Coronary Heart Disease is Women's #1 Killer


True or False, heart disease effects men more than women in the US?


If you answered true, you are on par with most Americans who have come to the false conclusion that heart disease is more a man's problem, when in fact more women die from heart disease than men! That being said, this month in hopes to bring to light the effects of heart disease on women our healthcare feature for the month will be on Coronary Artery disease, or CAD for short. Male readers, this doesn't mean you are off the hook; it would be to your advantage to read on as well since heart disease is the number one killer of Americans!


The good news is Prevention is key, minor lifestyle changes and checkups using advanced tests will drastically reduce your odds of developing heart disease. One such test, Cardiac Calcium Scoring was named the number one best predictor of a future heart attack by preventative cardiologist, Dr. Agatston in February's issue of Prevention Magazine under the byline "Heart Attacks: 7 Heart Tests That Can Save Your Life"


Cardiac scoring is a non-invasive i.e. painless test performed using our state of the art CT under the direction of OFMC's Board Certified Cardiologist, Jimmy London. Cardiac calcium scoring is done to check for plaque buildup in your coronary arteries and takes less than 20 minutes from start to finish. For more information or to set up an appointment call 352.237.4133 or talk to your OFMC healthcare provider today.


What is Coronary Artery Disease (CAD)?


Coronary artery disease (CAD) is a condition affecting the coronary artery that supplies the heart muscles (Myocardium) with blood for nutrition, and oxygen for carrying away its waste products. CAD occurs when atherosclerosis advances causing "atherosclerotic plaques."


These plaques are formed of cholesterol and other materials accumulating in the inner wall of the coronary artery. Eventually, these plaques grow in size, blocking the blood supply to the heart and reducing the nutrients and oxygen delivered. This causes accumulation of waste products, giving what is called a state of ischemia to the heart. Ischemia causes weakening, and ultimately death of the heart muscles.


CAD is a leading cause of death in both males and females greater than 20 years of age. In CAD, the ischemia causes damage to the myocardium, according to the degree of occlusion. If these plaques narrow the lumen but allow only minimal blood flow, barely keeping the heart muscle alive, a state of heart muscle weakness occurs leading to heart failure and arrhythmias.


Heart failure means that the heart will not be able to pump adequate blood supply to the body tissues. Arrhythmia refers to abnormal beating rhythms of the heart. Both consequences are potentially fatal, requiring urgent medical and/or surgical intervention. If the plaques cause complete or "almost" complete arterial occlusion, the part of the heart muscle supplied by the occluded artery will eventually die causing what is known as Myocardial Infarction.


CAD is a progressive disease developing over decades of life. Patients may remain asymptomatic until developing a heart attack or chest pain known as Angina pectoris or angina. The attack is caused by sudden ischemia affecting the heart especially during exercise or with efforts that lead to increased work-load on the heart, thus requiring more blood supply to the myocardium than it is able to provide.


Narrowing of the coronary artery will block the blood supply reducing blood flow through the vessel causing severe "crushing" chest pain radiating at times to various areas such as the left shoulder, back, neck, throat and jaw.


Another pathology occurs when the atherosclerotic plaques are big in relation to the lumen diameter, or when the plaques rupture releasing emboli (undissolved foreign bodies) that occlude the coronary artery branches which can involve a main coronary artery. This can result in sudden heart failure and myocardial infarction which is a leading cause of sudden death.


The risk of developing coronary artery disease is increased with age especially when associated with lifestyles that include smoking, and diets consisting of high fat intake. Other medical conditions such as diabetes, hypertension and high cholesterol levels contribute to the risk of atherosclerotic plaques.


Smoking causes constriction of blood vessels and increased carbon monoxide CO levels, impairing delivery of good oxygenation and nutrition to the tissues.


Obesity, high stress lifestyle and lack of physical exercise or physical inactivity are also risks for developing CAD. People with these risk factors should start diet modification and physical exercise and discuss, with their healthcare professional, the proper tests to evaluate their risk of CAD. Additionally, a family history of CAD means that the patient may be at higher risk to develop CAD sometime in his/her life.


If you have symptoms suggesting CAD, or one of the mentioned risk factors, you should seek medical advice and be sure to discuss this with your physician. According to your history, physical examination, and routine tests (e.g. complete blood picture, cholesterol and homocysteine levels, ...etc) your doctor may perform other diagnostic tests such as Electrocardiogram (ECG), Echocardiogram, CT scan and Magnetic resonance.


Treatment of CAD starts with lifestyle modifications such as quitting smoking, controlling stress, consuming a healthy diet and engaging in mild, regular exercise. Depending on the tests results and the severity of the disease, the physician may prescribe a drug treatment or schedule an evaluation with a specialist.


Medical treatment includes different medications such as sublingual nitrate tablets (to be used in case of developing chest discomfort) beta blockers, ACE inhibitors, calcium channel blockers and cholesterol-modifying medications such as statins, niacin, fibrates and bile acid sequestrants. These will all be prescribed by you primary care provider.


A vascular treatment may be needed to improve the coronary blood flow. This may include angioplasty with stent insertion. If the artery is not able to be opened by stenting, the only option may be coronary artery bypass surgery.


All procedures should be accompanied by strict lifestyle modifications, regular follow up and control of any risk factors such as diabetes, hypertension and high cholesterol levels.