Over 95% of all cases of coronary artery disease are caused by inflammation and deterioration in the blood vessels over a period of several decades. The extent of the deterioration varies depending on the cause, including older age, genetics, hypertension, diabetes, high cholesterol, smoking, obesity and lack of exercise. If the coronary arteries narrow by more than 50%, there will be increased symptoms of fatigue during physical exertions that recover after resting. However, with up to 75% or more of narrowing, fatigue can occur even while at rest. Furthermore, in some cases, plaque can rupture inside the arteries, causing platelets and blood coagulation factors to obstruct the affected coronary artery, leading to acute thrombosis, chest pain, fatigue in more severe cases (heart failure), and even cardiac arrest. These symptoms are collectively known as acute coronary syndrome (ACS). It is a medical emergency requiring urgent treatment. Normal people call it a heart attack.
Who are at greater risk of developing this disease?
This disease used to be common among middle-aged men and women in their golden years, but today this condition is becoming increasingly frequent among younger people due to higher levels of stress today, increasing competition, a fast-paced lifestyle, and changes in consumer behaviors, all of which have contributed to more rapid deterioration of the coronary arteries. Thus, it is unsurprising to see more patients experiencing acute coronary syndrome in their 30s. Some people even experience heart attacks while driving when just 48-49 years old. All of the above are risk factors for coronary artery disease.
- Uncorrectable Factors: Age, being male, family history of father’s death due to heart disease before turning 55 years old or mother’s death due to heart disease before turning 65 years old.
- Correctable Factors: Hypertension, diabetes, high cholesterol, smoking, abdominal obesity (abdominal circumference > 36 inches in males and > 32 inches in females), lack of exercise and being in a constantly stressful state.
Risk Factor Control
- Permanently quit smoking. (This can help with other diseases, too.)
- Control blood pressure to be less than or equal to 130/85 for non-diabetic. Meanwhile, diabetic people should control their blood pressure to be less than or equal to 130/80, and patients with poor kidney function should strive to have a blood pressure level that is less than or equal to 125/75 (people with more than 1 gram of albumin in the urine).
- Control diabetes for blood sugar levels to be < 130 mg% at 6 hours of fasting and for the average blood sugar levels over a period of 3 months (HbA1c) to remain at < 7%.
- Control cholesterol levels to remain at < 200 mg%, triglycerides at < 150 mg%, LDL (bad cholesterol) < 100 mg%, HDL (good cholesterol) > 40 mg% (males) and > 45 mg% (females).
- Control weight for body mass index (BMI) < 25 or abdominal circumference < 36 inches (males) or < 32 inches (females).
- Perform aerobic exercise by > 30 minutes for more than 5 times/week.
- Rest sufficiently and avoid being stressed all the time.
Symptoms of Coronary Artery Disease
Pain and tightness in the middle of the chest that extends to the left shoulder and left arm. Some patients experience shooting pain in their neck as well with symptoms worsening during exercise but improving when at rest. Some cases with blocked coronary arteries experience severe ischemia in their heart muscles, which eventually leads to myocardial infarction. This causes the patient to experience intense chest pain, agitation and sweating while the body is cool. If the patient is not taken to the hospital in time, death might result.
Keeping the above symptoms in mind, if anyone suspects of having any of these symptoms, it is important to quickly seek medical attention. In any case, chest pain can be caused by 2 different cases, namely, ischemia due to narrowing of the coronary arteries or myocardial infarction caused by sudden obstruction to the blood supply of the heart.
If the ischemia is due to narrowing of the coronary arteries, symptoms will occur when exerting oneself physically or while exercising. In this case, stop the exertion or exercise that caused the symptoms and quickly go see the doctor, although it is not an emergency yet. On the other hand, if there is myocardial infarction caused by sudden blockage of the arteries supplying blood to the heart, i.e., symptoms occur even while at rest or remaining still and the symptoms are quite severe, urgently seek medical attention at your nearest hospital, or else most of the heart muscles will die within 4-6 hours. If we can correct the problem within the 4-6 hours, it is possible to restore normal heart function. In particular, today we have drugs that can be injected to very effectively dissolve blood clots that cause obstructions in the arteries. Therefore, if you experience the above symptoms of coronary artery disease, you are experiencing a medical emergency requiring urgent treatment within 4-6 hours. Finally, hyperlipidemia and high cholesterol levels increase risk of developing coronary artery disease.
Treatments for Coronary Artery Disease
Today, there are many approaches to treating coronary artery disease, including bypass surgery by connecting a blood vessel from another part below the blocked coronary artery, use of balloon angioplasty to expand arteries and use of a stent to support the blocked artery. However, in cases where an obstruction has already developed, these treatment methods can only provide palliative care to the symptoms. Therefore, prevention is the best treatment. People who have high blood pressure, high blood sugar levels or high cholesterol levels and people who smoke should change their behaviors by quitting smoking, normalizing their blood pressure levels, exercising regularly and modifying their dietary behaviors by consuming less fatty, starchy and sugary food while eating more food with high fiber content.
There are two coronary artery bypass surgery techniques performed today as follows:
- Off-pump coronary artery bypass grafting (CABG) or the kind that does not require “stopping of the heart”. This technique has the advantages of requiring less blood during surgery and less operation time, less anesthesia and shorter recovery time in the hospital than on-pump CABG.
- On-pump coronary artery bypass grafting (on-pump CABG) requires the use of a lung and heart machine to totally “stop” the function of the heart.
Appropriate Diet for People with Coronary Artery Disease
Patients should eat soft foods that are easy to digest and not to strongly flavored. They should consume high-fiber carbohydrates with a low glycemic index in addition to eating food with low fat content, and the fat that they consume should contain unsaturated fatty acids. Furthermore, these patients should eat more fruits, vegetables, wholegrains and water-soluble fiber, which are sources of vitamins and antioxidants and can help lower blood cholesterol levels, prevent constipation and reduce risk for colorectal cancer. Additionally, patients should avoid strongly-flavored fruits and food.
