Coronary artery disease (CAD)

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Coronary artery disease
atherosclerotic heart disease,[1] atherosclerotic cardiovascular disease,[2] coronary heart disease[3]
Blausen 0257 CoronaryArtery Plaque.png
Illustration depicting atherosclerosis in a coronary artery.
Classification and external resources
Specialty Cardiology, cardiac surgery
ICD-10 I20-I25
ICD-9-CM 410-414, 429.2
MedlinePlus 007115
eMedicine radio/192
Patient UK Coronary artery disease
MeSH D003324

Coronary artery disease (CAD), also known as ischemic heart disease (IHD),[4] is a group of diseases that includes: stable angina, unstable angina, myocardial infarction, and sudden cardiac death.[5] It is within the group of cardiovascular diseases of which it is the most common type.[6] A common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw.[7] Occasionally it may feel like heartburn. Usually symptoms occur with exercise or emotional stress, last less than a few minutes, and get better with rest.[7] Shortness of breath may also occur and sometimes no symptoms are present.[7] The first sign is occasionally a heart attack.[8] Other complications include heart failure or an irregular heartbeat.[8]

Risk factors include: high blood pressure, smoking, diabetes, lack of exercise, obesity, high blood cholesterol, poor diet, and excessive alcohol, among others.[9][10] Other risks include depression.[11] The underlying mechanism involves atherosclerosis of the arteries of the heart.[10] A number of tests may help with diagnoses including: electrocardiogram, cardiac stress testing, coronary computed tomographic angiography, and coronary angiogram, among others.[12]

Prevention is by eating a healthy diet, regular exercise, maintaining a healthy weight and not smoking.[13] Sometimes medication for diabetes, high cholesterol, or high blood pressure are also used.[13] There is limited evidence for screening people who are at low risk and do not have symptoms.[14] Treatment involves the same measures as prevention.[15][16] Additional medications such as antiplatelets including aspirin, beta blockers, or nitroglycerin may be recommended.[16] Procedures such as percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) may be used in severe disease.[16][17] In those with stable CAD it is unclear if PCI or CABG in addition to the other treatments improve life expectancy or decreases heart attack risk.[18]

In 2013 CAD was the most common cause of death globally, resulting in 8.14 million deaths (16.8%) up from 5.74 million deaths (12%) in 1990.[6] The risk of death from CAD for a given age has decreased between 1980 and 2010 especially in developed countries.[19] The number of cases of CAD for a given age has also decreased between 1990 and 2010.[20] 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.[21] Rates are higher among men than women of a given age.[21]

 

Coronary Artery Disease - Coronary Heart Disease

Coronary Artery Disease - Coronary Heart Disease

Updated:May 20,2016
Cholesterol and CAD illustration
 View an animation of cholesterol and CAD

Coronary heart disease is a common term for the buildup of plaque in the heart’s arteries that could lead to heart attack. But what about coronary artery disease? Is there a difference? 

The short answer is often no — health professionals frequently use the terms interchangeably.

However, coronary heart disease , or CHD, is actually a result of coronary artery disease, or CAD, said Edward A. Fisher, M.D., Ph.D., M.P.H., an American Heart Association volunteer who is the Leon H. Charney Professor of Cardiovascular Medicine and also of the Marc and Ruti Bell Vascular Biology and Disease Program at the NYU School of Medicine.

With coronary artery disease, plaque first grows within the walls of the coronary arteries until the blood flow to the heart’s muscle is limited. View an illustration of coronary arteries. This is also called ischemia. It may be chronic, narrowing of the coronary artery over time and limiting of the blood supply to part of the muscle. Or it can be acute, resulting from a sudden rupture of a plaque and formation of a thrombus or blood clot.

The traditional risk factors for coronary artery disease are high LDL cholesterol, low HDL cholesterol, high blood pressure, family history, diabetes, smoking, being post-menopausal for women and being older than 45 for men, according to Fisher. Obesity may also be a risk factor.

“Coronary artery disease begins in childhood, so that by the teenage years, there is evidence that plaques that will stay with us for life are formed in most people,” said Fisher, who is former editor of the American Heart Association journal, ATVB. “Preventive measures instituted early are thought to have greater lifetime benefits. Healthy lifestyles will delay the progression of CAD, and there is hope that CAD can be regressed before it causes CHD.”

Living a healthy lifestyle that incorporates good nutrition, weight management and getting plenty of physical activity can play a big role in avoiding CAD.

 “Coronary artery disease is preventable,” agreed Johnny Lee, M.D., president of New York Heart Associates, and an American Heart Association volunteer. “Typical warning signs are chest pain, shortness of breath, palpitations and even fatigue.”

If you feel any of these symptoms, don’t delay — call 9-1-1.
 

Risk Factors and Coronary Heart Disease

The risk factors on this list are ones you're born with and cannot be changed. The more of these risk factors you have, the greater your chance of developing coronary heart disease. Since you can't do anything about these risk factors, it's even more important for you to manage the risk factors that can be changed.

Increasing Age
The majority of people who die of coronary heart disease are 65 or older. At older ages, women who have heart attacks are more likely than men are to die from them within a few weeks.

Male Sex (Gender)
Men have a greater risk of heart attack than women do, and they have attacks earlier in life. Even after menopause, when women's death rate from heart disease increases, it's not as great as men's.

Heredity (Including Race)
Children of parents with heart disease are more likely to develop it themselves. African Americans have more severe high blood pressure than Caucasians and a higher risk of heart disease. Heart disease risk is also higher among Mexican Americans, American Indians, native Hawaiians and some Asian Americans. This is partly due to higher rates of obesity and diabetes. Most people with a strong family history of heart disease have one or more other risk factors. Just as you can't control your age, sex and race, you can't control your family history. Therefore, it's even more important to treat and control any other risk factors you have.

 



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This content was last reviewed July 2015.