Premature Heart Disease - Harvard Health Publishing
All About Coronary Revascularization
Coronary revascularization procedures treat narrowed arteries to improve blood flow to the heart. Common types include percutaneous coronary intervention and bypass surgery.
If you have a condition that prevents blood from flowing to areas of your heart, like coronary artery disease (CAD), a procedure called coronary revascularization may help reduce the risk of serious complications, such as heart attack.
Coronary revascularization is a procedure that treats ischemia. Ischemia is cell damage from insufficient blood flow to the heart.
Reduced blood flow is usually due to atherosclerosis. This condition occurs when fatty deposits build up in the walls of the arteries, causing them to harden and narrow.
Coronary revascularization restores blood flow to the areas of your heart that need it.
According to 2021 guidelines, a doctor may recommend coronary revascularization for people with coronary artery blockages or narrowing, such as for the following conditions:
In some cases, such as for a severe heart attack, doctors may perform revascularization as an emergency procedure. But in other cases, such as for chronic or longstanding CAD, doctors may safely delay the procedure.
The guidelines note that in the past, women and non-white people — including African Americans, Hispanics, and South Asians — were less likely to have coronary vascularizations and other heart treatments in the United States, resulting in worse outcomes.
To address these inequities, the guidelines propose that recommendations for coronary revascularization be applied regardless of sex or race.
There are two main types of coronary revascularization procedures: percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG), also called heart bypass surgery.
Percutaneous coronary intervention (PCI)PCI is a minimally invasive, nonsurgical procedure.
A cardiologist (a doctor specializing in cardiovascular conditions) restores blood flow to your heart by inserting a catheter inside a major blood vessel, typically in your upper thigh or wrist. The cardiologist then steers the catheter to your heart.
Cardiologists typically perform PCI using a technique called angioplasty. It involves using a catheter-tipped balloon to widen the blocked artery. This is almost always followed by stent placement, a small mesh tube to keep the artery open.
Coronary artery bypass graft (CABG)To restore blood flow to a blocked artery, a surgeon constructs a bypass or pathway by removing a blood vessel from your arm, leg, or back and then inserting it around the artery.
There are two ways to access your heart for a CABG:
In some cases, the surgical team may stop your heart during this procedure while a heart-lung bypass machine circulates your blood.
After open-heart surgery, the surgeon puts your ribs back in place, wires your breastbone, and sews up the incision.
For minimally invasive surgery, the surgeon removes the tools and stitches the incision.
Before coronary revascularization, a doctor may perform heart tests and imaging to see which arteries are blocked. These tests may include:
A doctor may discuss with you what to do before the procedure, such as:
Research shows that the outlook for people with severe heart disease may improve following coronary revascularization.
For people admitted to a hospital with a heart attack, coronary revascularization is a lifesaving procedure.
A 2020 study with 9,016 people with chronic stable CAD at high risk of heart attacks suggests that those who underwent coronary revascularization survived longer and with a lower risk of heart attacks than those who did not have this procedure.
In a 30-year study in Denmark with people who underwent CABG, about 70% survived more than 10 years after the procedure. However, the risk of dying from a heart attack, stroke, or heart failure was significantly higher in the 30 days following the procedure.
The following are answers to some frequently asked questions about coronary revascularization.
What is the best treatment for heart blockage?The best treatment for restoring blood flow to your heart depends on several factors, such as the severity of your heart disease.
CABG, which creates a new pathway for blood flow, may be the best treatment for people with extensive CAD that affects multiple blood vessels. Noninvasive PCI, which opens a clogged artery, may be best for people with single-vessel CAD.
Other factors to consider include the nature of the heart blockage and your overall health. A doctor can help you determine your best treatment option.
Is revascularization the same as bypass surgery?"Coronary revascularization" is an umbrella term that refers to restoring blood flow to your heart. It includes both coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI).
CABG restores blood flow by creating a new pathway to your heart.
Is revascularization the same as stenting?Stenting is one of the techniques used to perform a percutaneous coronary intervention (PCI) to help restore blood flow to your heart. A surgeon inserts a stent, or small mesh tube, in the clogged artery to keep it open so blood can flow through it.
For people with extensive CAD, revascularization may increase survival rates and lower the risk of heart attacks.
The coronary revascularization procedure a surgeon performs — usually either a PCI or CABG — depends on several factors, such as:
A doctor can talk with you about the best treatment for a positive outcome.
Prevention Of Coronary Artery Disease
Coronary artery disease (CAD) is the leading cause of death in the United States for males and females. Making changes to diet, lifestyle, and physical activity levels can improve heart health and may help to prevent CAD.
CAD, also known as coronary heart disease, is when the arteries narrow due to a buildup of plaque. While it is a serious condition, it is also preventable.
A person can help prevent CAD by addressing factors that increase their risk, as well as adopting habits that can protect against it.
