Jun 5, 2013 4 min read

Atherosclerosis, often called “hardening of the arteries,” is caused by atherosclerotic plaque made up of cholesterol, calcium, and certain cells that form within the walls of arteries. This plaque can build up in any artery, but when it grows in the coronary arteries, it is called coronary artery disease. Coronary artery disease usually progresses slowly over many years before causing severe problems.

Coronary artery disease is a major cause of death in the United States. When plaque builds up in the arteries, it increases the risk of a heart attack (myocardial infarction) by causing the coronary artery to become unstable. This unstable state can lead to rupture and blood clot formation. The blood clot then plugs the artery, shutting off blood supply to an area of the heart, and consequently leading to a heart attack. Oftentimes, heart attacks can be caused by less than a 50% plaque obstruction in the artery. In order to prevent a heart attack, one must reduce the risk of coronary artery disease. There are a number of ways to reduce the risk of coronary artery disease including, exercise, proper diet, and a number of medicines and treatments.

Exercise and proper diet are both ways to reduce the risk of coronary artery disease. It is recommended that one should get at least 30 minutes of exercise a day and follow a diet rich in fruits and vegetables, low in saturated fats, and avoid trans-fats.

Although living a healthy lifestyle is probably one of the best ways to reduce the risk of coronary artery disease, sometimes additional medicine and/or treatment it needed. Since the medical community has begun to understand that coronary artery disease is an inflammatory condition, anti-inflammatory medications such as “statins” and over-the-counter aspirin can often help to reduce the risk of heart disease. Statins, often thought of as cholesterol reducing medications, are also believed to reduce inflammation within the arteries. This is why statins have been rigorously studied and shown to reduce the risk of fatal and non-fatal heart attacks, and thus, have become a cornerstone in the treatment of coronary artery disease. Aspirin is also often used to prevent heart attack in people who are at risk because aspirin reduces the bodies’ ability to form a clot. Therefore, if a plaque were to rupture within the coronary artery, aspirin reduces the chance that a clot will completely obstruct the artery and cause a heart attack.

Other medicines used to reduce the risk of coronary artery disease include beta blockers, which reduces the “stress” put onto the heart, and nitroglycerin, which can help dilate (or enlarge) the coronary arteries, facilitating better blood flow. These medicines are often reserved for people who have already been diagnosed with coronary artery disease, although they are used for other medical conditions as well.

Procedural treatments are usually recommended by a cardiologist and/or a cardiac surgeon if medications alone are insufficient in treating the coronary artery disease. Procedural treatments often recommended for coronary artery disease include, coronary artery angioplasty and stenting, or even coronary artery bypass surgery.

Symptoms of coronary artery disease may include chest pain or heaviness, jaw discomfort, left (or right) arm discomfort, shortness of breath with or without activity, diffuse sweating, and fatigue. A heart attack may include one or many of these symptoms as well. If the arteries are less than 50 percent blocked, there are typically no symptoms.

Diagnosing coronary artery disease often requires performing regular diagnostic tests for people who are identified as at risk for the condition. These tests may include EKGs, stress tests, coronary CAT scans, coronary calcium scores, or cardiac catheterizations. Depending upon the clinical situation, the appropriate test is chosen by one’s physician after discussion of the risks and benefits.

In the instances that coronary artery disease does cause a heart attack, a cardiologist may choose to angioplasty and stent open the coronary artery that is affected. This will restore blood flow in the artery in the midst of a heart attack. Following angioplasty, with or without a stent, the above mentioned medicines, and often some others, are used to reduce the risk of subsequent heart attacks.

Dr. James Richardson is a cardiologist with Washington Health System Cardiovascular Care .

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