Cardiovascular diseases (CVDs) are the leading cause of mortality in the world, accounting for more than 17.9 million deaths each year (1). Even more, 85 % of these deaths are due to heart attack and stroke (1). Fortunately, there are often symptoms of impeding issues. Find out how you can help your physician identify them before it is too late.
With heart attack at the top of the list of lethal CVDs, it is no surprise that the medical science has invested considerable resources in identifying and treating heart related diseases and conditions. Most heart attacks are caused by the coronary artery disease (CAD), which accounts for most of heart attacks and is the most common type of CVD (2).
What is actually coronary artery disease?
Simply explained, it is the reduction of blood flow to the heart muscle due to the build-up of plaque in the blood vessels that supply the heart. Reduced blood flow causes ischemia, cell starvation due to reduced oxygen supply, and can lead to total cell death and the destruction and scarring of heart muscle tissue. This is myocardial infarction or, as is commonly known, a heart attack.
CAD, known also as coronary heart disease (CHD), accounted for 43.8 % of deaths attributed to CVDs in 2018 in the United States of America (3). Situation in Europe is similar, with 171.1 deaths per 100 000 inhabitants for males and 94.8 per 100 000 inhabitants for females (data from 2015 for 28 member states of European Union) (4). Percentagewise that is 44.9 % (for males) and 24.88 % (for females) of deaths attributed to CVDs.
Careful reader will note that the mortality rate from CAD is significantly higher for males than for females. But, gender is not the only risk factor and there are many others, some seemingly unconnected to CAD or CVDs in general. Primary care physicians are usually well acquainted with both the medical history of their patients and any associated risk factors as well as symptoms of CAD/CVDs, but are often overworked and might miss even obvious signs of potential heart or other cardiovascular issues.
This is where you can help your physician and mitigate the possibility of CAD or other heart-related issues. How are you going to do that? By recognizing that you are in at-risk group, if that was not already communicated to you by your chosen primary care physician, and informing your physician of any symptoms you are experiencing, especially if they have started occurring suddenly and frequently.
Are you at risk for coronary artery disease?
Coronary artery disease has a myriad of risk factors, some carrying more weight than others. Genetics is for example and important factor, not only due to the fact that it accounts for 50 % to 60 % of all cases, but because the individual affected has no control over that (5). Gender is another significant determinant. The lifetime risk of developing CAD at age 40 is 48.6 % for males and 31.7 % for females (6). In general, males are at a higher risk of developing any CVD in general than females, since the disease on average develops 7 to 10 years earlier in males than females (7). The last major risk factor is age. Studies have shown that among the CVDs, CAD was the primary cause of death, with 82 % of all deaths occurring in individuals older than 65 years (8).
Nevertheless, there are several other, lifestyle related factor that contribute to the development of CAD and are within individual’s control. Those include, but are not limited to, smoking, obesity, frequency of physical activity or lack of, (un)healthy diet and stress. Otherwise healthy individuals can greatly reduce the odds of CAD by abstaining from tobacco, maintaining appropriate (for their height) weight, being physically active, eating a balanced diet and managing stress. All of this is especially true for genetically predisposed individuals with a family history of CAD and CVD.
Risk factors for development of coronary artery disease (CAD)
- Family history of CVDs. Who was afflicted? When was it diagnosed? What was the outcome?
- Your gender. Males are at a higher risk than females overall for both CAD and other CVDs.
- Old age. We are more susceptible to a variety of diseases as we grow older. Higher incidence of CAD for both genders.
- Are you a smoker? Studies have shown that the odds of developing CAD increase for a factor of 1.5 to 3 in smokers than in non-smokers (9). The good news is that smoking cessation reduces the risk of mortality and further cardiac event in patients with CAD by as much as 50 % (9).
- Are you maintaining a healthy weight? Data collected during the ongoing Framingham Heart Study and published in 1996 has shown that individuals with an BMI (Body Mass Index) of more than 30 kg/m2 (considered obese) have and approximately two times greater chance (age-adjusted) to develop CAD than those with a BMI of less than 21 kg/m2 (in the normal range) over a 10-year period (10). Cutting down on excess food and being physically active also has many other positive health benefits.
- Do you have type 1 or type 2 diabetes? CAD accounts for more than half of deaths of diabetic individuals (11). Even more, diabetics have a 2 to 4 times greater chance to die from CAD than non-diabetics (in comparison to age-matched control groups) (11).
- High blood pressure. Were you diagnosed with high blood pressure? Above average values of blood pressure (hypertension) are connected to 2.3 times greater mortality rate from CAD (12). Hypertension is also a risk factor for other CVDs, vision loss, chronic kidney disease (CKD) and dementia.
