Coronary artery disease (CAD) is a type of heart disease that affects the arteries responsible for supplying oxygen-rich blood to the heart muscle. It happens when fatty deposits called plaque accumulate within the arteries, a process known as atherosclerosis.
The condition poses a significant threat to heart health, leading to an estimated 400,000 deaths annually according to data from the CDC. What's particularly alarming is that 20% of these deaths occur in individuals under the age of 65.
Dr. Juan Carlos Rozo, a cardiologist at Houston Methodist, compares plaque buildup to a clogging drainpipe. Just as you'd want to fix a slow-draining sink in your home, clogged arteries need to be addressed.
"Left unchecked, these plaque deposits lead to the narrowing and hardening of the arteries, impairing blood flow to the heart muscle and potentially resulting in severe and life-threatening complications," explains Dr. Rozo.
If your doctor has raised concerns about your cholesterol levels, atherosclerosis or coronary artery disease, it's crucial to take proactive steps to manage the issue effectively.
The consequences of clogged arteries
Dr. Rozo underscores the severity of atherosclerosis, particularly if plaque ruptures.
"A rupture in plaque deposits within the arteries can result in a complete blockage of blood flow, precipitating a heart attack — an emergency that demands immediate medical attention," emphasizes Dr. Rozo.
Chest pain is the most common of the coronary artery disease symptoms, its occurrence during a heart attack sometimes the first indication that arteries are clogged. But Dr. Rozo notes that symptoms such as shortness of breath and indigestion also can be early signs of blockage.
"Additionally, cardiac chest pain, known as angina, is a prevalent manifestation of coronary artery disease," says Dr. Rozo. "This discomfort, often accompanied by shortness of breath and fatigue, requires prompt attention and should not be dismissed, regardless of its frequency."
Left untreated, coronary artery disease can lead to additional complications, including arrhythmia and congestive heart failure, both of which carry significant risks of sudden cardiac death.
"Prolonged reduced blood flow to the heart muscle weakens its function, resulting in irregular heart rhythms and eventual heart failure," explains Dr. Rozo. "Therefore, it is imperative to promptly address the condition to reduce the risk of these serious consequences."
Can atherosclerosis be reversed?
A clogged drainpipe can be cleared. But can you unclog your arteries?
"Unfortunately, plaque buildup cannot be fully reversed," says Dr. Rozo. It's a reality that emphasizes the importance of preventing atherosclerosis in the first place. But while existing deposits may not be reversible, effective management of coronary artery disease can help prevent further plaque buildup.
To achieve this, comprehensive lifestyle modifications are critical. The American Heart Association's Life's Essential 8 provides a good guide, emphasizing a healthy diet, regular physical activity, not smoking, weight management and other heart healthy habits.
Dr. Rozo offers several specific recommendations to manage coronary artery disease, including:
- Reduce saturated fat intake
- Avoid diets high in saturated fats, like the keto diet
- Aim to follow the Mediterranean diet instead
- Eat starchy carbohydrates in moderation
- Prioritize complex carbohydrates over simple ones
- Be physically active throughout the day
The bottom line: While atherosclerosis may not be fully reversible, proactive lifestyle changes and dietary modifications can effectively manage coronary artery disease — reducing the risk of further plaque deposition and promoting overall heart health.
Additionally, incorporating antioxidant-rich foods into your diet can further support heart health and overall well-being. Aim to eat a variety of colorful fruits and vegetables and choose whole grains whenever possible. Enjoy fatty fish like salmon, mackerel, herring and sardines regularly for their omega-3 fatty acids and antioxidant properties. Furthermore, limit processed foods and sugary drinks to maximize your antioxidant intake and support optimal health.
When are medications needed to manage coronary artery disease?
Whether medications are needed to manage coronary artery disease depends on the severity of atherosclerosis and its impact on the person. While lifestyle changes play a crucial role in preventing disease progression, medications become necessary when significant damage or plaque burden has already occurred.
"We must consider each person individually when determining the best course of action," emphasizes Dr. Rozo. "If plaque burden is substantial, stabilizing it becomes critical. By doing so, we can mitigate the risk of plaque rupture, which is the primary concern as it can lead to an acute heart attack."
Statins, a type of cholesterol medication, serve as the cornerstone of treatment. They not only lower cholesterol levels but also stabilize plaque and reduce inflammation in the arteries.
"Statin therapy has additional benefits beyond cholesterol reduction, which include decreasing the risk of cardiovascular events," Dr. Rozo explains.
Additionally, medications such as beta-blockers may be recommended to alleviate stress on the heart muscle, while low-dose aspirin may be prescribed to prevent blood clot formation.
"A coronary artery calcium (CAC) scan is an invaluable screening tool that aids in identifying individuals at a higher risk of a heart attack, even in the absence of symptoms," Dr. Rozo adds. "During the scan, calcium deposits in the coronary arteries are detected, and based on the amount of calcification present, a score is assigned. The higher the score on the CAC scan, the greater the buildup of plaque, indicating a heightened risk of plaque rupture and subsequent heart attack."
If the CAC scan reveals significant plaque burden, your doctor may recommend any of statins, beta blockers or aspirin, in addition to lifestyle changes.
"While our primary goal is to prevent heart disease altogether by prioritizing a healthy lifestyle, there's still hope if arteries are already clogged," Dr. Rozo emphasizes. "Other therapies are available, and adherence to lifestyle modifications and, in some cases, medication regimens, becomes paramount — thus, it's crucial to follow your doctor's recommendations diligently."
