Coronary Artery Disease | cdc.gov

Coronary artery disease is caused by plaque buildup in the wall of the arteries that supply blood to the heart (called coronary arteries). Plaque is made up of cholesterol deposits. Plaque buildup causes the inside of the arteries to narrow over time. This process is called atherosclerosis.

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What is coronary artery disease?

Coronary artery disease (CAD) is the most common type of heart disease in the United States. It is sometimes called coronary heart disease or ischemic heart disease.

For some people, the first sign of CAD is a heart attack. You and your health care team may be able to help reduce your risk for CAD.

What causes coronary artery disease?

CAD is caused by plaque buildup in the walls of the arteries that supply blood to the heart (called coronary arteries) and other parts of the body.

Plaque is made up of deposits of cholesterol and other substances in the artery. Plaque buildup causes the inside of the arteries to narrow over time, which can partially or totally block the blood flow. This process is called atherosclerosis.

What are the symptoms of coronary artery disease?

Angina, or chest pain and discomfort, is the most common symptom of CAD. Angina can happen when too much plaque builds up inside arteries, causing them to narrow. Narrowed arteries can cause chest pain because they can block blood flow to your heart muscle and the rest of your body.

For many people, the first clue that they have CAD is a heart attack. Symptoms of heart attack include

• Chest pain or discomfort (angina)
• Weakness, light-headedness, nausea (feeling sick to your stomach), or a cold sweat
• Pain or discomfort in the arms or shoulder
• Shortness of breath

Over time, CAD can weaken the heart muscle. This may lead to heart failure, a serious condition where the heart can’t pump blood the way it should.

Learn the facts about heart disease, including coronary artery disease, the most common type of heart disease.

What are the risks for coronary artery disease?

Overweight, physical inactivity, unhealthy eating, and smoking tobacco are risk factors for CAD. A family history of heart disease also increases your risk for CAD, especially a family history of having heart disease at an early age (50 or younger).

To find out your risk for CAD, your health care team may measure your blood pressure, blood cholesterol, and blood sugar levels.

Learn more about heart disease risk factors.

How is coronary artery disease diagnosed?

If you’re at high risk for heart disease or already have symptoms, your doctor can use several tests to diagnose CAD.

Heart tests and what they do.

Test	What it Does
ECG or EKG (electrocardiogram)	Measures the electrical activity, rate, and regularity of your heartbeat.
Echocardiogram	Uses ultrasound (special sound wave) to create a picture of the heart.
Exercise stress test	Measures your heart rate while you walk on a treadmill. This helps to determine how well your heart is working when it has to pump more blood.
Chest X-ray	Uses x-rays to create a picture of the heart, lungs, and other organs in the chest.
Cardiac catheterization	Checks the inside of your arteries for blockage by inserting a thin, flexible tube through an artery in the groin, arm, or neck to reach the heart. Health care professionals can measure blood pressure within the heart and the strength of blood flow through the heart’s chambers as well as collect blood samples from the heart or inject dye into the arteries of the heart (coronary arteries).
Coronary angiogram	Monitors blockage and flow of blood through the coronary arteries. Uses X-rays to detect dye injected via cardiac catheterization.
Coronary artery calcium scan	A computed tomography (CT) scan that looks in the coronary arteries for calcium buildup and plaque.

What is cardiac rehabilitation and recovery?

Cardiac rehabilitation (rehab) is an important program for anyone recovering from a heart attack, heart failure, or other heart problem that required surgery or medical care. In these people, cardiac rehab can help improve quality of life and can help prevent another cardiac event. Cardiac rehab is a supervised program that includes

• Physical activity
• Education about healthy living, including healthy eating, taking medicine as prescribed, and ways to help you quit smoking
• Counseling to find ways to relieve stress and improve mental health

A team of people may help you through cardiac rehab, including your health care team, exercise and nutrition specialists, physical therapists, and counselors or mental health professionals.

How can I be healthier if I have coronary artery disease?

