Coronary Artery Disease

Dr. Thomas Amidon, MD
Overlake Internal Medicine
Bellevue, Washington

Coronary artery disease affects over ten million people in the United States and is the leading cause of death in both men and women. Angina refers to symptoms that result from plaque narrowing coronary arteries. This is often described as pressure, tightness or burning in the chest that may occur during exercise. The discomfort may radiate to the left arm or jaw and often is accompanied by nausea, sweating or shortness of breath. Angina usually subsides after several minutes of rest.

A number of risk factors contribute to coronary atherosclerosis. These include high cholesterol, diabetes, high blood pressure, smoking or a family history of coronary artery disease. Chronic inflammation may contribute to this process. Treatment of these risk factors can lessen the likelihood of developing coronary disease or having adverse events such as a heart attack.

Recently there has been much focus on treating hypercholesterolemia. It is important to recognize that there is a good component (HDL) and a bad component (LDL) to a blood cholesterol measurement. There are also more sophisticated measurements such as triglycerides, lipoprotein(a) and homocysteine that may be helpful in determining one’s risk.

Treatment of hypercholesterolemia begins with lifestyle modification. Restricting cholesterol and saturated fat in the diet can lower LDL whereas exercise can raise HDL. A number of different drugs can be helpful when life­style modification alone does not lead to desirable levels. The most effective class of drugs are the statins. When used appropriately these can reduce the risk of heart attack, stroke and death. They can supplement exercise, healthy diet, smoking cessation control of blood pressure and diabetes.

Smoking greatly increases the risk of developing coronary artery disease, stroke and peripheral vascular disease in addition to increasing the risk of emphysema, lung cancer and oral cancer. Exposure to second hand smoke also increases one’s risk. Smoking cessation reduces this risk and may be more easily accomplished with nicotine replacement (gum, patch, inhaler) and/or the drug bupropion (Zyban).

All men should have their blood pressure and cholesterol checked by age 40. If you are concerned about symptoms of angina, consultation with your health care provider is essential.

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