Overview of Coronary Artery Disease (CAD)

Quitting smoking Smoking Cessation While often very challenging, quitting smoking is one of the most important things smokers can do for their health. Quitting smoking brings immediate health benefits that increase over time... read more is most important. People who quit smoking decrease their risk of developing coronary artery disease by half compared with those who continue to smoke. How long people smoked before quitting does not matter. Quitting also decreases the risk of death after coronary artery bypass surgery or after a heart attack. Avoiding secondhand smoke is also important.

Several changes are beneficial:

Limiting the amount of fat to no more than 25 to 35% of daily calories is recommended to promote good health. However, some experts believe that fat must be limited to 10% of daily calories to reduce the risk of coronary artery disease. A low-fat diet also helps lower high total and LDL (the bad) cholesterol levels, another risk factor for coronary artery disease. The type of fat consumed is as important as the amount of fat. Thus, eating oily fish, such as salmon, which are high in omega-3 fats (good fats), regularly and strictly avoiding the more harmful trans fats are recommended. Trans fats are being removed from ingredients in many packaged food products, fast food sites, and restaurants.

Eating at least five servings of fruits and vegetables daily can decrease the risk of coronary artery disease. Such foods contain many phytochemicals. Whether the phytochemicals are responsible for the risk reduction is unclear because people who consume such diets also tend to eat less fat, more fiber, and more foods containing vitamins C, D, and E. People who eat foods rich in a group of phytochemicals called flavonoids (found in red and purple grapes, red wine, and black teas) appear to have a lower risk of coronary artery disease. However, there is no clear cause-and-effect relationship. Some other factor in their life may account for the apparent lower risk.

A high-fiber diet is also recommended. There are two kinds of fiber. Soluble fiber (which dissolves in liquid) is found in oat bran, oatmeal, beans, peas, rice bran, barley, citrus fruits, strawberries, and apple pulp. It helps lower high cholesterol levels. It may decrease or stabilize high blood sugar (glucose) levels and increase low insulin levels. Thus, soluble fiber may help people with diabetes Diabetes Mellitus (DM) Diabetes mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar (glucose) levels to be abnormally high. Urination and thirst are... read more reduce their risk of coronary artery disease. Insoluble fiber (which does not dissolve in liquid) is found in most grains and grain products and in fruits and vegetables such as apple skin, cabbage, beets, carrots, Brussels sprouts, turnips, and cauliflower. It also helps with digestive function. However, eating too much fiber can interfere with the absorption of certain vitamins and minerals.

The diet should contain the recommended daily requirements of vitamins and minerals. Vitamin supplements are not considered an acceptable substitute for a healthy diet. The role of supplements in reducing the risk of coronary artery disease is somewhat controversial. Taking supplements of vitamin E or vitamin C does not seem to prevent coronary artery disease. Taking folate or vitamins B6 and B12 may lower homocysteine levels, but studies have not shown that taking these supplements decreases the risk of coronary artery disease.

Limiting the amount of simple sugar carbohydrates (such as refined white flour, white rice, processed foods) and increasing the amount of whole grains may help reduce the risk of coronary artery disease because it reduces the risk of obesity and possibly of diabetes, which are also risk factors for coronary artery disease.

Overall, people should maintain a healthy weight and eat a variety of foods. Several specific diets have been proposed to reduce the risk of heart disease or stroke. The Mediterranean diet appears to reduce the risk of coronary artery disease as well as the risk of further heart attacks in those who already have heart disease. According to the American Heart Association, the Mediterranean diet consists of plenty of fruits, vegetables, nuts, seeds, bread and other grains, potatoes, beans, and olive oil. Dairy products, eggs, fish and poultry are eaten in low to moderate amounts. Fish and poultry are more common than red meat in this diet. It also centers on minimally processed, plant-based foods with fruit as a common dessert instead of sweets. Wine may be consumed in low to moderate amounts, usually with meals.

People who are physically active are less likely to develop coronary artery disease and high blood pressure High Blood Pressure High blood pressure (hypertension) is persistently high pressure in the arteries. Often no cause for high blood pressure can be identified, but sometimes it occurs as a result of an underlying... read more . Exercise Type of Exercise People should consult their doctor before beginning competitive sports or an exercise program. Doctors ask about known medical disorders in the person and family members and about symptoms the... read more that promotes endurance (aerobic exercise such as brisk walking, bicycling, and jogging) or muscle strength (resistance training with free weights or weight machines) helps prevent coronary artery disease. Walking just 30 minutes each day can be beneficial. People who are out of shape or who have not exercised in a long time should consult their doctor before they start an exercise program.

Modifying the diet and engaging in physical activity can help control obesity Obesity Obesity is excess body weight. Obesity is influenced by a combination of factors, which usually results in consuming more calories than the body needs. These factors may include physical inactivity... read more . Decreasing alcohol consumption can also help because alcohol is high in calories. A loss of even 10 to 20 pounds (4½ to 9 kilograms) can reduce the risk of coronary artery disease.

High total and LDL (the bad) cholesterol levels can be lowered by exercising and by quitting smoking as well as by reducing the amount of fat in the diet. Drugs that lower levels of total and LDL cholesterol in the blood (lipid-lowering drugs Lipid-lowering drugs Dyslipidemia is a high level of lipids (cholesterol, triglycerides, or both) or a low high-density lipoprotein (HDL) cholesterol level. Lifestyle, genetics, disorders (such as low thyroid hormone... read more ) may be used. The benefits of lowering cholesterol levels are greatest in people with other risk factors, such as smoking, high blood pressure, obesity, and physical inactivity.

Increasing the level of HDL (the good) cholesterol also helps reduce the risk of coronary artery disease. The same lifestyle changes that lower total and LDL cholesterol levels can help increase HDL cholesterol levels. Certain drugs can also increase HDL levels, but it is not clear whether using drugs to increase HDL levels is helpful. For people who are overweight, losing weight can also help.

Lowering high blood pressure High Blood Pressure High blood pressure (hypertension) is persistently high pressure in the arteries. Often no cause for high blood pressure can be identified, but sometimes it occurs as a result of an underlying... read more reduces the risk of coronary artery disease. Treatment of high blood pressure begins with lifestyle changes: eating a healthy diet that is low in salt and, if needed, losing weight and increasing physical activity. Drug therapy Drug Treatment of High Blood Pressure High blood pressure is very common. It often does not cause symptoms; however, high blood pressure can increase the risk of stroke, heart attack, and heart failure. Therefore, it is important... read more may also be necessary.

Good control of diabetes Diabetes Mellitus (DM) Diabetes mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar (glucose) levels to be abnormally high. Urination and thirst are... read more reduces the risk of some complications of diabetes, but the effects of such control on the development of coronary artery disease are less clear. Good control of diabetes may also reduce the risk of complications of coronary artery disease.

Aspirin, sometimes recommended in the past for people who have never had coronary artery disease, is not currently recommended for such people.

With new techniques, chest incisions can be much smaller, resulting in minimally invasive bypass surgery (sometimes this type of surgery is called a keyhole procedure). One technique involves robotics. While sitting at a computer console, a surgeon uses pencil-sized robotic arms to do the operation. The arms hold specially designed surgical instruments that can do intricate movements, mimicking those of the surgeon’s hands. Through a viewing scope, the surgeon watches a magnified three-dimensional image of the operation. The operation requires three 1-inch (about 2 ½-centimeter) incisions—one for each of the two robotic arms and one for a camera, which is connected to the scope. Thus, the surgeon does not need to split open the person’s breastbone. The operating time and hospital stay are usually shorter with the newer procedures than with open-heart surgery.