“You have coronary heart disease.” When your doctor says those words to you or to someone you love, it’s frightening and confusing.  You probably have dozens of questions: What is coronary heart disease? Do I need to change my lifestyle?

Coronary heart disease (CHD), also called coronary artery disease (CAD) or ischemic heart disease, is a form of heart disease that’s caused by narrowing of the coronary arteries that feed the heart.  If you or someone you love has been diagnosed with CHD, it may  help to know that you are not alone. In fact, CHD is the most common form of heart disease, affecting at least 12 million Americans.  It is the single largest killer of both men and women in the United States, responsible for nearly a half million deaths each year, or about 1 out of every 5 deaths.  CHD causes nearly all heart attacks (myocardial infarctions). Every 29 seconds, an American suffers a coronary event (a heart attack or fatal CHD), and every minute one of us will die from one.  The american Heart Association estimates that this year alone, more than a million Americans will suffer from a new or recurrent coronary event, and nearly 40 percent of those will die from it.

Coronary heart disease isn’t just an American problem. CHD is very common in other Westernized countries, too, such as many in Europe. Diseases of the heart and circulation such as heart attacks and stroke (a “brain attack”) kill more people worldwide than any other cause. The World Health Organization estimates that as many as 30 percent of all deaths are caused by heart and circulation diseases like CHD.

The good news is that you don’t have to become another CHD statistic. There is a lot you can do to reduce your risk of having a heart attack or dying from CHD. Sometimes just changing your lifestyle - following a heart-healthy diet, exercising regularly, and reducing the stress in your life-can prevent a heart attack or even reverse the narrowing in your arteries. There are a number of medications-and new ones being developed every day-that can help lower your heart attack risk. Surgical procedures such as angioplasty and stenting or bypass surgery can help compensate for blockages in your arteries and help keep your heart supplied with the blood it needs. By educating yourself about your treatment options, and working closely with your doctor you and your doctor can choose the best treatments that will enable you to live a long and healthy life.

The Circulatory System

The first step in taking charge of your CHD is to learn all you can about the disease. To understand what CHD is and how it affects your heart, you need to understand a little about your heart and how it works.

Your circulatory system, also called your cardiovascular system, is made up of the heart, the lungs, and blood vessels called arteries and veins. This system carries blood, food, and oxygen to every cell in the body. It also carries waste products away from the cells and out of the body. (A cell is a building block of every tissue and organ in the body.) Think of your circulatory system as a busy highway system composed of massive freeways and large streets that feed into smaller and smaller streets, and finally into tiny lanes and alleyways. This system is made up entirely of one-way streets. In our imaginary highway system, cars, or in this case, blood, can flow in only one direction. The one-way streets called arteries and arterioles (small arteries) carry blood enriched with oxygen and nutrients away from the heart to the cells in the body. The one-way street called veins and venules (small veins) carry blood loaded with waste products from the cells back to the heart.

Between these two one-way street systems are tiny blood vessels called capillaries. Almost too tiny to see and often thinner than a strand of hair, capillaries connect the smallest arteries with the smallest veins. They are the brides that connect our two systems of one-way streets. The walls of these tiny capillaries are so thin that food and oxygen in the blood pass through them into the surrounding cells. These thin walls also allow waste products from the cells to pass into the capillaries. This enables the blood to carry waste from the cell to be removed by the kidneys, liver, and lungs.

If you can imagine a single drop of blood flowing through this system, it might look something like this. The blood droplet, full of oxygen and nutrients, (fuel), is pumped out of the left side of the heart into the largest arteries. There is flows into progressively smaller arteries and finally into the capillaries, where it delivers its load of oxygen and food for the cells. At the same time, the blood picks up waste products from the cells and flows into tiny veins, then into larger and larger veins. Finally, the blood droplet arrives back at the right side of the heart, where it’s pumped into the lungs and unload carbon dioxide, pick up a fresh supply of oxygen, and begin its circular journey again.

