Understanding coronary heart disease

In the first part of his online article on coronary heart disease, Dr Dwayne Conway gives us his insights. He talks about the risk factors, how to prevent coronary heart disease through lifestyle changes and common symptoms.

What are the risk factors for coronary heart disease?

Coronary heart disease (CHD) is a complex condition influenced by many risk factors. The heart is a muscular pump dependent on its own energy supply via the coronary arteries, which carry blood containing oxygen and nutrients to the working heart muscle. Disruption to this blood flow can occur due to artery narrowing caused by atherosclerosis.

Atherosclerosis is the transformation of elastic, youthful arteries into thicker, stiffer arteries as we age, due to the development of atherosclerotic plaques in the artery walls. High blood pressure and smoking directly injure artery walls, speeding up the development of atherosclerosis and leading to earlier development of heart disease.

Inflammatory responses to artery damage play a vital role, with inflammatory cells attempting to heal the injured arteries inadvertently worsening the problem by carrying fats into the plaque. Factors like diabetes and higher cholesterol levels can increase this problem. The aftermath is a mixture of inflammation, fat, collagen deposition and smooth muscle cell growth in artery walls; the thicker walls leave less room for blood flow in the artery.

Recognised risk factors therefore include aging, cigarette smoking, high blood pressure, diabetes, high cholesterol, and genetic variation. Family history significantly influences these factors. Lifestyle choices, such as weight management and physical activity, are important. Gender, with men at higher risk, also plays a role due to hormonal differences.

How can I prevent coronary heart disease through lifestyle changes?

Although there are some risk factors beyond our control such as age, family history and gender at birth, there are also several risk factors we can influence. Lifestyle choices can address the additional risks from smoking, obesity and dietary habits.

Balancing calorie intake with physical activity is crucial to avoid excess weight gain, a risk factor for heart issues. Prioritise fruits and vegetables in your diet to reduce calorie consumption while increasing satisfaction due to their high fibre and water content, plus all the added health benefits from their vitamins.

It’s also important to minimise intake of foods containing high levels of sugar, refined carbs, and saturated fats. Dietary patterns like the mediterranean diet, with fresh fish and vegetables, have been proven to reduce cardiovascular disease. In addition to these dietary changes, vital lifestyle practices for heart disease prevention include not smoking, staying physically active, maintaining a healthy weight, and managing blood pressure.

What are the common symptoms of coronary heart disease?

Coronary heart disease can manifest with various symptoms or none at all. When atherosclerosis narrows the arteries, reducing blood flow, the heart receives less oxygen leading to symptoms, with angina being the classic one. Angina is usually experienced as chest pressure but some people feel it in the jaw, neck, or shoulder.

The pain's location tends to be consistent, and it's usually triggered during physical activity when the heart requires more blood flow. Diabetics have a higher risk of heart disease but might not feel pain as acutely due to diabetic neuropathy. Instead, they might perceive fatigue or shortness of breath on exertion.

Coronary artery narrowing can lead to various problems like heart muscle weakness, causing fluid retention and shortness of breath, or abnormal heart rhythms resulting in palpitations and dizziness. The most severe consequence is a heart attack, typically caused by a blood clot forming in a narrowed artery. A heart attack can lead to prolonged angina-like pain (but at rest and longer lasting, and often more intense), cardiac arrest or heart failure.

Dr Dwayne Conway is a distinguished consultant interventional and general cardiologist with over 25 years of experience. You can schedule an appointment with Dr Conway on his Top Doctors profile.