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Heart Disease (Coronary Artery Disease) (cont.)

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How many people have heart (cardiovascular) disease, and what is the prognosis?

  • An estimated 15.5 million people in the United States have coronary artery disease.
  • Each year, 1.5 million patients suffer an acute myocardial infarction and more than 600,000 people die.
  • With better understanding of the different signs and symptoms of heart disease, especially the "atypical" symptoms experienced by women and the elderly, the diagnosis of heart disease has improved.
  • The prognosis for the patient is better when diagnosis and treatment are initiated early.
  • Educating the public about early access to emergency services when a patient develops acute chest pain can help save lives.
  • The goal for the treatment of heart disease is to maximize longevity and quality of life.

Can cardiovascular disease be prevented?

It may take 10 to15 years from the beginning of a plaque formation in a coronary artery to narrow that artery to constrict blood flow.

The American Heart Association and the American College of Cardiology have developed guidelines so that health-care professionals may counsel and treat their patients to decrease the risk of developing heart disease. New attention is being paid to the role of weight reduction, diet, exercise, and the use of cholesterol-lowering medications called statins.

In the past, the goal for statin drugs like atorvastatin, was to lower the blood cholesterol level to a specific number and statins were prescribed for patients with high cholesterol levels or those who had had heart attacks. The new guidelines recommend that more patients may benefit from these statin drugs. Rather than having specific cholesterol numbers as a goal, the new goal is to lower the blood cholesterol level by 50% in high-risk patients and by 30% to 50% in those who are at lower risk to develop heart disease.

Patients with a history of heart attack, transient ischemic attack (TIA), or stroke, statins may be appropriate for patients with high LDL cholesterol levels (the “bad” cholesterol), for example, those who have type 2 diabetes, and those who have a 10-year risk of heart attack greater than 7.5%. You and your health-care professional may estimate risk by using the American Heart Association and American College of Cardiology's ASCVD (Atherosclerotic Cardiovascular Disease) Risk Calculator.

Preventing cardiovascular disease is a lifelong commitment to control blood pressure, high cholesterol, quit smoking, and diabetes. Now, new opportunities exist to decrease risk even further with these new guidelines. These are also the steps to take to decrease the risk of stroke and peripheral artery disease.

Which specialties of doctors treat heart (cardiovascular) disease?

Cardiologists are specialists who treat cardiovascular heart disease. In addition to confirming the diagnosis using a heart catheterization, they often are able to perform angioplasty to dilate or open a narrowed or blocked artery and restore blood supply to heart muscle. As well, cardiologists help manage patients with chest pain to minimize the risk of future heart muscle damage.

Cardiothoracic surgeons operate on the heart and perform coronary artery bypass surgery, if the coronary arteries are severely blocked and the patient is not a candidate to have angioplasty. These surgeons also repair or replace heart valves and perform other surgeries that involve the structure of the heart.

Primary care practitioners, including those in family medicine, internal medicine specialists and women's health, often help make the initial diagnosis of heart disease and are able to manage stable patients who do not need invasive procedures or interventions. These providers are also work to help minimize potential risk factors for heart disease, so that it does not develop, or if it is already present, to minimize progression of the artery blockages.

Emergency physicians often make the diagnosis of angina when a patient presents with symptoms of heart disease. As well, when patients present to the ER with symptoms of a heart attack, they work as a team with the cardiologists to treat the patient quickly to restore blood supply to dying heart muscle.

REFERENCES:

Arnett, D. K., et al. "AHA/ACC/HHS Strategies to Enhance Application of Clinical Practice Guidelines in Patients with Cardiovascular Disease and Comorbid Conditions." Circulation 130.18 (2014): 1662-1667.

Bamberg, F., et al. "Meta-analysis and systematic review of the long-term predictive value of assessment of coronary atherosclerosis by contrast-enhanced coronary computed tomography angiography." Journal of the American College of Cardiology 57.24 (2011): 2426-2436.

Centers for Disease Control and Prevention. "Coronary Artery Disease (CAD)." Updated: Aug 10, 2015.
<https://www.cdc.gov/heartdisease/coronary_ad.htm>

Centers for Disease Control and Prevention. "Heart Attack Signs and Symptoms." Updated: Aug 05. 2015.
<https://www.cdc.gov/heartdisease/signs_symptoms.htm>

Centers for Disease Control and Prevention. "Health, United States, 2015: With Special Feature on Racial and Ethnic Health Disparities."
<http://www.cdc.gov/nchs/data/hus/hus15.pdf>

Centers for Disease Control and Prevention. "Leading Causes of Death." Updated: Oct 07, 2016.
<http://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm>

Greenland, P., et al. "2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines." Journal of the American College of Cardiology 56.25 (2010): e50-e103.

Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.

Stone, N. J., et al. "2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines." Journal of the American College of Cardiology 7 Nov. 2013.


Medically Reviewed by a Doctor on 10/24/2016

Source: MedicineNet.com
http://www.medicinenet.com/heart_disease_coronary_artery_disease/article.htm

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