If you have CAD, your health care team may suggest the following steps to help lower your risk for heart attack or worsening heart disease:

• Lifestyle changes, such as eating a healthier (lower sodium, lower fat) diet, increasing physical activity, reaching a healthy weight, and quitting smoking
• Medicines to treat risk factors for CAD, such as high cholesterol, high blood pressure, or an irregular heartbeat
• Surgical procedures to help restore blood flow to the heart

Arteriosclerosis & Atherosclerosis in Brighton, MA

What is Atherosclerosis?

Atherosclerosis is hardening of a blood vessel from a buildup of plaque. Plaque is made of fatty deposits, cholesterol and calcium. Plaque buildup causes the artery to narrow and harden. Plaque buildup can slow and even stop blood flow. This means the tissue supplied by the artery is cut off from its blood supply. This often leads to pain or decreased function. This condition can cause a number of serious health problems. Depending on the location of the blockage, it can cause:

• Coronary heart disease – loss of blood to areas of the heart
• Stroke – loss of blood to areas of the brain
• Peripheral vascular disease – loss of blood to the extremities

Atherosclerosis

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A hardened artery is more likely to be damaged. Repeated damage to the inner wall of an artery causes blood clots to form. The clots are called thrombi. They can lead to a further decrease in blood flow. A thrombus sometimes becomes so large that it completely closes off the artery. It could also break into clumps, called emboli. These clumps travel through the bloodstream and lodge in smaller arteries, blocking them off. The tissue supplied by the artery receives no oxygen. It quickly dies. When this occurs in the heart, it is called a heart attack . In the brain, it is called a stroke. Long-term atherosclerosis can also cause arteries to weaken. They may bulge under pressure. This bulge is called an aneurysm. If untreated, they can rupture and bleed.

Causes & Risk Factors for Atherosclerosis

Causes

Atherosclerosis is caused by plaque. Plaque is created by high levels of cholesterol and fat in the blood. Scar tissue and calcium from vessel injury can also add to the plaque buildup. The process leading to this may begin in childhood. It takes decades before it causes serious health problems.

Risk Factors

Men, especially those over 45 years of age, are more likely to have this condition. Atherosclerosis is more common in women over 55 years of age.

Factors that increase your chance of getting atherosclerosis include:

• Family history of the disease
• High cholesterol – especially low-density lipoprotein (LDL) cholesterol and low high-density lipoprotein (HDL) cholesterol
• High blood pressure
• Poor diet
• Cigarette smoking
• Diabetes type 1 and type 2
• Overweight and obesity
• Lack of physical activity
• Metabolic syndrome – a combination of three out of the following five findings:
  • Low HDL-cholesterol – also called good cholesterol
  • High triglycerides
  • Elevated blood sugar
  • Elevated blood pressure
  • Increased waist circumference – greater than 40 inches in men and 35 inches in women

Symptoms of Atherosclerosis

Early atherosclerosis does not have any symptoms. Symptoms may begin to appear as the arteries become harder and narrower. Symptoms can occur suddenly if a clot blocks a blood vessel or a large blockage breaks free. Symptoms depend on which arteries are affected. For example:

• Coronary arteries of the heart – may cause symptoms of heart disease, such as chest pain
• Arteries to the brain – may cause symptoms of a stroke such as weakness, vision problems, speech problems or headache
• Arteries in the lower extremities – may cause pain in the legs or feet and trouble walking

Diagnosing Atherosclerosis

Most people are diagnosed after they develop symptoms. However, people can be screened and treated for risk factors.You will be asked questions to help determine what arteries might be affected. You will also be asked about your symptoms and medical history. A physical exam will be done. Tests will depend on which arteries may be involved. Many of these tests detect problems with the tissue that is not getting enough blood. Tests that evaluate the atherosclerotic arteries are:

• Angiography
• Cardiac catheterization
• Ultrasound
• Electrocardiogram (ECG)

Treatments for Atherosclerosis

An important part of treatment is reducing risk factors. To do so, see the steps in the prevention section below. Treatment depends on the area of the body most affected. Treatment may include:

Medical Drug Therapy

Medications can:

• Interfere with the forming of blood clots
• Control blood pressure if elevated
• Lower cholesterol if elevated
• Improve the flow of blood through narrowed arteries

How to Prevent Atherosclerosis

Follow these methods to attempt to prevent and reverse atherosclerosis:

• Eat a healthy diet. It should be low in saturated fat and cholesterol. It should also be rich in whole grains, fruits and vegetables.
• Exercise regularly.
• Maintain a healthy weight. If you are overweight, lose weight.
• Don’t smoke. If you smoke, talk to your doctor about ways to quit.
• Control any chronic conditions you may have, such as diabetes.

