What You Need to Know If You Have Coronary Artery Disease
If your doctor has told you that you have coronary artery disease, or if your doctor has told you that you are at increased risk for developing atherosclerosis (commonly called hardening of the arteries), then this Patient Page is for you.
Why does atherosclerosis develop in the first place? This disease is often the result of many factors. The 5 most important risk factors are (1) tobacco smoking, (2) diabetes mellitus, (3) a familial tendency to develop this condition, (4) high blood pressure, and (5) an abnormally high cholesterol level in the blood. Other problems that contribute to the development of atherosclerosis include a sedentary lifestyle, obesity, and psychological stress. Atherosclerosis can lead to anginal complications (chest discomfort), heart attack, stroke, or peripheral vascular disease.
Doctors are frequently asked, “I understand that I have hardening of the arteries. What can I do to slow the progression of this disease or even reverse this unhealthy process?” Answers to this question are listed below and inTable 1.1,2
You must stop smoking tobacco products. Tobacco smoke and especially cigarette smoke are poisonous. Chemicals in this smoke damage the arteries that carry blood to all organs. Patients who continue to smoke after they have already developed atherosclerosis are at great risk for developing a fatal heart attack. In addition to atherosclerosis, smoking is a major contributor to incapacitating lung disease and many forms of cancer.
You must get good advice and therapy to control diabetes mellitus or a tendency to develop diabetes mellitus. Diabetes mellitus accelerates the process leading to atherosclerosis. Excellent control of diabetes mellitus or prevention through weight reduction, exercise, diet, and medication can slow the development of hardening of the arteries. Primary care physicians, endocrinologists, and cardiologists can help patients control or prevent diabetes mellitus.
Familial or inherited tendencies for developing certain diseases are very common. Some families have many members afflicted with cancer, whereas others have many individuals who develop heart attacks and strokes. At this time, it is impossible to change a person's genetic or inherited tendencies. However, all of the other risk factors for atherosclerosis listed in this Patient Page can be modified, thereby markedly decreasing the risk for developing atherosclerosis even when there is a strong family history for this illness. Maintaining ideal body weight, avoiding cigarettes and foods rich in saturated (usually animal) fat, regular exercise, and, at times, medication can reduce the risk for many individuals.
A large portion of the American population has high blood pressure also known as hypertension. Abnormally high blood pressure damages arteries and accelerates the development of atherosclerosis, leading to heart attacks and strokes. Maintaining ideal body weight, regular exercise, avoiding high–saturated fat and salty foods, and use of certain prescription medications are excellent strategies for controlling high blood pressure. There are a variety of medicines that are highly effective for treating high blood pressure, and many of these have minimal side effects. Patients usually need to take these medications for their entire life in order to maintain a normal blood pressure.
The typical Western diet contains high levels of saturated animal fat. Red meat is often the major contributor of saturated fat in the Western diet, although butter, cream, ice cream, many cheeses, and solid vegetable shortenings also contain large amounts of saturated fat. Eating a diet that is high in saturated fat results in increased blood levels of cholesterol, which can accelerate the development of atherosclerosis. Many books contain excellent advice about the ideal diet for patients with atherosclerosis or patients who have a propensity to develop this disease. The American Heart Association publishes a number of cookbooks as well as pamphlets with detailed descriptions and recipes for heart-healthy nutrition.3 Heart-healthy diets emphasize restriction of red meat and rich dairy products. Experts in nutrition also suggest that individuals concerned about their blood cholesterol levels eat increased amounts of fruits, vegetables, and whole grain foods.
A tendency to develop high blood cholesterol levels is often inherited. Dietary restrictions alone are usually insufficient to lower blood cholesterol levels enough, so that further damage to blood vessels is prevented. Consequently, many patients are given prescriptions for drugs that are highly effective in lowering blood cholesterol levels. These drugs include members of the statin family such as pravastatin, as well as other lipid-lowering medications such as niacin and gemfibrozil (a member of the fibrate family; seeTable 2).
Sedentary lifestyles frequently accompanied by obesity contribute to the development of atherosclerotic disease. The cardiovascular system thrives on exercise, and it is therefore an excellent idea to initiate a daily exercise program such as walking, cycling, rowing, or swimming for 30 to 60 minutes each day.4 Exercise also helps to reduce weight and reverse obesity.
Psychological stress is difficult to measure. There is even controversy as to whether distress of this nature actually contributes to the development of atherosclerosis. Nevertheless, a substantial number of clinical studies support the idea that patients with coronary artery disease should practice some form of regular stress reduction such as meditation, yoga, or tai chi chuan. There are no or only very minimal side effects from such a program, and many patients report increased wellbeing when they use these modalities.
The lifestyle changes just described are often not sufficient by themselves to control the progression of atherosclerotic vascular disease. Over recent years, a number of medicines have been shown to be highly effective in slowing or in some cases even reversing the atherosclerotic process.
Heart attacks damage the heart, and this can lead to a variety of complications, such as abnormally slow or fast heart beats that may even be life threatening. In addition, damage to heart muscle may reduce the pumping ability of the heart, leading to fatigue, shortness of breath, and swelling of the skin and underlying tissues (edema). A variety of medicines as well as interventional catheterization techniques such as balloon angioplasty, coronary artery stenting, and surgical procedures such as coronary artery bypass grafting are used to correct or lessen these problems.
Dr Alpert has consulted for Elsevier Publications Inc, Sanofi-aventis, Merck, Bristol-Myers-Squibb, Pfizer, Astra-Zeneca, McNeill, Organon, Berlex, Novartis, Ciba-Geigy, Servier, Boehringer-Ingleheim, Bayer, Johnson & Johnson, Exeter CME; North American Center for Continuing Medical Education (NACCME), FRANCE foundation, and CME.
The information contained in this Circulation Cardiology Patient Page is not a substitute for medical advice, and the American Heart Association recommends consultation with your doctor or healthcare professional.
- © 2011 American Heart Association, Inc.
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The American Heart Association. http://www.heart.org. Accessed July 7, 2011.