Coronary Artery (Heart) Disease / Angina

Please add those who had unspecified "heart disease", coronary artery disease or coronary heart disease. Angina also would be appropriate here.

SEE also: Arteriosclerosis / Atherosclerosis, if the arteriosclerosis or atherosclerosis is in an area other than the coronary arteries.

Coronary heart disease (CHD) is atherosclerosis, which is the hardening and narrowing of the arteries due to the build-up of fatty material and plaque. This reduces blood flow through the coronary arteries to the heart muscle. Reduced or cut-off blood flow and oxygen supply to the heart muscle can result in angina, heart attack and lead to heart failure and arrhythmias.

• Coronary heart disease , or CHD, is actually a result of coronary artery disease, or CAD

Coronary artery disease (CAD) is the most common type of heart disease. It is the leading cause of death in the United States in both men and women.

• CAD happens when the arteries that supply blood to heart muscle become hardened and narrowed. This is due to the buildup of cholesterol and other material, called plaque, on their inner walls. This buildup is called atherosclerosis. As it grows, less blood can flow through the arteries. As a result, the heart muscle can't get the blood or oxygen it needs. This can lead to chest pain (angina) or a heart attack. Most heart attacks happen when a blood clot suddenly cuts off the hearts' blood supply, causing permanent heart damage.
• With coronary artery disease, plaque first grows within the walls of the coronary arteries until the blood flow to the heart’s muscle is limited, which results in ischemia. It may be chronic, narrowing of the coronary artery over time and limiting of the blood supply to part of the muscle. Or it can be acute, resulting from a sudden rupture of a plaque and formation of a thrombus or blood clot.
• Over time, CAD can also weaken the heart muscle and contribute to heart failure and arrhythmias. Heart failure means the heart can't pump blood well to the rest of the body. Arrhythmias are changes in the normal beating rhythm of the heart.

Cardiovascular disease includes two major sub-types:

• Coronary heart disease (CHD)
• Cerebrovascular disease (stroke) 

In the United States, coronary heart disease (CHD) is a leading cause of death for both men and women. Each year, about 370,000 Americans die from coronary heart disease.

The primary result of CHD:

CHD presents in two main forms: myocardial infarction (heart attack) and angina.

Angina Pectoris:

• Angina pectoris is the medical term for chest pain or discomfort due to coronary heart disease.  It occurs when the heart muscle doesn't get as much blood as it needs. This usually happens because one or more of the heart's arteries is narrowed or blocked, also called ischemia.
• Angina usually causes uncomfortable pressure, fullness, squeezing or pain in the center of the chest.  You may also feel the discomfort in your neck, jaw, shoulder, back or arm.  (Many types of chest discomfort — like heartburn, lung infection or inflammation — aren‘t related to angina.) Angina in women can be different than in men.
• Angina often occurs when the heart muscle itself needs more blood than it is getting, for example, during times of physical activity or strong emotions. Severely narrowed arteries may allow enough blood to reach the heart when the demand for oxygen is low, such as when you're sitting. But, with physical exertion—like walking up a hill or climbing stairs—the heart works harder and needs more oxygen.
• Unstable angina should be treated as an emergency. If you have new, worsening or persistent chest discomfort, you need to go to the ER. You could be having a heart attack which puts you at increased risk for severe cardiac arrhythmias or cardiac arrest, which could lead to sudden death. Learn about an unstable form of angina called Prinzmetal angina.

Causes:

Research suggests that coronary heart disease (CHD) starts when certain factors damage the inner layers of the coronary arteries. These factors include:

• Smoking
• High levels of certain fats and cholesterol in the blood
• High blood pressure
• High levels of sugar in the blood due to insulin resistance or diabetes
• Blood vessel inflammation
• Plaque might begin to build up where the arteries are damaged. The buildup of plaque in the coronary arteries may start in childhood.
• Over time, plaque can harden or rupture (break open). Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. This can cause angina (chest pain or discomfort).
• If the plaque ruptures, blood cell fragments called platelets (PLATE-lets) stick to the site of the injury. They may clump together to form blood clots. Blood clots can further narrow the coronary arteries and worsen angina. If a clot becomes large enough, it can mostly or completely block a coronary artery and cause a heart attack.

