Coronary heart disease

Coronary artery disease is caused by a hardening or narrowing of the arteries to your heart. The medical term is atheroma or atherosclerosis. Patches of the inner lining of the arteries become furred up from a mixture of fat, cholesterol and cells deposited in the wall. Veins, unlike arteries, do not 'fur up' unless they are asked to do the work of arteries, for example after a bypass operation (see Bypass surgery in Chapter 3). If you think of an artery as a three-lane motorway, the narrowed part of the artery is like a lane of the motorway being coned off; the flow of blood is restricted a bit like the traffic is slowed down as it tries to filter into the lanes that are open. The patches of narrowing are called plaque (pronounced 'plack'), so you may hear doctors refer to atheromatous plaque or plaque disease. Plaque may cause a progressive narrowing of your arteries, restricting blood flow and causing angina (see Chapter 3), or it may rupture or tear causing clots to form, which totally block the artery, and this can lead to a heart attack.

The major causes of atheroma developing are:

• raised cholesterol level;

• cigarette smoking; and

• high blood pressure.

Usually symptoms develop leading to a diagnosis of angina, heart attack or heart failure. Occasionally, the first evidence may be when someone dies suddenly from a heart attack, but there is usually a warning and it is important to understand what the warning signs are.

There are some factors in a person's life called risk factors. People with risk factors have an increased chance of developing a particular condition. For example, working with asbestos or down a coalmine increases the chance (or risk) of developing lung disease, and is thus considered a risk factor. Risk factors for coronary artery disease can be divided into those that can be avoided and those that can not (see Table 2.1). Avoidable risk factors, including diabetes, account for 90% of coronary disease. Risk factors for coronary disease are like penalty

Table 2.1 Avoidable and unavoidable risk factors for heart disease

Avoidable Unavoidable

Cigarette smoking

Male sex

High blood pressure

Family history

High cholesterol

Diabetes (unavoidable to some extent)

Obesity

Age (getting older)

Diabetes (avoidable in many)

Lack of exercise

Stress

Low intake of fruit and vegetables

Excess alcohol

points on a driving licence, only they multiply rather than add up: smoking may give you 3 penalty points and high blood pressure 3 penalty points, but both risk factors at the same time may give you 9 penalty points; if you also have 3 penalty points for a high cholesterol level, then your penalty points may multiply to 2 7 in total.

Are there any risk factors that I can't change?

Your parents, your age and your sex may increase your risks. Your race may also bring risk: people from the Indian subcontinent have more coronary disease, African-Caribbeans less. Having a family history of heart disease, being a male and getting older means that you need to take more care. A high risk family is one in which a close female relative aged 65 years or less, or a male relative aged 55 years or less, or both, developed coronary disease.

But remember that you can lessen many of your risk factors and improve your chances of not developing heart problems.

Prevention is always the best medicine so the first part of this chapter looks at what puts you at risk of developing coronary artery disease, and then how it can be prevented or treated.

RISKS OF SMOKING

I have smoked since my teens just as my father and grandfather did. My father is still alive and my grandfather lived until he was 65. What are my risks of heart disease?

There is overwhelming evidence that smoking causes hardening of the coronary arteries as well as hardening of your arteries to the brain and legs; this hardening leads to narrowed arteries and thus poor blood flow to your heart. It also leads to chronic lung diseases as well as lung cancer, and increases your chances of developing a stomach ulcer. Whilst some people escape the consequences of cigarette smoking, the majority do not.

 
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