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Dr. David Ostrander, medical director of the Cardiac Catheterization Laboratory at Sharp Memorial Hospital, responds:
Coronary artery disease, also referred to as atherosclerotic heart disease or hardening of the arteries, is the result of a build up of fatty plaque within the walls of the arteries that bring blood to the heart muscle. This buildup often begins during the teenage years.
As we grow and mature, so does plaque in our coronary arteries; gradually occupying more and more space in the walls of our blood vessels. Coronary artery disease is a common killer and can develop at any age. The good news: It’s 90 percent preventable.
The granddaddies of all heart disease risk factors are cigarette smoking and diabetes. Cigarette smoking alone increases a young woman's chance of having a heart attack by six-fold. Patients with diabetes are assumed to have atherosclerosis; 80 percent of patients with diabetes will eventually die of a heart attacks or stroke. The good news is we don’t have to smoke and most diabetes is preventable through diet and exercise.
If we are fortunate and our arteries narrow slowly, we may have weeks or months of warning symptoms of chest tightness or shortness of breath before we actually have a heart attack. If the symptoms are evaluated with stress testing or angiography the coronary blockage can be identified and symptoms relieved with medicines, angioplasty or surgery. If we are not so lucky, our first symptom may be chest pain followed shortly thereafter by sudden death.
Symptoms vary widely among individuals. In general, pain or pressure in the chest, arms, neck, jaw or back, especially if provoked by physical or emotional stress should be evaluated. Associated symptoms of a breathlessness, sweating or nausea should be a cause of concern.
These symptoms take on added significance in individuals who have risk factors for coronary disease. Chest pain, especially if severe or occurring at rest, can be warning symptoms of impending heart attack and requires urgent evaluation. Chest pain that persists for more than a few minutes and is not relieved by nitroglycerin should prompt a 911 call. Bottom line: Don’t mess around with chest pain. Get it checked out.
Eating a diet that is heavy on the fruits and vegetables and light on the meat and dairy is a good place to start, and the start should be in childhood. Thirty to 60 minutes a day of exercise is equally important and this too should be a habit that starts when we are young. Part of the reason that diet and exercise are so important is that they help us to maintain a normal body weight. People who are overweight or obese are more likely than people of normal weight to develop high blood pressure and diabetes and, consequently, coronary artery disease.
Cholesterol and Blood Pressure Basics
An ideal blood pressure is under 120/80 for most people, although very recent data suggest that for the elderly and patients with diabetes, 135/85 may be a better target. While doctors continue to debate about how low cholesterol should be, patients with known atherosclerosis or diabetes should have cholesterol above 40mg/dl for men and above 50mg/dl for women. If blood pressure and cholesterol levels aren’t at target, a wide variety of effective and well tolerated medications are available from your doctor.
So, what's the take home message?
While we can't predict when most heart attacks are going to occur we can determine if you’re at risk for a heart attack by evaluating your cardiac risk profile which includes: weight, cholesterol level, blood pressure, blood sugar, exercise regimen, diet, and smoking history and family history.
Use our heart care tools to find out if you might be at risk for heart disease.
For More Information
For more information about heart and vascular care at Sharp or to find a Sharp-affiliated doctor, search for a San Diego cardiologist or call 1-800-82-SHARP (1-800-827-4277), Monday through Friday, from 8 am to 6 pm. To find general information about heart and vascular care, visit Cardiovascular Diseases in Adult Health or read the Heart and Cardiovascular News archive.