Coronary Artery Disease (CAD)

Author: Kayla Romero

Editor: Nicole Nwosu, Rebecca Ting, Dina Abbas

Overview

Coronary Artery Disease (CAD),  also known as Coronary Heart Disease (CHD), is one of the leading causes of mobility and mortality worldwide (Khera, 2017). Characterized by the development of atherosclerosis plaque formation in coronary arteries, CAD affects blood flow in the large arteries on the surface of the heart (Khera, 2017). The initiation and formation of atherosclerosis can occur at the very early stage in life and further progress to narrow the artery (Khera, 2017).

This disease affects both men and women, however, it is predominant in men, multiple factors contribute to the development of CAD including age, male gender, genetic predisposition, obesity, diabetes, and personal lifestyle (Khera, 2017). The chance of an individual developing CAD can be influenced by the interaction between genetic and lifestyle factors (Khera, 2017).

Having a healthy lifestyle can help prevent or lower the risk of CAD (Khera,2017). Of all the cardiovascular diseases, about 33-50% are caused by CAD. Each year, across 49 countries within Europe and northeast Asia, over four million people die from this disease (Wang, 2020).

 

Etiology

Atherosclerosis’s complex development is initiated by endothelial cells dysfunction, where the endothelial cells that are lining the inner arteries have lost the ability to regulate the vascular tone, contraction, and relaxation, with the nitric oxide signaling pathway (Khera, 2017). 

Atherosclerosis is caused by hyperlipidemia and inflammation and is considered to be the main cause of the development of coronary artery disease (Li et al ., 2018). Atherogenesis, the formation of atheromatous plaques, is a result of subendothelial accumulation of fatty deposits, as well as the infiltration of leukocytes within the arterial wall and fatty deposits caused by endothelial damage (Li et al ., 2018). The arteries thus become more narrow and reduce the amount of blood flow to the heart (Li et al ., 2018).

Genome-Wide Association Studies (GWAS) highlights the association between common variance of genetic factors and CAD (Musunuru, 2019). Through the understanding of how all these genetic variances work in the progenesis of the CAD, it helps to provide more promising effective pharmaceutical treatments for patients (Musunuru, 2019). 

 

Symptoms

  • Angina/chest pain
  • Shortness of breath
  • Dizziness or light-headedness
  • Nausea or indigestion
  • Fatigue (Peter, 2007)

 

Risk Factors

Individuals that contain one or more risk factors of CAD are 90% likely to experience coronary heart disease events (Wang, 2020). The following conditions can cause individuals to develop CAD (Li et al ., 2018):

  • High blood pressure
  • Obesity
  • Diabetes mellitus
  • High cholesterol
  • Smoking
  • Poor diet
  • Lack of exercise

 

Medical Diagnosis

Clinical Features

Clinicians can diagnose CAD using a patient’s medical history, family history, and associated risk factors (Khera, 2017). An individual’s diet, lifestyle, weight, and risk factors can be indicative of coronary artery disease (Khera, 2017). 

Pathological Features 

Coronary artery disease can be diagnosed through various tests such as blood tests, electrocardiograms (EKG), dobutamine exercise stress tests (Peter, 2007; Dietmar, 2001; Herzog et al., 1999), cardiac MRI, positron emission tomography (PET) scans, and coronary angiography (Beddhu et al., 2003).

Blood tests can detect the individuals’ cholesterol, triglyceride, lipoprotein, or C-reactive protein levels that serve as markers of CAD  (Li et al ., 2018; Peter, 2007).

 

Treatment

Non-Pharmaceutical Treatment

Smokers are encouraged to quit and those who drink alcohol are encouraged to reduce their intake or to practice sobriety (Ridker PM et al., 2014; Khera, 2017) .

 

Pharmaceutical Treatment 

Pharmaceutical treatment therapy that is proved to decrease the death rate including angiotensin-converting enzyme inhibitors (ACEI), adrenergic receptors blockers (BB), 3-methylglutaryl CoA reductase inhibitors, calcium channel blockers (McCullough, 2007). Metformin, nitrates, Ranolazine, and statins are the current medications prescribed to individuals with coronary artery disease to help manage their risk factors and any underlying causes (McCullough, 2007).

