Coronary Heart Disease Risk: How Can We Decrease It?

LEXINGTON, Ky. (Nov. 21, 2011) - The following column appeared in the Lexington Herald-Leader on Sunday, Nov.20.

Coronary heart disease risk: How can we decrease it?

By Dr. Thomas F. Whayne Jr.

Coronary heart disease is the major medical problem we face in the United States — especially in Kentucky. CHD refers to hardening of the coronary arteries, which bring the heart its blood supply and without which survival is not possible. 

This hardening is actually a disease known as atherosclerosis, which involves abnormal deposits of cholesterol, called plaques. These plaques build up, and can restrict blood flow so that chest pain, known as angina, can develop when obstruction is greater than 70 percent. 

Heart attacks usually occur with much smaller obstructions, between 40 and 50 percent. These plaques do not significantly obstruct the flow of blood in a coronary artery unless an emergency event occurs — usually a rupture of the plaque followed by the rapid clotting of blood over the rupture site. While this clotting is a normal response by the body to repair the damage, the clotting proves to be even more harmful than the plaque itself.

Severe damage to the heart muscle can result, depending on the size of artery involved and the amount of heart muscle served. If the patient survives, as occurs in most cases with quick emergency care, heart disability can still occur depending on the amount of muscle damage. The phrase “time is muscle” emphasizes why chest pain must be explained and, if a heart attack is suspected, emergency care must be given rapidly. 

The standard of care is urgent cardiac catheterization. If accomplished quickly enough, it can save heart muscle. The arterial obstruction is opened by balloon angioplasty, combined with stent placement. However, even if such emergency expertise is not immediately available, medical help should be sought as quickly as possible, since other clot-busting and stabilization treatments may make a difference.

An even more desirable scenario involves educating patients on how to avoid heart attack in fhe first place. Simply put, many heart attacks can be avoided by lowering cholesterol, especially the “bad guys” known as low density lipoproteins (LDL). 

A healthy lifestyle is always a good idea, but frequently that is not enough. The statin class of medications is the major means of lowering the LDL. Like any treatment, statins can cause some problems, but their benefit far outweighs any risk. In addition to their potent reduction of LDL, they also have several other effects that reduce cardiovascular risk.

The next frontier in prevention appears to be elevation of the high density lipoproteins, frequently called the “good guys.”  Future cardiovascular medicine offers the promise of more and more improvement in quality and prolongation of life.

Dr. Thomas F. Whayne Jr. is professor of medicine (cardiology) at the University of Kentucky College of Medicine and a physician in the UK Gill Heart Institute.