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| | __NOTOC__ |
| '''For patient information on coronary heart disease click [[Coronary heart disease (patient information)|here]]''' | | '''For patient information on coronary heart disease click [[Coronary heart disease (patient information)|here]]''' |
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| '''For patient information on coronary risk profile click [[Coronary risk profile (patient information)|here]]''' | | '''For patient information on coronary risk profile click [[Coronary risk profile (patient information)|here]]''' |
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| {{DiseaseDisorder infobox |
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| Name = Coronary heart disease |
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| ICD10 = I20-I25 |
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| ICD9 = {{ICD9|410}}-{{ICD9|414}}, {{ICD9|429.2}} |
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| {{Coronary heart disease}} | | {{Coronary heart disease}} |
| {{CMG}} | | {{CMG}} |
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| ==Overview==
| | {{SK}} Coronary artery disease; arteriosclerotic heart disease; ischemic heart disease; myocardial ischemia; CHD; CAD |
| '''Coronary heart disease ''' (CHD), also called [[coronary artery disease]] ([[CAD]]), [[ischaemic heart disease]], [[atherosclerosis|atherosclerotic]] [[heart disease]], is the end result of the accumulation of [[atheroma|atheromatous plaques]] within the walls of the [[Coronary circulation|arteries]] that supply the [[myocardium]] (the muscle of the [[heart]]) with oxygen and nutrients. While the symptoms and signs of coronary heart disease are noted in the advanced state of disease, most individuals with coronary heart disease show no evidence of disease for decades as the disease progresses before the first onset of symptoms, often a "sudden" [[myocardial infarction|heart attack]], finally arise. After decades of progression, some of these [[atheroma|atheromatous plaques]] may rupture and (along with the activation of the [[blood clot]]ting system) start limiting [[blood flow]] to the [[cardiac muscle|heart muscle]]. The disease is the most common cause of [[cardiac arrest|sudden death]]<ref>http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1835183</ref>, and is also the most common reason for death of men and women over 20 years of age.
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| According to present trends in the United States, half of healthy 40-year-old males will develop CHD in the future, and one in three healthy 40-year-old women.<ref>http://circ.ahajournals.org/cgi/content/full/115/5/e69/TBL3179728</ref> According to the Guinness Book of Records, Northern Ireland is the country with the most occurrences of CHD.
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| ==[[Atherosclerosis Prevention and Risk Factor Modification]]==
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| ==[[Chronic Stable Angina]]==
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| ==[[Unstable Angina]]==
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| ==[[Non ST Elevation Myocardial Infarction]]==
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| ==[[ST Elevation Myocardial Infarction]]==
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| ==[[Cardiac Rehabilitation]]==
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| ==Atherosclerosis==
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| Atherosclerotic heart disease can be thought of as a wide spectrum of disease of the heart. At one end of the spectrum is the [[asymptomatic]] individual with atheromatous streaks within the walls of the coronary arteries (the arteries of the heart). These streaks represent the early stage of atherosclerotic heart disease and do not obstruct the flow of blood. A [[coronary angiogram]] performed during this stage of disease may not show any evidence of coronary artery disease, because the lumen of the coronary artery has not decreased in calibre.
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| Over a period of many years, these streaks increase in thickness. While the atheromatous plaques initially expand into the walls of the arteries, eventually they will expand into the lumen of the vessel, affecting the flow of blood through the arteries. While it was originally believed that the growth of atheromatous plaques was a slow, gradual process, recent evidence suggests that the gradual buildup may be complemented by small plaque ruptures which cause the sudden increase in the plaque burden due to accumulation of thrombus material.
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| [[Image:IVUS of CAD.png|right|thumb|400px|[[Intravascular ultrasound]] image of a coronary artery (left), with color coding on the right, delineating the lumen (yellow), external elastic membrane (blue) and the atherosclerotic plaque burden (green). As the plaque burden increases, the lumen size will decrease.]]Atheromatous plaques that cause obstruction of less than 70 percent of the diameter of the vessel rarely cause symptoms of obstructive coronary artery disease. As the plaques grow in thickness and obstruct more than 70 percent of the diameter of the vessel, the individual develops symptoms of obstructive coronary artery disease. At this stage of the disease process, the patient can be said to have [[ischemic heart disease]]. The symptoms of ischemic heart disease are often first noted during times of increased workload of the heart. For instance, the first symptoms include exertional [[Angina pectoris|angina]] or decreased exercise tolerance.
