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Coronary artery disease

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**Symptoms and Risk Factors:**
– Signs and symptoms include chest pain, angina, shortness of breath, sweating, and nausea.
– Females may experience symptoms like shortness of breath, fatigue, and chest pain.
– Risk factors involve atherosclerosis, smoking, diabetes, high blood pressure, obesity, lack of exercise, and poor diet.
– Genetics contribute to around 50% of cases, with smoking and obesity being significant factors.

**Blood Fats and Genetics:**
– Different fats in the diet influence cholesterol levels in the bloodstream.
– Genetics play a role in CAD, with over 160 genetic susceptibility loci identified.
– Specific genes like FoxP1, ICOSLG, and TCF3/E2A are associated with CAD.
– Heritability of CAD is estimated between 40% and 60%.

**Treatment and Prevention:**
– Prevention measures include a healthy diet, regular exercise, weight management, and not smoking.
– Medications like aspirin, beta blockers, and statins are commonly used.
– Procedures such as PCI or CABG may be necessary for advanced cases.
– CAD affected 110 million people and caused 8.9 million deaths in 2015.

**Pathophysiology and Diagnosis:**
– CAD leads to ischemia in heart muscle cells due to atherosclerosis.
– Plaques in arteries cause partial obstruction to blood flow.
– Diagnosis involves symptoms and initial investigations like ECG.
– Non-invasive tests like CTA and PET are used for diagnosis.

**Prevention Strategies and Secondary Prevention:**
– Up to 90% of cardiovascular disease is preventable through physical exercise, healthy diet, and smoking cessation.
– Lifestyle changes like weight control, smoking cessation, and stress reduction are crucial for secondary prevention.
– Specific diets like the Mediterranean diet and high fiber diet can lower the risk of CAD.
– Counseling and education are beneficial for high-risk groups.

Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), myocardial ischemia, or simply heart disease, involves the reduction of blood flow to the cardiac muscle due to build-up of atherosclerotic plaque in the arteries of the heart. It is the most common of the cardiovascular diseases. Types include stable angina, unstable angina, and myocardial infarction.

Coronary artery disease
Other namesAtherosclerotic heart disease, atherosclerotic vascular disease, coronary heart disease
Illustration depicting atherosclerosis in a coronary artery
SpecialtyCardiology, cardiac surgery
SymptomsChest pain, shortness of breath
ComplicationsHeart failure, abnormal heart rhythms, heart attack, cardiogenic shock, cardiac arrest
CausesAtherosclerosis of the arteries of the heart
Risk factorsHigh blood pressure, smoking, diabetes, lack of exercise, obesity, high blood cholesterol
Diagnostic methodElectrocardiogram, cardiac stress test, coronary computed tomographic angiography, coronary angiogram
PreventionHealthy diet, regular exercise, maintaining a healthy weight, not smoking
TreatmentPercutaneous coronary intervention (PCI), coronary artery bypass surgery (CABG)
MedicationAspirin, beta blockers, nitroglycerin, statins
Frequency110 million (2015)
Deaths8.9 million (2015)

A common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw. Occasionally it may feel like heartburn. Usually symptoms occur with exercise or emotional stress, last less than a few minutes, and improve with rest. Shortness of breath may also occur and sometimes no symptoms are present. In many cases, the first sign is a heart attack. Other complications include heart failure or an abnormal heartbeat.

Risk factors include high blood pressure, smoking, diabetes, lack of exercise, obesity, high blood cholesterol, poor diet, depression, and excessive alcohol consumption. A number of tests may help with diagnoses including: electrocardiogram, cardiac stress testing, coronary computed tomographic angiography, biomarkers (high-sensitivity cardiac troponins) and coronary angiogram, among others. Ways to reduce CAD risk include eating a healthy diet, regularly exercising, maintaining a healthy weight, and not smoking. Medications for diabetes, high cholesterol, or high blood pressure are sometimes used. There is limited evidence for screening people who are at low risk and do not have symptoms. Treatment involves the same measures as prevention. Additional medications such as antiplatelets (including aspirin), beta blockers, or nitroglycerin may be recommended. Procedures such as percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) may be used in severe disease. In those with stable CAD it is unclear if PCI or CABG in addition to the other treatments improves life expectancy or decreases heart attack risk.

In 2015, CAD affected 110 million people and resulted in 8.9 million deaths. It makes up 15.6% of all deaths, making it the most common cause of death globally. The risk of death from CAD for a given age decreased between 1980 and 2010, especially in developed countries. The number of cases of CAD for a given age also decreased between 1990 and 2010. In the United States in 2010, about 20% of those over 65 had CAD, while it was present in 7% of those 45 to 64, and 1.3% of those 18 to 45; rates were higher among males than females of a given age.

Clogged artery
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