If your doctor recommends it, take medication to reduce your risk factors. This may include medication for high blood pressure or high cholesterol. Talk to your doctor about screening tests for coronary artery disease if you have risk factors.

Atherosclerosis of the arteries of the neck – symptoms, causes, examinations and diagnosis

What should be done for the early diagnosis of atherosclerosis of the vessels of the neck? The patient, first of all, needs to make an appointment for a consultation with a cardiologist, a general practitioner and make laboratory tests (lipidogram).

After the initial appointment, the doctor may prescribe additional examinations:

• Ultrasound of the brachiocephalic vessels (BCA)
• Coronary angiography
• Ultrasound of liver vessels
• Ultrasound of head and neck vessels
• Ultrasound of the vessels of the penis.

Atherosclerosis is a disease that occurs due to plaque buildup on the inner walls of arteries in the neck. Arteries are blood vessels that carry blood and oxygen from the heart to the rest of the body. Plaque is a sticky substance made up of fat, cholesterol, calcium, and other substances. As plaque builds up, the cervical arteries become hard and narrow. Hardening of the neck vessels can cause several problems. Narrow or blocked arteries cannot deliver enough blood, oxygen, and nutrients to the brain. The blockage can eventually lead to the death of brain tissue. A piece of plaque can break out and then get stuck somewhere in the brain. Atherosclerosis of the vessels of the neck can begin to develop in childhood and worsen over time.

Stages of neck atherosclerosis

There are several stages of atherosclerosis of the vessels of the neck. Each stage includes changes in the wall of the artery. These changes are so small that most of them cannot be seen without a microscope. But in sum, they can cause serious damage to the artery. Stages of cervical atherosclerosis pass for many years. And often go unnoticed.

Stage 1: endothelial injury and immune response . Atherosclerosis of the vessels of the neck begins when damage to the inner layer of the artery wall occurs. This layer is called the intima. The surface of the intima is lined with endothelial cells. This thin membrane, called the endothelium, is the barrier between the blood and the artery wall. Many factors can harm the endothelium:

• high level of cholesterol circulating in the blood.
• toxins as from cigarette smoke.
• high blood pressure that persists for a long time.

Body response after endothelial injury:

• cholesterol from the blood begins to accumulate at the site of injury
• cholesterol is oxidized and triggers an immune response

The

• immune response causes many white blood cells to move into this area. These white blood cells are called monocytes. They collect and lead to inflammation in the arteries.

Stage 2: “Fat streak” is the first visible sign of atherosclerosis. This is a yellow streak or spot formed by dead cells at the site of endothelial injury. Formation of “strip”:

• monocytes that move into the artery turn into cells called macrophages. Macrophages surround and consume invaders to get rid of them. In this case, macrophages consume cholesterol
• when macrophages are filled with cholesterol, they take on a frothy appearance. That is why they are called “foam cells”
• after foam cells consume cholesterol, they die
• as the cells die, the body sends more and more white blood cells to this area. Cells continue to consume cholesterol, foam and die. As this process continues, it further damages the patient’s endothelium.

All dead cells form a bulge under the endothelium. The “fat streak” is the beginning of plaque formation.

Stage 3: plaque growth Dead cells and other waste continue to accumulate in place of the fat streak. The fatty strip gradually increases and turns into a larger layer of plaque. The smooth muscle cells of the artery form a layer on top of this plaque. This is called a fibrous cap. A fibrous cap covers the plaque. It prevents pieces of plaque from entering the bloodstream. At the same time, the raid continues to grow. It gets calcium, which makes it harder. For a while, the blood flow circulates normally because the wall of the artery expands outward, making room for the plaque. But for now, the vessel can only expand outward. As the plaque gets too big, the opening of the artery gets narrower and narrower. Plaque can remain stable for a long time. But eventually the plaque can rupture.