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| As the degree of coronary artery disease progresses, there may be near-complete obstruction of the [[lumen]] of the coronary artery, severely restricting the flow of oxygen-carrying blood to the myocardium. Individuals with this degree of coronary heart disease typically have suffered from one or more [[myocardial infarction]]s (heart attacks), and may have signs and symptoms of chronic coronary ischemia, including symptoms of [[Angina pectoris|angina]] at rest and flash [[pulmonary edema]].
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| A distinction should be made between myocardial ischemia and myocardial infarction. Ischemia means that the amount of oxygen supplied to the tissue is inadequate to supply the needs of the tissue. When the myocardium becomes ischemic, it does not function optimally. When large areas of the myocardium becomes ischemic, there can be impairment in the relaxation and contraction of the myocardium. If the blood flow to the tissue is improved, myocardial ischemia can be reversed. Infarction means that the tissue has undergone irreversible death due to lack of sufficient oxygen-rich blood.
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| An individual may develop a rupture of an atheromatous plaque at ''any'' stage of the spectrum of coronary heart disease. The acute rupture of a plaque may lead to an acute [[myocardial infarction]] (heart attack).
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| ==Pathophysiology==
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| Limitation of blood flow to the heart causes [[ischemia]] (cell starvation secondary to a lack of oxygen) of the myocardial cells. When myocardial cells die from lack of [[oxygen]], this is called a [[myocardial infarction]] (commonly called a heart attack). It leads to [[cardiac muscle|heart muscle]] damage, [[cardiac muscle|heart muscle]] death and later scarring without [[cardiac muscle|heart muscle]] regrowth.
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| Myocardial infarction usually results from the sudden occlusion of a coronary artery when a plaque ruptures, activating the clotting system and [[atheroma]]-clot interaction fills the lumen of the artery to the point of sudden closure. The typical [[stenosis|narrowing]] of the lumen of the [[coronary artery|heart artery]] before sudden closure is typically 20%, according to clinical research completed in the late 1990s and using [[IVUS]] examinations within 6 months prior to a [[myocardial infarction|heart attack]]. High grade [[stenosis|stenoses]] as such exceeding 75% blockage, such as detected by [[Cardiac stress test|stress testing]], were found to be responsible for only 14% of acute [[myocardial infarction|heart attack]]s the rest being due to plaque rupture/ spasm. The events leading up to plaque rupture are only partially understood. [[Myocardial infarction]] is also caused, far less commonly, by spasm of the artery wall occluding the lumen, a condition also associated with [[atheroma]]tous plaque and CHD.
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| CHD is associated with [[Tobacco smoking|smoking]], [[obesity]], [[hypertension]] and a chronic sub-clinical lack of vitamin C. A family history of CHD is one of the strongest predictors of CHD. Screening for CHD includes evaluating [[homocysteine]] levels, [[High density lipoprotein|high-density]] and [[Low density lipoprotein|low-density lipoprotein]] ([[cholesterol]]) levels and [[triglyceride]] levels.
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| == Differential Diagnosis of Causes of Coronary Heart Disease==
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| * [[Air embolism]]
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| * [[Anomalous origin of coronary artery]]
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| * [[Aortic dissection]]
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| * [[Aortic stenosis]]
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| * [[Atrial myxoma]]
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| * [[Chest trauma]]
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| * [[Cocaine]]
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| * [[Collagen vascular disease]]
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| * [[Coronary artery dissection]]
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| * [[Endocarditis]]
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| * [[Hypercoagulable state]]
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| * [[Hypertrophic cardiomyopathy]]
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| * [[Hypotension]]
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| * [[Luetic aortitis]]
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| * [[Nitrate withdrawal]]
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| * [[Raynaud's Disease]]
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| * [[Takayasu's Disease]]
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| * [[Thrombi]] from:
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| *:* Catheter
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| *:* [[Left atrium]]
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| *:* [[Left ventricle]]
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| *:* [[Artificial heart valve|Prosthetic valve]]s
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| * [[Variant angina]]
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| ==Angina==
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| [[Angina pectoris|Angina]] that occurs regularly with activity, upon awakening, or at other predictable times is termed stable angina and is associated with high grade [[stenosis|narrowings]] of the [[heart]] [[artery|arteries]]. The symptoms of angina are often treated with nitrate preparations such as [[Glyceryl trinitrate (pharmacology)|nitroglycerin]], which come in short-acting and long-acting forms, and may be administered transdermally, sublingually or orally. Many other more effective treatments, especially of the underlying [[atheroma]]tous disease, have been developed.