The Heart: An Amazing Pump

The heart is the pump that keeps the blood flowing around and around in an endless circle throughout the body. Think of it as the traffic cop that coordinates the flow of traffic throughout our highway system. The heart is a hollow muscle that weighs less than a pound and is about the size of a man’s fist. Despite its small size, this amazing organ an average of 100,000 times a day, pumping about 2,000 gallons of blood every day. If you live to be 70, your heart will beat more than 2.5 billion times.

Located in the center of the chest and protected by the breastbone and rib cage, the heart is actually a double pump thats divided into four chambers, two upper ones and two lower ones. A thin wall of muscle separates the left and right sides of the heart. The top chamber (atriums or atria) and lower chambers (ventricles) are connected by valves that act like one-way doors. These valves make sure blood flows only in one direction. In the heart, the blood is pumped from the left and right atriums to the left and right ventricles. The right side of the heart sends blood to the lungs. The left side of the heart pumps blood out to the cells in the body.

Coronary Arteries

Just like other muscles in the body, the heart needs its own supply of blood and oxygen to work properly. Even though the heart pumps blood through its chambers, the heart itself receives no significant nourishment from this blood. There is a separate set of arteries that branch off the aorta (the main artery that receives blood from the left ventricle) that provide the heart’s blood supply. These are called coronary arteries. The coronary arteries encircle the top and sides of the heart bringing plenty of oxygen-rich blood to the heart. The two major coronary arteries are the left coronary artery and the right coronary artery. These vessels divide into many smaller coronary arteries that feed the heart.

What Is Coronary Heart Disease?

Healthy coronary arteries have smooth, flexible walls that provide plenty of blood to the heart. However, over many years, these flexible walls can become progressively irritated and damaged by such substance as fats, cholesterol, calcium, cellular debris, and platelets (tiny cells responsible for blood clotting). When the walls of the arteries are damaged, these substances are able to “stick” to them. Coronary heart disease (CHD) occurs when these coronary arteries become narrowed and clogged.

This buildup inside the artery walls is a process called atherosclerosis, which produces a substance known as plaque. As it builds, plaque is a lot like the dirt, fat, and minerals that build up inside your home’s plumbing. As the buildup becomes thicker, the flow through the pipes becomes less and less and may even completely stop. Similarly, when your heart doesn’t get enough oxygen due to narrowed arteries, you may feel chest pressure or pain called angina. If the blood supply to part of the heart is completely cut off, the result is often a heart attack.

Everyone has a certain amount of atherosclerosis as they age. For many of us, atherosclerosis begins in childhood. Some people have a rapid increase in the buildup of atherosclerotic plaque after age 30. For others, plaque buildup does not become a problem until we’re in our 50s or 60s.

What Causes CHD

We don’t know for sure why atherosclerosis occurs or even how it begins, but  there are several theories. Some medical experts believe the atherosclerotic buildup in the inner layer of the arteries may be caused by several conditions, including:*Elevated levels of LDL cholesterol (low-density lipoprotein) and triglycerides in the blood*Low levels of HDL CHOLESTEROL (high-density lipoprotein)*High blood pressure*Tobacco smoke*High blood sugar levels (diabetes mellitus)*Inflammation.

It’s likely that more than one process is involved in the buildup of plaque. Many researchers believe that when excess fat combine with oxygen, they become trapped in the arterial wall. This attracts white blood cells which help prevent infection when tissue is damaged. Then substances call prostaglandins, which are involved in blood clotting and altering tone (firmness) within arteries, become active. Any injury to the artery wall, such as damage caused by smoking, can activate prostaglandins. The activated prostaglandins stimulate more plaque growth and narrow arteries and/or cause blood clots to form.

Regardless of how plaque forms, advanced plaque is made up mostly of living cells. In fact, about 85 percent of advanced plaque consists of cell debris, calcium, smooth muscle cells, connective tissue, and foam cells (white blood cells that have digested fat). About 15 percent of advanced plaque is made up fatty deposits.

Once the plaque develops, plaque containing cells can be easily damaged. This can lead to blood clots forming on the outside of the plaque. Small clots can further damage other layers of the blood vessel wall and stimulate more plaque growth. Larger blood clots can partially or totally block the artery.

