Coronary Artery Disease – Risk Factors And Causes
Coronary artery disease is a very common heart suffering, polymorphic in terms of clinical significance with severe consequences, caused by imbalance between the oxygen supply of the myocardium (heart muscle) and its needs at rest and during exercise. In over 95% of patients the cause of the coronary artery disease is coronary atherosclerosis. The term of coronary artery disease is very close related to that of ischemic heart disease. Coronary heart disease is responsible for 14% of overall mortality worldwide. In the last 30 years, in most developed countries we can see a noticeable reduction in deaths due to coronary artery disease, due to the implementation of national programs of primary and secondary prevention.
Coronary Artery Disease Risk Factors
Recognition and control of cardiovascular risk factors through lifestyle changes or pharmacological treatment, contribute to reducing morbidity and mortality from coronary artery disease.
Classic cardiovascular risk factors:
Unhealthy life style : smoking, diets high in saturated fat and cholesterol, excessive alcohol consumption, sedentary lifestyle
Modifiable biological and clinical factors: hypertension, increased LDL cholesterol (bad cholesterol), low HDL (good cholesterol), increased levels of triglycerides, diabetes mellitus, obesity (especially abdominal)
Individual uninfluenced factors: age – men over 45, women over 55, male gender (in postmenopausal women the cardiovascular artery disease risk equates to that of men at the same age), family history of coronary disease or other atherosclerotic diseases.
The major risk factors for the coronary artery disease are: smoking, hypertension, high levels of serum cholesterol and / or LDL cholesterol, reduce serum HDL cholesterol levels and hyperglycemia. In addition to classical cardiovascular risk factors which can be modified or unmodified, a number of ”new” factors were identified with a role in promoting the process of atherosclerosis: hyperhomocysteinemia, plasma fibrinogen, inflammatory markers (C reactive protein, TNF-alpha, IL-6), impaired fibrinolytic activity, microalbuminuria.
Coronary Artery Disease Causes
Coronary atherosclerosis is the main cause of coronary artery disease. The characteristic lesion is plaque, which causes narrowing of the lumen and loss of arterial elasticity. Atherosclerotic arterial lesions have several stages: fatty streaks, fibrous plaque, complicated plaque. Complications of plaque include rupture or erosion of atheroma plaque that are associated with different degrees of thrombosis, vasoconstriction and distant embolization (life-threatening complications of the coronary artery disease)
Due to atherosclerosis the heart muscle can not be fed properly resulting in myocardial ischemia.
Under normal basal conditions the energy necessary for the cardiac activity comes from the oxidation of free fatty acids and secondary glucose oxidation. In case of ischemia due to coronary artery disease the heart switches to preferential use of glucose as energy substrate, as an adaptive mechanism, reducing myocardial oxygen consumption level. Coronary atherosclerosis is a patchy process, ventricular performance is impaired in the myocardial territory corresponding to the coronarian trunk affected.
Chest Pain In Coronary Artery Disease
It represents the main sign of coronary artery disease and it is considered a warning sign of ischemia. The character and intensity of pain varies from patient to patient, some describe it as a tightness or claw that squezzes their heart, crushing sensation, or as an iron corest that prevents them from breathing. In other cases the pain is compared with a stab. Pain intensity is very high in 70-75% of cases and in 10-12% of cases is reported as a simple chest discomfort, a burning sensation, a bearable weight sensation in the precordial area. Pain or discomfort is located in the chest region but can be located in the epigastrium, abdomen, arms, forearms, elbows and fists. Pain also may radiate to any region of the thorax.