Every 34 seconds, someone in the United States has a heart attack. Each minute, someone dies from a heart disease related event. Coronary Artery Disease (CAD) is the leading cause of death around the world. It kills 380,000 people in the United States every year. CAD is a specific form of Cardiovascular Disease (CVD). It results from progressive accumulation of fatty plaque, called atherosclerosis, on the inner walls of the small arteries in your heart known as your coronary arteries. When this plaque builds up, it restricts oxygen-rich blood from reaching your heart muscles. It is important to understand that CAD is something that is progressive. Heart attacks might happen suddenly, but the events that lead up to a heart attack, take decades to manifest themselves and are mostly because of poor health habits.
Let’s imagine a regular plumbing pipe in your house that transports water to a faucet in your home from the main water line. After years and years of use, let’s say about 30 years or so, rust and sediment have built up in the pipe and you notice over time that the water pressure, and consequently the amount of water that is coming out of your faucet per minute of use is less and less. And one day, it is down to a trickle. You have to call a plumber and he can either snake out your pipe or if it is in very bad shape, he may have to replace that section of pipe. This is exactly what happens to your coronary arteries over time. If they get to the point that the blood flow is blocked and can’t make it into your heart muscle, you suffer what we call a myocardial infarction, or heart attack.
What are the official risk factors for CAD?
Dietary choices will directly affect CAD (National Institute of Health (NIH) 2014). The key is to limit foods that are high in trans-fats (deep-fried and processed foods), and saturated fats (deep-fried, dairy products, processed foods), as they have been shown to raise LDL cholesterol levels in the blood (NIH 2014). It is also important to monitor salt intake, as high-salt foods can elevate blood pressure (Added sugars from desserts, sodas, canned fruits packed in syrup, and fruit drinks may bump up calorie intake and thus be a precursor to overweight and obesity, raising the risk for CAD). Last, alcohol consumption should be limited (no more than one drink per day for women and two for men), as too much alcohol raises blood pressure and adds extra undesirable calories to the diet.
According to the NIH (2014), inactive people are nearly twice as likely to develop CAD as those who are active. Physical inactivity is highly associated with other CAD risk factors such as high blood pressure, high LDL cholesterol, prediabetes, diabetes, overweight and obesity (NIH 2014).
Overweight and obesity
CAD risk factors such as high blood cholesterol, high blood pressure, diabetes and high triglyceride levels are all correlated with overweight and obesity, which is why these conditions are considered CAD risk factors.
Blood cholesterol levels
The body creates cholesterol to form cell membranes and hormones. Although cholesterol is a known risk factor for CAD, it is the oxidized form of LDL that is more responsible for the beginning and progression of atherosclerosis. Low levels of HDL cholesterol are also a risk factor for CAD. It is to be noted, that how much of a risk factor cholesterol actually is today is a subject of more and more debate. It may not be as much of a risk factor as previously thought.
The constant forces of elevated blood pressure against the innermost layer of heart blood vessels can be a key factor in the development of atherosclerosis and CAD. One high reading does not necessarily mean a person has high blood pressure. However, if readings continue to remain at systolic 140 (or higher) or diastolic 90 (or higher) over days of repeated measurements, a treatment to address high blood pressure will be recommended. Children can also develop high blood pressure, particularly if they are overweight or obese (NIH 2014).
Tobacco use and sustained exposure to second-hand smoke elevate the risk of CAD because smoking damages the lining of blood vessels, increasing the risk of fatty plaque buildup. Nicotine from tobacco also causes the heart rate to accelerate, leading to hypertension.
Prediabetes and diabetes
Diabetes is a chronic metabolic disease characterized by elevated levels of glucose. Prediabetes means the body cannot use insulin effectively; blood sugar levels are above normal but lower than typically seen in people with diabetes. People with prediabetes who fail to manage their blood glucose levels are likely to get type 2 diabetes within 10 years. Prediabetes and diabetes are associated with obesity, lack of physical inactivity and poor dietary choices.
Family history of heart disease can predispose a person to CAD. People are at higher risk if either their mother or a sister was diagnosed with CAD before age 65, or if their father or a brother was diagnosed with CAD before age 55. However, just because CAD runs in a family, it is not certain that others in the family will get it. Much depends on lifestyle and whether an individual has other CAD risk factors. Also, some medicines that treat another risk factor may lessen the genetic influences and slow the progression of CAD (NIH 2014).
Anxiety and stress can play a role in CAD development. These psychological conditions may trigger arteries to tighten, constricting blood flow and leading to hypertension (NIH 2014).
Some research indicates that high levels of triglycerides (or blood fats) may be a risk factor for CAD, especially in women.
CAD risk increases with age. Most people have some plaque buildup in their heart arteries by the time they’re in their 70s (NIH 2014). In women, the risk increases faster after age 55; in men, it increases more quickly after age 45.
Some CAD risk factors cause different problems depending on gender. For instance, diabetes raises the risk of CAD more in women than in men. Also, preeclampsia is a risk factor for CAD. Affecting approximately 5%–8% of all pregnancies, preeclampsia is a progressive disorder distinguished by high blood pressure and the presence of protein in the urine (Preeclampsia Foundation 2010). Before age 55, women have a lower risk of CAD than men of the same age because estrogen appears to provide a protection against the development of CAD (NIH 2014). After 55, CAD risk is similar for women and men.
The good news? Just as CAD is progressive over years from bad health habits, changing those habits can stop the progression and yes, it can even reverse it. According to a study by Professor Alves in 2014, physical activity’s ability to reduce cardiovascular risk is as meaningful as the risk reduction from drugs, including statins used to lower cholesterol. And if you have CAD, not only is it safe to exercise (preferably under supervision), it is highly beneficial to do so.
Your heart health is mostly in your hands. Your lifestyle habits will mostly determine your risk of getting CAD and changing those habits can also change the course of how efficiently your heart will work. Exercise and proper eating to prevent or reverse CAD will “add hours to your day, days to your year, and years to your life.”