Highlights

Coronary Artery Disease

Coronary artery disease (CAD), also called heart disease, is a condition in which fatty deposits called plaque build-up in the heart’s arteries. These deposits cause arteries to become narrow and blocked, which restricts blood and oxygen flow to the heart muscle. CAD is the leading cause of death, for both men and women, in the United States.

Risk Factors

Some of the main risk factors that increase the risk for CAD are:

• Smoking
• Unhealthy cholesterol and lipid levels
• High blood pressure
• Diabetes
• Lack of exercise
• Obesity

Symptoms

Angina is the primary symptom of coronary artery disease. Angina feels like gripping pain or pressure in the chest area.

• Stable angina is predictable chest pain that lasts a few minutes or less and is usually relieved by rest or medication. It is often triggered by physical exertion or emotional stress.
• Unstable angina is unpredictable chest pain that occurs unexpectedly, even when at rest. It is a more serious condition than stable angina and can be a warning sign of a heart attack.

Some patients with CAD have few or no symptoms. Sometimes a heart attack may be the first sign that a person has CAD.

Treatment

• Lifestyle changes (such as a healthy diet and regular physical activity) are essential for preventing and treating CAD.
• Medications for preventing and treating CAD include aspirin, cholesterol-lowering drugs (statins), and high blood pressure medications. Some patients take nitroglycerin or other nitrate drugs to treat angina.
• Procedures may be needed to open blocked or narrowed coronary artery and improve blood flow to the heart. This approach is known as reperfusion therapy. Percutaneous coronary intervention (PCI), also called angioplasty, uses a small balloon to open the blood vessel. Coronary artery bypass graft (CABG) is a more invasive procedure that is generally recommended for patients with severe heart disease. It uses grafts from arteries or veins to reroute blood flow.

Clopidogrel and Proton Pump Inhibitors

Clopidogrel (Plavix) is an antiplatelet drug recommended for some patients with CAD. It is used to help prevent blood clots from forming in the arteries or in the stents that doctors place to help arteries stay open after PCI. Clopidogrel can increase the risk for upper gastrointestinal bleeding, especially for patients who have pre-existing ulcers or other risk factors. For this reason, doctors often prescribe a proton pump inhibitor (PPI) drug along with clopidogrel to help suppress gastric acid production.

There have been concerns that PPI drugs can interfere with clopidogrel’s anti-clotting effects. In 2010, the American College of Cardiology, American College of Gastroenterology, and the American Heart Association released a consensus statement advising that patients at risk for gastrointestinal problems should take a PPI drug along with clopidogrel as the benefit of PPI drugs outweigh potential adverse effects.

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Coronary Artery Disease Introduction

Review Date: 05/05/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)