 

COVID-19 in patient with CAD 

Coronavirus Disease 2019 (COVID-19) was officially announced as the global pandemic by the World Health Organization (WHO) on March 11th, 2021 (Liang,2021). The meta-analysis study was conducted to investigate the prognosis of COVID-19 patients with pre-existing CAD (Liang, 2021).

Based on the statistical report of the study, people with pre-existing CAD have a higher risk of developing severe COVID-19 symptoms (Liang, 2021). These associations were highly correlated with hypertension, therefore CAD patients are highly encouraged to get their COVID-19 vaccination as it is the most effective way to prevent severe outcomes due to COVID-19 (Liang, 2021). 

For more information about COVID-19 for professionals:

COVID-19 (SARS-CoV-2 Coronavirus)

 

Misdiagnosis Articles

 

Bösner, S., Haasenritter, J., Keller, H., Abu Hani, M., Sönnichsen, A. C., Baum, E., & Donner-Banzhoff, N. (2011). The Diagnosis of Coronary Heart Disease in a Low-Prevalence Setting. Deutsches Ärzteblatt International, 108(26), 445–451. https://doi.org/10.3238/arztebl.2011.0445

Messerli, F. H. (2019). Ephemeral Coronary Heart Disease: Now you see it, now you don’t: A cardiologist’s personal story. European Heart Journal, 40(24), 1906–1908. https://doi.org/10.1093/eurheartj/ehz400

 

References

Khera, A. V., & Kathiresan, S. (2017). Genetics of coronary artery disease: discovery, biology and clinical translation. Nature reviews. Genetics, 18(6), 331–344. https://doi.org/10.1038/nrg.2016.160

Liang, C., Zhang, W., Li, S., & Qin, G. (2021). Coronary heart disease and COVID-19: A meta-analysis. Medicina clinica, 156(11), 547–554. https://doi.org/10.1016/j.medcli.2020.12.017

Li, H., Sun, K., Zhao, R., Hu, J., Hao, Z., Wang, F., … & Zhang, Y. (2018). Inflammatory biomarkers of coronary heart disease. Front Biosci (Schol Ed), 10, 185-96.

Musunuru, K., & Kathiresan, S. (2019). Genetics of Common, Complex Coronary Artery Disease. Cell, 177(1), 132–145. https://doi.org/10.1016/j.cell.2019.02.015 

Sanchis-Gomar, F., Perez-Quilis, C., Leischik, R., & Lucia, A. (2016). Epidemiology of coronary heart disease and acute coronary syndrome. Annals of translational medicine, 4(13).

Wang, M. (2020). Coronary Artery Disease: Therapeutics and Drug Discovery. Springer Nature.

Peter A. McCullough, CJASN May 2007, 2 (3) 611-616; DOI: 10.2215/CJN.03871106

Srinivasan Beddhu, Christine M. Logar, Charles A. Herzog,Diagnosis and Therapy of Coronary Artery Disease in Renal Failure, End-Stage Renal Disease, and Renal Transplant Populations,The American Journal of the Medical Sciences,Volume 325, Issue 4,2003, Pages 214-227, ISSN 

0002-9629,https://doi.org/10.1097/00000441-200304000-00008

Charles A. Herzog, Thomas H. Marwick, Alfred M. Pheley, Carl W. White, Venkateswara K. Rao, Candace D. Dick,

Dobutamine stress echocardiography for the detection of significant coronary artery disease in renal transplant candidates,American Journal of Kidney Diseases,Volume 33, Issue 6,1999,Pages 1080-1090,ISSN 0272-6386, https://doi.org/10.1016/S0272-6386(99)70145-9

Elsner, Dietmar,How to diagnose and treat coronary artery disease in the uraemic patient: an update,Nephrology Dialysis Transplantation,Nephrol Dial Transplant,2001,10.1093/ndt/16.6.1103,VO 16,IS 6,SP 1103,OP 1108,SN 0931-0509,RD 9/3/2021,UL https://doi.org/10.1093/ndt/16.6.1103

Ridker PM, Libby P, Buring JE. Risk Markers and the Primary Prevention of Cardiovascular Disease. In: Bonor RO, Mann DL, Zipes DP, Libby P, editors. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 10. Atlanta, GA: Elsevier Health Sciences; 2014. pp. 891–933. 

Peter A. McCullough, Coronary Artery Disease,CJASN May 2007, 2 (3) 611-616; DOI: https://doi.org/10.2215/CJN.03871106 

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