Coronary Artery Disease CAD

Coronary artery disease (CAD) refers to any one of the conditions that affect the coronary arteries and reduces blood flow and nutrients to the heart.

According to the American Heart Association, heart disease is the most common cause of cardiac arrest, and 95 percent of cardiac arrest patients die before they reach the hospital. That high mortality rate has prompted the placement of portable defibrillators in places such as schools, airplanes, police cars, and in this service plaza along the Pennsylvania Turnpike. [Photograph by Keith Srakocic. AP/Wide World Photos. Reproduced by permission.]

It is the leading cause of death worldwide for both men and women. The most common kind of CAD is atherosclerosis, which results in narrowing and hardening of the arteries. Coronary atherosclerosis is at epidemic proportions worldwide.

Traditionally, CAD was seen as a disease of aging and was observed primarily in the elderly. However, atherosclerosis is now occurring more often in younger populations. One out of every three individuals worldwide, estrogen: hormone that helps control female development and menstruation menopause: phase in a woman's life during which ovulation and menstruation ends lipid: fats, waxes, and steroids; important components of cell membranes cholesterol: multi-ringed molecule found in animal cell membranes; a type of lipid triglyceride: a type of fat trans-fatty acids: type of fat thought to increase the risk of heart disease obesity: the condition of being overweight, according to established norms based on sex, age, and height diabetes: inability to regulate level of sugar in the blood stress: heightened state of nervousness or unease calorie: unit of food energy fiber: indigestible plant material which aids digestion by providing bulk

Chronic stress is a risk factor for heart disease, and acute stress can trigger heart attacks. Regular yoga or other exercise may help prevent both conditions by releasing stress and strengthening the heart muscle. [AP/Wide World Photos. Reproduced by permission.]

and one in five in the United States, dies from heart disease each year. In the United States, CAD has declined more rapidly in whites than in blacks. CAD affects women ten years later than men, mostly due to the protective production of estrogen. After menopause, a woman is two times more susceptible to heart disease than women who have not reached menopause.

Risk factors. Controlled risk factors associated with CAD include hypertension; cigarette smoking; elevated blood lipids (e.g. cholesterol, triglyceride); a high-fat diet (especially saturated fats and trans-fatty acids); physical inactivity; obesity; diabetes; and stress. Lifestyle changes can assist in prevention of CAD. Uncontrolled risk factors include a family history of CAD, gender (higher in males), and increasing age.

Tobacco use is one of the leading contributors to heart disease. Smoking increases the risk of heart attacks (and increases the risk of lung diseases) by decreasing oxygen flow to the heart and lungs. Hypertension, which makes the heart work harder than normal, can be caused by poor diet, excessive dietary salt, lack of exercise, smoking, and chronic stress. Adult-onset diabetes mellitus may result from poor dietary habits and lack of exercise over a lifetime. Uncontrolled diabetes can lead to heart failure. Exercise can reduce the risk for CAD by increasing coronary blood flow, and it has shown positive effects on blood flow to the heart (myocardial perfusion). Long-term benefits of exercise include lower incidences of coronary heart failure and increased cardiac function in normal subjects.

Prevention. Health professionals recommend that dietary fat be reduced to 30 percent or less of total calories. The diet also should have no more than 10 percent of its calories from saturated fats, no more than 300 milligrams (mg) of cholesterol daily, no more than 2,400 mg of sodium, and at least 3,500 mg of potassium. A plant-based diet consisting primarily of whole grains, fruits, and vegetables is recommended. Eating at least 25 grams of fiber and five servings of fruits and vegetables daily may reduce the risk for heart disease.

Individuals who consume alcohol should do so in moderation. Moderation is defined as two drinks for men and one drink for women daily. Alcohol is a very addictive substance, however, and should not be used as a primary means of prevention. Caffeine in moderation has no adverse effect; however, excessive intake may make the heart pump faster. Increased heart rate stresses the heart and may cause long-term damage to blood vessels.

Establishing good exercise and dietary habits early in childhood is important to prevent heart disease. Regular activity and proper nutrition decreases reactivity to stress and makes the heart stronger and more efficient. At least thirty minutes of moderate exercise daily is recommended to prevent heart disease. Stress management helps to prevent high blood pressure, which is a major contributor to heart disease. Techniques such as yoga, deep breathing, and meditation may prevent coronary disease by improving resistance to stress. see also Arteriosclerosis; Atherosclerosis; Cardiovascular Diseases; Exercise.

Teresa Lyles

Bibliography

Goldberg, I. J.; Mosca, L.; Piano, M. R.; and Fisher, E. A. (2001). "Wine and Your Heart: A Science Advisory for Healthcare Professionals from the Nutrition Com-

mittee, Council on Epidemiology and Prevention, and Council on Cardiovascular Nursing of the American Heart Association." Circulation 103:472-475.

Insel, P. M., and Roth, W. T. (2004). "Cardiovascular Disease and Cancer." In Core Concepts in Health, 9th (brief) edition. New York: McGraw-Hill.

Mosby's Medical, Nursing, and Allied Health Dictionary, 6th edition (2003). St. Louis, MO: American Dietetic Association.

Internet Resources

American Heart Association. "Congenital Heart Defects in Children Fact Sheet." Available from <http://www.americanheart.org>

American Heart Association/American Stroke Association. "Heart Disease and Stroke Statistics—2003 Update." Available from <http://www.americanheart.org>

"Description of Congenital Heart Defects." Available from <http://www.congenital heartdefects.com/typesofcad.html>

"Heart Attack." Available from <http://www.heartcenteronline.com/myheartdr>

nutrition: the maintenance of health through proper eating, or the study of same reactivity: characteristic set of reactions undergone due to chemical structure high blood pressure: elevation of the pressure in the bloodstream maintained by the heart meditation: stillness of thought, practiced to reduce tension and increase inner peace

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