Coronary artery disease
Coronary artery disease is a condition affecting the arteries supplying the heart (coronaries) and is caused by the deposition of atheromatous plaques within the wall of the artery. It is the commonest cause of death in developed countries and it is expressed clinically with angina (stable or unstable), myocardial infarction (heart attack) and sudden cardiac death.

The atheromatous plaque consists of cholesterol crystals, calcium and different types of cells such as smooth muscle cells and white blood cells. The formation of the plaque and its presence is a dynamic process which involves a varying degree of inflammation.

Atheromatous plaques appear at an early age and enlarge according to different risk factors. The plaque may be stable and cause no problems, it can increase in size and cause narrowing of the vessel or it can rupture, a process that leads to bleeding within the plaque, formation of blood clot and obstruction of the vessel. Narrowing of the artery usually causes angina while obstruction can cause myocardial infarction. These will be dealt with at a later stage.

There are a number of risk factors that can lead to atheromatous vessels. The factors that cannot be altered include age, gender and genes. Coronary artery disease is commoner in older people, men and people with a family history.

Particular emphasis must be given to risk factors that can be regulated with our intervention and their control can reduce the risk of developing coronary artery disease while it also decreases the risk of future events in patients with established disease.

These factors include diabetes mellitus, hypertension (high blood pressure), dyslipidaemia (high cholesterol), smoking, sedentary lifestyle, central obesity, stress as well as a number of well recognized but less significant risk factors.

Each and every one of these risk factors contributes to the risk of developing coronary artery disease, while the presence of more than one multiplies the risk.

One of the primary aims of disease prevention is lifestyle modification. Exercising, healthy diet, stopping smoking, weight loss, are all necessary measures for risk modification and disease prevention. Medication is only complementary to the above with regards to prevention but it is necessary with regards to treatment of coronary heart disease.
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