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The culprits are many - genetics, obesity, smoking, inactivity - but they all commit the same crime. They destroy the human heart. Every year 650,000 Americans die as a result of coronary heart disease (CHD). It's the number one killer of both men and women in this country. An additional 15 million Americans have some form of the condition. They face $304.6 billion in health care costs annually as a result. In the event of a heart attack, 47 percent of those effected will die before they ever reach a hospital. The good news is that CHD is treatable and preventable.

The direct physical cause of CHD is atherosclerosis, a condition in which fats and plaque build up in the arteries, narrowing the vessels and slowing or stopping the flow of blood to the heart. Atherosclerosis can be an inherited condition, but it is also caused by high blood pressure, high cholesterol, diabetes, physical inactivity, smoking, and obesity. Treat or correct any one of those causes and the chances of developing CHD or of the condition leading to a fatal heart attack are immediately lessened.

Symptoms

Most people believe that the tell-tale signs of a heart attack are chest pain and shortness of breath. Women, however, are more likely to suffer from sharp, atypical, intermittent pains in the left chest, back, arm, or abdomen. These pains, unlike the typical variety, do not correlate with physical exertion or an emotional incident and are not relieved by nitroglycerin. Typical pains center under the breast bone and are described as heavy and constrictive or "squeezing" in nature.

Diagnosis

Generally physicians use multiple tests to determine the presence of CHD. The traditional test is an electrocardiogram or EEG, generally followed by an angiogram, a procedure in which a catheter is threaded into an artery in the groin into which a dye is injected so x-rays may be taken to evaluate the cardiovascular system. An exercise stress test under monitored conditions is also common, as are nuclear scans, and electron-beam computed tomography (EBCT) to look for calcium lining the arteries.

Treatment

Treatments vary by the degree of the condition. In severe cases, surgery may be necessary to place stents in the effected vessels or even to bypass the blockage. If the disease is present without symptoms, medicines are used including ACE inhibitors to lower blood pressure, blood thinners to minimize the production of blood clots, or beta-blockers to regulate heart rate and lower blood pressure. Calcium channel

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