1. The Big Killer
Statistics in the United States demonstrate that coronary artery disease is the most common cause of death. It is the disease responsible for "Acute Coronary Syndrome," more commonly known as a heart attack. This is a circumstance where a narrowed area of one of the arteries that supply blood to the heart, the coronary arteries, explodes and forms a clot. The clot plugs the artery and muscle cells of the heart die. If the person having the heart attack lives, scar replaces these muscle cells, decreasing the heart's strength as a pump. Unfortunately, many people do not live long enough for the scar to form. Their first heart attacks are their last.
2. What you eat, What you do, and Who you are
There are a number of risk factors that increase one's chances of developing coronary artery disease. These include eating a diet high in unsaturated fats, smoking cigarettes, drinking too much alcohol, leading a sedentary life style and being overweight. It's also true that one's genes play a crucial role in how sensitive a person is to these factors. The present theory of coronary artery disease is that plaque, the narrowed areas of coronary arteries, is an inflammatory response to injuries imparted by toxins, like those in tobacco, as well as high levels of fats.
3. Women are Catching Up in a Race They Don't Want to Win
For many years, men had a much higher incidence of coronary artery disease than women. Recently, the difference between sexes has decreased. Unfortunately, this is due not only to a decrease in coronary artery disease in men. It is also due to an increase in women. In fact, after age 70, the incidence of coronary artery disease is greater in women than men. Some of this is a statistical aberrance since many men die of heart attacks before age 70.
4. Not Surprisingly--Women and Men are Different
Female coronary artery disease has been "poorly understood, under treated, and misdiagnosed" for the last three decades. But that is increasingly no longer the case. Female coronary artery disease is much less a mystery than it was just five years ago. It appears that women do not "remodel" coronary arteries the way men do. Instead of forming plaques, they flatten the areas of damage across the entire length of coronary arteries. When these arteries are studied with an angiogram, they appear normal,if somewhat more narrow. However, an imaging device called intravascular ultrasound, IVS, shows the presence of atherosclerosis all along the arteries. That is abnormal.
5. For Now, Treatment is the Same
For now, the first line of therapy is the same for men and women. Patients should reduce risk factors with life style changes and use medications that reduce lipids where indicated. They should treat chest pain aggressively with medications that dilate coronary arteries. They should also follow up regularly with a doctor who knows them well. This plan makes much more sense than one that involves hyperbaric oxygen, radical vitamin therapy and a variety of other unproven treatments, even if it's not quite as sexy.
