Coronary Heart Disease

CHD develops gradually over time due to a combination of genetic and lifestyle factors. The key risk factors include:

1. Modifiable Risk Factors (Lifestyle and Health Conditions)

• High cholesterol levels – Excess low-density lipoprotein (LDL, “bad” cholesterol) contributes to plaque buildup in the arteries.
• High blood pressure (hypertension) – Increases strain on the arteries, making them more prone to damage.
• Smoking – Chemicals in tobacco damage blood vessels, increase plaque formation, and raise the risk of blood clots.
• Obesity and poor diet – A diet high in saturated fats, processed foods, and sugar contributes to weight gain and increases CHD risk.
• Diabetes – Uncontrolled blood sugar levels accelerate atherosclerosis and increase the likelihood of heart disease.
• Physical inactivity – Lack of exercise is linked to weight gain, high blood pressure, and poor heart health.
• Excessive alcohol consumption – Can lead to high blood pressure and increased cholesterol levels.
• Chronic stress – Long-term stress may contribute to high blood pressure and unhealthy lifestyle habits.

2. Non-Modifiable Risk Factors (Genetics and Demographics)

Age – CHD risk increases with age, particularly in men over 45 and women over 55.

Family history – A history of heart disease in close relatives increases individual risk.

Ethnicity – Certain ethnic groups, including South Asian, African, and Caribbean populations, have a higher risk of developing CHD.

While some risk factors cannot be changed, lifestyle modifications and medical management can significantly reduce the risk of CHD.

CHD may not always cause noticeable symptoms, but when it does, the most common signs include:

1. Angina (Chest Pain or Discomfort)
•       A tight, squeezing, or pressure-like pain in the chest.
•       Often triggered by physical activity or stress and relieved by rest.
•       Can radiate to the jaw, neck, shoulders, arms, or back.

2. Shortness of Breath
•       A result of the heart struggling to pump blood efficiently.

3. Fatigue and Weakness
•       Feeling excessively tired, especially after exertion.

4. Heart Attack (Myocardial Infarction)

A heart attack occurs when a coronary artery becomes completely blocked, cutting off blood supply to part of the heart muscle. Symptoms include:
•       Severe chest pain (may feel like pressure, tightness, or burning).
•       Pain spreading to the arm, neck, jaw, or back.
•       Sweating, nausea, dizziness, or shortness of breath.

A heart attack is a medical emergency – if you suspect one, call 999 immediately.

CHD is diagnosed through a combination of clinical assessment and diagnostic tests, including:

• Electrocardiogram (ECG) – Detects abnormal heart rhythms and signs of previous heart damage.
• Echocardiogram (Heart Ultrasound) – Assesses heart function and blood flow.
• Blood Tests – Check cholesterol levels, blood sugar (for diabetes), and markers of heart damage (troponin).
• Coronary Angiography – Uses contrast dye and X-ray imaging to assess artery blockages.
• CT Coronary Angiogram (CTCA) – A non-invasive scan providing detailed images of the coronary arteries.
• Exercise Stress Test – Monitors heart function during physical activity.

Early detection allows for timely intervention and better outcomes.

The treatment approach for CHD depends on its severity and aims to reduce symptoms, slow disease progression, and prevent complications like heart attacks.

1. Medications

• Statins – Lower LDL (“bad”) cholesterol and prevent plaque buildup.
• Beta-blockers – Reduce heart rate and blood pressure, easing strain on the heart.
• ACE inhibitors / ARBs – Help lower blood pressure and protect heart function.
• Antiplatelet drugs (e.g., aspirin, clopidogrel) – Reduce the risk of blood clot formation.
• Nitrates – Used to relieve angina symptoms by relaxing blood vessels.

2. Medical Procedures and Surgery

In severe cases, procedures may be required to restore blood flow to the heart:

• Coronary Angioplasty and Stenting
• A minimally invasive procedure where a small balloon is used to widen narrowed arteries, followed by the insertion of a stent to keep the artery open.
• Coronary Artery Bypass Graft (CABG) Surgery
• A major open-heart surgery where a healthy blood vessel from the leg, arm, or chest is used to bypass blocked arteries, restoring proper blood flow to the heart.

3. Lifestyle Changes for Prevention and Long-Term Management

• Heart-Healthy Diet – Increase intake of fruits, vegetables, whole grains, and lean proteins, while reducing saturated fats, sugar, and salt.
• Regular Exercise – Aim for at least 150 minutes of moderate activity per week.
• Quit Smoking – Eliminates exposure to harmful chemicals that damage the arteries.
• Weight Management – Maintaining a healthy weight lowers blood pressure, cholesterol, and diabetes risk.
• Manage Stress – Techniques like meditation, yoga, and deep breathing exercises can help reduce stress levels.

Adopting these lifestyle habits significantly lowers the risk of CHD progression and complications.

Key Facts
•       Coronary heart disease causes over 65,000 deaths annually in the UK.
•       Kills twice as many women as breast cancer each year.
•       It is the single biggest killer of men in the UK.