Coronary Artery Disease
Disease Details
Family Health Simplified
- Description
- Coronary artery disease is a condition characterized by the narrowing or blockage of the coronary arteries due to the buildup of plaque, which can lead to reduced blood flow to the heart muscle.
- Type
- Coronary artery disease (CAD) is a multifactorial disease, meaning it results from a combination of genetic and environmental factors. The genetic transmission of CAD does not follow a simple Mendelian pattern but is influenced by multiple genes, each contributing a small amount to the overall risk. Common genetic variations, such as single nucleotide polymorphisms (SNPs), can increase susceptibility to CAD, especially when combined with lifestyle factors like diet, smoking, and physical inactivity.
- Signs And Symptoms
- The most common symptom is chest pain or discomfort that occurs regularly with activity, after eating, or at other predictable times; this phenomenon is termed stable angina and is associated with narrowing of the arteries of the heart. Angina also includes chest tightness, heaviness, pressure, numbness, fullness, or squeezing. Angina that changes in intensity, character or frequency is termed unstable. Unstable angina may precede myocardial infarction. In adults who go to the emergency department with an unclear cause of pain, about 30% have pain due to coronary artery disease. Angina, shortness of breath, sweating, nausea or vomiting, and lightheadedness are signs of a heart attack, or myocardial infarction, and immediate emergency medical services are crucial.With advanced disease, the narrowing of coronary arteries reduces the supply of oxygen-rich blood flowing to the heart, which becomes more pronounced during strenuous activities during which the heart beats faster and has an increased oyxgen demand. For some, this causes severe symptoms, while others experience no symptoms at all.
- Prognosis
- Coronary artery disease (CAD) prognosis varies based on several factors, including the severity of the disease, the presence of other health conditions, lifestyle changes, and adherence to treatment. With appropriate medical management, lifestyle modifications, and, if necessary, surgical interventions like angioplasty or coronary artery bypass grafting, many individuals with CAD can lead relatively normal lives. However, CAD remains a leading cause of morbidity and mortality, and complications such as heart attacks or heart failure can significantly impact prognosis. Regular follow-up with a healthcare provider is crucial for managing the disease effectively.
- Onset
- The onset of coronary artery disease (CAD) typically develops over many years and is often a result of atherosclerosis, where plaque builds up in the coronary arteries. This process can begin as early as childhood or adolescence but usually manifests as symptoms in middle age or older adults. Factors such as high blood pressure, high cholesterol, smoking, diabetes, obesity, and a sedentary lifestyle can accelerate its development. Initially, CAD might not present any symptoms, but as the disease progresses, it can lead to angina (chest pain), shortness of breath, heart attacks, and other serious complications.
- Prevalence
- The prevalence of coronary artery disease (CAD) varies by region, but it is one of the most common cardiovascular diseases globally. In the United States, it is estimated that about 18.2 million adults aged 20 and older have CAD. The prevalence increases with age and is higher in men compared to women.
- Epidemiology
- As of 2010, CAD was the leading cause of death globally resulting in over 7 million deaths. This increased from 5.2 million deaths from CAD worldwide in 1990. It may affect individuals at any age but becomes dramatically more common at progressively older ages, with approximately a tripling with each decade of life. Males are affected more often than females.It is estimated that 60% of the world's cardiovascular disease burden will occur in the South Asian subcontinent despite only accounting for 20% of the world's population. This may be secondary to a combination of genetic predisposition and environmental factors. Organizations such as the Indian Heart Association are working with the World Heart Federation to raise awareness about this issue.Coronary artery disease is the leading cause of death for both males and females and accounts for approximately 600,000 deaths in the United States every year. According to present trends in the United States, half of healthy 40-year-old males will develop CAD in the future, and one in three healthy 40-year-old females. It is the most common reason for death of males and females over 20 years of age in the United States.After analysing data from 2 111 882 patients, the recent meta-analysis revealed that the incidence of coronary artery diseases in breast cancer survicors was 4.29 (95% CI 3.09-5.94) per 1000 person-years.
- Intractability
- Coronary artery disease (CAD) is not entirely intractable but managing it can be challenging. Treatments include lifestyle changes, medications, and procedures like angioplasty or bypass surgery to manage symptoms and improve quality of life. Complete cure is often not possible, but effective management can significantly reduce the impact of the disease.
