Coronary Artery Disease (CAD), also known as Ischemic Heart Disease (IHD) involves the reduction of blood flow to the heart muscle due to a buildup of plaque in the arteries of the heart. Coronary Artery Disease (CAD) is a major cause of mortality and morbidity all over the world. According to a report of World Health Organization (WHO) in 2005, Cardiovascular Disease (CVD) caused 17.5 million (30%) of the 58 million deaths that occurred worldwide. There has been a rapid increase in Non-communicable Diseases (NCD). A common symptom is chest pain or discomfort which may travel into the left shoulder, arm, back, neck, or jaw. Usually, symptoms occur with exercise or emotional stress, last less than a few minutes, and improve with rest. Shortness of breath may also occur and sometimes no symptoms are present. According to the Global Burden of Disease study age-standardized estimates (2010), nearly a quarter (24.8%) of all deaths in India are attributable to CVDs.
The following lists contain the most frequently implicated
CAD risk factors:
Modifiable risk factors
- Elevated blood lipids
- Personality and behavior patterns
- Cigarette smoking
- Sedentary lifestyle
- Excessive body fat
- Diabetes mellitus
- Tension and stress
- Elevated homocysteine
Non-modifiable risk factors
- Age (After age 35 in men and age 45 in women)
- Ethnic background
- Family history
Find out if your heart is healthy. The following are Guidelines from the 2019 American College of Cardiology/American Heart Association (ACC/AHA) on the Primary Prevention of Cardiovascular Disease (CVD):
Consume a healthy plant-based or Mediterranean-like diet high in vegetables, fruits, nuts, whole grains, lean vegetable or animal protein (preferably fish), and vegetable fiber, which has been shown to lower the risk of all-cause mortality. The increased availability of affordable, palatable, and high-calorie foods along with decreased physical demands of many jobs have fueled the epidemic of obesity and the consequent increases in hypertension and T2DM.
Adults diagnosed as obese (body mass index [BMI] ≥30 kg/m2) or overweight (BMI 25-29.9 kg/m2) are at increased risk of CAD, compared with those of normal weight. Obese and overweight adults are advised to participate in comprehensive lifestyle programs for 6 months that assist participants in adhering to a low-calorie diet (decrease by 500 kcal or 800-1500 kcal/day) and high levels of physical activity (200-300 minutes/week). Clinically meaningful weight loss (≥5% initial weight) is associated with improvement in blood pressure (BP), LDL-C, triglycerides, and glucose levels among obese or overweight individuals, and delays the development of T2DM. In addition to diet and exercise.
Engage in at least 150 minutes/week of moderate-intensity or 75 minutes/week of vigorous-intensity physical activity including resistance exercise. Eg- Walking, Running, Jogging, Swimming, Cycling.
Type 2 Diabetes Mellitus, defined as a hemoglobin A1c (HbA1c) >6.5%, is a metabolic disorder characterized by insulin resistance leading to hyperglycemia. The development and progression are heavily influenced by dietary pattern, physical activity, and body weight. Dietary counseling for a heart-healthy diet that in T2DM lowers CVD events and CVD mortality. Among options include the Mediterranean, DASH, and vegetarian/vegan diets that achieve weight loss and improve glycemic control. At least 150 minutes/week of moderate to vigorous physical activity (aerobic and resistance) in T2DM lowers HbA1c about 0.7% with an additional similar decrease by weight loss. Other risk factors should be identified and treated aggressively.
In adults with elevated or borderline hypertension (BP 120-129/<80 mm Hg) or hypertension, the initial recommendations include weight loss, heart-healthy diet (DASH or DASH Mediterranean), sodium restriction of 1000 mg reduction and optimal <1500 mg/d), diet rich in potassium ,exercise as described including aerobic, isometric resistance,dynamic resistance (weights), and limited alcohol intake.
Smoking and smokeless tobacco (e.g., chewing tobacco) increase the risk of all-cause mortality and causal for CVD. Secondhand smoke is a cause of CVD and stroke, and almost one-third of CHD deaths are attributable to smoking and exposure to secondhand smoke. Even low levels of smoking increase risks of acute myocardial infarction; thus, reducing the number of cigarettes per day does not totally eliminate risk. Electronic Nicotine Delivery Systems (ENDS), known as e-cigarettes and vaping, is a new class of tobacco products that emit aerosol containing fine and ultrafine particulates, nicotine, and toxic gases that may increase the risk for CV and pulmonary diseases.
Those who use tobacco should be assisted and strongly advised to quit on every visit. Referral to specialists is helpful for both behavioral modification, nicotine replacement, and drug treatments.