Multiple factors can put someone more at risk of developing CAD. Many of these factors may be within a person's control, such as:
As a result, the things that may help prevent CAD include:
Some risk factors for CAD are not within a person's control. These include:
While someone cannot change these, addressing other factors can still lower the risk of CAD.
While not relevant to everyone, smoking is an important risk factor for cardiovascular disease (CVD), which is the leading cause of death in the United States.
According to the Food and Drug Administration (FDA), around 20% of annual deaths from CVD are due to smoking. Passive or secondhand smoke can also raise this risk.
Smoking tobacco harms the heart and blood vessels. When someone inhales tobacco smoke, they breathe in chemicals that can cause plaque buildup in the arteries, known as atherosclerosis.
To reduce the risk of CAD, people should avoid exposure to secondhand smoke. If relevant, they can also stop smoking themselves.
For support, people can talk with a healthcare professional or smoking cessation service about ways to quit. Options such as behavioral programs, nicotine replacement therapy, and medications may help.
A diet high in refined sugar, trans fats, sweetened beverages, and red or processed meats has associations with CAD. Saturated fat is also connected to CAD, although its significance is less clear.
Eating a heart-healthy diet can lower the risk of heart disease. It can also help address other underlying conditions that contribute to CAD, such as diabetes, obesity, and high cholesterol.
Diet recommendations generally involve limiting sugar, trans fats, saturated fats, and salt. There are also a few specific food plans that aim to preserve heart health.
For example, the Dietary Approaches to Stop Hypertension (DASH) diet focuses on:
The Mediterranean diet is a similar eating plan that can also benefit heart health. It prioritizes eating fruits, vegetables, whole grains, legumes, nuts, and fish.
Regular physical activity is important for heart health. Exercise can help address high cholesterol, blood pressure, or blood sugar levels and aid in weight management.
In people with CAD, exercise can also reduce the rate of cardiovascular events, such as heart attacks and stroke.
The CDC recommends getting 150 minutes of moderate-intensity activity each week. Examples of moderate-intensity activities include brisk walking, cycling, and swimming.
However, a 2018 review of previous research suggests that overall cardiovascular fitness as a result of vigorous activity may be more important than the duration of the exercise.
One of the major causes of CAD is underlying conditions that affect the heart and blood vessels, such as:
Following the prevention steps in this article for reducing CAD risk can also reduce the likelihood of these conditions, too. However, these conditions can affect anyone. Also, some, such as high blood pressure, may not cause any noticeable symptoms.
For this reason, it is important to have regular health check-ups with a doctor. People can discuss with a doctor whether at-home blood pressure or sugar monitors could help with monitoring their health.
If someone has an underlying condition that puts them at risk for CAD, they should consult a doctor about the best treatment options for them.
While CAD is serious, it is often preventable. A person can help prevent CAD by addressing the risk factors they may be able to change, such as smoking, an imbalanced diet, and a lack of exercise.
Even among people who do not smoke, it is important to avoid exposure to secondhand smoke. Reducing alcohol consumption, stress, and salt intake may also help.
Monitoring and managing conditions that raise the risk of CAD, such as high blood pressure, is a key part of CAD prevention. People who have concerns about their cardiovascular health can speak with a doctor for advice and treatment options.
Potential Novel Biomarkers Of Coronary Heart Disease Discovered
Coronary heart disease is a major global health problem, especially among people with type 2 diabetes. Researchers at the German Center for Diabetes Research (DZD), Helmholtz Munich, and Ludwig-Maximilians-University Munich (LMU) have identified novel protein biomarkers that are associated with the development of CHD in people with and without diabetes. The results have been published in Cardiovascular Diabetology.
Coronary heart disease (CHD) is one of the most common causes of death worldwide -- especially in Europe: Here, it is responsible for nearly half of all deaths. Among middle-aged adults, individuals with type 2 diabetes (T2D) have a two to four times higher risk of developing CHD than people without T2D. The research team investigated the predictive performance of protein biomarkers on incident CHD in individuals with and without T2D.
For their study, the researchers used data from Cooperative Health Research in the Region of Augsburg (KORA). The validation cohort included 888 participants from the KORA-Age1 study with 70 incident cases of CHD (19 vs. 51 cases in the group with T2D and without T2D, respectively) during 6.9 years of follow-up. They tested blood samples of the subjects for 233 plasma proteins related to cardiovascular disease and inflammation.
The researchers thus identified two proteins associated with incident CHD in individuals with diabetes and 29 proteins in those without baseline T2D. Six of these proteins are novel candidates for incident CHD.
The results of this study contribute significantly to a better understanding of the pathophysiology of CHD in T2D patients and offer potential new approaches to the prevention and treatment of this serious complication. They underscore the importance of further research in this area and the role of the German Center for Diabetes Research in resolving pressing issues related to diabetes and its complications.
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