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Coronary Artery Disease (CAD)

Written by Emma To; Edited by Emily Begnel, MPH; Edited by Courtney Coleman

 

Introduction

The CDC states that “[c]oronary artery disease (CAD) is the most common type of heart disease in the United States” (1). From 2017-2020, it was reported that 20.5 million Americans 20 years or older had CAD, which is also known as coronary heart disease (CHD) (2). Of these individuals, 11.7 million were male and 8.8 million were female, accounting for 8.7% and 5.8% of their respective populations (2). Although it is prevalent, there are preventative measures that people can take in order to reduce their risk. Thus, it is an important chronic illness about which to learn and stay informed (3, 4). 


Causes and Symptoms

CAD occurs when coronary arteries are blocked or narrowed by plaque build up (1). 

Plaques are formed when “bad cholesterol” (low-density lipoproteins) enter the artery tissue and oxidize, which triggers an immune response that results in lesions called fatty streaks (3, 5, 6). Smooth muscle cells in the heart then produce other extracellular components around these streaks, turning them into “fibrous plaque[s]” that harden and begin to obstruct the blood vessel (6). Blocked blood vessels can cause feelings of heaviness and pressure because oxygen demand is not met by the blood supply (7). Another common symptom is chest pain, but many people learn they have CAD because they have a heart attack, which can be identified by symptoms like “pain or discomfort in the arms or shoulder” and/or “shortness of breath” (1). 


Risk Factors and Prevention/Treatment

Several risk factors can help predict one’s likelihood of having CAD. One study called “Genetic-Epidemiologic Study of Early-onset Ischemic Heart Disease” analyzed 207 patients in Colorado who had heart attacks before they were 55 years old (8, 9). It showed that people with “first-degree relative[s]” that experienced an onset of CAD before they were 55 years old were at a higher risk for also having CAD (8). Other chronic conditions like high cholesterol, diabetes, obesity, and increased blood pressure can also increase risk for CAD (3). Additionally, external lifestyle factors including smoking, alcohol use, stress, inactivity, and lack of sleep have been shown to increase the risk for CAD (3). These lifestyle factors are also opportunities for prevention. For example, exercising, quitting smoking, controlling blood pressure and cholesterol, and managing stress can reduce the risk for CAD (3).


Diagnosis/Treatment

In order to diagnose CAD, a doctor will run tests to assess heart function. Examples of these tests include an EKG (measure of the heart’s electrical activity), an echocardiogram (ultrasound of the heart), an X-ray, stress test, and/or a coronary angiogram (identifying blockages by following an injected dye) (1). Once diagnosed, CAD is treated in different ways depending on disease severity. One intervention is to physically open up the obstructed artery with mechanisms like a small temporary balloon that is inflated in the artery (angioplasty) or a permanent mesh stent that holds the artery open (6). Another method of treatment is anti-platelet medication, which decreases the likelihood of blood clots that can cause heart attacks, especially for people with CAD (6, 10).


Conclusion

Chronic illnesses like CAD are common and can have sudden and potentially deadly effects on health. In addition to physical harm, CAD is also a significant financial burden. In 2017, the American Heart Association reported that the total direct CAD medical costs were $89 billion, and costs are estimated to be $215 billion by 2035 (11). They also reported that the indirect costs were $99 billion in 2017 and projected to be $151 billion by 2035 (11). The indirect costs included expenses like missing work, needing to hire help, and loss of income because of premature death (11). These financial burdens put stress on pre-existing social inequalities, which are important to address when learning about, treating, and preventing CAD in diverse communities (11). The burden of CAD/CAH makes education about the disease so important because its effects can be mitigated with a healthy lifestyle and management of other internal factors like blood sugar and cholesterol.

 

References

  1. Coronary Artery Disease (CAD). Centers for Disease Control and Prevention. https://www.cdc.gov/heartdisease/coronary_ad.htm#:~:text=Print-,Coronary%20Artery%20Disease,This%20process%20is%20called%20atherosclerosis. Date updated July 19, 2021. Date accessed September 22, 2023.

  2. Tsao CW, Aday AW, Almarzooq ZI, et al. Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association. Circulation. 2023;147(8): e93 - e621. https://www.ahajournals.org/doi/epub/10.1161/CIR.0000000000001123. Date published February 21, 2023. Accessed October 13, 2023.

  3. Coronary Artery Disease. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/ coronary-artery-disease/symptoms-causes/syc-20350613. Date published May 25, 2022. Date accessed September 22, 2023.

  4. Know the Difference Cardiovascular Disease, Heart Disease, Coronary Heart Disease. NIH National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/sites/default/ files/publications/FactSheetKnowDiffDesign2020V4a.pdf. Accessed November 30, 2023.

  5. Ibanez B, Vilahur G, Badimon JJ. Plaque progression and regression in atherothrombosis. J Thromb Haemost. 2007;5 Suppl 1:292-299. doi:10.1111/j.1538-7836.2007.02483.x. Date published July 2007. Date accessed November 5, 2023.

  6. Malakar AK, Choudhury D, Halder B, Paul P, Uddin A, Chakraborty S. A Review on Coronary Artery Disease, Its Risk Factors, and Therapeutics. J Cell Physiol. 2019; 234(10): 16812–16823. https://doi-org.libproxy.berkeley.edu/10.1002/jcp.28350. Published February 2019. Date accessed September 29, 2023.

  7. Cassar A, Holmes DR, Rihal CS, et al. Chronic Coronary Artery Disease: Diagnosis and Management. Mayo Clinic Proceedings. 2009;84(12): 1130-1146. https://www.sciencedirect.com/science/article/pii/S0025619611603005. Published December 2009. Date accessed November 5, 2023.

  8. Nora JJ, Lortscher RH, Spangler RD, Nora AH, & Kimberling, WJ. Genetic--Epidemiologic Study of Early-Onset Ischemic Heart Disease. Circulation. 1980; 61(3), 503-508. https://www-ahajournals-org.libproxy.berkeley.edu/doi/epdf/ 10.1161/01.CIR.61.3.503. Date published March 1980. Date accessed October 29, 2023.

  9. Heart Attack Symptoms, Risk, and Recovery. Centers for Disease Control and Prevention. https://www.cdc.gov/heartdisease/heart_attack.htm. Date updated July 12, 2022. Date accessed December 1, 2023.

  10. Antiplatelet Drugs. Cleveland Clinic. https://my.clevelandclinic.org/health/drugs/ 22955-antiplatelet-drugs. Date updated: May 5, 2022. Date accessed October 29, 2023.

  11. Cardiovascular Disease: A Costly Burden for America Projections Through 2035. The American Heart Association. 2017. https://www.heart.org/-/media/Files/About-Us/ Policy-Research/Fact-Sheets/Public-Health-Advocacy-and-Research/CVD-A-Costly-Burden-for-America-Projections-Through-2035.pdf. Accessed November 5, 2023.

 

This post is not a substitute for professional advice. If you believe that you may be experiencing a medical emergency, please contact your primary care physician, or go to the nearest Emergency Room. Results from ongoing research is constantly evolving. This post contains information that was last updated on March 14, 2024.

 

Emma To is a third year microbial biology major at UC Berkeley.


Emily Begnel, MPH is a third year PhD candidate in epidemiology at the University of Washington in Seattle, where she also completed her MPH in 2017.


Courtney Coleman is a master's degree candidate in biology at Harvard and Co-President of Students vs Pandemics.

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