In addition to interfering with or totally blocking blood flow, plaque can hinder the arteries ability to dilate and contract. In order to respond to the bodies ever-changing need for blood, the arteries need to be strong and elastic. For instance, when you exercise, your body needs more blood. The heart responds by pumping faster, and the arteries respond by expanding to accommodate the increased volume of blood expanding to accommodate the increased volume of blood coming from the heart. As the artery becomes narrowed and hard, that elasticity is lost. Arteries that have atherosclerotic plaque are more apt to spasm (temporarily narrow), causing even less blood to flow to the heart and possible causing chest pain or heart attack.

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Certain medical conditions (e.g., diabetes), disorders, personal habits (e.g., smoking), and drugs or chemicals are known to increase the risk of coronary heart disease, particularly a heart attack. Such factors that lay the groundwork for heart problems are called coronary risk factors. To prevent heart attack, you should be fully aware of various coronary risk factors. They include High blood pressure, abnormal blood cholesterol levels, and smoking; these factors must be modified or even eliminated.

Some risk factors, such as age and male gender, are beyond our control, but we can modify many other factors and even eliminate them altogether. Family history of a heart attack is a very strong risk factor, but it can be limited to a certain degree. For instance, obesity, high blood pressure, hyperlipidemia, and cigarette smoking frequently run in the same family, but certain life styles and eating habits often influence these factors and can influence a family history of heart attack. Many individuals have been shown to have multiple risk factors. Typically, obese people have a tendancy to have high blood pressure, elevated cholesterol, and diabetes, and all that may be worsened by a sedentary life style.

Coronary risk factors can be summarized as major and minor. Major risk factors include:
* Genetic factors (e.g., a family history of premature coronary artery disease).
* Age and gender (e.g., men who are over 45 years of age, and women who are over 55 years of age).

Coronary heart disease risk factors also include:
* High blood pressure
* elevated blood lipods
* Diabetes Mellitus
* cigarette smoking
* obesity
* A sedentary lifestyle
* emotional stress

Emotional stress is a major risk factor that you might consider less important because it is not evident as a physical process. However, such stress often raises blood pressure, and it may cause overeating or smoking from nervous tension. Anger also does not always exhibit physical signs or effects. Yet angry young men are prone to premature coronary heart disease, particularly a heart attack.

One type of minor risk factor is the excessive use of alcohol. Excessive alcohol drinking can raise blood pressure and triglyceride blood levels, and overuse of alcohol often triggers the onset of various abnormal heart rhythms. Nevertheless, some medical reports state that consumption of a moderate amount of alcohol is said to be protection against heart attack. Another well known fact is that drinking large amounts of alcohol often produces heart muscle damage.

Another minor risk factor is type A personality. The term type A personality describes a person who has an aggressive, ambitious, and competitive character. Such people seem to have heart attacks more often, but this theory is smewhat controversial.

Homocysteine is a further minor risk factor. Abnormally high blood levels of amino acid Homocysteine are considered to create an increased risk for coronary heart disease and stroke. Homocysteine may harm the lining of the arteries and contribute to blood clotting. Excessive Homocysteine levels are reported to occur with the dificiency of vitamins B6, B12, and folic acid, so it may be beneficial to ensure that you get sufficient amounts of these vitamins to prevent high Homocysteine levels.

Other vitamins may also be beneficial in prevention of heart attacks. Vitamen E seems to reduce the risk of coronary heart disease, but its role is still controversial. Vitamin C may improve the function of the inner layer of the blood vessel called the endothelium, which can effect blood flow. High intake of beta carotene and other carotenoids from dark colored fruits and vegetables may also help t`o reduce the risk of heart attack.

Depression has adverse biological effects on the immune system, on blood clotting, on blood pressure, on the blood vessels, and on heart rhythms. This factor can even impair a patients desire to comply with heart medicines. Somewhat related are seasonal variations: More deaths from heart disease occur in the winter months , and the fewest occur in the summertime. Short daylight hours in gloomy or rainy weather often cause emotional depression and therefore an increased risk for heart attack.

