When it comes to coronary artery disease, think “prevention”

Coronary artery disease (CAD) is the most common type of heart disease, according to the Centers for Disease Control and Prevention. The good news is many CAD risk factors can be controlled through lifestyle changes and medications.

In coronary artery disease, also known as ischemic heart disease, at least one of the three coronary arteries that supply blood to the heart has plaque, a buildup of calcium and cholesterol. Plaque can create a blockage in blood flow and lead to angina, heart attack or cardiac arrest.

“Both men and women* are at risk of coronary disease, but men often present earlier in life when compared with women,” said Jennifer Frampton, DO, an interventional cardiologist with Yale New Haven Health’s Heart and Vascular Center and assistant professor of Medicine at Yale School of Medicine (YSM).

CAD risk factors include smoking, diabetes, high cholesterol, high blood pressure and obesity. Women who’ve had pre-eclampsia, gestational hypertension or gestational diabetes may also be at risk, said Dr. Frampton, who sees clinic patients in Norwich and Uncasville and performs cardiac procedures at Lawrence + Memorial and Yale New Haven hospitals. 

Diagnosing coronary artery disease

Tests help diagnose CAD, but symptoms can also be telling.

Common symptoms include chest pain, pressure or discomfort or shortness of breath with exertion that subsides at rest. If these symptoms occur during a heart attack, they are often much more severe and can occur even when you are sitting down, said Dr. Frampton. Women and people with diabetes may experience atypical symptoms of nausea, vomiting, dizziness or fainting.

Tests to assess CAD risk include:

• lipid profile blood panel to measure cholesterol levels  
• stress test 
• coronary calcium CT scan to check for calcium deposits in the heart’s arteries 
• angiography, a medical imaging technique, to capture photos and video of the heart’s anatomy

For heart attack patients the ideal treatment is an emergency angioplasty. This procedure uses a balloon that is temporarily inserted within the artery and inflated to break up blockage and expand the blood vessel. The balloon is then removed after which at least one stent (a metal, mesh-like tube) may be placed within the vessel wall to keep the artery open for normal blood flow. At Lawrence + Memorial Hospital, the interventional cardiologists at the Heart and Vascular Center are on call around-the-clock and are in close communication with paramedics and Emergency Department staff, to prepare for an emergency procedure before the patient arrives at the hospital, said interventional cardiologist Brian Cambi, MD, medical director of Yale New Haven Heath Heart and Vascular Center at L+M and Westerly hospitals and associate professor of Medicine at YSM. Dr. Cambi sees patients in New London and Westerly. 

“L+M is the only hospital in eastern Connecticut that offers emergency angioplasty and stenting for heart attack victims as well as elective angioplasty and stenting for patients with stable coronary artery disease,” he said. “And at Westerly Hospital, we provide an extensive array of heart and vascular services that include advanced diagnostic tests and emergency medicine, inpatient and outpatient evaluations, consultations and treatment in a community hospital setting.

Prevention and choices are key

Personal choices like what you eat and your activities can impact your risk for CAD.

“Aggressive risk factor modification and maintaining a healthy lifestyle are the best things to do to prevent development of coronary artery disease or to slow progression once diagnosed,” Dr. Frampton added.

This includes not smoking, keeping a healthy weight, exercising regularly, eating healthy foods and controlling your blood sugars if you have diabetes. Learning to manage emotional stress is another important component, according to Dr. Cambi.

Dr. Frampton favors the Mediterranean diet. “This diet focuses on eating lots of fruits, vegetables, whole grains, beans and olive oil. It recommends eating more seafood, particularly fish, as well as replacing saturated fats with unsaturated fats. Saturated fats consist of butter, fatty meat, and cheese, for example. I also recommend avoiding excess trans fats which are found in fried foods as well as desserts like cakes and cookies,” she said.

Treatment for CAD

Medications for CAD include statins to lower LDL cholesterol, reduce inflammation and stabilize plaque; aspirin to reduce clotting; and beta blockers to lower blood pressure and treat angina symptoms.

In addition to an angioplasty, other patients may benefit from open heart surgery with a coronary artery bypass grafting procedure offered at Bridgeport and Yale New Haven hospitals. Other surgeries include arterial bypass grafting and minimally invasive direct coronary artery bypass.

“The best thing that a patient can do is have a conversation with their primary care provider or cardiologist about their risk factors and how to modify them to prevent the development of coronary artery disease,” Dr. Frampton said. 

Learn more about Heart and Vascular Center services.

*Advancing Care uses the terms "female" and "male" to reflect biological status typically assigned at birth, and "women" and "men" when referring to gender. According to the Human Rights Campaign, a doctor or midwife assigns a child's sex as male, female or intersex at birth based on their external anatomy. Gender identification may differ from birth sex.