Expert Care for Coronary Artery Disease (CAD)

Risk Factors for CAD

Age is a primary risk factor for coronary artery disease. For men, the risk increases substantially after age 45. For women, the risk increases after age 55, likely due to hormonal changes that occur after menopause.

Risk factors include:

• Diabetes
• High blood pressure
• High cholesterol
• Physical inactivity
• Diet high in saturated fats
• Obesity
• Smoking

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Symptoms and Diagnosis of CAD

CAD typically doesn't cause noticeable symptoms in the early stages. As the coronary arteries continue to narrow, symptoms may include chest pain, shortness of breath, pain in the neck and shoulders, nausea, weakness and fatigue.

For patients with symptoms of or risk factors for coronary artery disease, one or more of the following diagnostic tests may be recommended:

• Cardiac catheterization: This test involves inserting a long, thin tube called a catheter into an artery and threading it to the heart to check for problems in the coronary arteries.
• Echocardiogram (echo): A test that uses sound waves to create a moving picture of your heart. An echo can show areas of poor blood flow to the heart.
• Electrocardiograms (ECG): ECGs record the electrical activity of the heart.
• Exercise stress test: An exercise stress test uses an ECG and is conducted on a stationary bike to measure heart and lung function during physical activity.
• Nuclear stress test: A nuclear stress test measures the blood flow to the heart during rest and activity to determine if it is low.

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Medical and Surgical Treatments for CAD

Reducing risk factors through lifestyle modifications is often the recommended treatment for early-stage CAD. Recommended changes may include:

• A heart healthy diet low in saturated fat and high in whole grains, fruits and vegetables
• Regular exercise
• Quitting smoking
• Management of chronic conditions such as diabetes and high blood pressure

In conjunction with lifestyle modifications, patients with CAD may also be treated with medications to control blood pressure, lower cholesterol, prevent blood clot formation and improve circulation.

Medications to treat coronary artery disease may include:

• Statins, PCSK9 inhibitors or bempedoic acid to help lower LDL cholesterol levels and reduce plaque buildup in the arteries.
• Aspirin to help thin the blood and prevent blood clots.
• Beta blockers to slow the heartbeat and lower blood pressure.
• Calcium channel blockers to help reduce chest pain.
• Angiotensin-converting enzyme (ACE) inhibitors and angiotensin 2 receptor blockers (ARBs) to help lower blood pressure and keep coronary artery disease from worsening.
• Nitroglycerin to help widen the heart arteries and control or reduce chest pain.
• Ranolazine to help reduce chest pain, with or instead of a beta blocker.

If lifestyle changes and medications are not effective, one of the following minimally invasive or open surgical procedures may be recommended:

• Coronary angioplasty: Also known as a percutaneous coronary intervention (PCI), a coronary angioplasty involves guiding a deflated balloon through your arteries and using X-rays to pinpoint the location of the blockage in your coronary artery. The balloon is then inflated to widen the artery and increase blood flow.
• Coronary artery stent placement: A mesh wire tube known as a stent is placed into your artery to keep it open. This procedure uses the same technique as angioplasty.
• Coronary atherectomy: in some cases, we need to remove part of an atherosclerotic plaque. We have several approaches to achieve this goal: rotational or orbital atherectomy, laser and calcium modifier techniques (to create calcium and plaque fractures).
• Coronary artery bypass graft (CABG) surgery: During a coronary artery bypass, veins from another part of your body are grafted onto your heart to allow blood to flow around blockages.
• Robotic MIDCAB surgery: This minimally invasive alternative may be recommended for high-risk patients to improve blood flow by creating a new pathway around a blocked artery using a healthy blood vessel from another part of the body.
• Heart transplant: The most advanced treatment option for CAD, this surgery is a total replacement of the heart with one from a healthy donor. It is reserved for the most severe cases of CAD when other treatment options have failed.