Wednesday, May 27, 2015

Heart Disease: An introduction to Coronary Artery Disease


Coronary artery disease (CAD), also called heart disease or ischemic heart disease, results from a complex process known as atherosclerosis (commonly called "hardening of the arteries"). In atherosclerosis, fatty deposits (plaques) of cholesterol and other cellular waste products build up in the inner linings of the heart’s arteries. This causes blockage of arteries and prevents oxygen-rich blood from reaching the heart (ischemia). There are many steps in the process leading to atherosclerosis, some not fully understood.

Click the icon to see an image of atherosclerosis.

Cholesterol and Lipoproteins. The atherosclerosis process begins with cholesterol and sphere-shaped bodies called lipoproteins that transport cholesterol.

  • Cholesterol is a substance found in all animal cells and animal-based foods. It is critical for many functions, but under certain conditions cholesterol can be harmful.
  • The lipoproteins that transport cholesterol are referred to by their size. The most commonly known are low-density lipoproteins (LDL) and high density lipoproteins (HDL). LDL is often referred to as "bad" cholesterol; HDL is often called "good" cholesterol.
Click the icon to see an image of cholesterol inside an artery.

Oxidation. The damaging process called oxidation is an important trigger of atherosclerosis:

  • Oxidation is a chemical process in the body caused by the release of unstable particles known as oxygen-free radicals. It is one of the normal processes in the body, but under certain conditions (such as exposure to cigarette smoke or other environment stresses) these free radicals are overproduced.
  • In excess amounts, they can be very dangerous, causing damaging inflammation and even affecting genetic material in cells.
  • In heart disease, free radicals are released in artery linings and oxidize low-density lipoproteins (LDL). The oxidized LDL is the basis for cholesterol build-up on the artery walls and damage leading to heart disease.

Inflammatory Response. For the arteries to harden there must be a persistent reaction in the body that causes ongoing harm. Researchers now believe that this reaction is an immune process known as the inflammatory response.

Click the icon to see an image of atherosclerosis.

There is growing evidence that the inflammatory response may be present not only in local plaques in single arteries but also throughout the arteries leading to the heart.

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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 (