acute coronary heart disease :: Article CreatorCoronary Artery Disease
Coronary artery disease (CAD; also atherosclerotic heart disease) is the end result of the accumulation of atheromatous plaques within the walls of the coronary arteries that supply the myocardium (the muscle of the heart) with oxygen and nutrients. It is sometimes also called coronary heart disease (CHD). Although CAD is the most common cause of CHD, it is not the only one.
CAD is the leading cause of death worldwide. While the symptoms and signs of coronary artery disease are noted in the advanced state of disease, most individuals with coronary artery disease show no evidence of disease for decades as the disease progresses before the first onset of symptoms, often a "sudden" heart attack, finally arises. After decades of progression, some of these atheromatous plaques may rupture and (along with the activation of the blood clotting system) start limiting blood flow to the heart muscle. The disease is the most common cause of sudden death, and is also the most common reason for death of men and women over 20 years of age. According to present trends in the United States, half of healthy 40-year-old males will develop CAD in the future, and one in three healthy 40-year-old women. According to the Guinness Book of Records, Northern Ireland is the country with the most occurrences of CAD. By contrast, the Maasai of Africa have almost no heart disease.
As the degree of coronary artery disease progresses, there may be near-complete obstruction of the lumen of the coronary artery, severely restricting the flow of oxygen-carrying blood to the myocardium. Individuals with this degree of coronary artery disease typically have suffered from one or more myocardial infarctions (heart attacks), and may have signs and symptoms of chronic coronary ischemia, including symptoms of angina at rest and flash pulmonary edema.
A distinction should be made between myocardial ischemia and myocardial infarction. Ischemia means that the amount of blood supplied to the tissue is inadequate to supply the needs of the tissue. When the myocardium becomes ischemic, it does not function optimally. When large areas of the myocardium becomes ischemic, there can be impairment in the relaxation and contraction of the myocardium. If the blood flow to the tissue is improved, myocardial ischemia can be reversed. Infarction means that the tissue has undergone irreversible death due to lack of sufficient oxygen-rich blood.
An individual may develop a rupture of an atheromatous plaque at any stage of the spectrum of coronary artery disease. The acute rupture of a plaque may lead to an acute myocardial infarction (heart attack).
Why Cases Of Death Due To Heart Attacks Is Higher In Winter As Compared To Any Time Of The Year? Know Details
Acute coronary syndrome (ACS) is the primary cause of death and one of the most prevalent health issues worldwide. It denotes a clinical situation in which serious myocardial ischemia develops quickly. The most common risk factors for coronary heart disease, according to Kass and Sewart's study, are smoking, hypertension, and hyperlipidemia. This is somewhat consistent with our findings, but the order of risk factors varies significantly. The most common risk factor in our study is hypertension (71.8%), which is not statistically substantially different from other risk factors based on the season. According to Dr Kedar Kulkarni, other risk factors that are present but are less common in our sample include smoking, hyperlipidemia, family history, and finally, diabetes mellitus.
During the winter, December had the highest incidence of Acute coronary syndrome (ACS), while March had the lowest incidence. ACS was more common in older patients during the Autumn/Winter season, when they had a lower socio-epidemiological status and, consequently, a different diet regimen. Age was the only factor that significantly influenced the occurrence of ACS, but not gender. Seasonal variations were also statistically significant (p=0.048) in the complications and outcomes of ACS; postinfarction angina pectoris was more common in the Spring/Summer season and heart failure (Killip III and IV) was more common in the Autumn/Winter season. Compared to the Spring/Summer season, the Autumn/Winter season saw a higher frequency of fatal ACS cases (p=0.001). The results obtained point to a seasonal influence of weather patterns on the incidence.
The results obtained indicate that seasonal meteorological conditions have an impact on the incidence, complications, and outcomes of ACS. As a result, patients must modify their lifestyle, especially in the winter, by eating a diet high in organic sulfates and vitamin D3, and they must spend as much time in the sun as they can.
