Prepared by Dr Ang Chi Yong
Consultant Interventional Cardiologist
Gleneagles Hospital Johor
What is Coronary Heart Disease?
Coronary heart disease (CHD) occurs when the blood supply to the heart is blocked or disrupted due to a build-up of fatty substances in the coronary arteries. Over time, these arteries can become narrowed and clogged with plaque, a condition known as atherosclerosis. This results in reduced blood flow to the heart, depriving it of the oxygen and nutrients it needs to function properly.
Coronary heart disease (CHD) is the leading cause of death in Malaysia, and it’s the most common type of heart disease. In 2014, it accounted for 13.5% of deaths in the country, followed by pneumonia (12%) and stroke (7%). This often preventable disease causes the dangerous thickening and narrowing of the coronary arteries (the vessels that bring blood to the heart), disrupting the flow of oxygen and nutrients to the heart and causing serious problems.
Without enough blood, coronary artery disease can lead to angina (chest pain). Over time, the heart has to work harder, possibly causing heart failure (when the heart cannot pump efficiently) or arrhythmia (when the heart beats irregularly or too quickly). The damaged arteries may become completely blocked, or become prone to clotting, causing a heart attack. The good news is that coronary heart disease is often preventable through early detection, lifestyle changes, and proper treatment.
Prevention of Coronary Heart Disease
Coronary artery disease (CAD) develops slowly, usually over decades, so the good news is that we have a huge window of opportunity for prevention, through risk factor control with a good lifestyle and healthy habits, proper medication, and regular check-ups, and many cases of coronary heart disease can be prevented.
Risk Factors for Coronary Heart Disease
There are several risk factors for coronary heart disease, some are non-modifiable like increasing age and genetic predisposition. However, many are modifiable, including:
- High cholesterol
- High blood pressure
- High blood sugar (diabetes)
- Cigarette smoking
Prevention habits should start early, but they remain important throughout life. It’s never too late to effect change, though the earlier in life you do so, the greater the advantage.
Smart Steps to Prevent Coronary Heart Disease
- Perform Routine Health Checks: Regular screenings by doctors to assess for various cardiac risk factors, including checking blood pressure, blood tests including sugar and cholesterol level, as well as kidney and liver functions.
- Healthy Diet: Eat less of the foods that add to heart problems, and more of the foods that protect the heart. Aim for an eating plan that’s low in saturated fats and trans fats, higher in monounsaturated and polyunsaturated fats found in olive oil and fish, high in fiber (found in plant foods), and low in salt and sugar.
- Both polyunsaturated and monounsaturated fatty acids help lower LDL. Most plant-derived oils, including canola, safflower, sunflower, olive, grapeseed, and peanut oils, contain both. Fatty fish (such as salmon, tuna, trout, herring, and mackerel), seeds, nuts, avocados, and soybeans are also great sources.
- Eat foods rich in omega-3 fatty acids. Though it doesn't affect LDL cholesterol, Omega-3 has other heart benefits, such as increasing high-density lipoprotein (HDL, or "good") cholesterol, reducing triglycerides (a type of fat in your blood), and lowering blood pressure. Some types of fish — such as salmon, mackerel, and herring — are rich in omega-3 fatty acids.
- Trans fats affect cholesterol levels by increasing the "bad" cholesterol and lowering the "good" cholesterol. This bad combination increases the risk of heart attacks. Trans fats can be found in fried foods and many commercial products, such as cookies, crackers, and snack cakes.
- Increase soluble fiber. There are two types of fiber: soluble and insoluble. Both have heart-health benefits, but soluble fiber also helps lower your LDL levels. You can add soluble fiber to your diet by eating oats and oat bran, fruits, beans, lentils, and vegetables.
- Add whey protein. Whey protein is one of two proteins in dairy products - the other is casein. Whey protein may account for many of the health benefits attributed to dairy. Studies have shown that whey protein supplementation lowers both LDL and total cholesterol.
- Quit Smoking: Smoking is considered one of the key risk factors for heart attack. Also, steer clear of secondhand smoke. If a household member is a smoker, help them find ways to quit.
- Become More Active, and Stay Active, All Through Life: A good goal is at least 150 minutes (2.5 hours) of moderate exercise each week, or 75 minutes (1.25 hours) of vigorous aerobic exercise each week. Or aim to be active for 30 minutes a day, most days of the week.
- Keep Your Weight Within the Normal Range on a Body Mass Index (BMI) Chart: If you’re overweight, losing just 5 percent to 10 percent of your current weight will lower your risk of developing coronary artery disease.
- Find Healthy Outlets for Your Stress: Some stress is unavoidable in life. But it tends to push us toward not-so-great habits (overeating, drinking, sitting too much). You’ll be more heart-healthy if you can offload stress in ways you enjoy and that are good for you, such as exercise, meditation, and relaxing with friends. A stress-management program can help.
Symptoms of Coronary Heart Disease (CHD)
Coronary heart disease (CHD) may not always present clear symptoms in its early stages. However, when symptoms do occur, they can include:
- Chest Pain (Angina): A common symptom of coronary artery disease, often triggered by physical exertion or stress.
- Shortness of Breath: Difficulty breathing, especially during physical activity or at rest, due to reduced blood flow to the heart.