- Disease Severity
- Coronary artery disease (CAD) severity ranges from mild to severe, based on the extent of artery blockage and reduction in blood flow to the heart. Mild cases may present with few or no symptoms and can often be managed with lifestyle changes and medications. Moderate cases may cause symptoms like chest pain (angina) and require more intensive treatment, including medications and possibly procedures like angioplasty. Severe CAD can lead to significant heart muscle damage, heart attacks, or heart failure, often necessitating surgical interventions such as bypass surgery. Managing CAD effectively requires ongoing medical evaluation to prevent complications and improve quality of life.
- Healthcare Professionals
- Disease Ontology ID - DOID:3393
- Pathophysiology
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Limitation of blood flow to the heart causes ischemia (cell starvation secondary to a lack of oxygen) of the heart's muscle cells. The heart's muscle cells may die from lack of oxygen and this is called a myocardial infarction (commonly referred to as a heart attack). It leads to damage, death, and eventual scarring of the heart muscle without regrowth of heart muscle cells. Chronic high-grade narrowing of the coronary arteries can induce transient ischemia which leads to the induction of a ventricular arrhythmia, which may terminate into a dangerous heart rhythm known as ventricular fibrillation, which often leads to death.Typically, coronary artery disease occurs when part of the smooth, elastic lining inside a coronary artery (the arteries that supply blood to the heart muscle) develops atherosclerosis. With atherosclerosis, the artery's lining becomes hardened, stiffened, and accumulates deposits of calcium, fatty lipids, and abnormal inflammatory cells – to form a plaque. Calcium phosphate (hydroxyapatite) deposits in the muscular layer of the blood vessels appear to play a significant role in stiffening the arteries and inducing the early phase of coronary arteriosclerosis. This can be seen in a so-called metastatic mechanism of calciphylaxis as it occurs in chronic kidney disease and hemodialysis. Although these people have kidney dysfunction, almost fifty percent of them die due to coronary artery disease. Plaques can be thought of as large "pimples" that protrude into the channel of an artery, causing partial obstruction to blood flow. People with coronary artery disease might have just one or two plaques, or might have dozens distributed throughout their coronary arteries. A more severe form is chronic total occlusion (CTO) when a coronary artery is completely obstructed for more than 3 months.Microvascular angina is a type of angina pectoris in which chest pain and chest discomfort occur without signs of blockages in the larger coronary arteries of their hearts when an angiogram (coronary angiogram) is being performed.
The exact cause of microvascular angina is unknown. Explanations include microvascular dysfunction or epicardial atherosclerosis. For reasons that are not well understood, females are more likely than males to have it; however, hormones and other risk factors unique to females may play a role. - Carrier Status
- Coronary artery disease (CAD) is not inherited through a simple carrier status as it is not caused by a single gene mutation. It is a complex condition influenced by multiple genetic and environmental factors. Some genetic predispositions can increase the risk, but lifestyle factors such as diet, exercise, and smoking also play significant roles.
- Mechanism
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Coronary artery disease (CAD) primarily results from the buildup of atherosclerotic plaques within the coronary arteries, which supply blood to the heart muscle. Here's a detailed look at its mechanisms and molecular underpinnings:
### Mechanism
1. **Endothelial Dysfunction**: Damage to the endothelial lining of coronary arteries due to factors like hypertension, smoking, diabetes, and high cholesterol.
2. **Lipid Accumulation**: Low-density lipoprotein (LDL) cholesterol infiltrates the endothelium, becoming oxidized in the subendothelial space.
3. **Inflammatory Response**: Oxidized LDL triggers an inflammatory response, attracting monocytes to the site. Monocytes differentiate into macrophages.
4. **Formation of Foam Cells**: Macrophages engulf oxidized LDL and become foam cells, a hallmark of early atherosclerotic plaques.
5. **Plaque Formation**: Smooth muscle cells migrate to the intimal layer and secrete extracellular matrix, forming a fibrous cap over the lipid core. This mature plaque can narrow the artery, restricting blood flow.
6. **Plaque Rupture**: Plaques can become unstable and rupture, leading to the formation of a thrombus (blood clot) that may fully occlude the artery, causing a heart attack.