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| Angina that changes in intensity, character or frequency is termed unstable. Unstable angina may precede myocardial infarction, and requires urgent medical attention. It is treated with morphine, oxygen, intravenous nitroglycerin, and aspirin. Interventional procedures such as [[angioplasty]] may be done.
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| ==Risk factors==
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| '''The following are confirmed independent risk factors for the development of CAD, in order of decreasing importance:'''
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| # [[Hypercholesterolemia]] (specifically, serum [[LDL]] concentrations)
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| # [[tobacco smoking|Smoking]]
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| # [[Hypertension]] (high systolic pressure seems to be most significant in this regard)
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| # [[Hyperglycemia]] (due to diabetes mellitus or otherwise)
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| # [[Type A personality |Type A Behavioural Patterns, TABP]]. Added in 1981 as an independant risk factor after a majority of research into the field discovered that TABP's were twice as likely to cause CHD than any other personality type.
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| # Hereditary differences in such diverse aspects as lipoprotein structure and that of their associated receptors, homocysteine processing/metabolism, etc.
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| '''Significant, but indirect risk factors include:'''
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| * Lack of exercise
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| * Stress
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| * Diet rich in [[saturated fat]]s
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| * Diet low in [[antioxidant]]s
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| * [[Obesity]]
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| * Men over 60; Women over 65 [http://findarticles.com/p/articles/mi_m0857/is_n6_v13/ai_17942856]
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| ==Screening==
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| Asymptomatic adults should not be screened for coronary artery disease with an [[electrocardiogram]].<ref name="pmid22847227">{{cite journal| author=Moyer VA, on behalf of the U.S. Preventive Services Task Force*| title=Screening for Coronary Heart Disease With Electrocardiography: U.S. Preventive Services Task Force Recommendation Statement. | journal=Ann Intern Med | year= 2012 | volume= | issue= | pages= | pmid=22847227 | doi=10.7326/0003-4819-157-7-201210020-00514 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22847227 }} </ref>
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| ==Prevention==
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| Coronary heart disease is the most common form of heart disease in the Western world. Prevention centers on the modifiable risk factors, which include decreasing [[cholesterol]] levels, addressing [[obesity]] and [[hypertension]], avoiding a [[sedentary lifestyle]], making healthy dietary choices, and [[smoking cessation|stopping smoking]]. There is some evidence that lowering [[uric acid]] and [[homocysteine]] levels may contribute. In [[diabetes mellitus]], there is little evidence that [[blood sugar]] control actually improves cardiac risk. Some recommend a diet rich in omega-3 fatty acids and [[vitamin C]]. The World Health Organization (WHO) recommends "low to moderate alcohol intake" to reduce risk of coronary heart disease.<ref>http://www.who.int/nutrition/topics/5_population_nutrient/en/index12.html</ref>
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| An increasingly growing number of other [[physiological]] markers and [[homeostatic]] mechanisms are currently under scientific investigation. Among these markers are [[low density lipoprotein]] and [[asymmetric dimethylarginine]]. Patients with CHD and those trying to prevent CHD are advised to avoid fats that are readily oxidized (e.g., saturated fats and [[trans-fats]]), limit carbohydrates and processed sugars to reduce production of [[Low density lipoprotein]]s while increasing [[High density lipoprotein]]s, keeping [[blood pressure]] normal, exercise and stop smoking. These measures limit the progression of the disease. Recent studies have shown that dramatic reduction in LDL levels can cause mild regression of coronary heart disease.