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The national institutes of health sponsored the diet heart feasibility study to determine if it was possible to lower the blood cholesterol levels of Americans eating at home by changing the kind and amount of fat in their diet. About 1000 men aged 45 to 54 in five cities, all healthy volunteers, were assigned to one of three diets. Diets 1 and 2 were low in cholesterol and saturated fats but high in polyunsaturated fats; that is, they had a higher ratio of polyunsaturated to saturated fats, or P/S ratio. Diet 2 differed from diet 1 in that it contained more polyunsaturated fat and monounsaturated fat. The control diet (diet 3) was similar to a typical American diet, that is, high in cholesterol, total fat, and saturated fat but with low P/S ratio.

The men picked up all their food at special distribution centers. The food containers did not list the ingredients, and neither the participants nor the doctors who conducted the study knew who was assigned to which diet. This research  design, called “double blind” is designed to reduce unintentional bias on the part of either the study subjects or the medical scientists, since neither knows who is in what program until the end of the study.

After one year on the assigned diets, the blood cholesterol levels fell between 11% & 12% in the men on diets 1 and 2. The average cholesterol level in the group on the typical American diet fell only 3%.

The next question was ” Will lowering blood cholesterol by diet in healthy Americans decrease the rate of coronary heart disease?” There were several problems in trying to answer this question. First, the symptoms of coronary heart disease usually take four or more decades to manifest themselves. Second, although coronary heart disease is the major cause of death and disability in this country, the actual rate of new cases per year in middle aged  people is relatively low, about five to ten new cases per 1000 middle aged male adults. Third, what control group might such a study use?

Ideally, neither the participants nor the staff conducting the study should know which participants are in the treatment group and which are in the untreated control group. Diets that are high or low in animal fat and cholesterol are clearly different, and unless unlabeled foods were given out at a commissary, everyone  would realize whether he was assigned to a diet low or high in cholesterol and saturated fat. Because 100,000 men were needed for a definitive diet heart study, it was not feasible to have a blind control group of the necessary size.

Because of these difficulties and a prospective price tag of about one billion dollars, another approach was taken. First, only patients with very high blood cholesterol levels were selected; second, a drug treatment was chosen that lowers the blood cholesterol level to a greater extent than diet alone. This approach reduces the number of participants needed to a manageable level. A drug trial can replace a diet trial, provided that the drug has a specific effect on lowering blood cholesterol (and LDL cholesterol). This permits a direct test of the hypothesis that a decrease in the blood cholesterol level reduces coronary heart disease. Further, a drug trial allows medical scienttists to develop  a suitable inactive medication or placebo that will not lower the blood cholesterol level, thus permitting the study to be double blind.

About 4,000 healthy middle aged men with high levels of blood total and LDL cholesterol were assigned to either a treatment group, which received an active medication called cholestyramine, or to a control group that received placebo. Cholestyramine was known to produce a significant decrease (10 to 20 percent) in the level of total and LDL cholesterol in the blood. Both the treatment and control groups were put on the same diet. Neither the participants nor the medical staff knew to which of the two groups a participant was assigned. Cholesterol levels were checked every other month. After one year the results of the study were as follows:

Man from group that took active drug: his cholesterol level at the beginning of the trial was 281, and at the end was 199. Man from group that was on placebo starting cholesterol level was 273, and at the end was 274. The men taking the cholestyramine had significantl greater decrease in there blood cholesterol than the men taking placebo. Therefor it is known that you can reduce the risk of coronary heart disease.

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Although testing cam be valuable in detecting existing blockages in your coronary arteries before sudden death, angina pectoris, or a heart attack occurs, ideally you should try to prevent blockages from forming in the first place. This why it is important  for you to understand how Atherosclerosis develops, and what factors accelerate it. Even if you already have coronary heart disease and have had coronary artery bypass surgery, you will want to decrease the chance that the blockages will return.

