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Atherosclerosis and Coronary Artery Disease

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Atherosclerosis and Coronary Artery Disease: Plaques’ Sneak Attacks

Atherosclerosis plaques in the coronary arteries can behave in several ways:

  • Plaques can grow slowly, never blocking the artery or causing clots.
  • They can expand significantly to block the blood flow in a coronary artery. This may cause no symptoms, even when the artery is significantly blocked.
  • Other times, the blockage does cause symptoms. Called stable angina, this is most commonly chest pain with exertion that goes away with rest. This is not a heart attack.
  • A plaque can rupture. The unstable material inside the plaque is exposed to the bloodstream. It causes blood to rapidly clot inside the coronary artery.

A plaque rupture is as terrible as it sounds. The result is a blood clot causing an acute coronary syndrome and, usually, chest pain. Two things can happen then:

  • Unstable angina. The clot doesn't totally block the blood vessel and then dissolves without causing a heart attack.
  • Myocardial infarction (heart attack). The coronary artery is blocked by the clot. Heart muscle, starved for nutrients and oxygen, dies.

Coronary artery disease is stealthy and unpredictable. Blood clots commonly occur in arteries with minor blockages. Fewer than one in five people with heart attacks have previous long-standing angina. And for as many as 50% of men, the first symptom of atherosclerosis is sudden death from a massive heart attack.

Reducing Your Risk of Coronary Artery Disease

No one can predict with certainty who will have a heart attack. But coronary artery disease isn’t random. The vast majority of people with coronary artery disease have one or more risk factors, many of which are controllable.

Studies suggest that upwards of 90% of the risk of a first heart attack is determined by the following risk factors. These cause atherosclerosis in general, and are the causes of coronary artery disease.

  • Cigarette smoking
  • High cholesterol
  • Obesity
  • Lack of physical activity
  • High blood pressure
  • Diabetes
  • Low fruit and vegetable consumption
  • Poor socioeconomic status

Most of us have plenty of room for improvement.

The best way to determine your risk level is to see your doctor. But you can start reducing your risk today. Eating right, not smoking, and exercising consistently will bring down most people's risk level.

For others, it may be necessary to take medicine to keep cholesterol and blood pressure under control. Medicines called statins can lower cholesterol dramatically and are proven to reduce the risk from coronary artery disease.

WebMD Medical Reference

Reviewed by James Beckerman, MD, FACC on May 26, 2014
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