### Molecular Mechanisms
1. **Lipoproteins and Lipid Metabolism**: Apolipoproteins, specifically ApoB-100 in LDL, play crucial roles in lipoprotein assembly and clearance. Oxidized LDL (ox-LDL) is particularly atherogenic.
2. **Oxidative Stress**: Reactive oxygen species (ROS) contribute to the oxidation of LDL and damage to the endothelial cells.
3. **Inflammatory Pathways**: Cytokines and chemokines like TNF-α, IL-1β, and MCP-1 mediate the recruitment and activation of inflammatory cells at the site of endothelial injury.
4. **Macrophage Activation**: Macrophage scavenger receptors such as CD36 and SR-A1 facilitate the uptake of ox-LDL, converting macrophages into foam cells.
5. **Smooth Muscle Cell Migration and Proliferation**: Growth factors such as PDGF (platelet-derived growth factor) and TGF-β (transforming growth factor-beta) stimulate smooth muscle cells to proliferate and migrate.
6. **Extracellular Matrix Remodelling**: Matrix metalloproteinases (MMPs) degrade the extracellular matrix, which can lead to plaque instability.
7. **Endothelial Adhesion Molecules**: Adhesion molecules such as VCAM-1 and ICAM-1 on endothelial cells aid in the adherence of leukocytes, facilitating their migration into the intima.
8. **Apoptosis and Necrosis**: Cell death within the plaque, particularly involving macrophages, contributes to the necrotic core and potential plaque rupture.
Understanding these mechanisms highlights potential therapeutic targets, such as antioxidant therapies to reduce oxidative stress, anti-inflammatory agents to mitigate the inflammatory response, and lipid-lowering drugs to manage cholesterol levels. - Treatment
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There are a number of treatment options for coronary artery disease:
Lifestyle changes
Medical treatment – commonly prescribed drugs (e.g., cholesterol lowering medications, beta-blockers, nitroglycerin, calcium channel blockers, etc.);
Coronary interventions as angioplasty and coronary stent;
Coronary artery bypass grafting (CABG) - Compassionate Use Treatment
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For coronary artery disease (CAD), compassionate use treatment, off-label, or experimental treatments are typically considered when standard treatments are ineffective or not applicable. Here are a few relevant approaches:
1. **Stem Cell Therapy**: Experimental studies are investigating the use of stem cells to repair damaged heart tissue and improve heart function.
2. **Gene Therapy**: This involves transferring genes into a patient's cells to repair or replace damaged genetic material, aiming to improve heart function or reduce plaque buildup.
3. **Enhanced External Counterpulsation (EECP)**: Off-label use to improve symptoms of angina. It involves compressive cuffs around the legs that inflate and deflate to improve blood flow to the heart.
4. **Novel Antiplatelet Agents**: Sometimes used off-label to prevent blood clots, beyond the standard aspirin or clopidogrel.
5. **LDL Apheresis**: A procedure that filters LDL cholesterol from the blood, used for patients with extremely high cholesterol levels resistant to medication.
6. **Experimental Drugs**: Various clinical trials are ongoing with new medications targeting different pathways involved in the development of CAD, such as anti-inflammatory drugs.
7. **Angiogenesis Stimulation**: Experimental therapies aimed at promoting the growth of new blood vessels to bypass clogged arteries.
Such treatments are typically accessed via clinical trials or special programs and always involve careful consideration by medical professionals to balance potential benefits and risks. - Lifestyle Recommendations
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For coronary artery disease, lifestyle recommendations include:
1. **Healthy Diet**: Adopt a diet low in saturated fats, trans fats, cholesterol, and sodium. Focus on fruits, vegetables, whole grains, and lean proteins.
2. **Regular Exercise**: Engage in at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity activity per week.
3. **Weight Management**: Maintain a healthy body weight to reduce strain on the heart and lower risk factors such as high blood pressure and diabetes.
4. **Smoking Cessation**: Quit smoking and avoid exposure to secondhand smoke to improve heart health.
5. **Stress Reduction**: Practice stress-relieving techniques such as mindfulness, meditation, or yoga to manage stress levels.
6. **Limit Alcohol**: If you drink alcohol, do so in moderation. This means up to one drink per day for women and up to two drinks per day for men.