Coronary heart disease results from the gradual development of Atherosclerosis in the coronary arteries. The term Atherosclerosis comes from the greek atheroma, meaning porridge, and skleros, meaning hard. At birth our coronary arteries are completely open, no blockages are present, and blood flow is unimpaired. Between the ages of 10 and 20, small deposits of lipid, called “fatty streaks,” begin to appear in the lining of the coronary arteries. Over time, some fatty streaks change gradually into larger deposits, called “fibrous Plaques.” As the fibrous plaque forms, it protrudes into the opening of the coronary artery.

These aerly stages of Atherosclerosis progress slowly through the teen age years and through the twenties and thirties, but by age 45 or 50 many people in our society have more advanced Atherosclerosis that may lead to coronary heart disease. If you have risk factors or have inherited a genetic problem in processing fat in your body, you are much more likely to have Atherosclerosis. The same factors may accelerate the early deposits of fatty streaks in the coronary arteries of your children.

Atherosclerosis has afflicted many populations throughout the history of mankind. For example, it has been found in egyptian mummies, but not all mammals are not susceptible to this disease. rats and dogs are quite resistant, at least partly because most of their blood cholesterol is in high density lipoproteins (HDL), the “good” cholesterol. In contrast, humans carry most of their blood cholesterol in low density lipoproteins (LDL), which promote Atherosclerosis. When animals consume diets rich in cholesterol or saturated fat, those that are susceptible, such as some nonhuman primates and rabbits, develop Atherosclerosis; those that are resistant, such as dogs and rats, do not.

The relationship between cholesterol in the diet and Atherosclerosis was first observed in rabbits in 1908 by a russian pathologist name Ignatowsky. Later studies of nonhuman primates demonstrated the direct relationship between cholesterol and saturated fat in the diet, cholesterol level in the blood, and the development of Atherosclerosis.

Can The Process of Atherosclerosis Be Reversed?

The answer is yes. Studies have shown that when the level of cholesterol in the blood of nonhuman primates is lowered by diet or drugs, the deposits of Atherosclerosis in their coronary arteries become smaller. A study has also shown this to be true in humans.

In the 1960s, medical researchers established that not all countries had the same amount of Atherosclerosis in their populations. The international Coronary Heart Disease and Atherosclerosis project studied people in 14 different countries. Arteries from 22,509 people who died between the ages of 10 and 69 years were examined under the microscope. In his book Geographic Pathology Of Coronary Heart Disease and Atherosclerosis DR. Henry McGill ranked  twelve of the fourteen populations according to fat intake, blood cholesterol level, and Coronary Heart Disease and Atherosclerosis. He found a direct and highly significant relationship between these factors; locations with greatest amount of Coronary Heart Disease and Atherosclerosis, such as the United States and Norway, had significantly higher average blood cholesterol levels and a significantly greater fat consumption.

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This article will describe coronary heart disease and its causes, and presents evidence linking intake of dietary cholesterol and fat with rates of coronary heart disease.

How is coronary heart disease detected?

Unfortunately, in one third of all cases the first sign of coronary heart disease is sudden, unexpected death. The victims are completely unaware of the blockages in their coronary arteries until it is too late.

In the rest of the cases, coronary heart disease first appears as chest pain or even a heart attack. Chest pain due to coronary heart disease is usually brought on by physical exertion. Physical activity  increases the demand  of the heart muscle  for oxygen; if significant blockage is present in a coronary artery, the demand cannot be met. This produces pain, usually in the middle of the chest behind the breastbone. The pain is often pressing or constrictive. Some people describe it by clinching their fist over their chest. The pain may radiate up into the throat or jaw.

You may have heard the phrase angina pectoris used to describe such pain (angina from the latin for throat, pectoris from the latin for chest). The pain of angina pectoris may also radiate up into the left shoulder and down the left arm. when triggered by exercise or exertion, angina pectoris is usually relieved by rest. Occasionally, angina is brought on by tension or emotions; or it may occur after eating a meal, or even at night when sleeping. Angina that occurs at rest is an indicator of even more serious atherosclerosis, because the heart is not getting enough oxygen even when it is not working hard. Angina pectoris may be the first signal that you have underlying coronary heart disease.

