Coronary Artery Disease (CAD)

Coronary artery disease (CAD) is the leading cause of death in the United States. Each year, more than 600,000 people die from CAD and 1.5 million people suffer myocardial infarction (a heart attack). Most CAD is caused by atherosclerosis, which is commonly referred to as "hardening of the arteries."

Most cases of CAD occur when fatty deposits, scar tissue, calcium or other materials build up inside the walls of the coronary arteries (the arteries that supply blood to your heart), narrowing and thickening them. This can lead to an eventual blockage or spasm within the coronary arteries, preventing them from delivering an adequate supply of oxygen-rich blood to the heart muscle. This, in turn, can lead to angina (chest pain) or a heart attack. An irregular pulse also may occur and in some cases the heart may stop beating.

Angina usually is temporary, occurring when damaged arteries fail to supply a sufficient supply of blood to the heart muscle for a given amount of work. Rest usually relieves the pain, as does a medication called nitroglycerin, which relaxes the coronary arteries.

A heart attack occurs when heart muscle dies from lack of oxygen. Symptoms include feelings of pressure, fullness, squeezing or crushing pain in the center of the chest that is not eased with rest; pain that spreads from your chest to your shoulder, jaw, neck, upper back, or arms; chest discomfort accompanied by light-headedness; fainting, cool clammy sweating; nausea; upper abdominal pain; shortness of breath; or a feeling of doom or danger. Take all chest pain seriously. Seek immediate care for all chest pain.

What You Can Do

A number of lifestyle measures can lower your risk of coronary artery disease. These steps also help slow the progression of the disease among those who already have it. You can control many risk factors for developing CAD, including smoking, high blood pressure, high blood cholesterol, physical inactivity and obesity. Learning to manage stress also is important. Risk factors you cannot control include your family history, gender, ethnicity, age and certain chronic conditions such as diabetes. However, by managing conditions like diabetes you also lower the risk of CAD and slow its progression if it already exists. The following measures are steps anyone can take, no matter what their age or health status:

Maintain a healthy diet. This includes eating plenty of fresh or steamed vegetables, fresh fruits, whole grains and lean proteins. You also should eat foods low in saturated fat, and cholesterol and eliminate as many foods containing trans-fatty acids as possible from your diet. Trans-fats are found in many fried and processed foods and in some margarine. Minimize your consumption of whole milk products, eggs, red meat, coconut and palm oil, processed foods, and fatty fried foods. Your doctor may recommend medications to lower your cholesterol if diet alone doesn't work.
Stop smoking. If you resume smoking after having a heart attack, your chances of having a second heart attack double. Smoking puts added strain on your heart because it constricts blood vessels, including those already narrowed and damaged. Smoking also makes your heart beat faster, raises your blood pressure and increases the level of carbon monoxide in your blood, which deprives your heart (and all other body tissues) of necessary oxygen.
Manage high blood pressure. High blood pressure (hypertension) is a major risk factor for heart disease. It puts added strain on your heart and, over time, may damage artery walls and eventually lead to heart failure. For many people, eating a healthy diet, stopping smoking, reducing stress and following a regular exercise program help lower blood pressure. Medication also may be necessary.
Begin an exercise program. Regular moderate exercise can increase your endurance, lower blood pressure and reduce blood cholesterol levels, relieve stress, and help control your weight. If you have angina or have had a heart attack, a cardiac rehabilitation program may be of benefit; it usually begins in the hospital under the supervision of your healthcare provider and a cardiac rehabilitation specialist. This program can be continued on an outpatient basis at a fitness center or at your home. Your doctor and rehabilitation specialist can prescribe an appropriate program for you that includes education about heart disease and emotional support.
Take medications as prescribed. Report any side effects to your healthcare provider. Don't just stop taking a medication or try to adjust the dosage on your own.
Maintain a healthy weight. The more overweight you are, the harder your heart has to work. If you need to lose weight, ask your doctor to help you design an exercise program and diet that will help you lose excess body fat safely and efficiently. Avoid crash diets and do NOT take diet pills or supplements that are advertised for weight loss.
Limit sodium intake. If you take medications for high blood pressure, eating salt can make them less effective. In certain individuals, the sodium in table salt and many packaged and prepared foods can cause the body to retain water, which increases blood volume and may raise blood pressure. Effective ways to reduce your sodium intake include removing the salt shaker from the table and not adding salt when you cook. Fresh foods contain very little sodium; most of the sodium we consume comes from processed foods.
Reduce stress. Chronic stress can increase your heart rate and blood pressure, and may damage the inside of artery walls. Exercise, visualization, muscle relaxation and deep breathing are easy stress reduction techniques that can help you manage your stress.
Manage your diabetes, if you have it. Diabetes greatly increases your risk for CAD. Therefore, controlling your blood sugar and following the lifestyle measures already mentioned helps lower your risk of CAD and other complications of diabetes.