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| ===Exercise===
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| Separate to the question of the benefits of exercise; it is unclear whether doctors should spend time counseling patients to exercise. The [http://www.ahrq.gov/clinic/uspstfix.htm U.S. Preventive Services Task Force (USPSTF)], based on a [[systematic review]] of [[randomized controlled trials]], found 'insufficient evidence' to recommend that doctors counsel patients on exercise.<ref name="pmid12160370">{{cite journal |author= |title=Behavioral counseling in primary care to promote physical activity: recommendation and rationale |journal=Ann. Intern. Med. |volume=137 |issue=3 |pages=205-7 |year=2002 |pmid=12160370 |doi=}}</ref> However, the [[American Heart Association]], based on a non-systematic review, recommends that doctors counsel patients on exercise <ref name="pmid12821592">{{cite journal |author=Thompson PD, Buchner D, Pina IL, ''et al'' |title=Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity) |journal=Circulation |volume=107 |issue=24 |pages=3109-16 |year=2003 |pmid=12821592 |doi=10.1161/01.CIR.0000075572.40158.77}} http://www.ngc.gov/summary/summary.aspx?ss=15&doc_id=5360&string=#s23</ref>
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| ===Preventive diets=== | | ==[[Coronary heart disease overview|Overview]]== |
| {{main|Diet and Heart Disease}}
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| It has been suggested that coronary heart disease is partially reversible using an intense dietary regimen coupled with regular cardio exercise.<ref name="Ornish-1990">{{cite journal | author= Ornish D, Brown SE, Scherwitz LW, Billings JH, Armstrong WT, Ports TA, McLanahan SM, Kirkeeide RL, Brand RJ, Gould KL. | title=Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. | journal=Lancet | year=1990 | volume=336 | issue=8708 | pages=129-33 | id=PMID 1973470}}</ref>
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| *Vegetarian diet: [[Vegetarianism|Vegetarians]] have been shown to have a 24% reduced risk of dying of heart disease.<ref name="Key-1998">{{cite journal | author=Key TJ, Fraser GE, Thorogood M, Appleby PN, Beral V, Reeves G, Burr ML, Chang-Claude J, Frentzel-Beyme R, Kuzma JW, Mann J, McPherson K | title=Mortality in vegetarians and non-vegetarians: a collaborative analysis of 8300 deaths among 76,000 men and women in five prospective studies. | journal=Public Health Nutr | year=1998 | volume=1 | issue=1 | pages=33-41 | id=PMID 10555529}}</ref>
| | ==[[Coronary heart disease historical perspective|Historical Perspective]]== |
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| *Cretan [[Mediterranean diet]]: The Seven Country Study found that Cretan men had exceptionally low death rates from heart disease, despite moderate to high intake of fat. The Cretan diet is similar to other traditional Mediterranean diets: consisting mostly of olive oil, bread, abundant fruit and vegetables, a moderate amount of wine and fat-rich animal products such as lamb, sausage and goat cheese.<ref name="Willett-1995">{{cite journal | author=Willett WC, Sacks F, Trichopoulou A, Drescher G, Ferro-Luzzi A, Helsing E, Trichopoulos D. | title=Mediterranean diet pyramid: a cultural model for healthy eating. | journal=Am J Clin Nutr | year=1995 | volume=61 | issue= 6 Suppl| pages=1402S-1406S | id=PMID 7754995}}</ref><ref>Perez-Llamas, F., et.al., ''J Hum Nutr Diet'', Dec [[1996]], 9:6:463-471</ref><ref name="Alberti-Fidanza-1994">{{cite journal | author=Alberti-Fidanza A, Paolacci CA, Chiuchiu MP, Coli R, Fruttini D, Verducci G, Fidanza F. | title=Dietary studies on two rural Italian population groups of the Seven Countries Study. 1. Food and nutrient intake at the thirty-first year follow-up in 1991. | journal=Eur J Clin Nutr | year=1994 | volume=48 | issue=2 | pages=85-91 | id=PMID 8194497}}</ref> However, the Cretan diet consisted of less fish and wine consumption than some other Mediterranean-style diets, such as the diet in Corfu, another region of Greece, which had higher death rates.
