Coronary Heart Disease (CHD), also known as coronary artery disease (CAD), is a widespread form of heart disease affecting the major blood vessels supplying the heart. It occurs when these arteries become damaged and narrowed due to a gradual buildup of plaque, a process called atherosclerosis. This plaque, made of cholesterol and fatty substances, restricts blood flow to the heart muscle. Reduced blood flow, or myocardial ischemia, can cause chest pain (angina) or a heart attack if blood flow is severely restricted. CHD is a progressive condition that worsens over time.
Factors That Increase CHD Risk
Several factors can increase a person’s chances of developing CHD, categorized as either modifiable or non-modifiable. Modifiable risk factors are those that can be changed through lifestyle adjustments or medical intervention. High blood pressure, or hypertension, contributes to CHD by stressing arterial walls. High levels of low-density lipoprotein (LDL) cholesterol, “bad” cholesterol, lead to plaque formation in the arteries, restricting blood flow.
Diabetes also elevates CHD risk because high blood sugar levels can damage blood vessels and nerves controlling the heart over time. Smoking is a preventable risk factor, as chemicals in tobacco damage blood vessels and raise blood pressure, increasing risk. Obesity increases CHD risk and often contributes to other modifiable risks. A lack of regular physical activity and an unhealthy diet high in unhealthy fats and sugars also contribute to increased risk. Chronic stress can also play a role, leading to higher blood pressure.
Non-modifiable risk factors are those that cannot be changed, but they are important for assessing overall CHD risk. Age is a factor, with the prevalence of CHD increasing after 35 years of age for both men and women. Men generally face a greater risk of CHD than pre-menopausal women, although the risk becomes similar after menopause. A family history of early heart disease in a parent or sibling significantly increases risk. Ethnicity also plays a role, with certain groups having an increased risk of CHD.
Identifying and Diagnosing CHD Risk
Identifying and diagnosing CHD risk involves medical history, physical examinations, and various diagnostic tests. Regular check-ups allow healthcare providers to assess individual risk factors, including personal and family medical history, blood pressure, and lifestyle habits. Symptoms like chest pain, shortness of breath, or unusual fatigue can also prompt investigation.
Common blood tests evaluate risk, measuring levels of:
Total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides.
Fasting blood glucose and hemoglobin A1c to screen for diabetes or prediabetes.
High-sensitivity C-reactive protein (hs-CRP), indicating arterial inflammation.
An electrocardiogram (ECG or EKG) records the heart’s electrical activity.
Further diagnostic tools include:
An exercise stress test, monitoring heart activity during physical exertion.
An echocardiogram, using sound waves for heart images and blood flow.
A coronary calcium scan (cardiac CT), measuring calcium deposits in coronary arteries.
A coronary angiogram, using X-rays and dye to visualize artery narrowing or blockages.
Strategies for Lowering CHD Risk
Lowering CHD risk involves a combination of lifestyle modifications and, when necessary, medical management. Adopting a heart-healthy diet is a cornerstone of prevention. This includes eating plenty of fruits, vegetables, whole grains, and lean proteins like fish and poultry. The Mediterranean diet, rich in plant-based foods, olive oil, and fish, has been shown to reduce the risk of cardiovascular events by influencing blood pressure and inflammation markers. Limiting saturated fats, refined sugars, and excessive salt intake is also recommended.
Regular physical activity strengthens the heart muscle and improves blood circulation, lowering cholesterol and blood pressure. Maintaining a healthy weight reduces strain on the heart and helps manage other risk factors like high blood pressure and diabetes. Quitting smoking is one of the most impactful changes, as the risk of heart disease begins to decrease shortly after cessation. Techniques for stress management, such as mindfulness or yoga, can also contribute to heart health.
When lifestyle changes are not enough, or for individuals at high risk, medical management becomes important. Medications like statins are prescribed to lower cholesterol levels and slow plaque buildup. Blood pressure medications, such as ACE inhibitors or beta blockers, help relax blood vessels and reduce the heart’s workload. For individuals with diabetes, medicines to control blood sugar can help lower the risk of CHD complications. Newer anti-inflammatory drugs, such as low-dose colchicine, have also been approved for patients with established CHD to reduce the risk of recurrent cardiovascular events. Adherence to medical advice and regular follow-up appointments are important for effective risk management.