After a Heart Attack

Unfortunately, by the time you've had a heart attack, a lot of damage has already occurred. However, by following your healthcare provider's advice on diet, medication, exercise and follow-up visits, you can greatly reduce your risk of having another one. Keep the following in mind:

Exercise

Regular moderate exercise improves the heart's pumping function. However, people who have suffered a recent heart attack should be cautious, start slowly, and increase the time and intensity of physical activity gradually. Many people start in a supervised program of cardiac rehabilitation following a heart attack. As your strength and tolerance increase, you can probably add more strenuous activities to your exercise program. Walking or using a stationary bicycle for a few minutes at a comfortable pace, with short rest periods between periods of activity, are often recommended for beginners.

Sexual Relations

Sex is usually considered safe within a few weeks after a heart attack. Don't be ashamed to talk to your healthcare provider about when you can safely have sex again. It's likely that your schedule will be linked to your ability to tolerate other types of exercise. Generally, by the time you are able to walk up two flights of stairs, you are able to safely have sex.

In addition, follow a few simple guidelines:

Avoid having sex immediately after a big meal or drinking alcohol; try waiting a couple of hours after either activity. Of course, moderation in both eating and drinking alcohol is important.
Make sure you're comfortable, relaxed and rested when you have sex; try not to feel "stressed out" by resuming intimacy. It may help to begin slowly and avoid intercourse until you feel relaxed.
Don't attempt new activities or sex with a new partner during the first few weeks following a heart attack. Such encounters may be stressful, which makes sexual activity difficult and may place you at risk of another heart attack.
If you take sildenafil (Viagra), vardenafil (Levitra) or tadalafil (Cialis) for erectile dysfunction, ask your healthcare provider about any special instructions or circumstances you should consider. (Note: These drugs are NOT appropriate for individuals who take nitrates; combining the medications can lead to dangerously low blood pressure.)

Rehabilitation

Enroll in a cardiac rehabilitation or exercise and nutrition program. If you've already had a heart attack, a cardiac rehabilitation program can help you reduce further risk and improve your general health through an individualized program of exercise, diet, smoking cessation and counseling. If you have been hospitalized, you may have already begun a program in the hospital. Outpatient programs are also available. Call your healthcare provider or local hospital for information on cardiac rehabilitation programs in your area. Also, check to see if your health plan covers this type of program.

Depression

It is normal after being diagnosed with CAD to feel depressed and angry, and to have trouble accepting your condition. If these feelings are long lasting and cannot be relieved by discussions with your family and friends, or by participating in a cardiac recovery program, call your healthcare provider or counselor to request assistance. Do not ignore depression or wait for it to pass. Symptoms of depression include significant weight loss or gain, insomnia or excessive sleeping, fatigue, feelings of worthlessness, feelings of guilt, difficulty concentrating or making decisions. In severe depression, recurrent thoughts of suicide or death may occur.

Final Note

Stay committed to making the lifestyle changes necessary to manage CAD. Take small steps, especially at first. It's important to set realistic goals, reward yourself for progress, and build a support system of people who understand what you are going through.

Organizations are also available to answer your questions and provide supportive services. The American Heart Association provides free literature; check your telephone directory for a local address and telephone number. Mended Hearts is a self-help organization that has monthly meetings for patients and families, a newsletter, and a hospital visitation program for patients undergoing coronary bypass surgery. Write them at 7320 Greenville Ave. Dallas, Texas 75231 or call 1-888-HEART99 (1-888-432-7899). Coronary Club Inc. is a national organization with local chapters. It has monthly meetings on heart care and rehabilitation, and a monthly bulletin called Heartline . Write them at 9500 Euclid Ave. Cleveland, Ohio 44195, or call 1-800-478-4255.

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