| | ==[[Coronary heart disease classification|Classification]]== |
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| The consumption of [[trans fat]] (commonly found in hydrogenated products such as margarine) has been shown to cause the development of [[endothelial dysfunction]], a precursor to [[atherosclerosis]].<ref name="Lopez-Garcia-2005">{{cite journal | author=Lopez-Garcia E, Schulze MB, Meigs JB, Manson JE, Rifai N, Stampfer MJ, Willett WC, Hu FB. | title=Consumption of trans fatty acids is related to plasma biomarkers of inflammation and endothelial dysfunction. | journal=J Nutr | year=2005 | volume=135 | issue=3 | pages=562-6 | id=PMID 15735094}}</ref>
| | ==[[Coronary heart disease pathophysiology|Pathophysiology]]== |
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| ===Aspirin=== | | ==[[Coronary heart disease differential diagnosis|Differentiating Coronary heart disease from other Diseases]]== |
| Aspirin, in doses of less than 75 to 81 mg/d<ref name="pmid17488967">{{cite journal |author=Campbell CL, Smyth S, Montalescot G, Steinhubl SR |title=Aspirin dose for the prevention of cardiovascular disease: a systematic review |journal=JAMA |volume=297 |issue=18 |pages=2018-24 |year=2007 |pmid=17488967 |doi=10.1001/jama.297.18.2018}}</ref>, can reduce the incidence of cardiovascular events.<ref name="pmid16418466">{{cite journal |author=Berger J, Roncaglioni M, Avanzini F, Pangrazzi I, Tognoni G, Brown D |title=Aspirin for the primary prevention of cardiovascular events in women and men: a sex-specific meta-analysis of randomized controlled trials |journal=JAMA |volume=295 |issue=3 |pages=306-13 |year=2006 |pmid=16418466 | url=http://jama.ama-assn.org/cgi/content/full/294/1/47}}</ref> The [http://www.ahrq.gov/clinic/uspstfix.htm U.S. Preventive Services Task Force] 'strongly recommends that clinicians discuss aspirin chemoprevention with adults who are at increased risk for coronary heart disease'.<ref name="pmid11790071">{{cite journal |author= |title=Aspirin for the primary prevention of cardiovascular events: recommendation and rationale |journal=Ann Intern Med |volume=136 |issue=2 |pages=157-60 |year=2002 |pmid=11790071 | url=http://www.annals.org/cgi/content/full/136/2/157}}</ref> The Task Force defines increased risk as 'Men older than 40 years of age, postmenopausal women, and younger persons with risk factors for coronary heart disease (for example, hypertension, diabetes, or smoking) are at increased risk for heart disease and may wish to consider aspirin therapy'. More specifically, high-risk persons are 'those with a 5-year risk ≥ 3%'. A risk calculator is available.<ref>http://www.med-decisions.com/</ref>
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| Regarding healthy women, the more recent Women's Health Study [[randomized controlled trial]] found [[statistical significance|insignficant]] benefit from aspirin in the reduction of cardiac events; however there was a [[statistical significance|signficant]] reduction in [[stroke]].<ref name="pmid15753114">{{cite journal |author=Ridker P, Cook N, Lee I, Gordon D, Gaziano J, Manson J, Hennekens C, Buring J |title=A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women |journal=N Engl J Med |volume=352 |issue=13 |pages=1293-304 |year=2005 |pmid=15753114 | rul=http://content.nejm.org/cgi/content/full/352/13/1293 | doi=10.1056/NEJMoa050613}}</ref> [[Subgroup analysis]] showed that all benefit was confined to women over 65 years old.<ref name="pmid15753114" /> In spite of the [[statistical significance|insignficant]] benefit for women < 65 years old, recent [[Clinical practice guideline|practice guidelines]] by the [[American Heart Association]] recommend to 'consider' aspirin in 'healthy women' <65 years of age 'when benefit for ischemic stroke prevention is likely to outweigh adverse effects of therapy'.<ref>http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.107.181546v1</ref>
| | ==[[Coronary heart disease epidemiology and demographics|Epidemiology and Demographics]]== |
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| ===Omega-3 fatty acids=== | | ==[[Coronary heart disease risk factors|Risk Factors]]== |
