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A balanced approach to treating Coronary Artery Disease

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Coronary artery disease (CAD) is reported by the Centers for Disease Control and Prevention (CDC) to be the leading cause of death among adults in America, not only because of its direct effect on the heart (through heart attacks or congestive heart failure) but also because of stroke and renal failure. At the same time, when it is caught early and treated appropriately, the prevention rate of serious outcomes is one of the best in current medicine.  When asking questions about the leading causes of CAD, seven main factors could generally cause this condition. Listed in probable order of significance, they are:
  • High blood pressure, or hypertension, is widely regarded as the leading risk factor, straining the heart and causing damage to arteries. 
  • High (“bad”) cholesterol in the diet leads to atherosclerosis, laying down plaque and clogging up arteries. 
  • Smoking, and even secondary smoke, is a significant risk factor for hypertension and lung damage, depriving the heart of oxygen-rich blood.
  • Diabetes that is poorly controlled can lead to a range of cardiovascular problems, like high blood pressure or cholesterol.
  • Being overweight or obese can result in high blood pressure, high cholesterol, and diabetes, compounding the risk for heart disease.
  • A diet high in saturated fats, trans fats, cholesterol, sugar, and sodium will raise blood pressure and cholesterol levels and could trigger diabetes.
  • A sedentary lifestyle and lack of regular exercise are linked to many factors, such as obesity and high blood pressure. Man-putting-stop-to-domino-effect
A fascinating observation drawn from this list is that there are strong relationships in which the original condition acts as a trigger for another and possibly a more serious one that is higher on the list. For example, obesity leads to high blood pressure and high cholesterol. A sedentary lifestyle can cause obesity and its accompanying risks. Poor dietary control can lead to diabetes, obesity, high cholesterol, etc. It’s an unfortunate domino effect.  As well as these trigger actions, there is a very special circular or reinforcing relationship between the two most dangerous triggers: hypertension and atherosclerosis. The relationship between hypertension (high blood pressure) and atherosclerosis (plaque) is complex and multifaceted. They are interconnected, and one can be both a cause and consequence of the other. 

How does atherosclerosis contribute to hypertension?

Atherosclerosis causes arteries to narrow and stiffen as a layer of plaque forms on the inner walls of blood vessels. As the blood flow is restricted, the heart must pump harder to push blood through these narrowed vessels, increasing blood pressure. Whereas healthy arteries are flexible and elastic, atherosclerosis makes them more rigid, increasing blood flow resistance and raising blood pressure. Atherosclerosis can narrow the arteries leading to the kidneys, impacting their function in regulating blood pressure. This can further contribute to hypertension by leaving too much salt in the body.

How can hypertension lead to atherosclerosis?

Chronic high blood pressure can damage the inner lining of arteries. The high pressure exerts a force against the arterial walls, causing microscopic injuries. These injuries to the arterial lining can lead to inflammation and the development of fatty plaques (atherosclerosis). Over time, these plaques narrow the arteries, which can lead to further elevation in blood pressure.

How do hypertension and atherosclerosis work hand-in-hand to exacerbate the risk of heart disease?

Hypertension can contribute to the development of atherosclerosis, and the reverse is also true. The conditions often coexist and exacerbate each other. The relationship establishes a vicious cycle where hypertension leads to atherosclerosis, and atherosclerosis causes further elevation in blood pressure. This complex relationship highlights the importance of a comprehensive approach to cardiovascular health. Preventing or managing one can reduce both the impact and the advancement of the other. This requires a multifaceted approach involving lifestyle modifications, a healthy diet, regular exercise, and appropriate medication. 

Can there be an integrated approach to treating these conditions together?

Because these conditions are so interwoven, targeting one can positively affect the other. This integrated approach helps to reduce the overall risk of coronary artery disease and other cardiovascular complications. The American Heart Association and other medical bodies emphasize the importance of understanding and managing these interrelated factors to reduce the overall risk of heart disease.

What are the best drugs that can halt the development of CAD and restore health?

The interrelated nature of atherosclerosis, hypertension, and coronary artery disease presents both a challenge and an opportunity in medical management. A coordinated approach is needed to address these coexisting conditions. 

What are the appropriate medications for hypertension?

Controlling blood pressure in patients with hypertension is typically the first line of attack, as it has multiple benefits, helping prevent or slow down the progression of atherosclerosis, kidney damage, and coronary artery disease.
  • Calcium channel blockers (CCBs) like Norvasc and Cardizem help fight against hypertension by blocking the entry of calcium.
  • Angiotensin-converting enzyme (ACE) inhibitors such as Vasotec, Vasodip Combo or Altace, and angiotensin II receptor blockers (ARBs) such as Cozaar, Hyzaar, or Avapro are both first-choice groups of medications for treating high blood pressure. They have similar benefits, and both work equally well. ARBs cause fewer side effects than ACE inhibitors.
  • Beta-blockers like Tenormian, Zebeta, or Coreg block the hormone epinephrine, which lets the heart beat more slowly and with less force.
  • Diuretics such as Lasix or Demadex improve the function of the kidneys to excrete more salt.

What are the appropriate medications for atherosclerosis:

Rather than directly targeting plaques, the treatment of atherosclerosis is more focused on managing underlying risk factors, such as cholesterol levels, Statins like Lipitor, Liptruzet, or Lovaza reduce LDL cholesterol levels and slow down the progression of plaque formation. Antiplatelet agents (blood thinners) containing aspirin can lower the risks of blood clots forming on atherosclerotic plaques. The American College of Cardiology and the American Heart Association both emphasize the need for a coordinated approach to atherosclerosis and hypertension. While managing hypertension is often the first-line strategy, it should also be integrated with efforts to control other risk factors, including atherosclerosis-related ones. Factors such as age, gender, overall cardiovascular risk, and other conditions like diabetes will influence the choice and focus of medication.

FAQ

What are some other risk factors for CAD?

Age, gender, and a family history of heart disease all contribute to coronary artery disease and heart failure risk. In particular, older men having a family history of heart disease have the highest risk of severe coronary failure. Chronic kidney disease strains the heart and, in turn, elevates heart disease risk, while alcohol abuse or heavy drinking can elevate high blood pressure, leading to heart failure and stroke. Chronic stress and poor mental health, like depression, can indirectly affect heart health through poor habits and lack of care in managing other risk factors. Disorders like sleep apnea can lead to problems like hypertension and arrhythmia.

Can a heart blockage cause high blood pressure?

Clogged or blocked arteries (atherosclerosis) can lead to high blood pressure (hypertension) and go on to cause a stroke or even death. It can lead to peripheral arterial disease (PAD), a narrowing of the arteries that carry blood to the arms and legs. The first signs of PAD may be pain or difficulty when walking.

What are the main signs of coronary artery disease?

Signs of coronary artery disease will begin when the flow of oxygen-rich blood to the heart muscles starts to diminish. Reduced oxygen flow to the heart can cause chest pain (angina) and shortness of breath. A complete stoppage can cause a heart attack.

Why does heart disease impact so many people?

According to the World Health Organization, the most prominent causes of heart disease and stroke worldwide are spreading unhealthy diets, physical inactivity, chronic use of tobacco, and overindulgence in alcohol. The effects of these behaviors are elevated risks of raised blood pressure, blood glucose and blood lipids, and obesity.
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