Coronary Heart Disease


Coronary heart disease (CHD), also called coronary artery disease (CAD), ischaemic heart disease, or atherosclerotic heart disease, is caused by blocks in the arteries of the heart. It is considered to be the major risk factor for humanity. More people are dying of coronary heart disease in the world than of cancer, accidents and homicides, all put together.

Various heart problems that include angina or chest pain, heart attack, and heart failure are referred to as coronary heart disease. Other heart conditions such as heart valve problems, congenital heart problems etc, are usually not included when we talk about ‘coronary artery disease’. 

Coronary arteries carry oxygen and nutrients to the myocardium or the heart muscle, and could develop blocks as a result of atheromatous plaques within the walls of the arteries. Atheroma is composed of inflamed tissues and fatty deposits and they develop slowly over a period of time on the inner surface of the artery.

When one or more of the coronary arteries get blocked, some part of the myocardium does not get its supply of oxygen and nutrients, causing a heart attack. If the damage is relatively limited, the heart can recover, but major damage can lead to death. 
Similar degeneration of arteries in the brain leads to loss of blood supply and stroke or death.

Most people with coronary heart disease do not show any signs of the disease in the first few years or even decades. Very often, in advanced stage of the disease, a ‘sudden’ heart attack is the first symptom. After years of building up, some of the plaques may rupture, and along with the activation of the blood clotting system, limit the blood flow into the heart muscle. The disease is the most common cause of ‘sudden death’, and is the world’s leading killer. 

The other common symptom of coronary artery disease, which can pre-empt a heart attack, is angina or chest pain. It’s not actually a pain, but a discomfort in the center of the chest, or some kind of constriction in the chest that causes distress. This usually occurs when people are physically exerting themselves, like climbing stairs or doing some physical exercise. Sometimes normal day-to-day activities can also lead to this discomfort or pain. 

People experiencing angina are the most vulnerable to heart attack and most certainly must undergo a thorough check-up and take appropriate treatment.

Risk Factors
The natural risk factors for coronary heart disease are:

  • Aging: Over 83 percent of people who die of coronary heart disease are 65 years or older.
  •  Male gender: Men have a greater risk of heart attack than women, and they are likely to have heart attacks earlier in life.
  • Heredity: Children of parents with heart disease are more likely to develop it themselves.

 Since it is not possible to control or alter the natural risk factors, it becomes even more important to treat and control any other risk factors we may have. 
Risk factors you can control by modifying your lifestyle or by taking medicine:

  • Consumption of tobacco: Smokers' risk of developing coronary heart disease is 2–4 times than that of non-smokers. Studies have established that nicotine raises blood pressure, damages blood vessels and multiplies the effect of cholesterol, and worsens the fatty build-up that leads to heart attacks.
  • Abnormal blood cholesterol: Abnormal blood cholesterol raises the risk of coronary heart disease.
  • High blood pressure: High blood pressure increases the heart's workload and increasing the risk of stroke, heart attack, kidney failure and congestive heart failure.
  • Physical inactivity: Studies have established that even moderate physical activity helps prevent heart and blood vessel disease.
  • Obesity: People who have excess body fat — especially those with a higher waist-hip ratio — are more likely to develop heart disease and stroke even if they have no other risk factors. Excess weight increases the heart's work. It also raises blood pressure and blood cholesterol and triglyceride levels, and lowers HDL (good) cholesterol levels. It can also make diabetes more likely to develop.
  • Diabetes mellitus: Diabetes increases the risk of developing cardiovascular disease. If a person has diabetes, it's extremely important to work with a doctor to manage and control it.

Nearly 95 percent of people who develop cardiovascular disease have at least one of these major risk factors. But the disease can also develop in the absence of any of the traditional risk factors, and several other risk factors may contribute to cardiovascular disease. 

Among the leading new potential culprits are C-reactive protein (CRP), Homocysteine, Fibrinogen, and Lipoprotein (a). Information on how these could contribute to cardiovascular disease is still emerging and routine screening tests may not include markers to these factors.

If a person is at a high risk of developing CAD, the doctor may put the person on drug treatment to reduce blood pressure or cholesterol. A low dose of aspirin is also advised for some people who are at high risk.

It is important to understand that after a person is diagnosed for coronary artery blocks through an angiogram, medicine cannot help clear the blocks. All that medicine can do is to improve the efficiency of the heart, even with the presence of the blocks. 

The presence of blocks prevents sufficient oxygen from coming into the heart muscles and there are good medicines available to ensure that the heart functions efficiently in spite of the reduced amount of oxygen coming into the heart muscles. But the blocks, as such, cannot be opened up by the medicines. Angioplasty or bypass surgery is required to open the blocks. 

One’s lifestyle plays an important role in avoiding potential risk of heart disease. Lifestyle factors that reduce the risk of developing atheromatous plaques in coronary arteries include:

  • Choosing a healthy diet: A healthy diet that consists of fruits and vegetables helps to protect against heart disease. Fruits and vegetables contain antioxidants in natural combinations with micronutrients and fibre, which go a long way in maintaining a healthy heart.
  • Not smoking: Studies have established that nicotine raises blood pressure, damages blood vessels and multiplies the effect of cholesterol, and worsens the fatty build-up that leads to heart attacks.
  • Keeping your weight and waist size down: Maintaining a healthy weight and waist-hip ratio helps reduce risk of heart disease.
  • Avoiding alcohol: Drinking too much alcohol can raise the levels of some fats in the blood (triglycerides). It can also lead to high blood pressure and an increased calorie intake.
  • Physical exercise: Even moderate exercise such as walking for 30 minutes every day can help reduce risk of heart disease.
  • Regular screening: Since the first symptom of heart disease is the onset of a heart attack, it is recommended that you undergo regular health screening to monitor your heart.