Coronary heart disease (CHD) is, hands down, the leading cause of death in the United States for both men and women.
As it happens, CHD is also an incredibly badly named disease. Coronary artery disease (CAD) is a far more accurate name according to Dr. Edward Fisher at the American Heart Association. Dr. Seth Baker here in Vero Beach agrees. It’s not the heart but the arteries that are diseased.
Baker, a cardiologist who has been practicing at Indian River Medical Center since 1998 admits, “There are a lot of terms being thrown around out there including coronary heart disease and atherosclerotic heart disease but coronary artery disease,” or CAD, he says, is the most accurate description.
In simple terms, CAD is the narrowing or blocking of arteries leading to the heart. Sometimes called “hardening” or “clogging” of the arteries, it is a result of the buildup of cholesterol and fatty deposits called plaque along the inner walls of the arteries. This plaque or pieces called clots that may break off from it can restrict or even block the flow of oxygen-rich blood to the heart muscle resulting in cardiac ischemia or the deprivation of oxygen to the heart. If the ischemia lasts too long, the oxygen-starved heart tissue begins to die. The hardest working muscle in the body desperately signals the problem with what’s known as “angina.”
Angina is chest pain or discomfort. It may feel like pressure or squeezing inside the chest and may also include pain in the shoulders, arms, neck, jaw, or back. It may even feel like indigestion. If the blood flow to the heart isn’t quickly restored, then what is likely to follow, in layman’s terms, is a heart attack or what your doctor would call “a myocardial infarction.”
According to the U.S. Centers for Disease Control and Prevention, about 715,000 people in the United States will have a heart attack brought on by clogged arteries. Of those, approximately 525,000 will be first time heart attacks and roughly 190,000 of those who survive will go on to have a second attack.
Nearly 8 million Americans have had a heart attack and every 44 seconds another one will strike. Over 385,000 die from this disease each year and almost two-thirds of the women and half the men who die suddenly from CHD will have shown no previous symptoms. To make matters worse, the Cleveland Clinic says this insidious killer starts to manifest itself much earlier in life than was previously thought.
According to Dr. Baker, “Coronary artery disease is a horrible thing and it affects everybody. Race, gender, age, it doesn’t leave anybody behind. We see people in the hospital who are 20 years old that come in with acute myocardial infarctions or heart attacks.”
That is precisely what Baker doesn’t want to see. “The key with cardiovascular medicine now, and I think with all the medicines, should be prevention,” he says. “It’s pretty easy to diagnose somebody when they come to the ER with a heart attack. You can open up a cookbook and figure out how to treat those people. The key is early prevention so that, number one, we can avoid complications, cardiac dysfunction, congestive heart failure, cardiac arrhythmia and death, right? So, the key is early detection or better than that, prevention.
“There are some really good primary care doctors out there in this community and we see a number of patients weekly that get referred from those doctors simply because the patient has the risk factors for heart disease [which helps with prevention[, but we’ve still got to do better.”
Just what are those risk factors?
High LDL cholesterol, low HDL cholesterol, high blood pressure, a family history of heart disease, diabetes, smoking, being post-menopausal for women and being older than 45 for men. Being overweight or obese, age, (simply getting older increases the risk), having sleep apnea, stress or the lack of physical activity are all linked to CAD.
Perhaps one of the most surprising things about CAD is how early it begins. The Cleveland Clinic’s research now confirms that even before the teen years, blood vessels begin to show streaks of fat building up on their walls. Over time other substances traveling through the blood stream, including cellular waste products, proteins and calcium, begin to stick to that fat and start to form plaque.
“We know from old autopsy data on Vietnam Veterans,” Baker explains, “that the first element of CAD or atherosclerotic disease, the buildup of plaque in the coronary arteries, can happen in the teens to early 20s, so yes, it can certainly start that early in life.”
That said, Baker and his colleagues at IRMC must also deal with Vero Beach’s uniquely older demographics. According to the 2012 U.S Census, the average age of residents in this seaside town three years ago was 50.9 years. That’s about 10 years older than the average age for the state of Florida as a whole and well past the age when signs of CAD begin to appear.
“Here in Vero Beach,” says Baker, “we see a lot of elderly patients and, you know, they may have cruised through adulthood being fairly healthy, but . . . everyone has the potential to develop coronary artery disease . . . and that potential increases with age.”
So while Baker’s desire is to see the medical community work harder on early detection and overall prevention of heart disease, the day-to-day reality is that a large portion of Vero’s population already has CAD and Baker and his colleagues must deal with that first.
Some of the most common symptoms of a CAD-induced heart problem include shortness of breath, palpitations, irregular heartbeats, skipped beats, a “flip-flop” feeling in the chest, weakness or dizziness, nausea and sweating – but remember, as stated above, almost two-thirds of women and half the men who die suddenly from heart attacks will have shown no prior symptoms at all.
According to Baker, “Beta blockers are the first line therapy” for his patients already showing signs of the disease with nitrates, aspirin therapy, statins, stents, calcium channel blockers and dual anti-platelet therapies all being important additional items in the cardiologist’s tool box.
With so many lives already being lost and so many more currently at risk, Baker’s top recommendation is that people should take the time to meet with their primary care physicians to see what can be done to reduce each individual’s risk factors and try to avoid becoming just one more statistic in the story of coronary artery disease.
