Understanding coronary artery disease

It's the nation's No. 1 killer and the most common type of heart disease in adults, but few people take coronary artery disease seriously until they're walloped with symptoms.

"The problem is, sometimes the wake-up call is the last call you have," said Dr. Michael Matilsky, a cardiologist and assistant professor of clinical medicine at Stony Brook University.

The coronary arteries are tubes that carry oxygen-rich blood to the heart. Coronary artery disease occurs when fat, cholesterol and other substances form a sticky plaque that gloms onto the walls of the arteries. Over time, those tubes stiffen, narrow and can become completely blocked.

Symptoms

Without a sufficient flow of blood to the heart, people with coronary artery disease often experience squeezing pain or pressure in the chest, called angina.

Angina typically lasts for a few minutes and may cause tightness in the chest, shortness of breath or indigestion. The pain may radiate through the arm, neck, back, jaw or stomach.

Some people, though, have no symptoms. Because of this, they may not be diagnosed until they have a heart attack, heart failure or an irregular heartbeat.

Risk factors

Though men and women alike can develop this type of heart disease, men are at greater risk. So are people with a family history of heart disease. It's also more common as people age.

Little can be done to alter those risk factors. But there are several other variables that people can do something about.

Smoking is a biggie. The risk of developing heart disease is two to four times greater among smokers than nonsmokers, according to the American Heart Association. Other risk factors include high cholesterol, high blood pressure, physical inactivity, being overweight, insulin resistance (which means the body cannot use insulin properly) and uncontrolled diabetes. 

Current thinking

Cholesterol-lowering statin drugs are widely recommended for people with heart disease and those at risk for the disease.

"The evidence is overwhelming in multiple scientific studies that statins prevent heart attack and death in patients with documented coronary disease," said Dr. George Petrossian, director of interventional cardiovascular procedures at St. Francis Hospital in Roslyn.

Other treatments, including angioplasty to clear blocked arteries or antiplatelet medication to prevent blood clots, are increasingly being tailored to individuals based on a whole host of factors, Petrossian explained.

There's also a move to intervene early, before symptoms occur. A simple blood test can check for levels of "high-sensitivity C-reactive protein," a substance linked to heart disease risk, Matilsky said.

The Long Island scene

The region boasts a number of outstanding cardiac-care programs for people who need urgent care as well as those seeking to prevent future heart problems.

Need to bone up on heart-healthy nutrition? The DeMatteis Center for Cardiac Research & Education in Greenvale, a St. Francis affiliate, offers an array of classes aimed at modifying risk factors.

A new low-dose CT scanner at Stony Brook University Medical Center enables physicians to diagnose heart disease without exposing people to high amounts of radiation.