Ways Coronary Artery Disease Can Sneak Up on You

Coronary artery disease starts silently, often early in life. In fact, there’s a good chance you at least have the beginnings of it – and you might not know it.

Heart disease is one of the leading causes of death for men and women in the United States. It is usually a coronary artery disease (CAD). The coronary arteries carry blood to the heart muscle. If the fatty plaques in these arteries restrict blood flow, it is coronary artery disease.

It doesn’t happen all of a sudden. But it’s “silent” at first.

“CAD is a lifelong process. It progresses over time, ”says Jeffrey Berger, MD, director of the Center for the Prevention of Cardiovascular Disease at NYU Langone Health. “It probably starts in your late teens or early teens. You start to develop fatty streaks in the arteries which then turn into plaque.

“Even at age 18, you can start to form blockages in your arteries,” says Leslie Cho, MD, section chief of preventive and rehabilitative cardiology and director of the Women’s Cardiovascular Center at the Cleveland Clinic.

When coronary artery disease begins

The DAO is usually inflated by the time men are in their 50s and 60s and women in their 60s and 60s. But it started decades earlier.

Berger and Cho both cite a 1953 study of people, mostly men, who died during the Korean War. Autopsies showed that more than 75% of their hearts had plaques lining the coronary arteries. They didn’t necessarily die of heart disease, but they had at least some of its signs.

This study was one of the first to help doctors understand that coronary artery disease starts early, without any signs, and develops over time.

Other studies have found the same, including one of those who died after trauma (like car crashes) before they turned 35. Even at this young age, 78% of their hearts showed signs of coronary artery disease. In 1 in 5 hearts, the coronary arteries were narrowed by more than half. And in almost 1 in 10 people, this narrowing was even more severe.

This work also indicates something else: “Most people don’t know they have coronary artery disease, that they have plaque,” ​​Berger says.

Do you have coronary artery disease?

In most cases, people find out they have coronary artery disease only after experiencing symptoms such as fatigue, chest pressure, tightness, or a general feeling of discomfort, known as angina. Symptoms usually get worse with exercise and improve with rest.

“They are functionally limited,” Cho says. “This is how the majority of people are diagnosed. Some are not diagnosed until after a heart attack or stroke. That’s the unfortunate way to find out.

Besides age, some of the things that put you at risk are high blood pressure, high levels of “bad” cholesterol, smoking, diabetes, and lack of physical activity.

There are several ways to diagnose CAD. Doctors can measure electrical signals in your heart or check that it is pumping normally. A stress test can also help. Doctors can also use imaging tests.

“Really, the plaque is almost always there,” says Berger. “It’s about figuring out how many there is, quantifying it.”

And all plates may not carry the same risk.

Put coronary heart disease in check

What doctors and patients really want to know, Berger says, is which plaques are most likely to open and trigger a potentially fatal problem.

“When the plaques rupture, that’s what causes a heart attack,” says Berger. He notes that some people who have heart attacks have relatively little plaque. “The Holy Grail predicts which plates will rupture. There’s a lot of data to help, but we’re not there yet.

These days, Berger says, doctors typically don’t use stents or perform other “invasive” procedures to open coronary arteries unless someone has a blockage and symptoms. The key to preventing coronary artery disease, or at least slowing it down, is to take aggressive action to tame your risk factors. This includes healthy lifestyle changes.

“You can do a lot of things,” says Berger. Lifestyle changes like being active, dealing with stress, eating a heart-friendly diet, and not smoking are very important. “People need to take an active role in their own heart health. “

Medications to control blood pressure, lower high levels of LDL (bad cholesterol), and prevent blood clots can also help a lot.

Your first step

Ask your primary care physician for a risk factor assessment, Cho says. This should include a physical exam during which your doctor:

  • Check your blood pressure
  • Collects blood samples for lab tests that check your cholesterol and fasting blood sugar levels
  • Questions about your family’s health history, including heart problems

You and your doctor can also review any lifestyle habits that might help you, such as exercising, changing your diet, managing stress, getting enough sleep, and not smoking. Also discuss any conditions you have that could affect the health of your heart. Managing these risks is essential.

Even if you already have early signs of CAD development, there is a lot of hope.

“The beauty of cardiovascular disease is that it’s preventable,” Cho says. “Even if you have the worst family history, you can prevent them with the right medication and the right lifestyle changes. This is the good news of prevention.

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