Coronary artery disease is the No. 1 cause of death for men and women, and the rate increases in women once they are past menopause, notes James Warnica, M.D., director of the Cardiac Intensive Care Unit at Foothills Medical Center in "The Merck Manual for Healthcare Professionals." There are several risk factors for this disease, and one of the main ones is having high low-density cholesterol levels.
Coronary Artery Disease
Coronary artery disease describes the condition where the coronary arteries of the heart are atherosclerotic. Some type of injury damaged the inner wall of a coronary artery. Fat and cholesterol entered the artery through the damaged area and accumulated at that site. Soon, white blood cells, clots, calcium, smooth muscle cells and connective tissue accumulate there and form plaques, notes Thomas Bashore, M.D., Professor of Medicine at Duke University Medical Center in "Current Medical Diagnosis & Treatment." Plaques make the arteries hard, or atherosclerotic, and make their passageways narrow.
Risk Factors and LDL
The main risk factors for coronary artery disease are hypertension, cigarette smoking, diabetes mellitus, low blood levels of high-density lipoproteins and high levels of LDL cholesterol, according to Elliott Antman, M.D., Professor of Medicine at Harvard Medical School in "Harrison's Principles of Internal Medicine." High levels of low-density lipoproteins in the bloodstream lead to their accumulation in the inner wall of the arteries, including the arteries of the heart. The LDL cholesterol change, and the modified form, trigger inflammation.
Complications
Eating too much cholesterol and saturated fats leads to high LDL levels, which accumulate and cause atherosclerosis in the cardiovascular system. As explained by Dr. Warnica in "The Merck Manual for Healthcare Professionals," plaques continue to grow and the passageway through them gets smaller and smaller, making it harder for the blood to pass through and deliver oxygen. People have pain when an area of the heart does not get enough oxygen. Plaques can rupture, and parts of a plaque or a clot can break off and block the blood flow.
Modifying the Risk
In "Current Medical Diagnosis & Treatment," Dr. Bashore writes that lowering the blood pressure, stopping cigarette smoking and lowering high LDL levels prevents coronary artery disease. It can even delay the development of the disease and its complications, in those with the disease, and sometimes cause the disease to regress. Fewer plaques develop and you'll have fewer symptoms of decreased blood flow. He writes about several clinical trials that show the benefit of statin medications in preventing death from this disorder. Statin medications lower the high LDL levels.
Statin Medications
Simvastatin, rosuvastatin, atorvastatin, lovastatin and fluvastatin are all statin medications. They are HMG-CoA reductase inhibitors because they interfere with, or inhibit, an enzyme called HMG-CoA reductase, explained in "Goodman & Gilman's The Pharmacological Basis of Therapeutics," by Robert Mahley, M.D., Ph.D., director of the Gladstone Institute of Cardiovascular Disease. HMG-CoA reductase is short for hydroxymethylglutaryl-coenzyme A reductase. Enzymes are proteins that increase the speed of a reaction. The liver uses the HMG-CoA reductase enzyme to make cholesterol. Statin medications interfere with this process.
References
- "Current Medical Diagnosis & Treatment 2011"; Stephen McPhee, M.D., Maxine Papadakis, M.D.; 2011
- "Goodman & Gilman's The Pharmacological Basis of Therapeutics"; Laurence Brunton, Ph.D.; 2006
- "Harrison's Principles of Internal Medicine"; Anthony Fauci, M.D., Dennis Kasper, M.D., Dan Longo, M.D. et al.; 2008
- The Merck Manual for Healthcare Professionals: Coronary Artery Disease
