According to Heart.com, a third of the population age 65 to 79 years of age has at least one comorbid condition that "increases the risk of disability and mortality" over an individual disease. This age group is also at high risk for the development of coronary artery disease. Specific comorbidities associated with coronary artery disease increase mortality.
Hypertension
"The Journal of the American College of Cardiology" reported in an article published in 2004 that the Coronary Artery Disease Index, which was developed to predict mortality, included hypertension as a significant comorbidity. Hypertension is defined as a blood pressure measurement greater than 140/89. Besides increasing the workload of the heart, hypertension accelerates the development of coronary artery disease. Hypertension more than doubles the risk of coronary artery disease at any given level of cholesterol, according to the Texas Arrhythmia Institute.org. Lifestyle changes, including diet modification and regular exercise, can lower blood pressure. Medications are available to treat blood pressure that does not respond to lifestyle changes.
Diabetes
Diabetics are at significant risk of developing coronary artery disease and are at increased risk of death if coronary artery disease is present. Uncontrolled sugar, mixed with high cholesterol, presents a complex metabolic problem. High blood glucose in the blood attaches to other proteins, including fat molecules, and alters their structure and the way the molecule functions. These alterations make it easier for the fat molecule to attach to the lining of the artery and form plaque. Blood glucose control is important in controlling the development of further coronary artery disease, according to the Texas Arrhythmia Institute.org. There are multiple treatment regimens that can be used to control blood glucose.
Tobacco Abuse
The CAD index includes smoking as a comorbidity that affects coronary artery disease outcomes. Smoking is "the single greatest avoidable cause of disease and death," according to a 2006 Office of the Surgeon General report. Nicotine in cigarettes is a known vasoconstrictor and can cause coronary artery spasms. The risk of death is up to six times higher in smokers than in non-smokers according to the Texas Arrhythmia Institute. Smoking induces an inflammatory response in the arteries, which then attracts lipids to attach to the lining of the artery. Smoking also increases the stickiness of platelets, which contribute to blood clot formation in arteries. Stress hormones are increased in smokers, which increases the inflammatory response. Nicotine replacement along with behavioral modification can help patients kick the smoking habit.
References
- Heart: Comorbid Conditions and Outcomes After Percutaneous Coronary Intervention; M. Singh et al.; 2008
- "Journal of the American College of Cardiology": Comorbidity and Outcome in Patients With Coronary Artery Disease; Mark A. Hlatky, M.D.; 2004
- Texas Arrhythmia Institue: Heart Disease
- The Office of the Surgeon General; The Health Consequences of Involuntary Exposure to Tobacco Smoke; 2006