Stage 4: plaque rupture In this final stage, the plaque ruptures and causes serious problems in the body. At the moment, the plaque has been in the artery for a long time – perhaps for many years. It increased in size and took up more space in the artery. But the fibrous cap had kept the plaque from rupturing up to this point. When the fibrous cap ruptures, the plaque inside comes into contact with blood. This can cause a blood clot to form, blocking blood flow and leading to a heart attack or stroke. Doctors are still learning how these tears happen and who is at risk. The thin fibrous membrane is more likely to rupture than the thicker one. The size of the plaque itself may not matter much. In some cases, small plaque bulges lead to a heart attack.

What causes atherosclerosis of the vessels of the neck?

Damage to the inner lining of an artery (endothelium) causes the onset of atherosclerosis. Damage usually occurs slowly and over time.

Risk factors for atherosclerosis

Some conditions may increase the risk of atherosclerosis:

• hyperlipidemia (high cholesterol)
• hypertension (high blood pressure)
• hyperglycemia (high blood sugar)
• immune response and inflammation. Smoking is the main reason.

What are the symptoms of atherosclerosis?

Cervical atherosclerosis often causes no symptoms until the artery becomes very narrow or completely blocked. Many patients are not even aware that they have a disease until a medical emergency occurs, such as a heart attack or stroke. The patient may begin to notice symptoms if the artery is more than 70% blocked. A blockage slows blood flow. As a result, the brain does not receive enough oxygen. Some early warning signs: A blood clot or blockage can also lead to a stroke. Stroke symptoms include:

• sudden numbness or weakness in the face, arms or legs, especially on one side of the body
• sudden trouble speaking or understanding others
• slurred or confused speech
• vision problems in one or both eyes
• severe dizziness or loss of balance
• trouble walking
• sudden and severe headache

Cervical atherosclerosis usually does not cause symptoms until the artery is severely blocked. But some patients experience early warning signs days or weeks before a medical emergency call. Atherosclerosis can lead to serious health problems and is a medical emergency.

Diagnosis of atherosclerosis of the vessels of the neck – examinations and tests

To determine the presence of atherosclerosis, a neurologist or vascular surgeon will do the following:

• family and personal history studies
• physical examination, listening with a stethoscope for weak or absent pulse or unusual sound in the arteries
• blood tests that can measure the amount of fat, cholesterol, sugar, and protein in the blood.

Your doctor may order additional tests and tests to diagnose atherosclerosis and plan the best treatment for you:

• CT angiography of neck vessels
• ankle-brachial index. Study compares ankle blood pressure to arm pressure to measure blood flow in limbs
• Ultrasound of the carotid arteries. Allows you to detect hardening or narrowing of the arteries as blood flows to the brain
• MRI of neck vessels.

Treatment

Treatment of cervical atherosclerosis may include lifestyle changes, medications, and surgical procedures. General treatment goals:

• reduced risk of blood clots
• prevention of complications such as heart attack or stroke
• relief of disturbing symptoms
• slowing down or stopping the formation of plaque in the arteries
• improve blood flow by widening arteries or bypassing blockages.

The following factors can be controlled with drugs:

• blood pressure
• cholesterol level
• blood glucose level
• thrombus formation.

Can atherosclerosis of the neck arteries be cured?

Atherosclerosis of the vessels of the neck is irreversible. But the attending physician will help to cope with atherosclerosis so that it does not worsen and does not lead to complications. Research continues to explore new treatments that can reverse atherosclerosis.

Prophylaxis

It is often impossible to prevent atherosclerosis. But it is possible to reduce the risk and reduce the consequences of the disease. Recommendations:

• Healthy diet low in saturated and trans fats, cholesterol, sodium (salt) and sugar
• regular exercise, light walks up to 30 minutes per day most days of the week
• healthy weight
• management of all health conditions, especially diabetes, high blood pressure and high cholesterol
• smoking cessation
• annual check-up by the attending physician.

