the occlusion, remains a popular intervention
because it is far less invasive than CABG, requires
minimal recovery time, and results in immediate
improvement of coronary circulation. However,
restenosis (return of the atherosclerotic narrow-
ing) is more the norm than the exception and
occurs in a fourth to a third of people within six
months. Angioplasty with STENTplacement (a tiny
springlike device that remains at the site of the
occlusion to hold pressure against the arterial
wall) fares somewhat better. Treatment options
and recommendations continue to evolve as new
medications and technologies become available.
The most significant long-term consequence of
CAD is damage following heart attack, which may
or may not improve with CABG. LEFT VENTRICULAR
EJECTION FRACTION(LVEF), a calculation of the per-
cent of blood that leaves the heart with each con-
traction of the left ventricle, projects the extent of
disability resulting from heart attack due to CAD.
LVEF above 60 percent generally correlates with
little loss of cardiovascular function except with
extreme physical exertion. Most people with an
LVEF greater than 40 percent can return to work
and normal activities. LVEF that drops below 40
percent limits the heart’s capacity to meet the
body’s oxygen needs during moderate physical
exertion, and below 20 percent restricts nearly all
physical activity.
MAJOR RISK FACTORS FOR CAD
age 50 or older cigarette smoking
DIABETES family history of youngHEART ATTACK
HYPERLIPIDEMIA HYPERTENSION
OBESITY PERIPHERAL VASCULAR DISEASE(PVD)
physical inactivity
Risk Factors and Preventive Measures
The most clear-cut early warning sign for the
development of CAD is HYPERLIPIDEMIA (elevated
cholesterol and triglycerides blood levels). Hyper-
lipidemia indicates dysfunction with the body’s
lipid synthesis and storage mechanisms, which
typically results in accumulations of fatty acids
along the inner arterial walls. These accumula-
tions irritate and inflame the artery’s intima,
establishing the foundation for atherosclerotic
plaque development. Numerous studies show that
lowering blood lipid levels reduces atherosclerotic
accumulations, slowing the progression of CAD.
DIABETES, HYPERTENSION, andOBESITYaccelerate the
progression of CAD. The prevalence of CAD in
young people alarms health experts, who empha-
size that it is never too early to implement a heart-
healthy lifestyle.
An important understanding about CAD is that
it is a chronic, lifelong cardiovascular condition.
Even with CABG or angioplasty, the disease
process continues. Treatments aim to slow the
progression but so far are not able to prevent it.
Lifestyle changes are imperative for people who
want to enjoy extended LIFE EXPECTANCYas well as
QUALITY OF LIFE. Though the outlook for controlling
CAD has never been brighter, CAD remains a
major health concern. Lifestyle modifications to
improve cardiovascular health, in combination
with medical interventions such as ASPIRIN THERAPY
and medications to regulate heart function, can
significantly impede CAD’s progression.
See also CARDIOVASCULAR DISEASE PREVENTION;
COENZYME Q 10 ; DIABETES AND CARDIOVASCULAR DISEASE;
DIET AND CARDIOVASCULAR HEALTH; PHYSICAL EXERCISE
AND CARDIOVASCULAR HEALTH; SMOKING AND CARDIO-
VASCULAR DISEASE; STROKE.c-reactive protein A substance the body’s tissues
release when they become inflamed. Some health
experts believe elevated levels of c-reactive pro-
tein in the BLOODmay indicate the presence of ATH-
EROSCLEROSIS. Though cardiologists and researchers
have known for some time that inflammatory
processes accompany atherosclerosis, studies in
the 1990s and early 2000s began to suggest that
INFLAMMATION, perhaps due to low-grade INFECTION,
might be a contributing cause of atherosclerosis.
Elevated blood levels of c-reactive protein in peo-
ple who have had HEART ATTACKSportend signifi-
cant increase in risk for subsequent HEARTattacks.
However, cardiologists are not certain how impor-
tant elevated c-reactive protein levels are in peo-
ple who do not appear to have CARDIOVASCULAR
DISEASE (CVD). Chronic inflammatory conditions
may also elevate c-reactive protein. Cardiologists
generally recommend considering a person’s level
of c-reactive protein in context with other RISK
FACTORS FOR CARDIOVASCULAR DISEASE, and base
intervention decisions on the overall cardiovascu-
lar risk picture.c-reactive protein 45