| The benefit of fish oil is controversial with conflicting conclusions reached by a negative [[meta-analysis]]<ref name="pmid16565093">{{cite journal |author=Hooper L, Thompson RL, Harrison RA, Summerbell CD, Ness AR, Moore HJ, Worthington HV, Durrington PN, Higgins JP, Capps NE, Riemersma RA, Ebrahim SB, Davey Smith G |title=Risks and benefits of omega 3 fats for mortality, cardiovascular disease, and cancer: systematic review |journal=BMJ |volume=332 |issue=7544 |pages=752-60 |year=2006 |pmid=16565093 |doi=10.1136/bmj.38755.366331.2F}}</ref> of [[randomized controlled trials]] by the international [[Cochrane Collaboration]] and a partially positive [[systematic review]]<ref name="pmid16825676">{{cite journal |author=Wang C, Harris WS, Chung M, Lichtenstein AH, Balk EM, Kupelnick B, Jordan HS, Lau J |title=n-3 Fatty acids from fish or fish-oil supplements, but not alpha-linolenic acid, benefit cardiovascular disease outcomes in primary- and secondary-prevention studies: a systematic review |journal=Am. J. Clin. Nutr. |volume=84 |issue=1 |pages=5-17 |year=2006 |pmid=16825676 |doi=}} http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat1a.chapter.38290</ref> by the [[Agency for Healthcare Research and Quality]]. Since these two reviews, a [[randomized controlled trial]] reported a reduction on coronary events in Japanese hypercholesterolemic patients.<ref name="pmid17398308">{{cite journal |author=Yokoyama M, Origasa H, Matsuzaki M, ''et al'' |title=Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis |journal=Lancet |volume=369 |issue=9567 |pages=1090-8 |year=2007 |pmid=17398308 |doi=10.1016/S0140-6736(07)60527-3}}</ref>
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| Omega-3 fatty acids are also found in some plant sources including flax seed oil, hemp seed oil, and walnuts. Plant sources may be safer as fish products have been shown to contain heavy metals and other fat soluble pollutants.
| | ==[[Coronary heart disease risk stratification|Screening and Risk Stratification]]== |
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| ===Secondary prevention=== | | ==[[Coronary heart disease natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| Secondary prevention is preventing further sequelae of already established disease. Regarding coronary heart disease, this can mean risk factor management that is carried out during cardiac rehabilitation, a 4-phase process beginning in hospital after MI, angioplasty or heart surgery and continuing for a minimum of three months. Exercise is a main component of cardiac rehabilitation along with diet, smoking cessation, and blood pressure and cholesterol management.
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| ====Anti-platelet therapy==== | | ==Diagnosis== |
| A [[meta-analysis]] of [[randomized controlled trials]] by the international [[Cochrane Collaboration]] found "that the use of clopidogrel plus aspirin is associated with a reduction in the risk of cardiovascular events compared with aspirin alone in patients with acute non-ST coronary syndrome. In patients at high risk of cardiovascular disease but not presenting acutely, there is only weak evidence of benefit and hazards of treatment almost match any benefit obtained.".<ref name="pmid17636787">{{cite journal |author=Keller T, Squizzato A, Middeldorp S |title=Clopidogrel plus aspirin versus aspirin alone for preventing cardiovascular disease |journal=Cochrane database of systematic reviews (Online) |volume= |issue=3 |pages=CD005158 |year=2007 |pmid=17636787 |doi=10.1002/14651858.CD005158.pub2}}</ref>
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| == Recent research ==
| | [[Coronary heart disease pretest probability|Pretest Probability]] | [[Coronary heart disease history and symptoms|History and Symptoms]] | [[Coronary heart disease physical examination|Physical Examination]] | [[Coronary heart disease laboratory findings|Laboratory Findings]] | [[Coronary heart disease electrocardiogram|Electrocardiogram]] | [[Coronary heart disease chest x ray|Chest X Ray]] | [[Coronary heart disease CT|CT]] | [[Coronary heart disease MRI|MRI]] | [[Coronary heart disease echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Coronary heart disease other imaging findings|Other Imaging Findings]] | [[Coronary heart disease other diagnostic studies|Other Diagnostic Studies]] |
| {{further|[[atheroma]] and [[atherosclerosis]]}}
