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What is coronary artery disease?

Coronary artery disease is a narrowing and blockage of the coronary arteries caused by deposits of cholesterol and fat (“plaques”) within their walls. The coronary arteries are crucial to the normal functioning of the heart because they supply blood flow to the heart muscle (“myocardium”). The build-up of cholesterol plaques is gradual over many years, but sometimes a clot (“coronary thrombus”) may form at the site of a plaque and suddenly block the blood supply to the heart muscle.

Symptoms of coronary artery disease

Symptoms of coronary artery disease can include chest pain, exertional pain (“angina”), shortness of breath, dizziness, lightheadedness, rhythm disturbances (arrhythmias) such as atrial fibrillation, congestive heart failure (CHF), and/or a heart attack or “myocardial infarction” (MI), where a portion of the heart muscle is damaged and undergoes necrosis (“dies”) from lack of blood flow to the heart muscle (“ischemia”).

In some patients, however, there may be little or no symptoms, even during a heart attack (“silent MI”).

How common is coronary artery disease?

The Cleveland Clinic points out that heart disease is the leading cause of death among men and women in the United States. Coronary artery disease affects 16.5 million Americans. The American Heart Association (AHA) estimates that someone in the US has a heart attack about every 40 seconds. In addition, for patients with no risk factors for heart disease, the lifetime risk of having cardiovascular disease is 3.6% for men and less than 1% for women. Having 2 or more risk factors increase the lifetime risk of cardiovascular disease to 37.5% for men and 18.3% in women.

[Ref:https://my.clevelandclinic.org/health/diseases/16898-coronary-artery-disease]

What are the risk factors for coronary artery disease?

There are risk factors for coronary artery disease that can be modified and those that cannot be modified.

The non-modifiable risk factors are those risk factors that you cannot control. They include gender (being male), race (being African American), getting older, and having a family history of heart disease.

Modifiable risk factors are things you can (and arguably should) control. They include high cholesterol, high blood pressure, diabetes mellitus, smoking, obesity, stress, and lack of physical exercise. Id.

The diagnosis of coronary artery disease

There are many blood tests, scans, and other diagnostic procedures that cardiologists use to evaluate the heart and diagnose coronary artery disease.

Blood tests are used to check the cholesterol, triglycerides, glucose, lipoproteins, and markers of inflammation (e.g., CRP).

Electrocardiogram (EKG) and echocardiography (echo) check the heart's pumping capacity and the function of its valves and chambers.

Stress tests check how the heart works during physical stress. They include a treadmill, stationary bike, stress echo, and a nuclear or thallium stress test.

Imaging studies include cardiac CT, MRI and PET scans.

Coronary calcium scan is used to measure calcium in the walls of the coronary arteries. Calcium deposits correlate with cholesterol deposits and are a good surrogate marker.  

Coronary angiography to show the insides of the coronary arteries is considered the “gold standard” in evaluating the heart for coronary artery disease.

Coronary guide wire sensor technology can assess he microvascular function of the heart.

[Ref: https://www.nhlbi.nih.gov/health-topics/ischemic-heart-disease]

Treatment of coronary artery disease

You can't modify “non-modifiable” risk factors, but “modifiable” risk factors are the place to start in the treatment of coronary artery disease.

The goal of treatment should be to relieve symptoms of coronary artery disease and to prevent complications, such as heart attack and death.

Medications that are commonly used to treat the symptoms of coronary artery disease include beta blockers, calcium channel blockers, and nitrates. Low dose aspirin helps to prevent coronary artery blood clots. “Statin” drugs, such as Lipitor and Crestor, decrease the level of cholesterol and triglycerides in the blood.

Percutaneous trans-luminal coronary angioplasty(“PTCA”), with or without stent-placement, is a procedure that is performed by cardiologists during coronary angiography to widen a narrowed coronary artery.

Coronary artery bypass graft(“CABG”) surgery is performed If the coronary arteries are severely narrowed or if there are many coronary blood vessels that are narrowed. CABG is open-heart surgery and involves taking a blood vessel from elsewhere in the body and bypassing the blocked coronary arteries.

Stem cell treatment for coronary artery disease

Stem cell treatments for coronary artery disease have been in the evaluation process for many years. In a recent peer-reviewed medical journal article from Poland, the authors concluded that “intramyocardial delivery of stem cells is more complicated than intracoronary administration, but it is safe and may provide better therapeutic outcomes. Further studies should be designed to define the optimal cell type to treat ischemic heart disease, including combination cell therapy.” Litwinowicz R et al. “The use of stem cells in ischemic heart disease treatment.” Kardiochir Torakochirurgia Pol.2018 Sep; 15(3): 196–199.

Other authors have similarly concluded that “intramyocardial (stem) cell therapy was feasible in treating patients with ischemic heart failure.”  Cheng K, et al. “Intramyocardial autologous cell engraftment in patients with ischemic heart failure: a meta-analysis of randomized controlled trials.” Heart Lung Circ. 2013 Nov;22(11):887-94.

However, many authors emphasize the importance of proper selection of patients for clinical study using stem cells and that some of the patients treated with stem cells respond poorly or not at all to the given stem cells.

As the NIH has concluded, “stem cells may well serve as the foundation upon which a future form of "cellular therapy" is constructed.” However, that time has not yet arrived, and much future research is required. [Ref:  https://stemcells.nih.gov/info/2001report/chapter9.htm]