Coronary disease, also known as coronary artery disease (CAD), is a leading cause of morbidity and mortality worldwide. Fortunately, many factors that cause CAD are modifiable through lifestyle changes and early intervention. Learn how we can help prevent the condition and support you with a heart-healthy lifestyle.
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Coronary artery disease, or CAD, occurs when the blood vessels supplying the heart muscle, known as coronary arteries, develop a buildup of fatty deposits through a process known as atherosclerosis. This can lead to a heart attack if the artery gets blocked suddenly, or chest pain called angina if it happens gradually.
Coronary artery disease is the biggest cause of premature death in the world. Fortunately, there are many ways to prevent, diagnose and treat it.
The hallmark of coronary artery disease is atherosclerosis; the formation of fat deposits within the coronary arteries. These deposits are called atheromas, and they are plaque-like substances consisting of cholesterol, fat, calcium, and other substances. They are thought to arise when the wall of the artery is disturbed into an unhealthy state, which can lead to cholesterol entering the wall of the artery and becoming trapped.
The build up of these deposits narrow the arteries, reducing and blocking blood flow. They can also detach, causing a blood clot that can result in a heart attack or a stroke.
We know from decades of research that several “risk factors” result in poor arterial health, which leads to coronary artery disease. These include:
Other more recently discovered risk factors include inflammation, and specific molecules like lipoprotein(a), also known as a “sticky” cholesterol.
Regular health check-ups and discussions with healthcare professionals can help assess and manage these risks.
Coronary artery disease affects both men and women. It is more common with age, with people over 50 usually more at risk. However, younger people can be affected if there is a genetic tendency or significant risk factors at play.
Women tend to have less heart disease before menopause, but afterwards this risk increases. It is important to note that heart disease can affect anyone, which is why it is the number one cause of early death in the world.
Prevention of coronary artery disease is a major goal of healthcare. At OneWelbeck Heart Health, we usually think of this in terms of preventing CAD and its consequences from happening in the first place (primary prevention), or by preventing CAD from progressing if it has already happened (secondary prevention).
The goal of primary prevention is to identify people who are otherwise well, but may be at risk of CAD, and to then help reduce their risk. This can be done with a clinical review and risk scoring tools that estimate a person’s risk of having a cardiovascular event over the next ten years.
Testing for CAD usually involves blood tests, which can provide information on diabetes, cholesterol values, and any underlying medical conditions. This data, along with blood pressure, height, and weight measurements can be used to estimate a risk score. The risk score can then guide the necessity for interventions
For some people, especially where the risk of CAD is borderline or could be underestimated, additional tests may include advanced cholesterol markers, or imaging the heart with a CT scanning procedure.
If someone’s CAD risk is found to be high, treatment usually involves modifying any medical conditions and supporting lifestyle and behavioural changes. If, after that, the risk still remains high, then medications such as statin therapy may be considered to lower overall risk, even if cholesterol levels are not high.
Where someone has already had a heart attack, stenting, bypass surgery, or a stroke, then the goal is usually to reduce the risk of this happening again and to avoid complications. This is known as secondary prevention.
The focus of secondary prevention is on preventing coronary artery disease from progressing or leading to further heart attacks. The most common and effective approach to do this is by lowering LDL cholesterol levels to as low as possible, along with use of other medications such as aspirin, beta blockers and blood pressure treatments.
In recent years, a wide range of newer treatments have become available. These include newer cholesterol-lowering injections such as Inclisiran, high-strength fish oils, anti-inflammatory treatments and more potent blood thinning medicines. Our coronary artery disease prevention specialists can advise you on how to lower the risk of heart attack occurring.
Early detection, management of risk factors, and lifestyle modifications are crucial in preventing or managing coronary disease. Investigations for risk of CAD and other cardiac-related conditions include:
Blood Tests: often conducted to measure cholesterol levels, triglycerides, and other lipid levels in the blood. Elevated levels of certain lipids, particularly low-density lipoprotein (LDL) cholesterol, are associated with an increased risk of coronary disease.
Electrocardiogram (ECG): measures the heart's electrical activity. It can help detect abnormal heart rhythms, signs of a previous heart attack, or ischemic changes (indicating reduced blood flow to the heart).
Other tests may also be recommended by your cardiologist including a full medical history, stress test, echocardiogram, coronary angiography, CT angiography or cardiac MRI.
Our world-class cardiologists have expertise in coronary disease risk management and offer longitudinal follow-ups to support your heart health.
Peace of mind: For those with no cardiac-related symptoms, our cardiologists can offer a range of diagnostic tests to assess your risk of coronary disease and offer personalised advice on managing your heart health.
Ongoing care: We can ensure that you have a trusted partner in caring for your cardiovascular well-being. This continuity of care fosters a deeper understanding of your unique health needs and allows for timely adjustments to any treatment or management plan if deemed necessary.
Integrated with other specialities: If any underlying conditions or causes are discovered, we seamlessly connect patients with specialists including endocrinology, bariatrics, and nutrition for comprehensive health support, all within the same building.
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The consultants at OneWelbeck Heart Health have been assembled based on their hard-earned international reputations and expertise. Together, they cover the major London teaching hospitals and leading cardiac services, making up the largest independent cardiology group in the UK.