Coronary Artery Disease (CAD)
Introduction
Coronary Artery Disease (CAD), also known as ischemic heart disease, is one of the leading causes of illness and death worldwide. It occurs when the arteries supplying the heart muscle with oxygen-rich blood become narrowed or blocked by fatty deposits called atherosclerotic plaques. CAD develops silently over years, often without noticeable symptoms until a serious event such as a heart attack occurs.
According to the World Health Organization (WHO), cardiovascular diseases cause more than 17.9 million deaths annually, with CAD being responsible for the majority. Beyond its medical toll, CAD also creates a massive economic burden, costing billions of dollars each year in medications, hospitalizations, surgical procedures, and rehabilitation programs.
Epidemiology
Worldwide
- Cardiovascular diseases are the number one cause of death globally.
- CAD accounts for the majority of cardiovascular deaths.
- Approximately 85% of cardiovascular deaths are due to heart attacks and strokes.
- Millions of new cases are diagnosed each year, particularly in low- and middle-income countries.
Middle East & Egypt
- CAD prevalence is higher than the global average due to high rates of smoking, obesity, and diabetes.
- In Egypt, cardiovascular diseases are responsible for ~46% of deaths, with CAD being the leading cause.
- Younger patients are often affected due to unhealthy lifestyles, such as heavy smoking and high-fat diets.
Future Trends
- CAD cases are expected to increase globally due to rising obesity and diabetes.
- Advanced treatments like stenting and statins have reduced mortality in developed countries, but developing nations face challenges.
Risk Factors
Risk factors are divided into three categories:
1. Non-modifiable factors
- Age: Risk increases with age.
- Sex: Men are at higher risk before menopause; women catch up afterward.
- Genetics: Family history of premature CAD increases risk significantly.
2. Modifiable factors
- Smoking 🚬 damages the lining of arteries.
- Hypertension accelerates arterial damage.
- Dyslipidemia: High LDL, low HDL.
- Diabetes mellitus increases vascular damage.
- Obesity raises cholesterol, blood pressure, and glucose levels.
- Physical inactivity 🛋️ reduces cardiovascular fitness.
- Unhealthy diet 🍔 rich in saturated fats and sugars.
- Chronic stress 😰 raises blood pressure and heart rate.
3. Emerging factors
- Chronic inflammation (elevated CRP).
- Vitamin D deficiency.
- Sleep disorders (e.g., sleep apnea).
Pathophysiology
- Endothelial dysfunction: Arterial lining is damaged by smoking, hypertension, diabetes, or cholesterol.
- Plaque formation: LDL cholesterol oxidizes and triggers immune responses, leading to foam cells.
- Arterial narrowing: Plaques reduce the arterial lumen, decreasing blood flow.
- Plaque instability: Fragile plaques rupture, forming clots that block arteries suddenly.
- Final outcomes: Stable angina, unstable angina, myocardial infarction, or heart failure.
Clinical Manifestations
- Stable Angina: Chest pain with exertion, relieved by rest or nitroglycerin.
- Unstable Angina: Pain at rest or minimal exertion, warning of imminent heart attack.
- Myocardial Infarction: Severe chest pain >20 minutes, sweating, nausea, shortness of breath.
- Atypical symptoms: Fatigue, indigestion, dyspnea (more common in women and elderly).
- Complications: Arrhythmias, heart failure, sudden death.
Diagnosis
- Clinical history & risk assessment.
- Laboratory tests: Troponins, CK-MB, lipid profile, HbA1c.
- ECG: Detects ischemia, arrhythmias, or MI.
- Echocardiography: Evaluates heart function.
- Stress testing: Identifies ischemia under exertion.
- CT angiography / Nuclear scans: Non-invasive imaging.
- Coronary angiography: Gold standard, also allows stenting.
Treatment
1. Lifestyle modifications
- Quit smoking 🚭
- Adopt a heart-healthy diet 🍎
- Exercise regularly 🏃♂️ (150 minutes/week)
- Lose excess weight ⚖️
- Control blood pressure and diabetes
2. Medications
- Aspirin (antiplatelet)
- Statins (cholesterol-lowering)
- Beta-blockers
- Calcium channel blockers
- Nitrates
- ACE inhibitors / ARBs
3. Interventions
- PCI: Percutaneous coronary intervention with stents.
- CABG: Coronary artery bypass graft surgery.
4. Cardiac Rehabilitation
A structured program combining exercise, nutrition, counseling, and medical follow-up improves outcomes and reduces recurrence risk.
Complications
- Heart failure
- Arrhythmias
- Sudden cardiac death
- Recurrent myocardial infarctions
Prevention
- Adopt a balanced diet low in saturated fats.
- Exercise regularly to improve cardiovascular health.
- Quit smoking and avoid secondhand smoke.
- Manage stress with relaxation techniques.
- Monitor blood pressure, cholesterol, and glucose regularly.
Conclusion
Coronary artery disease remains a global health challenge, silently developing for years before manifesting as angina, myocardial infarction, or sudden death. The key to reducing its impact lies in prevention and early management. By addressing modifiable risk factors—such as diet, exercise, smoking cessation, and stress management—individuals can dramatically reduce their risk. Medications and interventions remain vital for treatment, but prevention is always better than cure.
Core message: Your heart is your lifeline — protect it before it needs treatment ❤️