Coronary artery disease (CAD) occurs when the arteries that carry blood to the heart muscle become narrowed or clogged. This blockage is usually due to plaque buildup in the vessel walls.
- This condition is also called coronary heart disease (CHD), arteriosclerosis, atherosclerosis or “hardening of the arteries.”
- When any area of the heart muscle does not receive an adequate blood supply it can lead to pain, a heart attack, an abnormal heart rhythm or even death.
Certain medical conditions can lead to plaque buildup in coronary arteries. These conditions include high blood pressure, high cholesterol and diabetes.
- High blood pressure is a disorder in which the pressure of blood against the walls of your arteries is too high.
- New guidelines from the Eight Joint National Committee (JNC 8) state that for those under 60 years of age, your blood pressure is considered high if it is above 140/90 most of the time.
- The JNC 8 guidelines also state that if you are 60 years or older, and do not have diabetes and/or chronic kidney disease, then a blood pressure up to 150/90 is considered acceptable.
- Diabetes is a disorder in which your body does not make enough insulin or cannot use the insulin it does make effectively. This means the body cannot process sugar properly. HbA1c is a blood test that measures how well your diabetes is controlled. If you have diabetes, ask your healthcare provider what your target HbA1c should be.
Cholesterol is a fat (lipid) that is found in the blood. Too much LDL cholesterol can lead to the buildup of plaque in the arteries. This buildup can cause severe problems with circulation.
- Elevated LDL cholesterol is considered one of the most important risk factors for coronary artery disease.
- If you already have coronary artery disease and/or diabetes, you should be on a “statin” medication, even if your LDL level is within “normal” limits. This is the recommendation unless there is a good reason not to use these medications, such as drug allergy.
- The standard lab test to check your cholesterol includes LDL, HDL, triglycerides and total cholesterol.
- If you have CAD, your healthcare professional will check for the above conditions as well.
There are many factors that increase your risk of getting coronary artery disease. These factors include:
- Men over 45 and women over 55
- Family history
- High LDL cholesterol
- High blood pressure
- Lack of physical activity
African Americans have the highest risk of death due to coronary artery disease.
To decrease your risk of developing coronary artery disease you can make lifestyle changes that include:
- Quitting smoking
- Exercising regularly
- Eating a healthy diet
- Maintaining a healthy weight
- Limiting your alcohol and salt intake
In addition to life style changes, here are some additional recommendations.
- Keep your blood pressure, LDL cholesterol and blood sugar well controlled.
- If you have diabetes, follow your health provider's directions on diet, exercise and medication.
- See your healthcare provider at recommended intervals based on your health status.
The symptoms associated with coronary artery disease can vary greatly. They may also not reflect the severity of the condition. (This means that mild pain may happen with severe coronary artery disease.) Some of the more common symptoms include:
- Chest heaviness or a squeezing sensation in your chest
- Discomfort in your neck, arms, stomach or upper back
- Increased pain with activity and stress
- Pain that is relieved with nitroglycerin
- Shortness of breath
- Fatigue or unusual tiredness
Remember, women do not always have the same symptoms as men.
Contact your healthcare provider if you have any of the above symptoms. They will perform a physical examination that includes checking your blood pressure and listening to your heart. They may also recommend some tests to evaluate the blood flow to your heart and determine how well your heart is working. The tests can include:
- Lab tests (e.g., cholesterol and HbA1c)
- EKG (electrocardiogram)
- An echocardiogram or other imaging studies
- A stress test
- An x-ray of your coronary arteries called a coronary angiogram
If you have new symptoms or rapidly progressive symptoms, get immediate attention. If you think that you may be having a heart attack, then call 911 immediately.
Make an appointment with your healthcare provider if you have symptoms of CAD or think you may be at risk for CAD.
- Bring a copy of your medical history (past illnesses, surgeries, and hospitalizations).
- Bring a list of your medications (including over-the-counter).
- Write down any questions, symptoms or concerns you want to talk about.
- If your healthcare provider prescribes a medication for you, ask for a generic version. If your doctor thinks that a generic version is not right for you, ask for a medication on the lowest available tier of your Prescription Drug List (PDL).
Here are some questions to ask your healthcare provider:
- What are my risk factors for coronary artery disease? What dietary or lifestyle changes should I make?
- What should my blood pressure be? Should I have home blood pressure monitoring? What should I do if my home blood pressure reading is high?
- Could my symptoms be related to another disease?
- How will I know if I'm having angina or symptoms of a heart attack?
- Are you recommending any tests? Will the test results change my treatment plan? If not, why do I need the test?
- What are my treatment options? What are the goals of my treatment? Are there any alternatives? What are the risks?
- Are medication and lifestyle modifications a treatment option?
- Should I take a daily aspirin? Should I take an aspirin if I have chest pain?
- Can my symptoms be controlled with medications? If so, are their Tier 1 or Tier 2 medications on my Prescription Drug List that I should take?
- Will my heart medications interfere with other medications I'm taking?
- When might I start to see improvement in my symptoms?
- What should I do if my angina medication doesn't help?
- What types of physical activities are best for me?
- Will I need surgery? Are there other less invasive options?
- What are my follow-up plans? What symptoms should I report before my next appointment?
If you are a smoker, ask about smoking cessation programs in your area. Ask about other ways you might be able to stop smoking.
Make sure you understand your treatment plan, any possible alternatives and what medications are recommended (including possible side effects).