What You Need to Know If You Have Coronary Artery Disease
2011; Lippincott Williams & Wilkins; Volume: 124; Issue: 6 Linguagem: Inglês
10.1161/circulationaha.111.019836
ISSN1524-4539
Autores Tópico(s)Cardiac Imaging and Diagnostics
ResumoHomeCirculationVol. 124, No. 6What You Need to Know If You Have Coronary Artery Disease Free AccessBrief ReportPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessBrief ReportPDF/EPUBWhat You Need to Know If You Have Coronary Artery Disease Joseph S. Alpert, MD, FAHA, FACC, FESC, MACP Joseph S. AlpertJoseph S. Alpert From the University of Arizona College of Medicine, Tucson, AZ. Originally published9 Aug 2011https://doi.org/10.1161/CIRCULATIONAHA.111.019836Circulation. 2011;124:e176–e178If your doctor has told you that you have coronary artery disease, or if your doctor has told you that you are at increased risk for developing atherosclerosis (commonly called hardening of the arteries), then this Patient Page is for you.Why does atherosclerosis develop in the first place? This disease is often the result of many factors. The 5 most important risk factors are (1) tobacco smoking, (2) diabetes mellitus, (3) a familial tendency to develop this condition, (4) high blood pressure, and (5) an abnormally high cholesterol level in the blood. Other problems that contribute to the development of atherosclerosis include a sedentary lifestyle, obesity, and psychological stress. Atherosclerosis can lead to anginal complications (chest discomfort), heart attack, stroke, or peripheral vascular disease.Doctors are frequently asked, "I understand that I have hardening of the arteries. What can I do to slow the progression of this disease or even reverse this unhealthy process?" Answers to this question are listed below and inTable 1.1,2Table 1. Recommended Lifestyle Changes for Patients With Atherosclerosis Including Heart AttacksStop using all tobacco products.Control diabetes mellitus with diet, exercise, and medication.Eat a heart healthy, low saturated fat diet with lowered salt intake.Perform daily exercise such as walking, cycling, swimming, rowing, or other gymnasium exercises for 30 to 60 minutes.Use a program of exercise and diet to reach ideal body weight.If psychological stress is present, try to learn a technique to reduce stress. For example, meditation, yoga, or tai chi chuan.Work with your physician and cardiac rehabilitation team to reduce elevated blood pressure and blood cholesterol levels with diet, exercise, and medication.You must stop smoking tobacco products. Tobacco smoke and especially cigarette smoke are poisonous. Chemicals in this smoke damage the arteries that carry blood to all organs. Patients who continue to smoke after they have already developed atherosclerosis are at great risk for developing a fatal heart attack. In addition to atherosclerosis, smoking is a major contributor to incapacitating lung disease and many forms of cancer.You must get good advice and therapy to control diabetes mellitus or a tendency to develop diabetes mellitus. Diabetes mellitus accelerates the process leading to atherosclerosis. Excellent control of diabetes mellitus or prevention through weight reduction, exercise, diet, and medication can slow the development of hardening of the arteries. Primary care physicians, endocrinologists, and cardiologists can help patients control or prevent diabetes mellitus.Familial or inherited tendencies for developing certain diseases are very common. Some families have many members afflicted with cancer, whereas others have many individuals who develop heart attacks and strokes. At this time, it is impossible to change a person's genetic or inherited tendencies. However, all of the other risk factors for atherosclerosis listed in this Patient Page can be modified, thereby markedly decreasing the risk for developing atherosclerosis even when there is a strong family history for this illness. Maintaining ideal body weight, avoiding cigarettes and foods rich in saturated (usually animal) fat, regular exercise, and, at times, medication can reduce the risk for many individuals.A large portion of the American population has high blood pressure also known as hypertension. Abnormally high blood pressure damages arteries and accelerates the development of atherosclerosis, leading to heart attacks and strokes. Maintaining ideal body weight, regular exercise, avoiding high–saturated fat and salty foods, and use of certain prescription medications are excellent strategies for controlling high blood pressure. There are a variety of medicines that are highly effective for treating high blood pressure, and many of these have minimal side effects. Patients usually need to take these medications for their entire life in order to maintain a normal blood pressure.The typical Western diet contains high levels of saturated animal fat. Red meat is often the major contributor of saturated fat in the Western diet, although butter, cream, ice cream, many cheeses, and solid vegetable shortenings also contain large amounts of saturated fat. Eating a diet that is high in saturated fat results in increased blood levels of cholesterol, which can accelerate the development of atherosclerosis. Many books contain excellent advice about the ideal diet for patients with atherosclerosis or patients who have a propensity to develop this disease. The American Heart Association publishes a number of cookbooks as well as pamphlets with detailed descriptions and recipes for heart-healthy nutrition.3 Heart-healthy diets emphasize restriction of red meat and rich dairy products. Experts in nutrition also suggest that individuals concerned about their blood cholesterol levels eat increased amounts of fruits, vegetables, and whole grain foods.A tendency to develop high blood cholesterol levels is often inherited. Dietary restrictions alone are usually insufficient to lower blood cholesterol levels enough, so that further damage to blood vessels is prevented. Consequently, many patients are given prescriptions for drugs that are highly effective in lowering blood cholesterol levels. These drugs include