Prevention of Coronary Artery Disease
The concept of prevention in coronary artery disease (CAD) involves two general considerations:
- Prevention of CAD by preventing the conditions that promote atherosclerosis of the coronary arteries
- Prevention of CAD progression, quality of life impairment, and sudden cardiac death
Prevention of CAD
Prevention of the causes of CAD, usually atherosclerosis, is prevention of:
- Hypertension: Diet and weight management will improve hypertension, and, if necessary, antihypertensive medication can be added.
- Dyslipidemia: Elevations in LDC-cholesterol or lower HDC-cholesterol, and elevated triglyceride levels, contribute to the plaque formation of atherosclerosis, so using statin drugs are very helpful in preventing both the dyslipidemia and the CAD it promotes, as well as preventing peripheral arterial disease that can jeopardize lower extremity and another systemic perfusion.
- Smoking cessation: The causative relationships between smoking and atherosclerosis, smoking and CAD, and atherosclerosis and CAD is well established. Smoking may not be the sole cause of CAD, but it is a major cause of it, as well as a significant risk for COPD, emphysema, malignancies, and hypertension, all of which can contribute to CAD independent of the smoking factor.
Prevention of CAD Progression
The time to pursue prevention strategies in CAD is before it ever develops. Routine cardiac exams, especially for the elderly, diabetics, and those with concerning symptoms (chest pain, pre-syncope, or syncope), should be part of everyone’s “well care” maintenance.
Once CAD is diagnosed, it is important to determine whether the angina is stable or unstable. Stable angina can benefit from medical therapy and from lifestyle changes that impact atherosclerosis favorably (diet, weight management, exercise). Unstable angina crosses a threshold into an acute coronary syndrome, and with it, a higher risk for serious life-threatening developments. If medical management alone does not suffice, revascularization interventions are indicated to optimize one’s chance of long-term survival.