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 blockers also relax arteries and lower blood pressure as do diuretics. Nitrates, like nitroglycerine, stop persistent chest pain (angina) and improve the heart's blood supply. Statins lower cholesterol.
Prevention
Thirty minutes of exercise daily is the best way to prevent the development of CHD, even when there is a genetic history of the condition in the family. Coupled with a well-balanced, low-fat diet rich in fruits and vegetables, this program will help to keep blood pressure, blood sugar, and cholesterol within normal limits. While eliminating stress from daily life is all but impossible, people who are physically fit and not overweight are better equipped to deal with life's ups and downs. Staying away from cigarettes and other tobacco products and consuming alcoholic beverages in moderation (a glass a day for women, two for men) is also recommended.
New Approaches
When risk factors are present, a preventive, low-dose aspirin regimen may be used, but only under the supervision of a doctor. Recent research has shown that hormone replacement therapy for women does not minimize the risk of a heart attack. Since these HRT treatments have been linked to cancer and strokes in women, and because they carry no cardiac benefit, discontinuing the treatment is now widely advocated. By the same token, the belief that Vitamins C and E, antioxidants, and folic acid prevent or improve CHD has also been proved false.
At one time stenting a blocked or partially blocked artery was considered standard treatment, but the latest research indicates that in all but the most severe cases, medicine does the patient as much good and carries much less ancillary risk than surgery. A stent will not increase the patient's life expectancy when it is used, but the method can reduce angina pains and other CHD symptoms.
Prognosis
The good news is that it's never too late to improve life habits and to get healthy. The body has a tremendous capacity to heal itself in the absence of toxic substances like tobacco and in the presence of good habits like a sound diet and regular exercise. With early detection and appropriate treatment with medication or surgery, CHD can be a manageable condition long-term.