Coronary Artery Disease: Vital Facts on This Most Common Type of ‘Heart Disease’

Does coronary artery disease (CAD) refer to the more general term of “heart disease”? Not exactly, but CAD is the most common type of heart disease in the United States. It’s sometimes called coronary heart disease or ischemic heart disease.

With coronary artery disease, plaque first grows within the walls of the coronary arteries until the blood flow to the heart’s muscle is limited. Unfortunately, the first sign of CAD is a heart attack for some people. And that’s why it’s crucial for all adults to get their annual checkups and for them to “know their numbers,” explains Tarak Rambhatla, M.D., cardiologist with Miami Cardiac & Vascular Institute.

Tarak Rambhatla, M.D., cardiologist with Miami Cardiac & Vascular Institute.

“Know your numbers,” stresses Dr. Rambhatla. “Know your cholesterol; know your blood sugar; know your blood pressure; know your BMI (Body Mass Index), and get checked every year to see if any of those are out of the ordinary. On top of that, your doctor will ask about your family history of heart disease and your lifestyle — such as nutrition and whether you exercise — and work all that together and decide together with the patient what is the best approach for their primary preventive strategy.”

Heart disease remains the leading cause of death for men, women, and people of most racial and ethnic groups in the U.S. Dr. Rambhatla says it’s important to fully understand that CAD, or coronary artery disease, refers to one of four main systems of the heart.

“Generally, when people say ‘heart disease’ they think of coronary artery disease, which is cholesterol and developing atherosclerotic plaque in the arteries of the heart,” he said. “These arteries supplies the muscle of the of the heart and allows it to function properly.”

Here’s the four major systems of the heart, explains Dr. Rambhatla: “There is the arteries, which can result in coronary artery disease. There is the pumping function of the muscle of the heart. There is the function of the valves of the heart that let blood come in and go out properly. And then there’s the electricity of the heart.”

All four of these systems can cause individual problems, or they can overlap and “one can lead to a problem in the other,” he adds.

High Cholesterol and CAD

If a person has high cholesterol, they can have coronary artery disease. The reverse is also true. “There’s many people with high cholesterol who don’t necessarily have CAD,” says Dr. Rambhatla. “It just depends on what their other risk factors and how high their cholesterol has been and for how long. How much exercise to they do? Are they at or near obesity levels? How much inflammation is going on in the blood vessels? It all goes together.”

If your cholesterol is very high, it’ll gradually start to stick to the blood vessels. But if your “cholesterol could be normal, or even low, and it can still stick to the blood vessels if you have other risk factors.” Those risk factors include: high blood pressure, smoking, obesity, inactivity, diabetes and a family history.

Diagnosing CAD

Diagnosing coronary artery disease requires a review of your medical history and various medical tests beyond physical examination and routine blood work.

“Definitively, CAD is diagnosed with some assessment of the coronary anatomy, either with a cardiac catheterization, which is definitive and the gold standard, or it can be with a non-invasive assessment of the anatomy, which can include a CT scan of the coronary arteries.”

Your cardiologist may order a cardiac catheterization to diagnose a heart problem or determine the cause of chest pain, he said.  During cardiac catheterization, a long narrow tube called a catheter is inserted into a large blood vessel that leads to your heart. Once the catheter is in place, your doctor can use it to run diagnostic tests. The “cardiac cath” is performed to find out if you have disease of the heart muscle, valves or coronary arteries.

Other diagnostic tools include an echocardiogram that uses ultrasound waves to create images of how your heart and whether it is functioning properly. A stress test monitors the heart’s electrical activity while you walk on a treadmill or ride a stationary bike. Nuclear imaging may also be done during a stress test. For those who are unable to perform physical exercise, certain medications can utilized for stress testing.

“It’s important to start by knowing all your numbers and working with your doctor to make sure you stay healthy,” said Dr. Rambhatla. “One of the biggest messages I want to send is: Just because your cholesterol levels are ‘normal’, it does not mean that you cannot develop cholesterol plaque and heart disease because that’s just one aspect of all your risk factors.”