7. **Regular Check-ups**: Monitor your health regularly, including blood pressure, cholesterol levels, and blood sugar levels.
8. **Medication Adherence**: Follow prescribed medication regimens to manage risk factors like hypertension, high cholesterol, and diabetes.
These lifestyle changes can help manage and reduce the risk of coronary artery disease. - Medication
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Statins, which reduce cholesterol, reduce the risk of coronary artery disease
Nitroglycerin
Calcium channel blockers and/or beta-blockers
Antiplatelet drugs such as aspirinIt is recommended that blood pressure typically be reduced to less than 140/90 mmHg. The diastolic blood pressure however should not be lower than 60 mmHg. Beta blockers are recommended first line for this use. - Repurposable Drugs
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While the concept of repurposing drugs for the treatment of coronary artery disease (CAD) is actively researched, some drugs initially developed for other conditions have shown potential benefits for CAD. Notable examples include:
1. **Statins (originally for cholesterol management)**: These have been widely adopted in CAD management due to their ability to lower LDL cholesterol and reduce cardiovascular events.
2. **ACE inhibitors (for hypertension and heart failure)**: These drugs help relax blood vessels and have been found to reduce the risk of heart attacks in CAD patients.
3. **Aspirin (for pain and inflammation)**: Low-dose aspirin is often used for its antiplatelet effects to lower the risk of blood clots in CAD patients.
4. **Metformin (for type 2 diabetes)**: Emerging research indicates potential benefits in reducing cardiovascular events in patients with CAD, even in those without diabetes.
Always consult medical professionals for specific treatment recommendations. - Metabolites
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Coronary artery disease (CAD) involves the buildup of plaque in the coronary arteries that supply blood to the heart muscle.
**Metabolites associated with CAD:**
1. **Cholesterol**: Elevated levels, particularly of low-density lipoprotein (LDL) cholesterol, are linked to plaque formation.
2. **Triglycerides**: High levels can contribute to artery hardening or thickening.
3. **Homocysteine**: Elevated levels of this amino acid are associated with arterial damage and increased risk of CAD.
4. **Glucose**: Poorly controlled blood glucose levels in diabetics can accelerate CAD.
5. **Inflammatory markers**: Such as C-reactive protein (CRP), indicate inflammation in arteries.
"nan" likely stands for "not applicable" or is a prompt error. Please clarify if you need specific information related to "nan." - Nutraceuticals
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Coronary artery disease (CAD) refers to the narrowing or blockage of the coronary arteries, usually caused by atherosclerosis. It can lead to chest pain (angina), heart attacks, and other cardiovascular complications.
Nutraceuticals are food-derived products that offer health benefits, including the prevention and treatment of diseases like CAD. Common nutraceuticals for CAD include:
1. **Omega-3 Fatty Acids**: Found in fish oil, they can reduce inflammation, lower triglyceride levels, and improve heart health.
2. **Coenzyme Q10 (CoQ10)**: This antioxidant helps improve heart function and may lower blood pressure.
3. **Phytosterols**: Plant sterols and stanols can reduce LDL cholesterol levels.
4. **Policosanol**: Derived from sugar cane or beeswax, it may help lower cholesterol levels.
5. **Garlic**: Has been shown to have cholesterol-lowering properties.
6. **Green Tea Extract**: Contains antioxidants that can improve endothelial function and cardiovascular health.
7. **Red Yeast Rice**: Contains naturally occurring statins that can help lower cholesterol levels.
Evidence for these nutraceuticals varies, and they should not replace conventional medical treatments but might be used as complementary approaches. Always consult with a healthcare provider before starting any new supplement regimen, especially if you have CAD or other health conditions. - Peptides
- Peptides and nanoparticles (nan) have been explored in the context of coronary artery disease (CAD) for their potential therapeutic and diagnostic applications. Peptides can serve various roles, such as preventing platelet aggregation, reducing cholesterol levels, or inhibiting inflammatory processes that contribute to atherosclerosis. Nanoparticles can be used to deliver drugs or imaging agents specifically to atherosclerotic plaques, enhancing the precision of treatment and diagnosis. Their surface can be engineered to target specific molecules involved in CAD, making them promising tools for improving outcomes in CAD management.