Heart disease kills more people in the United States than the next three leading causes of death combined. Coronary artery disease is the most common cause of heart disease and is the cause of heart attacks.
Coronary artery disease refers to deposits of cholesterol in the walls of arteries supplying blood to the heart muscle. Risk factors for developing coronary artery disease include being older than 55 for men and 65 for women, smoking, diabetes, high cholesterol, high blood pressure and a family history of coronary artery disease. By age 60, about one-third of men and women have some degree of coronary artery disease.
Coronary artery disease presents in three scenarios. Cholesterol plaques can grow slowly over years until they severely narrow the coronary artery and limit blood flow to the heart muscle. This causes angina, defined as chest, neck or shoulder discomfort that develops with physical activity and resolves with rest or use of nitroglycerin. Treatment of severe coronary artery disease includes medicines, but sometimes the plaques require coronary stent procedures to reopen the artery or coronary artery bypass surgery to bypass the narrowing.
However, most people with coronary artery disease have no symptoms. In these instances, the cholesterol plaques cause mild narrowing of the coronary arteries, and do not impede blood flow to the heart muscle enough to cause symptoms.
These people can exercise or exert themselves without symptoms and typically pass stress tests without abnormalities.
The third presentation of coronary artery disease is a heart attack, or myocardial infarction. In these cases, a mild cholesterol plaque that had not caused symptoms ruptures and severely narrows or completely blocks the artery in a matter of minutes to hours. Patients develop sudden severe chest or shoulder discomfort, shortness of breath, nausea and sweating. This scenario is a medical emergency, as every minute the artery is blocked is a minute in which heart muscle dies. If you experience these symptoms, call 911.
Because many people with coronary artery disease have no symptoms, physicians must make a calculated guess whether to treat you for coronary artery disease.
If you have multiple risk factors for coronary artery disease, chances are you have coronary artery disease and are at risk of a heart attack. Two powerful medications to prevent heart attacks are aspirin and cholesterol-lowering medications called statins. Statin medications not only lower cholesterol levels in the blood but exert a powerful anti-inflammatory effect to stabilize plaques to prevent them from rupturing.
Dr. Tyler Richmond, an interventional cardiologist with Lexington Cardiology at Central Baptist, is medical director of Cardiac Rehabilitation Services at Baptist Health Lexington.