Major Risk Factors

Many factors can raise your risk for coronary artery disease,

• Unhealthy blood cholesterol levels. This includes high LDL cholesterol (sometimes called “bad” cholesterol) and low HDL cholesterol (sometimes called “good” cholesterol).
• High blood pressure. Blood pressure is considered high if it stays at or above 140/90 mmHg over time. If you have diabetes or chronic kidney disease, high blood pressure is defined as 130/80 mmHg or higher. (The mmHg is millimeters of mercury—the units used to measure blood pressure.)
• Smoking. Smoking can damage and tighten blood vessels, lead to unhealthy cholesterol levels, and raise blood pressure. Smoking also can limit how much oxygen reaches the body's tissues.
• Insulin resistance. This condition occurs if the body can't use its own insulin properly. Insulin is a hormone that helps move blood sugar into cells where it's used for energy. Insulin resistance may lead to diabetes.
• Diabetes. With this disease, the body's blood sugar level is too high because the body doesn't make enough insulin or doesn't use its insulin properly.
• Overweight or obesity. The terms “overweight” and “obesity” refer to body weight that’s greater than what is considered healthy for a certain height.
• Metabolic syndrome. Metabolic syndrome is the name for a group of risk factors that raises your risk for CHD and other health problems, such as diabetes and stroke.
• Lack of physical activity. Being physically inactive can worsen other risk factors for CHD, such as unhealthy blood cholesterol levels, high blood pressure, diabetes, and overweight or obesity.
• Unhealthy diet. An unhealthy diet can raise your risk for CHD. Foods that are high in saturated and trans fats, cholesterol, sodium, and sugar can worsen other risk factors for CHD.
• Older age. Genetic or lifestyle factors cause plaque to build up in your arteries as you age. In men, the risk for coronary heart disease increases starting at age 45. In women, the risk for coronary heart disease increases starting at age 55.
• A family history of early coronary heart disease is a risk factor for developing coronary heart disease, specifically if a father or brother is diagnosed before age 55, or a mother or sister is diagnosed before age 65.
• Although older age and a family history of early heart disease are risk factors, it doesn't mean that you’ll develop CHD if you have one or both. Controlling other risk factors often can lessen genetic influences and help prevent CHD, even in older adults.

Emerging Risk Factors:

• Researchers continue to study other possible risk factors for CHD.
• High levels of a protein called C-reactive protein (CRP) in the blood may raise the risk of CHD and heart attack. High levels of CRP are a sign of inflammation in the body. Inflammation is the body's response to injury or infection. Damage to the arteries' inner walls may trigger inflammation and help plaque grow.
• Research is under way to find out whether reducing inflammation and lowering CRP levels also can reduce the risk of CHD and heart attack.
• High levels of triglycerides in the blood also may raise the risk of CHD, especially in women. *Triglycerides are a type of fat.

Other conditions and factors may also contribute to CHD, including:

• Sleep apnea. Sleep apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep. Untreated sleep apnea can increase your risk for high blood pressure, diabetes, and even a heart attack or stroke.
• Stress. Research shows that the most commonly reported "trigger" for a heart attack is an emotionally upsetting event, especially one involving anger.
• Alcohol. Heavy drinking can damage the heart muscle and worsen other CHD risk factors. Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day.
• Preeclampsia. This condition can occur during pregnancy. The two main signs of preeclampsia are a rise in blood pressure and excess protein in the urine. Preeclampsia is linked to an increased lifetime risk of heart disease, including CHD, heart attack, heart failure, and high blood pressure.

Statistics:

Coronary heart disease is the most common type of heart disease. In 2008, 405,309 people died from coronary heart disease.

