The process of atherosclerosis begins as early as childhood and slowly develops ultimately leading to heart disease. Atherosclerotic cardiovascular disease is the leading cause of death and disability in the United States. In 1997 thirty-one percent (31.4%) of all deaths were due to diseases of the heart. Atherosclerosis is a process of the accumulation of lipids and complex carbohydrates in the blood vessels. It leads to narrowing of the arterial vessels of the body in the cerebral, peripheral and abdominal circulation.
In atherosclerosis the coronary arteries become occluded due to the deposition of atherosclerotic plaque. This interferes with arterial capability for providing sufficient oxygen to the heart muscles. Due to a reduction in oxygen supply, ischemia of the heart muscle can occur. With further progression, any increased demand on cardiac muscles may produce angina pectoris or chest pain, the cardinal symptom of coronary artery disease.
In patients with occlusive coronary artery disease, severe atherosclerosis eventually completely occludes the coronary artery causing the heart muscles supplied by the artery to die. This clinical event is known as myocardial infarction, more commonly called the heart attack, and is accompanied by prolonged chest pain, nausea, sweating, shortness of breath, and weakness. The arterial occlusion and subsequent tissue death may occur silently and without symptoms.
Although atherosclerosis occurs in the general population, some people are at greater risk for developing coronary artery disease. Epidemiological studies have identified several cardiac disease risk factors. These risk factors can be classified as either modifiable or non-modifiable (Table 2).
|Modifiable CAD Risk Factors||Non-modifiable CAD Risk Factors|
|Cigarette smoking||Males > 45 years|
Females > 55 years
|Hypertension (blood pressure >= 140 / 90 mmHg)||Family history of coronary artery disease|
These coronary artery disease risk factors in Table 2 can be identified from the patient history and physical examination.