Fundamentals of heart disease

Posted on: 12 September 2013 by Gareth Hargreaves

Reduced exercise and poor diet among over 50s is contributing to heart disease - spot the warning signs and stay healthier for longer.

Heart health warning signsHeart disease is the leading cause of death in this country, claiming the lives of approximately half a million people each year.

Caused by blockages in the blood vessels surrounding the heart (coronary arteries), heart disease is a preventable and treatable condition. The following are answers to some common questions about heart disease, risk factors associated with the disease, and important prevention measures.

What is atherosclerosis?

Atherosclerosis is the process that causes heart disease, or the narrowing of blood vessels that can lead to blockage of the coronary artery. It involves the build-up of a yellowish substance, termed atherosclerotic plaque, which contain cholesterol and fat material. Atherosclerosis can develop in many different arteries in the body, resulting in a number of different conditions, such as stroke and peripheral arterial disease. Like atherosclerosis in other areas of the body, the process in the heart that leads to the blockage of a coronary artery is complex and usually takes many years. A blockage that is more than 50 percent is considered significant and becomes critical when it is 90 percent or more. The blockage may be localized at a specific point in the artery or it may be diffuse, involving the entire length of the artery. The location of the blockage in an artery is also important; the further downstream the blockage in the artery, the less important the stoppage of blood becomes because there is less heart muscle to supply. These factors are important in determining the choice of treatment. For example, balloon angioplasty offers the best results when damaged areas (lesions) are short in length and the artery is not completely blocked.

What are the risk factors associated with coronary artery disease?

The common risk factors include:

  • High cholesterol
  • Family history of coronary artery disease
  • Male gender
  • Smoking
  • High blood pressure (hypertension)
  • Obesity
  • Sedentary lifestyle
  • Diabetes
  • Kidney failure
  • Depression


What happens if I have smoked for many years but now have stopped?

The risk factor from smoking decreases but is still likely to be higher than for someone who has never smoked.

Is smoking a pipe or cigars a risk factor?

Pipes and cigars are probably intermediate risk factors between cigarettes and not smoking at all. The bottom line is don't smoke.

How does family history contribute to coronary artery disease?

Certain inherited traits can increase the risk of coronary artery disease. Families with high levels of cholesterol in their blood may be the result of an inherited genetic defect related to the metabolism of cholesterol. There are different genetic defects that can increase the risk of coronary artery disease and their degree of severity can vary.

How do I know if I have a family history of coronary artery disease?

A family history of heart disease is suspected when someone in the family has been diagnosed with angina or has died from a heart attack. If the heart attack or death took place at a relatively early age (fifties or younger), the presence of a significant family history may be likely.

What should I do if I have a family history of coronary artery disease?

If there is a family history of heart disease, you should be particularly vigilant about preventive measures and getting the necessary medical attention. You should have an annual physical examination, which can be performed, at least initially, by a primary care physician. The evaluation should include a test for cholesterol and related blood chemistry. You may benefit from a more extensive cardiovascular examination such as a stress test that is begun at an earlier age and given more frequently than for those without a family history. A referral to a cardiologist may be made at the discretion of your primary care physician. Remember, each individual is different and your diagnosis and treatment is adjusted according to your particular condition, lifestyle, and risk factors.

Today, there are diet modifications and drug therapies that can lower blood cholesterol. If these changes are initiated at an early age, the onset of coronary artery disease may be delayed or stopped. If other risk factors are present, such as smoking, these should be stopped or modified.

How does diet affect risk?

There have been thousands of studies on diet and coronary artery disease. Reading these reports can be confusing. Overall, the studies show that the intake of a high fat and high cholesterol diet contributes to coronary artery disease. According to the American Heart Association, your daily cholesterol intake should not exceed 300 milligrams, and your total fat intake each day should be less than 30 percent of your total calories. A convenient way to determine your daily caloric requirement is adding a zero to your weight in pounds. So if you weigh 150 pounds, your daily caloric requirement is approximately 1,500 calories and no more than 30 percent of that (in this example, 450 calories) should come from fat. If you need to lose weight or have heart disease or high cholesterol, then the above formula is different and I would suggest a consultation with a nutritionist. Also, it is important to remember that the benefits from a diet program take time.

By: Windsor Ting, MD

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