• Every year about 785,000 Americans have a first coronary attack. Another 470,000 who have already had one or more coronary attacks have another attack.
• In 2010, coronary heart disease alone was projected to cost the United States $108.9 billion. This total includes the cost of health care services, medications, and lost productivity.
• About 610,000 people die of heart disease in the United States every year–that’s 1 in every 4 deaths.
• Heart disease is the leading cause of death for both men and women. More than half of the deaths due to heart disease in 2009 were in men.
• Coronary heart disease (CHD) is the most common type of heart disease, killing over 370,000 people annually.
• Every year about 735,000 Americans have a heart attack. Of these, 525,000 are a first heart attack and 210,000 happen in people who have already had a heart attack
• Heart disease is the leading cause of death for people of most ethnicities in the United States, including African Americans, Hispanics, and whites. For American Indians or Alaska Natives and Asians or Pacific Islanders, heart disease is second only to cancer.
• Coronary heart disease is now the leading cause of death worldwide. An estimated 3.8 million men and 3.4 million women die each year from CHD1.
• In developed countries heart disease is the leading cause of death in men and women2. In Europe CHD accounts for an estimated 1.95 million deaths each year4.
• CHD is the most common cause of deaths in the UK. An estimated 1 in 5 men and 1 in 6 women die from the disease each year5.
• In 2003 CHD caused around 114,000 deaths in the UK5.
• CHD is responsible for 110,000 deaths in England each year. More than 1.4 million suffer from angina and 275,000 people have a heart attack annually5.
• Death rates from CHD have been falling in the UK since the late 1970s. For people <65 years, they have fallen by 44% in the last ten years5. A recent study has suggested that 58% of decline in CHD during the 1980s and 1990s was attributable to reduction in major risk factors, principally smoking. Treatments to individual, including secondary prevention explained the remaining decline in mortality5.
• However despite recent declines the UK has a relatively high death rate from CHD. Among more developed countries only Ireland and Finland have a higher rate than the UK5.
• Death rates from CHD are highest in Scotland and Northern England. The premature death rate for men living in Scotland is 67% higher than in the South West of England and 84% higher for women5.
• Significant socio-economic differences in the mortality for CHD are evident. The premature deaths rate from CHD at the end of the 1980s for male manual workers was 58% higher than for male non-manual workers, while the premature death rate from CHD for female manual workers was more than twice as high5.
• The highest deaths rates for CHD in the UK have been observed among South Asians (Indians, Bangladeshis, Pakistanis and Sri Lankans).

Notables who died of Heart Disease

1. Ranker - Famous People Who Died of Heart Disease (93 listed as of 1/11/19)

• Mel Blanc (1908-1989) - Voice actor, comedian, singer, radio personality; (Wikipedia - Mel Blanc had advanced Coronary Artery Disease)
• Henry Fonda (1905-1982) - Actor; (Wikipedia - Henry Fonda; died from from heart disease, but also suffered from prostate cancer, which wasn’t a direct cause of death.)
• Joan Miró (1893-1983) - Spanish painter, sculptor, ceramicist; (Wikipedia - Joan Miró sufferred from heart failure
• E Lynn Harris (1955-2009) - American author;(Wikipedia - E Lynn Harris) He was found unconscious at the Peninsula Hotel in Beverly Hills, California, and was pronounced dead at Cedars-Sinai Medical Center in Los Angeles. An autopsy determined that the cause of death was heart disease. That same day, Harris had fallen ill on the train to Los Angeles and blacked out but was fine after, according to his publicist Laura Gilmore.
• Lonny Chapman (1920-2007) - Actor, playwright; (Wikipedia - Lonny Chapman) -- died of complications from heart disease
• John Steinbeck (1902-1968) - Novelist, short story writer, war correspondent; (Wikipedia - John Steinbeck (1902-1968) died of heart disease and congestive heart failure. He was 66, and had been a lifelong smoker. An autopsy showed nearly complete occlusion of the main coronary arteries.)

References & Additional Reading:

• -NIH - Coronary Heart Disease, Also know as Coronary Artery Disease
• [https://www.heart.org/en/health-topics/heart-attack/angina-chest-pa...]
• CDC Heart Disease in the United States
• Health Knowledge - Coronary Heart Disease
• Mayo Clinic - Mayo Clinic Q & A: Coronary artery disease-- prevention & early warning signs. By Liza Torborg, 23 Nov 2018
• MedlinePlus - Coronary Artery Disease
• American Academy of Family Physicians - Coronary Artery Disease
• American Heart Association - Coronary Artery Disease - Coronary Heart Disease
• WebMD - Coronary Artery Disease

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