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List of scientific literature

1. Zubarev A.R., Grigoryan P.A. Ultrasonic angioscanning. M.: Medicine, 1990, p.176.
2. Geraskina L.A., Suslina Z.A., Fonyakin A.V., Sharypova T.N. Cerebral perfusion in patients with arterial hypertension and with chronic forms of vascular pathology of the brain. Ter archive 2003;12:32-36.
3. Goryunov B.C. Surgical treatment of patients with combined lesions of the coronary and brachiocephalic arteries. Cardiology 1990;4:119-121.
4. Kulikov V.P. Fundamentals of ultrasound examination of blood vessels. Moscow: Vidar-M. 2015; from 392
5. Tsyb AF Ultrasound diagnosis of thyroid diseases. / A. F. Tsyb, V. N. Parshin, G. V. Nestaiko M.: Medicine. – 1998. – S. 341.

90,000 Scientists have found a link between certain gene variants and atherosclerosis

Cholesterol-independent gene variants increase
risk of heart disease, diabetes, high blood pressure,
writes eurekalert.org with
reference to Science Translational Medicine.

High cholesterol is the most commonly understood cause
atherosclerosis, a hardening of the arteries that increases the risk of heart
seizure and stroke. But now scientists from the Medical School
Washington University in St. Louis identified a gene that,
likely plays a causal role in coronary artery disease
regardless of cholesterol levels. Gene is also possibly playing
role in the development of cardiovascular diseases such as
high blood pressure and diabetes.

By studying mice and human genetic data, researchers
found that the SVEP1 gene produces a protein that stimulates
plaque formation in the arteries. In mice that lacked
one copy of SVEP1 had less plaque in the arteries than mice with
both copies. The researchers also selectively reduced the protein in
the walls of the arteries of mice, which further reduced the risk of atherosclerosis.

By evaluating a person’s genetic data, the researchers found that
that genetic variations affecting the levels of this protein in
body correlate with the risk of developing plaque in the arteries.
Genetically determined high protein levels mean more
high risk of developing plaques and vice versa. Just the same they
found that higher protein levels correlated with more
high risk of diabetes and higher rates
blood pressure.

“Cardiovascular disease remains the most common
cause of death worldwide, said cardiologist Nathan O.
Stitziel, MD, Associate Professor of Medicine and Genetics. –
The main goal of the treatment of cardiovascular diseases properly
way focused on lowering cholesterol levels. But we must
be causes of cardiovascular disease that are not related
with cholesterol – or lipids – in the blood. We can lower the level
cholesterol to very low levels, but some people still
will carry a residual risk of developing coronary heart disease in
the future. We’re trying to figure out what else is going on so we can
improve that too.”

This is not the first non-lipid gene to be identified.
involved in cardiovascular disease. But exciting
aspect of this discovery is that, according to
researchers, it is better suited for developing future methods
treatment.

Researchers including co-authors In-Hyuk Jung, Ph.D.,
staff researcher, and Jared S. Elenbaas, PhD student at
Stitziel’s laboratories have also shown that this protein is
a complex structural molecule and is produced by smooth
vessels. Muscle cells, which are cells
walls of blood vessels, contract and relax the vascular
net. The protein has been shown to cause inflammation in plaques on
artery walls and makes plaques less stable. unstable
plaque is especially dangerous because it can come off, which
lead to the formation of a blood clot, which can cause cardiac
seizure or stroke.

“In animal models, we found that the protein induces
atherosclerosis and contributes to the instability of plaque, –
Jung said. – We also saw that it increases the amount
inflammatory immune cells in plaques and reduces collagen,
which performs a stabilizing function in plaques.”

Other genes previously identified as
increase the risk of cardiovascular disease, regardless of
cholesterol appears to play a widespread role in
body and are therefore more likely to have
far-reaching unwanted side effects, if
block to prevent cardiovascular
diseases. Although SVEP1 is essential for early embryonic development,
According to the researchers, elimination of the protein in adult mice does not
had a harmful effect.