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Coronary artery disease (CAD), also known as atherosclerosis, is the most common type of heart disease, with the CDC reporting a prevalence of around 18.2 million adults aged 20 and older, representing about 6.7% of the population. The American Heart Association (AHA) reports that CAD accounts for approximately 360,000 deaths annually, making it the leading cause of death for both men and women. Many of these patients with CAD are unaware of their diagnosis until serious symptoms occur.

In fact, CAD may take place over decades, as it involves the buildup of plaque in the arteries. 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, patients may experience tightness in the chest during exertion, shortness of breath, fatigue, heart palpitations and lightheadedness. People who experience these symptoms should visit their primary care physician or a cardiologist.

Causes of CAD include several modifiable factors: high blood pressure, diabetes, smoking, and a sedentary lifestyle can all contribute to developing the disease. In addition, several non-modifiable risk factors: family history of CAD, age (increased risk with age), and gender (men greater risk than women) can also influence CAD risk.

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 elevated cholesterol levels, particularly elevated low-density cholesterol (LDL) or “bad cholesterol”. High density cholesterol (HDL) or “good cholesterol” can protect an individual from heart disease. We are also now checking other lipid markers in the blood like lipoprotein(a) – a low-density variant that can be a risk factor for atherosclerosis and related diseases – as well as inflammatory markers such as C-Reactive Protein (CRP), which have both been independently associated with higher CAD risk.

Another test that I recommend to patients is a coronary calcium score, which is a CT scan that evaluates for calcification in the coronary arteries which is suggestive of the presence of plaque. Having an elevated calcium score indicates elevated risk and can help your doctor treat you more appropriately based on your risk level. The test is a powerful tool to assess heart attack risk over a 10-year period. 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.

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 an invasive procedure or the need for 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.

Dr. Gregory Pontone is a noninvasive cardiologist and the Associate Medical Director of Ambulatory Quality and Physician Services at White Plains Hospital. To make an appointment, call 914-849-4800.

Health Matters
The original version of this article was published in Health Matters, a White Plains Hospital publication.