members of the statin family such as pravastatin, as well as other lipid-lowering medications such as niacin and gemfibrozil (a member of the fibrate family; seeTable 2).Sedentary lifestyles frequently accompanied by obesity contribute to the development of atherosclerotic disease. The cardiovascular system thrives on exercise, and it is therefore an excellent idea to initiate a daily exercise program such as walking, cycling, rowing, or swimming for 30 to 60 minutes each day.4 Exercise also helps to reduce weight and reverse obesity.Psychological stress is difficult to measure. There is even controversy as to whether distress of this nature actually contributes to the development of atherosclerosis. Nevertheless, a substantial number of clinical studies support the idea that patients with coronary artery disease should practice some form of regular stress reduction such as meditation, yoga, or tai chi chuan. There are no or only very minimal side effects from such a program, and many patients report increased wellbeing when they use these modalities.The lifestyle changes just described are often not sufficient by themselves to control the progression of atherosclerotic vascular disease. Over recent years, a number of medicines have been shown to be highly effective in slowing or in some cases even reversing the atherosclerotic process.Heart attacks damage the heart, and this can lead to a variety of complications, such as abnormally slow or fast heart beats that may even be life threatening. In addition, damage to heart muscle may reduce the pumping ability of the heart, leading to fatigue, shortness of breath, and swelling of the skin and underlying tissues (edema). A variety of medicines as well as interventional catheterization techniques such as balloon angioplasty, coronary artery stenting, and surgical procedures such as coronary artery bypass grafting are used to correct or lessen these problems.Table 2. Medical and Surgical Techniques That Are Often Used to Improve Quality and Length of Life in Patients With Atherosclerosis Including Heart AttacksDrugs to lower blood cholesterol levels, including statins, niacin, and fibrates.Drugs to lower elevated blood pressure, such as beta blockers, which slow the heart, blood vessel dilating agents to open contracted blood vessels, and diuretics to remove retained fluid.Drugs to improve heart muscle function and combat fluid retention (heart failure), such as beta blockers to slow heart rate, blood vessel dilating agents to reduce the work of the heart, and diuretics to help remove excess bodily fluid.Drugs that thin the blood in order to prevent blood clots from forming. For example, aspirin, clopidogrel (Plavix), as well as newer agents.Drugs to control abnormally fast heart rhythms from the upper or lower chambers of the heart.Pacemakers to increase abnormally slow heart rates.An implanted device that resembles a pacemaker but instead monitors the heart beat for dangerously abnormal heart rhythms. When such rhythms are detected, the device delivers a shock to the heart muscle in order to restore a normal heart beat. This device is called an internal cardiac defibrillator, or ICD.Procedures performed in the catheterization laboratory during which balloons and thin metal wire cylinders are used to open up blocked arteries in the heart and elsewhere in the cardiovascular system (balloon angioplasty and coronary artery stenting).Procedures performed in the operating room to bypass blocked arteries and occasionally to repair or replace damaged heart valves. The operation to deliver better blood flow to the heart is called coronary artery bypass grafting. During this operation, new blood vessels are inserted into the heart's circulation, resulting in marked increases in blood flow to heart muscle.DisclosuresDr Alpert has consulted for Elsevier Publications Inc, Sanofi-aventis, Merck, Bristol-Myers-Squibb, Pfizer, Astra-Zeneca, McNeill, Organon, Berlex, Novartis, Ciba-Geigy, Servier, Boehringer-Ingleheim, Bayer, Johnson & Johnson, Exeter CME; North American Center for Continuing Medical Education (NACCME), FRANCE foundation, and CME.FootnotesThe information contained in this Circulation Cardiology Patient Page is not a substitute for medical advice, and the American Heart Association recommends consultation with your doctor or healthcare professional.Correspondence to Joseph S. Alpert, MD, FESC, MACP, University of Arizona Health Science Center, 1501 N Campbell Ave, No. 6334, Tucson, AZ 85724-5034. E-mail [email protected]arizona.eduReferences1. Balady GJ, Williams MA, Ades PA, Bittner V, Comoss P, Foody JAM, Franklin B, Sanderson B, Southard D. Core components of cardiac rehabilitation/secondary prevention programs: 2007 Update. Circulation. 2007; 115:2675–2682.LinkGoogle Scholar2. Ades PA. Cardiac rehabilitation and secondary prevention of coronary artery disease. N Engl J Med. 2001; 345:892–902.CrossrefMedlineGoogle Scholar3. The American Heart Association. http://www.heart.org. Accessed July 7, 2011.Google Scholar4. Alpert JS. You only have to exercise on the days that you eat. Am J Med. 2011; 124:1.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Kusunose K, Sato M, Yamada H, Saijo Y, Bando M, Hirata Y, Nishio S, Hayashi S and Sata M (2016) Prognostic Implications of Non-Invasive Vascular Function Tests in High-Risk Atherosclerosis Patients, Circulation Journal, 10.1253/circj.CJ-15-1356, 80:4, (1034-1040), . Ong F, Bernstein, K and Rotter J (2013) Genetics of Blood Pressure Regulation Emery and Rimoin's Principles and Practice of Medical Genetics, 10.1016/B978-0-12-383834-6.00058-6, (1-22), . Raupach T and Brown J (2012) Treatment of tobacco addiction and the cardiovascular specialist, Current Opinion in Cardiology, 10.1097/HCO.0b013e328356db00, 27:5, (525-532), Online publication date: 1-Sep-2012. August 9, 2011Vol 124, Issue 6 Advertisement Article InformationMetrics © 2011 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.111.019836PMID: 21824926 Originally publishedAugust 9, 2011 PDF download Advertisement SubjectsTreatment
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