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Coronary Heart Disease: Overview and Risk Factors

Coronary heart disease (CHD) is the most common cause of death for both men and women in Western countries and is increasingly prevalent in developing countries. Also called coronary artery disease, this atherosclerotic process includes injury to arterial endothelium, fatty streaks due to macrophage ingestion of LDL cholesterol at the damaged site, platelet aggregation, and fibrosis. These events contribute to plaque formation in the intimal layer of medium and large arteries. Progressive arterial narrowing causes ischemia, which occurs initially with exertion, but may eventually occur at rest.

Atherosclerosis normally begins in childhood and slowly progresses throughout life. However, rapid progression may occur by the third decade of life. Symptoms often do not present until late stages. Angina pectoris is frequently the main presenting symptom. It results from ischemia due to the narrowing of one or more coronary arteries. Angina is typically described as substernal pressure, and it can radiate to the neck, arms, back, and upper abdomen. Stable angina tends to occur regularly or predictably with exertion, whereas unstable angina occurs unpredictably, often with minimal exertion or at rest.

When atherosclerotic plaques rupture, vasoconstriction and clot formation can lead to complete occlusion of a coronary artery, causing myocardial infarction (MI). MI may be silent, or it may be signaled by prolonged pain or discomfort similar to that associated with simple angina. Compared with men (who are more likely to experience crushing substernal chest pain), women are more likely to experience shortness of breath, jaw or back pain, and nausea/vomiting. Further, care is sometimes delayed for women because caregivers and patients may believe that women are not at significant risk for cardiac disease. 

Atherosclerosis of the extremities—ie, peripheral vascular disease—often presents as claudication, in which calf, thigh, or hip pain is associated with activity and relieved with rest. Other signs of peripheral vascular disease include underdeveloped calf muscles, hairless shiny skin on the lower extremities, dystrophic toenails, bruits over the femoral, iliac, or popliteal arteries, and decreased peripheral pulses. 

Risk Factors

  • Increasing age.
  • Male gender.
  • Family history.
  • Hypertension.
  • Cigarette smoking.
  • Dyslipidemia.
  • Obesity.
  • Diabetes.
  • Sedentary lifestyle.

In addition, psychological stress and socioeconomic status have been correlated with CHD risk, perhaps because they contribute to other risk factors.


Coronary Heart Disease: Diagnosis >>