Coronary heart disease (CHD)

Also known as ischemic heart disease, it occurs when there is less blood supply to heart muscle which means less oxygen and nutrients reaching the muscle cells. The cause could be due to atheroma formation (or deposition of plaque) in the coronary arteries (arteries supplying blood to the heart muscles). Atheroma/plaque leads to narrowing of the arteries and hence decreases the blood flow to the heart muscles. The symptoms show up when the narrowing of lumen of the arteries is more than 70%.

The symptoms of CHD are chest pain with or without radiation to the left arm and suffocation to mention a few.
The different stages CHD are as follows:
Asymptomatic: A patient has atheroma formation in the walls of coronary arteries but without any symptoms.
Angina: Symptoms appear only on physical exertion.
Myocardial infarction: Due to complete occlusion of artery, the blood supply to the muscle is cut off leading to permanent death of the muscle. It is commonly known as a heart attack.
CHD has several risk factors some are modifiable and other are non-modifiable.
Non-modifiable Risk Factors
Age: the older you get the greater the chance of heart disease. Four out of five people who die of congestive heart disease are 65 years of age or older.
Sex: males have a greater rate of congestive heart disease.
Race: minorities have a greater chance of heart disease. African Americans have a greater chance of high blood pressure. The risk is also higher in Mexican Americans, America Indians, native Hawaiians and Asian Americans.
Family history: is also included as unchangeable risk factors and your own personal medical history.
Modifiable Risk Factors
Smoking: A strong factor responsible for CHD. Mortality is as high as 60% in smokers due to CHD. Passive smokers have 25% higher risk of this disease.
Blood pressure & Hypertension: hypertension patients have double the chance of getting this disease. Increase in systolic blood pressure is more hazardous than increase in diasystolic blood pressure.
Blood cholesterol: The higher the cholesterol level above the normal range – Hypercholestrolemia, the more the number of chances of an individual getting held up with this disease. High level of low density of lipoprotein is hazardous whereas High level of High density lipoproteins prevents the disease.
Incidents of CHD increase two – three times in diabetes as compared to non diabetics. Women have relatively more chances of acquiring this disease than men. (British heart foundation, factfile, 2001)
Diet: People having a diet consisting of large amount of animal fat rich food in saturated fatty acids have more chances of CHD. Similarly high salt in a diet increases risk of CHD and free sugar increases LDL which leads to the same. Five portions of the diet should be from fruits and vegetables. Less consumption than the suggested increases the risk for CHD. In the UK, adults eat less than 3 portions and kids eat less than half of the suggested amounts of fruits and vegetables. Increase in serum homocysteine levels increases the hazard of this disease. Folic acid in diet reduces the serum homocysteine levels and thus decreases the risk of CHD.
Overweight & Obesity: Obesity is nowadays considered as an important risk factor for coronary heart disease. Especially the central or abdominal obesity is more important as far as coronary heart disease is concern because central obesity increases the risk of heart attacks to twice.
Physical Inactivity: People with sedentary lifestyle have high risk of coronary heart disease. 30 minutes of moderate physical activity like brisk walking, cycling or jogging reduces the possibility of CHD. Physical activity increases HDL and reduces LDL.
Alcohol Intake: Moderate amount of alcohol intake that is one – two units, recede the risk but excessive amount that is more than three – four units for men and two – three units for women increases the probability to have CHD.
The population of the under-developed and lower socio economic status of the country are more prone to this disease due to their poor diet, lack of exercise, smoking and excessive consumption of alcohol.
Recommendation for individual at risk of CVD
Assess smoking status, provide counselling, and implement smoking cessation program
Provide medical nutrition therapy
Encourage physical activity and exercise
Assist with weight management
Assess emotional health
Assess, control, and treat high blood pressure (hypertension)
Measure, evaluate, and treat lipids
Provide aspirin and antiplatelet therapy
Stop or slow the progression of albuminuria
Assess and treat anemia related to chronic kidney disease
Identify and treat sleep apnea
Control blood sugar
Use data systems to monitor and evaluate CVD risk factors among people with diabetes.