Heart disease affects more than 15 million Americans. It is the leading cause of death in the United States. Heart disease happens when your coronary arteries, which supply your heart with blood, oxygen and nutrients, become clogged or blocked. Coronary artery disease, or CAD, is the most common type of heart disease in the United States.
While CAD can devastate your health and well-being, it can also go unnoticed for decades. "Cholesterol-containing deposits, or plaque, can build up in your arterial walls without producing visible symptoms," explains Mir Basir, D.O., an interventional cardiologist at Henry Ford Health Center. When that plaque accumulates, decreased blood flow to the heart eventually can produce symptoms and even lead to a heart attack.
Understanding Coronary Artery Disease
CAD is largely preventable. There are a number of things you can do to reduce your chances of heart disease, even if you have strong risk factors.
To better understand CAD and help you sidestep a heart attack, we asked Dr. Basir to explain the ins and outs of the nation's number one killer.
Q: What causes coronary artery disease?
A: Coronary artery disease begins with damage to the inner layer of a coronary artery. That damage can happen for a number of reasons, including:
- A genetic predisposition (a family history of CAD)
- High blood pressure
- High cholesterol
When any of these things occur, fatty deposits (plaque) and cellular waste accumulate at the site in a process called atherosclerosis (“hardening of the arteries”).
Q: Which lifestyle strategies can help prevent heart disease?
A: Smoking is the single most important risk factor for CAD because it damages the inner lining of the blood vessels. If you're worried about CAD, stop smoking. Other risk factors you can control include keeping blood pressure in check and maintaining a healthy weight. Following a healthful, Mediterranean-style diet or the DASH (Dietary Approaches to Stop Hypertension) diet has been shown to reduce the risk of developing CAD. Implementing a regular exercise routine also reduces your risk. These steps can also help you avoid diabetes and metabolic syndrome, which are linked to an increased risk of CAD.
Q: What are the signs of blocked arteries?
A: When your coronary arteries narrow from a buildup of plaque, your heart may not receive enough oxygen-rich blood. As plaque continues to accumulate in the arteries, you may experience the following symptoms:
- Chest pain: You may notice intense pressure or tightness in your chest, especially during exertion like manual labor or exercise. Called angina, this pain typically occurs in the center of the chest. Angina can also radiate to the neck or shoulder, or travel down the arm or to the mid-back. While the pain usually dissipates within minutes of stopping the activity, you shouldn’t ignore it.
- Shortness of breath: If you're heart isn't pumping enough blood, you may quickly become fatigued and short of breath during activity.
- Fatigue: You may notice you're more tired than usual, or that you fatigue easily during activity.
- Heart attack: Left untreated, a blocked coronary artery can cause a heart attack. Classic signs of a heart attack include crushing pressure in your chest and pain or tingling in your shoulder, arm or neck. You might also become short of breath and overheated.
Some people never notice a single symptom before a heart attack. Others suffer from a silent heart attack, meaning they don't even recognize the event. Visiting your doctor at least annually can help you identify whether you're at risk of developing CAD.
Q: What is the first-line treatment for CAD?
A: The gold standard treatment for CAD is statin therapy. Statin drugs reduce plaque buildup on vessel walls and help reduce cholesterol levels. They also have anti-inflammatory properties, which help reduce the risk of heart attack or stroke. Studies suggest that medications such as beta-blockers and calcium channel blockers may work at least as well as surgical stenting for patients with blockages. In every case, treatment depends on how much narrowing there is, where it's located, how many arteries are affected, and whether symptoms are interfering with your quality of life and overall health.
Q: What about daily aspirin therapy?
A: While aspirin does reduce the risk of heart attack and stroke, it also increases your risk of bleeding. If you are at risk of CAD, discuss the risks and benefits of aspirin therapy with your doctor.
Paying Attention to Heart Disease
If you have a family history of CAD or you have high blood pressure, smoke or are overweight, talk to your doctor about your risk for CAD and if you would benefit from lifestyle changes or medications. Then, learn all you can about CAD how to sidestep further damage.
Most important, know the signs of a heart attack:
- Chest pain
- Pain or discomfort in one or both arms that radiates to the neck, jaw or back
- Shortness of breath
- Difficulty breathing
- Feeling lightheaded
It's never too late to protect your heart from further damage. More people than ever before are living with CAD as a result of earlier diagnosis and better treatments.
Dr. Mir Basir is an interventional cardiologist who sees patients at Henry Ford Hospital in Detroit.