Heart Attack Prevention Overview
Medical
Authors: Daniel Lee Kulick, MD, FACC, FSCAI and
Dennis Lee, MD
Medical Editor: William C. Shiel Jr., MD, FACP, FACR
Additional Heart Attack Prevention Series Information (related articles)
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Heart Disease Prevention in Women
Medical Author: Dr. Daniel Kulick, MD, FACC, FSCAI
Medical Editor: Dr. Melissa Conrad Stöppler
 As more information is learned on the prevention of coronary artery disease,
it becomes increasingly clear that women should be considered at similar risk as
men, and should undergo equally as aggressive preventative measures. Coronary
artery disease is the leading cause of death in women, accounting for 38% of
deaths among women, according to the American Heart Association.
The accepted risk factors for coronary artery disease (lipid status,
smoking,
high blood pressure, diabetes, and genetic profile) should be as aggressively
pursued and modified in women as well as men. Every effort should be made to
lower LDL cholesterol (ideally below 70-80), increase HDL cholesterol, use
whatever means to stop smoking, and control blood pressure, especially in women
with multiple risk factors. This includes aggressive
dietary measures, 45 to 90
minutes of aerobic exercise daily, and pharmaceutical therapies as directed by
by one's personal physician. The majority of over the counter supplements have
not been proven to be of benefit in preventing coronary artery disease –
including folic acid, antioxidants such as
Vitamin E, and beta carotene.
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Introduction
Coronary atherosclerosis is the hardening and narrowing of
the arteries that supply blood to the heart muscle. Coronary atherosclerosis is
the major cause of heart attacks. Heart
attacks
are the major cause of sudden unexpected death
among otherwise healthy adults in the prime of their lives. Heart attacks are
also a significant cause of heart failure (due to weakened heart muscle) in this
country. Heart failure considerably decreases a person's longevity and quality
of life. In dollar terms, coronary heart disease is costly. The total cost of
coronary artery bypass surgery, coronary
angioplasty and stenting, medications,
and hospitalizations exceeds 50 billion dollars annually.
Coronary atherosclerosis, and hence heart attacks, are preventable. A person
can significantly lower his or her risk of heart attack by lowering
high blood
pressure, controlling diabetes, stopping
cigarette smoking, losing excess
weight, exercising regularly, and lowering the levels of bad "LDL" cholesterol
and increasing the level of the good "HDL" cholesterol in the blood. In recent
years, other risk factors for coronary atherosclerosis have been identified.
These include a high serum homocysteine level and certain subtypes of LDL
cholesterol. The following is a comprehensive review of the causes of
atherosclerosis and heart attacks, and the means for their treatment and
prevention.
What is atherosclerosis?
Atherosclerosis is a gradual process whereby hard cholesterol substances
(plaques) are deposited in the walls of the arteries. Cholesterol plaques cause
hardening of the artery walls and narrowing of the inner channel (lumen) of the
artery. Arteries carry blood that is enriched with oxygen and nutrients to the
vital organs such as the brain, heart, kidneys, and liver. Arteries also
transport blood to other tissues such as the fingers, toes, nerves, bones, skin,
and muscles. Healthy arteries can deliver an ample supply of blood to the organs
and tissues. In contrast, arteries that are narrowed by atherosclerosis have
difficulty delivering blood to the parts of the body they supply. For example,
atherosclerosis of the arteries in the legs causes poor circulation in the lower
extremities. Poor circulation in the lower extremities can lead to pain while
walking or exercising, deficient wound healing, and/or leg ulcers.
Atherosclerosis can also cause the complete blockage of an artery from a blood
clot. This complete blockage interrupts oxygen supply and results in tissue
injury or death. Thus, the blockage of an artery that furnishes blood to the
brain can lead to a stroke (death of brain tissue). Likewise, the blockage of
the arteries to the heart can result in a heart attack (death of heart muscle),
also called myocardial infarction (MI).
What are coronary heart diseases (CHD)?
Coronary atherosclerosis refers to the hardening and narrowing of the
coronary arteries. The coronary arteries supply the blood that carries oxygen
and nutrients to the heart muscle. When coronary arteries are narrowed or
blocked by atherosclerosis, they cannot deliver an adequate amount of blood to
the heart muscle. Disease caused by the lack of blood supply to heart muscle is
called coronary heart disease (CHD). Coronary heart diseases include heart
attacks, sudden unexpected death, chest pain (angina), abnormal heart rhythms,
and heart failure due to weakening of the heart muscle.
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