October 2011). "Prevalence of coronary heart disease—United States, 2006–2010". MMWR. Morbidity and Mortality Weekly Report. 60 (40): 1377–1381. PMID 21993341.

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