- Lack of exercise. Do you prefer a sedentary lifestyle? Do you take a car to nearby shop or work instead of walking or cycling? Do you exercise? Findings in the 2018 Physical Activity Guidelines Advisory Committee Scientific Report indicate that highly physically active individuals benefit from an up to 25 % risk reduction for CAD (13). Benefits of regular physical activity extend to middle and old age since moderate to high amounts of physical activity lower the risk of coronary artery disease (CAD) for 20 % and 30 %, respectively (14).
- High blood cholesterol. Do you like fatty food? Drink alcoholic beverages in excess? Unhealthy diet and excessive alcohol intake are one of the culprits of high blood cholesterol. Individuals with high total cholesterol have twice the risk of CAD than individuals with normal cholesterol levels (15).
- Are you having difficulties balancing work or school and family life? Do you often feel tired and emotionally drained after coming home from work? Individuals with high work or private life related stress have 1.1 to 1.6 time higher incidence of CAD (16). Learn stress managing techniques for better cardiovascular and overall health.
Knowing these risk factors and if they apply to you personally facilitates better communication with your primary care physician on the topic of cardiovascular health and CAD prevention and management.
How is coronary artery disease (CAD) diagnosed?
There are several diagnostic method for determining coronary artery disease (CAD) and other associated cardiovascular conditions that differ in their complexity and invasiveness for the patient.
Overview of diagnostic methods
- Electrocardiogram (EEG). The most common diagnostic method, used for diagnosis of many other heart issues and conditions beside CAD.
- Exercise stress test. Similar to EEG, but with the added element of physical stress. The patient walks, runs or pedals a stationary bike, which makes the heart work harder and beat faster, while connected to an electrocardiograph. Differences in electrocardiograms during rest and maximum cardiac exertion can indicate the possibility of CAD.
- Ultrasound examination of heart for evidence of CAD and other heart issues.
- Coronary angiography. A more invasive method, entailing the introduction of a special dye (contrast medium) into the bloodstream through a catheter and subsequent X-ray imaging of heart showing narrowed and blocked blood vessels.
- Computerized tomography (CT). Similar to X-ray imaging, but capable of producing 3D images of scanned body parts, in this case images of the heart and the chest cavity.
- Magnetic resonance imaging (MRI). Similar to CT, but uses strong magnetic fields instead of X-rays.
- Ankle–brachial pressure index (ABPI) measurement. Recent studies have shown that 30 % to 50 % of patients with abnormal ABPI, who are consequently suffering from peripheral artery disease (PAD), also have CAD (17). Diagnosing PAD therefore goes hand in hand with CAD diagnosis. Even more, ABPI measurements are indicative of overall cardiovascular health and may improve the accuracy of cardiovascular risk prediction (18).
Helping your physician diagnose CAD
Primary care physician are well versed in diagnosis of a variety of diseases and medical conditions, but are practically without exception overworked world over and often have little time to sufficiently devote themselves to the wellbeing of their patients during routine check-ups. Failures in identification and diagnosis are common, but can be deadly in case of CVDs, especially CAD. This is where YOU can help.
Notify your physician if you are exhibiting any of the following symptoms*:
- Chest discomfort. Pain in your chest that feels worse when you are physically active.
- Chest pain (angina). Usually quite severe chest pain, tightness and pressure, far worse than mere discomfort. It is most intense on the left side of the chest and may spread to the jaw and left shoulder.
- Shortness of breath. Often more evident when under physical exertion or emotional stress.
- Dizziness/light-headedness. Often accompanying physical exertion, but can happen any time.
- Lack of energy. A sense of diminished energy levels and frequent and unexplained fatigue.**
- Feeling tightness in your jaw.**
- Pain in upper back.**
- Pain in upper arm.**
- Upper abdominal pain.**
- Throat pain.**
- Stomach pain.**
*Note: This is NOT medical advice. Accurate diagnosis can only be made by a physician.
**Note: These symptoms are more common in women, but can also affect men.
These are the symptoms most commonly associated with CAD, but can be applied to other diseases and medical conditions. Besides notifying about these symptoms, don’t forget to remind your physician that you are in a risk group for CAD whenever you are examined, even if the reasons are not heart related.
References:
(1) https://www.who.int/en/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
(2) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340604/
(3) https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000558
(4) https://ec.europa.eu/eurostat/statistics-explained/pdfscache/37359.pdf
(5) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4728103/
(6) https://www.ncbi.nlm.nih.gov/pubmed/10023892
(7) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3018605/
(8) https://www.ncbi.nlm.nih.gov/pubmed/19075105/
(10) https://www.ahajournals.org/doi/10.1161/01.ATV.16.12.1509
(11) http://journal.diabetes.org/clinicaldiabetes/v17n21999/pg.58.htm
(12) https://www.nature.com/articles/1001345#ref5
(13) https://health.gov/paguidelines/second-edition/report/pdf/pag_advisory_committee_report.pdf
(14) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4241367/
(16) https://www.nature.com/articles/nrcardio.2017.189
(17) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2733014/
(18) https://jamanetwork.com/journals/jama/article-abstract/182221
