Coronary Disease, Screening and Primary Prevention

Terminology

• Coronary artery disease is a term used to describe atherosclerotic changes that occur in the blood vessels that supply the heart

• Coronary artery disease ranges from asymptomatic nonobstructive atherosclerosis and stable angina to acute coronary syndromes such as unstable angina, non–ST-elevation myocardial infarction, and ST-elevation myocardial infarction

• Screening for coronary artery disease refers to evaluation of asymptomatic and at-risk patients with the goal of identifying existing disease

• Primary prevention encompasses interventions undertaken with aim of preventing or delaying onset of coronary disease

Epidemiology

• Atherosclerotic cardiovascular disease remains the leading cause of mortality, morbidity, and overall health care costs globally despite significant improvement in outcomes in recent years1-3

• WHO reported that ischemic heart disease was responsible for approximately 9 million deaths worldwide in 20164

• Currently, the estimated annual incidence of myocardial infarction in the United States is 605,000 new attacks and 200,000 recurrent attacks5

• Significant opportunity to improve clinician and patient participation in evidence-based screening and prevention remains

Etiology and Risk Factors

Etiology

• Coronary artery disease is a multifactorial inflammatory disease involving a complex interaction of genetic and environmental risk factors resulting in atherosclerosis

• The inciting event for atherosclerotic cardiovascular disease is generally endothelial injury or dysfunction resulting in an inflammatory response that leads to formation of atherosclerotic plaque/atheroma consisting of inflammatory cells, cellular debris, smooth muscle cells, and varied amounts of cholesterol (ie, lipid core) (6,7,8)

Risk Factors

• Major risk factors (9,10)

  • Older age

  • Male sex

  • Hypertension

  • Diabetes

  • Dyslipidemia

  • Obesity

  • Smoking

Additional risk factors

• Low socioeconomic status has been linked to cardiovascular risk as a result of early and ongoing exposure to behavioral, educational, dietary, stress-related, and social risks that influence adherence to dietary, exercise, and pharmacological recommendations for heart health (10)

• Poor quality sleep, short sleep duration (less than 6 hours), and poor sleep hygiene contribute to risk of hypertension, obesity, and adverse cardiovascular outcomes (10)