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CORONARY ARTERY DISEASE PREVENTION

What is coronary heart disease ?

The heart is a pump and the coronary arteries are its fuel supply pipes. The fuel is oxygen, which is carried in the blood. Coronary arteries may narrow due to a thickening of their walls and and this reduces blood flow to the heart muscle. The process is called arteriosclerosis. In its early stages this does not affect the heart's function. When the narrowing gets worse, the lack of oxygen may cause pain called angina. If the narrowing becomes critical, it can cause a complete blockage and lead to a heart attack (properly called a myocardial infarction). In the early stages of the narrowing process, there are no symptoms. Sometimes a myocardial infarction is the first sign that there is any problem. It is all the more important, therefore, to prevent or limit the narrowing process before it causes problems. There is no simple test to screen people for their risk of early narrowing of their arteries. However, even once a heart attack has occurred, the risk of a further attack can be reduced.

How does coronary heart disease occur / Prevention of coronary heart disease

The coronary arteries narrow because fatty substances accumulate in their walls; we do not know the exact reason for this process: therefore we cannot completely prevent it. However, there are several things called risk factors which seem to speed it up. Coronary prevention aims to reduce them. Although the risk of coronary disease may not be completely abolished, it can be substantially reduced. Smoking is the most important of all the risk factors. It is difficult to over-emphasize the part it plays in the acceleration of coronary disease. Angina and heart attacks would be much less common if smoking could be abolished.

Contrary to popular belief, smoking small amounts is nearly as bad as heavy smoking, so that cutting down does not help very much; smoking cigars and pipes is also bad, as the harmful ingredients of smoke are also absorbed through the mouth. It is never too late to stop smoking. However, it takes about 10 years for the effect of smoking to wear off in somebody who has stopped, so the sooner one stops, the better. There is no easy remedy although nicotine substitutes (e.g. Nicorette) help a little. Raised blood pressure also presents a risk for developing coronary artery disease, particularly when there are other risk factors. Contrary to popular opinion, blood pressure may be raised without any symptoms at all. It can only be picked up by actually measuring it; therefore it is important to have it measured regularly.

Diabetes is another condition that may exist without one knowing and can be spotted by testing the urine for sugar. Careful treatment of diabetes should reduce the extent of coronary disease. Exercise reduces the risk of coronary disease risk and lack of exercise increases it. People with a sedentary job should therefore find a form of exercise which they can do regularly. It needs to be sufficient to make one slightly breathless. It should last for 20 30 minutes and be performed at least 2 3 times a week; the actual form of exercise is not important, but you are more likely to keep it up if it is something that you enjoy.

Raised blood cholesterol and other fatty substances in the blood also increase the risk. Cholesterol is a natural substance made in the body and the blood cholesterol level represents a mixture of what your body makes and what you eat. The danger of an elevated blood cholesterol level is relatively small compared with some of the other factors, such as smoking and raised blood pressure, but eating the prudent diet (see below) is sensible. If dieting does not reduce the blood cholesterol enough, your doctor may consider treating you with medication, which may need to be taken lifelong. Modifying your diet may reduce the blood level of cholesterol and other fats. Even if your cholesterol level is quite normal, eating a healthier diet may still benefit your coronary arteries. Because your body makes some of the blood cholesterol, reducing the cholesterol in your food may not reduce your blood cholesterol very much. Nevertheless, you should try to reduce your intake of animal fats and dairy products. Food with high saturated fatty acids is high in cholesterol; a diet with polyunsaturated fatty acid is better and this is achieved by eating less animal fat and fewer dairy products.

The so-called prudent diet has less red meat and fat and more chicken and fish; grills are better than fried food, and vegetable oils, especially corn oil, should be used instead of animal fats. Butter, cream, milk, and cheese should be reduced in favour of corn oil margarine, skimmed milk, and soft cheese. There is no evidence that taking this diet to extremes is important; if one follows it at home, then having what comes when occasionally eating out should not matter. Several books are available which provide guidance on how to eat well but healthily. A family history of coronary heart disease also adds to the risk. Such a risk is of course impossible to avoid but if you have a family history of heart attacks, it is even more important to avoid the other risks. If several close relatives have had angina or heart attacks, or have died from coronary disease, especially if below the age of 60, if is worth seeking medical advice. You may have inherited a particularly high level of cholesterol and stronger tablet treatment and a stricter diet would then be sensible.

Stress may play a part in causing coronary artery disease. In the USA, workaholics seem more at risk, but in the UK executives and managers seem to be less at risk than manual workers. If you do have coronary artery disease, emotion can certainly produce attacks of angina. So there is much to be said for adopting as calm a lifestyle as possible. Aspirin taken daily in a low dose is useful to reduce the build up of blood clot in the artery wall.