Internal Medicine
Coronary artery disease begins in childhood and gradually progresses when the clinical manifestations become apparent in middle or old age. Atherosclerosis is a Greek word that means “focal accumulation of fat.” According to one hypothesis, atherosclerosis begins in response to endothelial injury. The injured vessel is more susceptible to deposition of fats and thrombus formation.
Types
CAD manifests itself as:
Atherosclerosis occurs worldwide, with greater incidence in developed countries in Europe and US. The prevalence is less in Mediterranean regions as they use more monounsaturated fatty acids in their diet.
The exact number of cases of CAD is difficult to measure because the condition is usually asymptomatic and starts in childhood, progressing to middle age, where the most advanced lesions begin to form.
Factors that increase the risk of CAD are:
Signs and symptoms of coronary artery disease include:
Following labs are used to diagnose CAD:
Differential diagnoses of CAD include:
The mainstay of treatment against CAD is to prevent the process of atherosclerosis by eliminating the causative factors and preventing any clinical manifestations such as angina or MI from developing. Clinical manifestations of CAD vary, ranging from angina, MI to ischemic cardiac myopathy. These are managed accordingly. Interventional treatment procedures for them include:
CAD is almost always caused by atherosclerosis, and the most common cause of atherosclerosis is a high level of blood cholesterol. Statins are used to treat high levels of cholesterol in the body.
Dietary modifications are also advised, including limiting the intake of bad cholesterols and increasing fiber intake in the diet. Insulin resistance is also known to cause high body cholesterol levels, as seen in diabetes type 2. Good glycemic control with treatment compliance and limited sugar intake is aimed for diabetic patients to prevent hypercholesteremia in these patients.
ACE inhibitors are used for blood pressure control and prophylaxis as their use has been linked with a decrease in remodeling of heart muscle after acute coronary syndrome.
Antiplatelets cause blood thinning and are also used to prevent thrombus formation inside coronary vessels.
Following medications are used to manage CAD:
The prognosis of CAD depends upon the extent of the disease and systemic involvement. The factors that influence prognosis include compliance with the medical therapy, earlier detection, and prophylaxis with lifestyle modifications, presence of comorbid conditions, presence of arrhythmias, revascularization potential, and plaque stability.
People with angina and unstable angina that comply with medication and exercise proper care have a good prognosis. People with myocardial infarction (MI) or congestive heart failure (CHF) who develop complications have higher mortality.
Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 16, 2023.
A review on coronary artery disease, its risk factors, and therapeutics - Malakar - 2019 - Journal of Cellular Physiology
https://onlinelibrary.wiley.com/doi/abs/10.1002/jcp.28350
Coronary artery disease (CAD) is a disease of heart vessels that causes atherosclerosis and its manifestations. Atherosclerosis is defined as the thickening of vessel walls due to the deposition of fat and cholesterol inside it. Thickening causes the lumen of these vessels to narrow, obstructing blood flow and hence oxygen flow. Depending upon the extent of narrowing, various manifestations such as angina, unstable angina, myocardial infarction, etc., can be caused.