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You are Here: Home Page > Chronic Disease > Coronary Heart Disease  

Coronary Heart Disease

What is coronary heart disease?

• Coronary heart disease (CHD), sometimes called ischemic heart disease, refers to atherosclerosis of the arteries that supply the heart muscle. Insufficiency of blood supply may result from a reduction of blood flow through one or more of these arteries. Heart cells are dependent on blood flow through these arteries to provide oxygen and to carry away metabolic products. Without an adequate flow of blood, these cells can become injured or die. When this occurs, immediate emergency treatment is necessary to stop the injury from widening, killing additional heart cells, and increasing the risk of complications or death.

What is atherosclerosis?

• Atherosclerosis is a disease condition that can occur throughout the arterial circulation. It is a broad term that refers to the thickening and hardening of the arteries. Atherosclerosis consists of deposits of fatty substances, cholesterol, cellular waste products, calcium and fibrin (a clotting material in the blood). When these materials build up on the arterial walls, it is called plaque. When plaque partially or totally blocks the flow of blood through an artery, it can cause a hemorrhage (bleeding) into the plaque itself, or the formation of a blood clot on the plaque's surface. This blood clot is called a thrombus. If either of these things occur a heart attack may result. Atherosclerosis does not develop quickly. It begins early in life. Some people experience a rapid progression in this disease process in their 30s, but in most cases it is not apparent until they are in their 50s and 60s.

How large is the problem of CHD in the United States?

• CHD is the single largest killer in the United States, causing 481,287 deaths in 1995 -nearly 1 in every 5 deaths. It is estimated that better than 1 million Americans will have a new or recurrent coronary attack, and about one-third of them will die. Every 29 seconds, an American will suffer a coronary event, and about every minute someone will die from one. Each year more than 250,000 people will die of CHD within 1 hour of the onset of symptoms and before they reach a hospital. Almost 14 million people have a history of heart disease.

Who is at high risk for heart disease?

• Approximately 65% of all heart attacks and 85% of all CHD deaths occur to people aged 65 or older. CHD is the leading cause of death for people over 65 years of age and the second leading cause of disability. All throughout life, men have a much higher death rate from CHD than do women. In the United States, the age-adjusted death rate for men is twice as high as it is for women. CHD risk increases with age. Major increases in the occurrence of heart disease begin for men at the age of 35. Women begin to display a marked increase after menopause. CHD death rates are higher among blacks than whites, until advanced age. In 1995, CHD death rates were 124.4 for white males and 133.1 for black males. Black females have a death rate 35% higher than white females, and in ages under 75, the black female death rate from CHD is more than 71% higher than that of white women. CHD incidence and mortality rates go up as socioeconomic status goes down. Historically, the greatest improvements in death rates have occurred for the highest levels of income and education and among workers in white-collar jobs. Although its role is not completely understood, family history can contribute to premature heart disease. Evidence seems to indicate that family history can predispose a person to premature CHD through a combination of genetics and a tendency for high levels of risk factors (e.g., smoking, poor diet) to cluster within families.

Should women be concerned about CHD?

• There is a misperception that heart disease is a man's illness. Heart disease takes a considerable toll on women too. As women approach menopause, they lose the protective effect of estrogen. After menopause, their risk of heart disease continues to rise with age. Recent surveys have shown that women are more concerned with breast cancer than with heart disease. However, the death rate for heart disease is nearly 3 times as high as that of breast cancer for both white and black women. Women need to be made aware of their risk for heart disease so that they can take steps to reduce its occurrence.

What are the risk factors that contribute to CHD?

• Risk factors for CHD can be divided between those that are modifiable and those that are not. Modifiable risk factors include high blood pressure, elevated blood cholesterol, cigarette smoking, and physical inactivity, diabetes, obesity, dietary factors and environmental tobacco smoke. Alcohol use and stress may also contribute to CHD. Heredity, being male, and age are examples of risk factors which are not modifiable. Public health is primarily concerned with modifiable risk factors. The major, modifiable risk factors are described below.
• Smoking is the single largest contributor to the risk of having a heart attack. In fact, smokers are twice as likely to have a heart attack than are nonsmokers, and they are between 2 and 4 times more likely to experience sudden death. Exposure to environmental tobacco smoke in the home and at the workplace has also been shown to increase the risk for CHD. Yet the ability to recover from tobacco use is quite remarkable. Within three years after quitting, the risk of death from heart disease for people who smoke a pack a day or less is almost the same as for people who never smoked.
• High blood cholesterol increases the risk of CHD, especially when other risk factors are present. Having a total blood cholesterol level of 200 mg/dL or lower is considered desirable by the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). According to the panel, total cholesterol levels of between 200 and 239 mg/dL are considered borderline high, and those above 240 mg/dL are high. The panel recommends that adults also be screened for LDL and HDL cholesterol. An LDL cholesterol level below 100 mg/dL is optimal; LDL between 100-129 mg/dL is near optimal, 130-159 mg/dL is borderline high, 160-189 mg/dL is high and above 189 mg/dL is considered very high. HDL cholesterol should not be below 40 mg/dL; ideally HDL should be 60 mg/dL or above. The panel recommends that healthy adults age 20 and over have a fasting lipoprotein profile (total cholesterol, LDL, HDL, triglycerides) once every five years. Those with other risks for coronary heart disease, such as smoking, obesity, diabetes, or previous heart attack or stroke, may need more frequent monitoring. High cholesterol can be controlled through diet modification, increased physical activity and with the use of lipid lowering agents.
• High blood pressure increases the heart's workload, causing it to enlarge and weaken. It increases the risk for a number of diseases, including congestive heart failure, kidney failure, heart attack, and stroke. When other risk factors are present, the risk from high blood pressure increases several times over. High blood pressure can be controlled through proper diet, losing excess weight, regular exercise, restricting salt intake, and through the use of antihypertensive medications.
• Physical Inactivity plays a significant role in the occurrence of heart disease. The Surgeon General recommends people of all ages to include a minimum of 30 minutes of physical activity of moderate intensity (such as brisk walking) on most, if not all, days of the week. Examples of such activities include aerobics, jogging, and vigorous walking. As a rule of thumb, any exercise that makes you breath hard and your heart beat rapidly should provide this benefit. Recent studies have indicated that even modest levels of low-intensity exercise will provide increased cardiovascular fitness. These activities include walking for pleasure, gardening, housework, and dancing. It is also acknowledged that for most people, greater health benefits can be obtained by engaging in physical activity of more vigorous intensity or of longer duration.
• Good diet and nutrition can help to prevent CHD. There is evidence that plant foods play a role in preventing atherosclerotic heart disease. Plant foods provide dietary fiber that help lower blood cholesterol and antioxidants that help in lipoprotein oxidation. On the other hand, the consumption of saturated fat, dietary cholesterol, and red meat have all been shown to increase the incidence of heart disease. Early work concentrated on how these substances played a role in the level of total and LDL cholesterol (low-density lipoproteins -the bad cholesterol) in the blood. Lowering dietary lipid patterns to decrease saturated fatty acids and cholesterol and increasing polyunsaturated fatty acids will result in decreases in total and LDL cholesterol levels. More recent research indicates that monounsaturated fatty acids also increase HDL cholesterol (high-density lipoproteins -the good cholesterol).

For additional information, refer to The Burden of Cardiovascular Disease in New York   (PDF - 3.5MB)    Posted: 04/20/2004