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| A 2006 study by the [[Cleveland Clinic]] found a region on Chromosome 17 was confined to families with multiple cases of myocardial infarction.<ref name="Farrall-2006">{{cite journal | author=Farrall M, Green FR, Peden JF, Olsson PG, Clarke R, Hellenius ML, Rust S, Lagercrantz J, Franzosi MG, Schulte H, Carey A, Olsson G, Assmann G, Tognoni G, Collins R, Hamsten A, Watkins H, on behalf of the PROCARDIS Consortium | title=Genome-Wide Mapping of Susceptibility to Coronary Artery Disease Identifies a Novel Replicated Locus on Chromosome 17 | journal=PLoS Genetics | year=2006 | volume=2 | issue=5 | pages=e72 | url=http://genetics.plosjournals.org/perlserv/?request=get-document&doi=10.1371%2Fjournal.pgen.0020072 | id=PMID 16710446}}</ref>
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| A more controversial link is that between ''[[Chlamydophila pneumoniae]]'' infection and atherosclerosis.<ref name="Saikku-1992">{{cite journal | author=Saikku P, Leinonen M, Tenkanen L, Linnanmaki E, Ekman MR, Manninen V, Manttari M, Frick MH, Huttunen JK. | title=Chronic Chlamydia pneumoniae infection as a risk factor for coronary heart disease in the Helsinki Heart Study. | journal=Ann Intern Med | year=1992 | volume=116 | issue=4 | pages=273-8 | id=PMID 1733381}}</ref> While this intracellular organism has been demonstrated in atherosclerotic plaques, evidence is inconclusive as to whether it can be considered a causative factor. Treatment with antibiotics in patients with proven atherosclerosis has not demonstrated a decreased risk of heart attacks or other coronary vascular diseases.<ref name="Andraws-2005">{{cite journal | author=Andraws R, Berger JS, Brown DL. | title=Effects of antibiotic therapy on outcomes of patients with coronary artery disease: a meta-analysis of randomized controlled trials. | journal=JAMA | year=2005 | volume=293 | issue=21 | pages=2641-7 | id=PMID 15928286}}</ref>
| | ==Treatment== |
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| On September 29, 2008, the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research released a science advisory outlining their recommendations for screening, referral and treatment of [[depression]] in patients with coronary heart disease (CHD). Their recommendations include: 1. CHD patients should be routinely screened for depression; 2. CHD patients with positive screens should be evaluated by professionals skilled in dealing with depression; 3. CHD patients with depression should be monitored for both cardiovascular and [[mental health]] issues; 4. Care for CHD patients with depression should be coordinated between cardiovascular and [[mental health professional]]s.<ref name="Lichtman-2008">{{cite journal | author=Lichtman JH, Bigger JT Jr, Blumenthal JA, Frasure-Smith N, Kaufmann PG, Lespérance F, Mark DB, Sheps DS, Taylor CB, Froelicher ES; American Heart Association Prevention Committee of the Council on Cardiovascular Nursing; American Heart Association Council on Clinical Cardiology; American Heart Association Council on Epidemiology and Prevention; American Heart Association Interdisciplinary Council on Quality of Care and Outcomes Research; American Psychiatric Association | title=Depression and coronary heart disease: recommendations for screening, referral, and treatment: a science advisory from the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Psychiatric Association | journal=Circulation | year=2008 | volume=118 | issue=17 | pages=1768-1775 | url=http://circ.ahajournals.org/cgi/content/abstract/118/17/1768?etoc | id=PMID 18824640}}</ref>
| | [[Coronary heart disease medical therapy|Medical Therapy]] | [[Coronary heart disease surgery|Surgery]] | [[Coronary heart disease primary prevention|Primary Prevention]] | [[Coronary heart disease secondary prevention|Secondary Prevention]] | [[Coronary heart disease cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Coronary heart disease future or investigational therapies|Future or Investigational Therapies]] |
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| ==References== | | ==Case Studies== |
| {{Reflist|2}}
| | [[Coronary heart disease case study one|Case #1]] |
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| ==See Also== | | ==Related Chapters== |
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| * [[Atherosclerosis]] | | *[[Atherosclerosis]] |
| | *[[Atherosclerosis Prevention and Risk Factor Modification]] |
| | *[[Chronic Stable Angina]] |
| | *[[Non ST Elevation Myocardial Infarction]] |
| | *[[ST Elevation Myocardial Infarction]] |
| | *[[Unstable Angina]] |
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| {{Circulatory system pathology}} | | {{Circulatory system pathology}} |