Week 2 530 B Path Coronary Artery Disease Essay
Week 2 530 B Path Coronary Artery Disease Essay
Coronary artery disease (CAD) is the principal cause of death in the United States and worldwide. It refers to ischemic heart disease due to stenosis or obstruction of coronary arteries following atherosclerosis with a subsequent mismatch between myocardial oxygen supply and demand (Shahjehan & Bhutta, 2021). According to Shahjehan and Bhutta (2021), the lifetime risk of developing this condition at age 50 is approximately 50%. Approximately 1.72% of the global population is affected by this devastating condition (Shahjehan & Bhutta, 2021). This academic paper will elaborate on the development of CAD, its associated risk factors, markers, and testing of cardiovascular risk as well as prevention and treatment recommendations.
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Development of CAD and Associated Risk Factors
The development of CAD is a slow and progressive process that is complex and multifactorial. The process is caused by atherosclerosis, a disease of large and medium-sized muscular arteries characterized by endothelial dysfunction, vascular inflammation, and accumulation of lipids, cholesterol, cellular debris, and calcium within the intima (Fioranelli et al., 2018). Dyslipidemia, hypertension, smoking, diabetes mellitus, obesity, and sedentary lifestyle induce chronic stress to the endothelium causing endothelial injury and or dysfunction. Consequently, invasion and migration of inflammatory cells, secretion of inflammatory mediators, and stimulation of migration and proliferation of smooth muscle cells (SMCs) results. Macrophages and SMCs then ingest cholesterol and transform into foam cells that accumulate to form fatty streaks.
These cells further produce an extracellular matrix leading to the development of a fibrous plaque (atheroma). It takes approximately 15 years from onset to development of fatty streak (Fioranelli et al., 2018). The plaque then may undergo calcification, rupture, ulceration, hemorrhage, and erosion among other acute plaque changes. Similarly, atheroma leads to vascular remodeling, acute and chronic luminal obstruction with resultant turbulent blood flow, and diminished oxygen supply.
Markers and Testing for Cardiovascular Risk
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Testing for atherosclerotic cardiovascular disease (ASCVD) is based on the 2013 AHA/ACC guidelines that recommended the utilization of a revised calculator for approximating the 10-year risk of developing an initial ASCVD event. An event implies stroke, death from myocardial ischemia, or nonfatal MI in a previously healthy individual(Malakar et al., 2019). Additionally, the calculator incorporates several risk factors include age, sex, race, total cholesterol, HDL cholesterol, systolic blood pressure, treatment for elevated blood pressure, diabetes, and smoking (Malakar et al., 2019). The clinical risk factors are to be assessed every 4-6 years in individuals aged 20-79 years without clinical ASCVD (Malakar et al., 2019). Finally, biomarkers are significant predictors of death and major cardiovascular events. For instance, Malakar et al. (2019) recommend B-type natriuretic peptide, CRP, homocysteine, renin, cystatin C, urinary albumin to creatinine ratio, and HDL cholesterol as the most informative markers for predicting cardiovascular death.
Prevention and Treatment
Strategies for primary and secondary prevention of ASCVD include lifestyle modification (which encompasses dietary modification, exercise, and smoking cessation), management of hypertension, management of hypercholesterolemia, management of diabetes mellitus management of obesity, and antiplatelet therapy with aspirin or clopidogrel (Shahjehan & Bhutta, 2021). Management of hypercholesterolemia is mainly with statins and other lipid-lowering drugs whereas antihypertensives are indicated for elevated blood pressure with a target BP of less than 130/80 mmHg (Shahjehan & Bhutta, 2021). Finally, antiplatelet therapy, antianginal drugs, and techniques such as percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are indicated for coronary artery disease.
Conclusion
CAD is associated with high mortality. However, it is largely preventable through both primary and secondary prevention of the enormous modifiable risk factors consistent with the development of atherosclerosis.
References
Fioranelli, M., Bottaccioli, A. G., Bottaccioli, F., Bianchi, M., Rovesti, M., & Roccia, M. G. (2018). Stress and inflammation in coronary artery disease: A review psychoneuroendocrineimmunology-based. Frontiers in Immunology, 9, 2031. https://doi.org/10.3389/fimmu.2018.02031
Malakar, A. K., Choudhury, D., Halder, B., Paul, P., Uddin, A., & Chakraborty, S. (2019). A review on coronary artery disease, its risk factors, and therapeutics: MALAKAR et al. Journal of Cellular Physiology, 234(10), 16812–16823. https://doi.org/10.1002/jcp.28350
Shahjehan, R. D., & Bhutta, B. S. (2021). Coronary artery disease. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK564304/
Discuss the development of coronary artery disease (CAD) and the links to dyslipidemia, hypertension, cigarette smoking, diabetes mellitus, obesity and sedentary lifestyle. Review the current scholarly literature and describe the markers and testing of cardiovascular risk and prevention and treatment recommendations.