|Coronary heart disease|
|Classification and external resources|
Coronary heart disease (CHD) is the narrowing or blockage of the coronary arteries, usually caused by atherosclerosis. Atherosclerosis (sometimes called “hardening” or “clogging” of the arteries) is the buildup of cholesterol and fatty deposits (called plaques) on the inner walls of the arteries. These plaques can restrict blood flow to the heart muscle by physically clogging the artery or by causing abnormal artery tone and function.
Without an adequate blood supply, the heart becomes starved of oxygen and the vital nutrients it needs to work properly. This can cause chest pain called angina. If blood supply to a portion of the heart muscle is cut off entirely, or if the energy demands of the heart become much greater than its blood supply, a heart attack (injury to the heart muscle) may occur. Coronary heart disease (CHD) is the leading cause of death for both men and women and accounts for approximately 600,000 deaths in the United States every year.
It is most commonly equated with atherosclerotic coronary artery disease, but coronary disease can be due to other causes, such as coronary vasospasm, where the stenosis to be caused by spasm of the blood vessels of the heart it is then usually called Prinzmetal's angina.
Coronary artery disease has a number of well determined risk factors. The most common risk factors include smoking, family history, hypertension, obesity, diabetes, high alcohol consumption, lack of exercise, stress, and hyperlipidemia. Smoking is associated with about 54% of cases and obesity 20%. Lack of exercise has been linked to 7–12% of cases.
Job stress appear to play a minor role accounting for about 3% of cases. In one study, women who were free of stress from work life saw an increase in the diameter of their blood vessels, leading to decreased progression of atherosclerosis. Contrastingly, women who had high levels of work-related stress experienced a decrease in the diameter of their blood vessels and significantly increased disease progression. Also, having a type A behavior pattern, a group of personality characteristics including time urgency, competitiveness, hostility, and impatience  is linked to an increased risk of coronary disease.
Parental history of high blood pressure can also contribute to a higher risk of heart disease in an individual. People whose parents are hypertensive have greater systolic and diastolic blood pressure numbers when compared with individuals without hypertensive parents. High blood pressure has been shown to be a cause of heart disease.
For symptomatic patients, stress echocardiography can be used to make a diagnosis for obstructive coronary artery disease. The use of echocardiography is not recommended on individuals who are exhibiting no symptoms and are otherwise at low risk for developing coronary disease.
Lifestyle changes have been shown to be effective in reducing (and in the case of diet, reversing) coronary disease:
- A plant-based diet has been shown by Caldwell Esselstyn and T. Colin Campbell among others to be effective as a treatment of coronary disease, and generalized atherosclerosis. In several peer reviewed studies by Caldwell Esselstyn the progression of heart disease has been shown to halt, and in some cases, the disease process may be reversed. Information recommending a healthier diet has been established for over 50 years.
- Weight control
- Smoking cessation
- Avoiding the consumption of trans fats (in partially hydrogenated oils)
- Exercise Aerobic exercise, like walking, jogging, or swimming, can help decrease blood pressure and the amount of blood cholesterol over time.
- Fish oil consumption to increase omega-3 fatty acid intake
- Decrease psychosocial stress.
- Statins, which reduce cholesterol, reduce risk of coronary disease 
- ACE inhibitors, which treat hypertension and may lower the risk of recurrent myocardial infarction
- Calcium channel blockers and/or beta-blockers
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See also