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By Gregory Pontone, MD, MBA, Cardiology
Coronary artery disease (CAD), also known as atherosclerosis, is the most common type of heart disease, with the CDC reporting that it killed 375,476 people in 2021. About 5% of those aged 20 and older have CAD – but many may not even be aware of it until serious symptoms occur.
In fact, CAD may take place over decades, as it involves the buildup of plaque. Plaque is made of several substances, including cholesterol. Plaque buildup can start at an early age and is caused by a combination of genetic and lifestyle risk factors. As plaque builds up over time, the arteries become increasingly narrow; the resulting poor blood flow to the heart can result in angina (chest pain) as well as blood clots, further blocking the arteries and possibly leading to a heart attack.
Indeed, many symptoms of CAD, are similar to those of a heart attack: in addition to chest pain, they may experience tightness in the chest during exertion, shortness of breath, fatigue, and lightheadedness. People who experience these symptoms during exertion may feel relief when they stop physical activity, but if it recurs when they begin exerting themselves, it may be time to visit their primary care physician or a cardiologist.
Causes of CAD include several modifiable factors: high blood pressure, diabetes, smoking, and a lack of exercise can all contribute to developing the disease. In addition, a family history of CAD (primiarly in your parents or siblings) can also be a significant consideration.
Furthermore, men are at a higher risk for developing CAD, although menopause increases a woman’s risk of developing the disease due to the many hormonal changes they experience during and after menopause.
Determining a given patient’s risk for developing (or already having) CAD can involve a number of tests, including a routine blood test, which will reveal if they have low-density lipoprotein (LDL) – commonly called the “bad” cholesterol” –, high-density lipoprotein (HCL) chloesterol (the “good” cholesterol). We also are now checking other markers in the blood like lipoprotein (a) and C-Reactive Protein (CRP), which is an indication of unusual inflammation.
Another test I perform is a coronary calcium score, which is a CT scan that looks at calcification in order to assess your risk of a heart attack over 10 years. There are three levels of results: mild is any number between one and 100; moderate is anywhere from 100 to 300; and severe is any number greater than 300; in fact, a severe score can be several hundred, indicating that action should be taken quickly.
Prevention and Treatment
A good diet can help reduce your risk of coronary artery disease. I recommend eating vegetables, fruits, fish, and legumes. It is also important to get enough exercise; I recommend at least 150 minutes of moderate aerobic activity, or 75 minutes of vigorous aerobic activity, a week. As is always the case, the long-term use of cigarettes or other nicotine products can have serious health risks, including the development or acceleration of CAD.
If a person’s case of CAD is found to be especially concerning, there are several prudent treatment options. These can range from taking medications to undergoing surgery. If you are concerned that you may be at risk for, or already have, CAD, ask your doctor to perform an EKG, bloodwork, and/or a calcium score test.
The original version of this article was published in Health Matters, a White Plains Hospital publication.