- Pain in the Neck, Shoulders, Jaw, or Arms: Discomfort that can radiate from the chest, signaling a potential heart attack.
- Feeling Faint: Dizziness or lightheadedness, which can occur when the heart struggles to pump blood efficiently.
- Nausea: Some people with coronary artery disease experience nausea, especially during a heart attack or angina.
It’s important to note that not everyone experiences the same symptoms, and some individuals may not show any symptoms until coronary heart disease is diagnosed. Early detection through routine screenings can help identify coronary artery disease before symptoms become severe.
Causes of Coronary Heart Disease (CHD)
Coronary heart disease (CHD) occurs when the coronary arteries become narrowed or blocked by the build-up of fatty deposits (atheroma) in the arterial walls, a condition called atherosclerosis.
The main causes of atherosclerosis include:
These factors contribute to the narrowing of the arteries, reducing blood flow to the heart and increasing the risk of heart attack and heart failure.
Diagnosis of Coronary Heart Disease
It’s common for individuals with coronary artery disease to notice symptoms such as shortness of breath or chest pains when they exert themselves physically. Some people have mild episodes of these symptoms. For others, the first experience is more severe chest pain, even a heart attack.
To diagnose coronary artery disease, your doctor will look at several factors such as blood pressure, cholesterol profile, and blood glucose (from a blood test), as well as your health history and family history. This information can help estimate your 10-year cardiovascular risk (your odds of a heart attack or stroke). Depending on the symptoms you have, your doctor may recommend the following tests for further evaluation:
- Electrocardiogram (ECG): Measurement of the electrical activity of your heartbeat during rest to detect any irregularities in heart rhythm.
- Exercise Stress Test (Treadmill Test): A test done on a treadmill to measure your heart rate and ECG changes to detect blockage when the heart has to pump harder.
- Echocardiogram: An ultrasound image of your heart to assess heart structure and function, helping detect any abnormalities or damage.
- Chest X-ray: Provides images of your heart, lungs and other chest organs to look for any issues affecting blood flow.
- Cardiac CT Angiogram: A CT scan provides images of the heart arteries, showing plaque buildup and potential blockage in the arteries.
- Cardiac Catheterization/Coronary Angiogram: A test in which a thin tube is inserted into an artery to check for blockages in the heart’s arteries, allowing for direct visualisation and potential intervention.
These diagnostic tests help assess the extent of coronary artery disease and guide appropriate treatment plans.
Treatment of Coronary Heart Disease
Early identification and intervention are crucial in coronary artery disease treatment, as treatments are most effective when applied early. Depending on your health status and goals, there are three key approaches to treating heart disease:
1. Lifestyle changes
The same lifestyle modifications that help prevent coronary artery disease also form the basis for treatment. Key changes include:
- Adopting a heart-healthy diet
- Increasing physical activity
- Managing stress
- Quitting smoking.
These changes can significantly improve blood flow, lower cholesterol and blood pressure, and reduce the risk of further complications.
2. Medication
In some cases, medication may be prescribed to manage the risk factors associated with coronary heart disease, including:
- High blood pressure
- High cholesterol
- Prediabetes or diabetes
These medications help control underlying conditions that contribute to the progression of coronary artery disease and reduce the risk of a heart attack.
3. Procedures to Open Blood Vessels
When lifestyle changes and medication aren’t enough, medical procedures may be required to repair or improve blood flow. These may include:
- Coronary Angioplasty: A balloon catheter is inserted into the blocked artery and inflated to open the blood vessel. A stent (a mesh tube) is often placed to keep the artery open. In some cases, advanced tools such as intravascular ultrasound or a rotablator are used to prepare the artery for stent placement.
- Coronary Artery Bypass Graft Surgery (CABG): In this open heart surgery, an artery or vein from another part of the body (often the leg) is grafted onto the coronary artery to bypass the blocked section. Multiple grafts may be performed depending on the number of blockages.
These procedures help restore blood flow to the heart, reduce the risk of a heart attack, and improve overall heart health.
Coronary Artery Bypass Graft Surgery (CABG)
Coronary artery bypass graft surgery is in open heart surgery, used to treat coronary artery disease (CAD) when an artery or vein is blocked or narrowed. During this procedure, an artery or vein is taken from another part of your body, such as your leg, and grafted onto the coronary artery to bypass the blocked or narrowed segment. This new route restores blood flow to the heart muscle, relieving symptoms like chest pain and reducing the risk of a heart attack.
In some cases, more than one graft may be performed at the same time to bypass multiple blocked arteries, improving overall heart function and reducing the risk of complications.
CABG is particularly effective for people with severe coronary artery disease who have multiple blockages that cannot be treated with angioplasty or other procedures. The surgery is designed to improve blood supply to the heart, enhance heart muscle function, and improve long-term survival.
Take Action Today: Protect Your Heart at Gleneagles Hospital Johor
If you're at risk for coronary heart disease or are experiencing symptoms, don't wait. Early detection and intervention are key to preventing serious heart issues. Visit Gleneagles Hospital Johor today for comprehensive heart health screenings, personalized care, and expert treatment from our experienced cardiologists. Your heart health is our priority.
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