Trends In Cardiovascular Risk Factors Among Patients With Coronary Heart Disease
1. Chambless L, Keil U, Dobson A, et al.: Population versus clinical view of case fatality from acute coronary heart disease: results from the WHO MONICA Project 1985–1990. Multinational Monitoring of Trends and Determinants in Cardiovascular Disease. Circulation 1997; 96: 3849–59. MEDLINE 2. Collins R, Peto R, MacMahon S, et al.: Blood pressure, stroke, and coronary heart disease. Part 2, Short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet 1990; 335: 827–38. CrossRef MEDLINE 3. Scandinavian Simvastatin Survival Study Group: Randomised trial of cholesterol lowering in 4 444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994; 344: 1383–9. MEDLINE 4. Critchley JA, Capewell S: Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. JAMA 2003; 290: 86–97. CrossRef MEDLINE 5. De Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N: Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 1999; 99: 779–85. MEDLINE 6. Taylor R, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K: Exercise-based rehabilitation for patients with coronary heart disease: Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Med 2004; 116: 682–92. CrossRef MEDLINE 7. Graham I, Atar D, Borch-Johnsen K, et al.: European guidelines on cardiovascular disease prevention in clinical practice: Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur J Cardiovasc Prev Rehabil 2007; 14(suppl 2): S1–113. CrossRef MEDLINE 8. EUROASPIRE Study Group: EUROASPIRE. A European Society of Cardiology survey of secondary prevention of coronary heart disease: principal results. European Action on Secondary Prevention through Intervention to Reduce Events. Eur Heart J 1997; 18: 1569–82. MEDLINE 9. EUROASPIRE Study Group: Lifestyle and risk factor management and use of drug therapies in coronary patients from 15 countries; principal results from EUROASPIRE II Euro Heart Survey Programme. Eur Heart J 2001; 22: 554–72. CrossRef MEDLINE 10. EUROASPIRE I and II Group: Clinical reality of coronary prevention guidelines: a comparison of EUROASPIRE I and II in nine countries. EUROASPIRE I and II Group. European Action on Secondary Prevention through Intervention to Reduce Events. Lancet 2001; 357: 995–1001. MEDLINE 11. Enbergs A, Liese A, Heimbach M, et al.: Evaluation of secondary prevention of coronary heart disease. Results of the EUROASPIRE study in the Münster region. Z Kardiol 1997; 86: 284–91. MEDLINE 12. Heidrich J, Liese AD, Kalic M, et al.: Secondary prevention of coronary heart disease. Results from EUROASPIRE I and II in the region of Munster, Germany. Dtsch Med Wochenschr 2002; 127: 667–72. CrossRef MEDLINE 13. Kotseva K, Wood D, De Backer G, De Bacquer D, Pyörälä K, Keil U; EUROASPIRE Study Group. EUROASPIRE III: a survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries. Eur J Cardiovasc Prev Rehabil 2009; 16: 121–37. CrossRef MEDLINE 14. Kotseva K, Wood D, De Backer G, De Bacquer D, Pyörälä K, Keil U; EUROASPIRE Study Group. Cardiovascular prevention guidelines in daily practice: a comparison of EUROASPIRE I, II, and III surveys in eight European countries. Lancet 2009; 373: 929–40. CrossRef MEDLINE 15. Wu P, Wilson K, Dimoulas P, Mills EJ: Effectiveness of smoking cessation therapies: a systematic review and meta-analysis. BMC Public Health 2006; 6: 300. CrossRef MEDLINE PubMed Central 16. Lancaster T, Stead LF: Individual behavioural counselling for smoking cessation. Cochrane Database of Syst Rev 2005; CD001292. MEDLINE 17. Baigent C, Keech A, Kearney PM, et al.: Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 2005; 366: 1267–78. CrossRef MEDLINE 18. Malmberg K, Yusuf S, Gerstein HC, et al.: Impact of diabetes on long-term prognosis in patients with unstable angina and non-Q-wave myocardial infarction: results of the OASIS (Organization to Assess Strategies for Ischemic Syndromes) Registry. Circulation 2000; 102: 1014–9. MEDLINE 19. Prugger C, Wellmann J, Heidrich J, Brand-Herrmann SM, Keil U: Cardiovascular risk factors and mortality in patients with coronary heart disease. Eur J Epidemiol 2008: 23: 731–7. CrossRef MEDLINE 20. Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O: Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 2003; 348: 383–93. CrossRef MEDLINE 21. Hubert HB, Feinleib M, McNamara PM, Castelli WP: Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation 1983; 67: 968–77. CrossRef MEDLINE 22. Klein S, Burke LE, Bray GA, et al.: Clinical implications of obesity with specific focus on cardiovascular disease: a statement for professionals from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation 2004; 110: 2952–67. CrossRef MEDLINE 23. Lenfant C: Shattuck lecture—clinical research to clinical practice—lost in translation? N Engl J Med 2003; 349: 868–74. CrossRef MEDLINE 24. Heidrich J, Behrens T, Raspe F, Keil U: Knowledge and perception of guidelines and secondary prevention of coronary heart disease among general practitioners and internists. Results from a physician survey in Germany. Eur J Cardiovasc Prev Rehabil 2005; 12: 521–9. MEDLINE 25. Hobbs FD, Erhardt L: Acceptance of guideline recommendations and perceived implementation of coronary heart disease prevention among primary care physicians in five European countries: the Reassessing European Attitudes about Cardiovascular Treatment (REACT) survey. Fam Pract 2002; 19: 596–604. CrossRef MEDLINE e1. Sacks FM, Pfeffer MA, Moye LA, et al.: The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators. N Engl J Med 1996; 335: 1001–9. MEDLINE e2. Critchley J, Capewell S: Smoking cessation for the secondary prevention of coronary heart disease. Cochrane Database Syst Rev 2004; CD003041. MEDLINE e3. Pyorala K, De Backer G, Graham I, Poole-Wilson P, Wood D: Prevention of coronary heart disease in clinical practice. Recommendations of the Task Force of the European Society of Cardiology, European Atherosclerosis Society and European Society of Hypertension. Eur Heart J 1994; 15: 1300–31. MEDLINE e4. Wood D, De Backer G, Faergeman O, Graham I, Mancia G, Pyorala K: Prevention of coronary heart disease in clinical practice: recommendations of the Second Joint Task Force of European and other Societies on Coronary Prevention. Atherosclerosis 1998; 140: 199–270. MEDLINE e5. De Backer G, Ambrosioni E, Borch-Johnsen K, et al.: European guidelines on cardiovascular disease prevention in clinical practice: third joint task force of European and other societies on cardiovascular disease prevention in clinical practice. Eur J Cardiovasc Prev Rehabil 2003; 10(Suppl 1): 1–10. MEDLINE e6. Hughes JR, Stead LF, Lancaster T: Antidepressants for smoking cessation. Cochrane Database Syst Rev 2007; CD000031. MEDLINE e7. Braunwald E, Domanski MJ, Fowler SE, et al.: Angiotensin-converting-enzyme inhibition in stable coronary artery disease.N Engl J Med 2004; 351: 2058–68. CrossRef MEDLINE PubMed Central e8. Law MR, Wald NJ, Rudnicka AR: Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis. BMJ 2003; 326: 1423. CrossRef MEDLINE PubMed Central e9. Löwel H, Koenig W, Engel S, Hormann A, Keil U: The impact of diabetes mellitus on survival after myocardial infarction: can it be modified by drug treatment? Results of a population-based myocardial infarction register follow-up study. Diabetologia 2000; 43: 218–26. MEDLINE e10. Miettinen H, Lehto S, Salomaa V, et al.: Impact of diabetes on mortality after the first myocardial infarction. The FINMONICA Myocardial Infarction Register Study Group. Diabetes Care 1998; 21: 69–75. MEDLINE e11. Mukamal KJ, Nesto RW, Cohen MC, et al.: Impact of diabetes on long-term survival after acute myocardial infarction: comparability of risk with prior myocardial infarction. Diabetes Care 2001; 24: 1422–7. MEDLINE e12. Manson JE, Colditz GA, Stampfer MJ, et al.: A prospective study of obesity and risk of coronary heart disease in women. N Engl J Med 1990; 322: 882–9. MEDLINE e13. Wilson PW, D'Agostino RB, Sullivan L, Parise H, Kannel WB: Overweight and obesity as determinants of cardiovascular risk: the Framingham experience. Arch Intern Med 2002; 162: 1867–72. CrossRef MEDLINE e14. Tunstall-Pedoe H, Kuulasmaa K, Mähönen M, et al.: Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA project populations. Monitoring trends and determinants in cardiovascular disease. Lancet 1999; 353: 1547–57. MEDLINE e15. Keil U: Das weltweite WHO-MONICA-Projekt: Ergebnisse und Ausblick. Gesundheitswesen 2005; 67: 38–45. CrossRef MEDLINE e16. Mosca L, Linfante AH, Benjamin EJ, et al.: National study of physician awareness and adherence to cardiovascular disease prevention guidelines. Circulation 2005; 111: 499–510. MEDLINE e17. Weingarten SR, Henning JM, Badamgarav E, et al.: Interventions used in disease management programmes for patients with chronic illness – which ones will work? Meta-analysis of published reports. BMJ 2002; 325: 925–8. MEDLINE e18. Koch K, Miksch A, Schürmann C, Joos S, Sawicki PT: The German health care system in international comparison: the primary care physicians´ perspective. Dtsch Arztebl Int 2011; 108(15): 255–61. MEDLINE PubMed Central
Comments
Post a Comment