A Not-So Rare Disease: Coronary Heart Disease
By Kelly Landucci
February is Heart month; and with the recent celebration of Valentine’s Day, we all have hearts on our mind. There is no better time to bring awareness to the most common disease in America that kills over 370,000 adults annually(1): coronary heart disease (CHD).
What is it?
CHD (also called coronary artery disease) occurs when the arteries are blocked in some way and this limits blood flow to the heart. Arteries are the major blood vessels that supply the heart with a constant flow of oxygen and nutrition—so you may see why CHD causes problems. A person with heart disease has arteries that are more prone to blockage and build-up resulting from cholesterol-containing deposits called plaque. Over time, plaque builds up within the arteries and causes them to narrow; however, this plaque may also break apart causing the creation of a blood clot, which blocks the flow of blood within the arteries. A complete blockage of an artery leads to a heart attack and may result in death(2).
Signs & Symptoms
An individual with CHD may experience signs and symptoms due to the fact that as the arteries narrow, it becomes more and more difficult for the oxygen-rich blood to flow to the heart. These may include shortness of breath, mild to extreme chest pain, and ultimately, a heart attack. Shortness of breath is the most common sign, as even a small amount of physical exertion will cause this due to limited blood flow to the heart. Chest pain due to CHD (also called angina) may cause a sensation similar to the pressure of someone standing on your chest, however it usually goes away within minutes. Many initial signs and symptoms of CHD go unnoticed, as they are often triggered by emotional stress and physical activity. Finally, a heart attack is the biggest indicator of CHD as this is caused by a complete blockage of an artery. Extreme chest pain and shortness of breath may be sign of a heart attack, however a heart attack may occur without any signs or symptoms at all(3).
Is it genetic?
Yes and no—CHD has important genetic risk factors as well as environmental factors. Studies show that CHD is somewhere between 40% and 60% hereditary(4). Approximately 1/250 individuals in the general population do have a mutation in a single gene, resulting in a condition called Familial Cholesterolemia (FH). Early identification and treatment of individuals with FH is a top CDC Priority. But for most of us, the risks are spread out across a number of different genes. Although Polygenic Risk Scores (PRS) may be coming to help sort out which of us have more or less of these risk factors—we’re not there quite yet!
The other 60-40% of the factors contributing to CHD are environmental and lifestyle choices. These other risk factors may include:
- High blood pressure
- High cholesterol
- Diabetes or insulin resistance
- Lack of physical activity
- High stress
- Unhealthy diet
Individuals who have a history of heart disease in their family should be particularly conscious of their heart health, but those with no family history must also be aware of these important risk factors. An overall healthy lifestyle that contains a balance of exercise and eating right is your best bet for avoiding heart disease!
Protect the hearts of the ones you love.
A shocking 46.9% of heart attacks occur outside of the hospital(5). A small number of these deaths are related to hereditary cardiomyopathies or arrhythmias which are caused by mutations in single genes. But coronary heart disease is a much more common underlying cause.
Small lifestyle changes will make the biggest impact on allowing those with CHD to live a healthy life with a healthy heart—this may be as simple as pursuing an active lifestyle along with a balanced diet. A study done by a researcher at Harvard University found that individuals who are able to do more push-ups are less likely to suffer from CHD and other heart diseases in their lives(6).
If you or a loved one feels as though they may be at risk for CHD or any type of heart disease, it is important to talk to your doctor.
If you have a family history of heart disease that you think may be related to Familial Hypercholesterolemia, and particularly if you have a personal history of very high cholesterol, scheduling an appointment with a cardiovascular genetic counselor can help you to understand if and how genetic testing related to Familial Hypercholesterolemia may be appropriate for you as well as how the results might help to guide your medical care. To hear a from someone living with Familial Hypercholesterolemia, check out this podcast episode!
If you have a family history of sudden cardiac death with no known history of heart disease, evaluation by an cardiologist and/or an electrophysiologist as well as evaluation of your personal and family history of by a cardiovascular genetic counselor can be life-saving. To hear from a genetic counselor who works with families who have lost a loved one to sudden cardiac death, check out this podcast episode!
References & Further Reading:
- “Heart Disease Facts.” Centers for Disease Control and Prevention. Nov 28, 2017.
- “Coronary Artery Disease: Overview.” NCBI. July 27, 2017.
- “Coronary Artery Disease: Symptoms & Causes.” Mayo Clinic. May 16, 2018.
- McPherson, Ruth, Tybjaerg-Hansen, Anne. “Genetics of Coronary Artery Disease.” Circulation Research. Feb 19, 2016.
- “State-Specific Mortality from Sudden Cardiac Death–United States, 1999.” Morbidity and Mortality Weekly Report. Feb 14, 2002.
- Yang, Justin. Christophi, Costas A., et al. “Association Between Push-Up Exercise Capacity and Future Cardiovascular Events Among Adult Active Men.” JAMA Network. Feb 15, 2019.