A heart attack develops when a clot forms on top of the blockage in a coronary artery. This completely prevents blood from flowing through the artery, and deprives the tissue beyond the blockage of needed oxygen and nutrients. The cells in the heart muscle (myocardium) then die, producing what is commonly referred to as a heart attack (myocardial infarction).

Often the first sign of a heart attack is the development of pressing chest pain. When a heart attack is taking place, the chest pain is often not relieved by rest. This persistent chest pain is often also accompanied by weakness, fainting, profuse sweating, nausea, and vomiting. Emergency medical attention is needed, and hospitalization is required. When  a heart attack occurs, the part of the heart muscle that is injured is left with a scar.

Is your heart being deprived of oxygen without symptoms?

If you have significant blockages in your coronary arteries, you may be having “silent” episodes in which your heart muscle is not receiving enough oxygen (ischemia). Such episodes are transient, lasting only several minutes at a time, and are termed “silent myocardial ischemia” by heart doctors (cardiologists). People with this problem may be totally without symptoms, may have suffered a heart attack but gone on to be symptom free, or may have attacks of angina alternating with episodes of silent ischemia.

How common is silent ischemia?

Some doctors estimate that 2 to 3 out of every 100 men have silent ischemia during exercise; that survivors of heart attacks have one chance in tenof having silent icshemia; and that of the four million patients with angina pectoris in this country, about 80% also have episodes of silent ischemia. If you are having angina attacks, you probably are having more episodes od ischemia than is suggested by your angina attacks alone.

How is ischemia detected? Your doctor can use several different tests.

Resting electrocardiogram. The electrocardiogram (or EKG) is the best known test for heart disease. The muscle cells of your heart contract in response to electrical impulses from the nerves. Electrodes attached to your body detect these impulses as they travel through the various parts of your heart. The recording or tracing that results is the EKG. If part of your heart muscle has been damaged by a heart attack, the electrical impulses do not travel through it properly, producing an abnormal EKG. A resting EKG can also detect abnormalities (arrhythmias) in the rhythm of your heart.

The resting EKG has its limitations. For example, about three out of four patients with angina pectoris have normal resting EKGs. Many patients with with significant blockages of their coronary arteries have normal EKGs. Having a normal resting EKG does not mean that you do not have any blockages in your coronary arteries, nor does it mean you can ignore risk factors you may have for coronary heart disease.

Other tests to ask your doctor about.

Stress Exercise Electrocardiogram (Stress Test).

Stress Thallium Exercise Electrocardiogram (Stress Thallium Test).

Holter EKG Monitoring.

Coronary Angiography.

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Coronary heart disease (CHD), also known as coronary artery disease (CAD) and atherosclerotic heart disease, is the result of accrual of atheromatous plaques (an abnormal inflammatory accrual of the macrophage white blood cells) within the walls of the arteries.

The symptoms and signs of coronary heart disease can only be noted in the progressed state of the disease. Most people who experience from coronary heart disease can have no evidence of its existence for long periods of time before they have a stroke.

Causes of Coronary Heart Disease

- Family history of coronary heart disease
- Males are more prone to this particular disease
- Being 65-years-old or greater
- Smoking
- High blood pressure
- Diabetes
- Lack of physical behavior
- Menopause in women
- Infection that causes irritation of the artery wall

Symptoms leading to coronary heart disease may not always be easily readable, as many live with clogged arteries for years before they realize they have a difficulty. Usually people suffering from coronary heart disease walk in the emergency room with a heart attack on their hands.

Here are several of the symptoms that could help you recognize this disease:

- Chest pain
- Shortness of breath

As prevention is always better then treatment, one should try and have regular check ups and follow the doctor’s advice. Knowing in time that you are likely to have a heart problem may save you from being faced with an emergency situation, which can sometimes turn to be fatal.

Preventing Coronary Heart Disease

Coronary heart disease is the most common of heart diseases in the western world. Here are several ways to prevent ever suffering from it in the near future:

- Reduce your cholesterol level.
- Maintain your ideal body weight – obesity is one of the main factors of coronary heart disease.
- If you are a smoker, this is yet another reason you should stop smoking.
- Have a he