History

Fact Explanation
Chest pain [1] The coronary arteries supply oxygen-rich blood to heart. If plaque narrows or blocks these arteries, angina (chest pain or discomfort) occurs as the heart muscle doesn't get enough oxygen-rich blood [1]
Shortness of breath [1] Reduced blood supply leading to less oxygen to tissues due to narrowing of vessels by the plaques. [1]
Fatigue [1] Reduced blood supply leading to less oxygen to tissues due to narrowing of vessels by the plaques [1]
Sudden weakness of limbs [2] Carotid arteries supply oxygen-rich blood to brain. If plaque narrows or blocks these arteries (carotid artery disease), patients may have symptoms of a stroke [2]
Loss of consciousness [2] Carotid arteries supply oxygen-rich blood to brain. If plaque narrows or blocks these arteries (carotid artery disease), patients may have symptoms of a stroke [2]
Sudden and severe headache [2] Carotid arteries supply oxygen-rich blood to brain. If plaque narrows or blocks these arteries (carotid artery disease), patients may have symptoms of a stroke [2]
Numbness of limbs/ pain in limbs [3] Plaque also can build up in the major arteries that supply oxygen-rich blood to the legs, arms, and pelvis.Narrowing of these vessels can give rise to numbness , pain in limbs [3]
Symptoms of kidney failure (loss of appetite, nausea, swelling in the hands or feet, itchiness or numbness, and trouble concentrating etc.) [4] The renal arteries supply oxygen-rich blood to kidneys. If plaque builds up in these arteries, patients may develop chronic kidney disease. Over time, chronic kidney disease causes a slow loss of kidney function.Early kidney disease often has no signs or symptoms. As the disease gets worse it can cause tiredness, changes in urination (more often or less often), loss of appetite, nausea, swelling in the hands or feet, itching or numbness, and trouble concentrating [4]
Smoking [5] Damage the inner layers of the arteries and plaque may begin to build up where the arteries are damaged. Over time, plaque hardens and narrows the arteries [5]
High cholesterol levels in blood [5] Damage the inner layers of the arteries and plaque may begin to build up where the arteries are damaged. Over time, plaque hardens and narrows the arteries [5]
High blood pressure [5] Damage the inner layers of the arteries and plaque may begin to build up where the arteries are damaged. Over time, plaque hardens and narrows the arteries [5]
History of diabetes [5] High levels of sugar in blood, damage the inner layers of the arteries and plaque may begin to build up where the arteries are damaged. Over time, plaque hardens and narrows the arteries [5]
Obesity / lack of physical activity [6] Risk factor for atherosclerosis [6]
Older age [7] Risk for atherosclerosis increases with age. Genetic or lifestyle factors cause plaque to build up in arteries with age.In men, the risk increases after age 45. In women, the risk increases after age 55 [7]
Family history of early heart disease [8] Risk for atherosclerosis increases if there’s a family history. (If a 1st degree male relative was diagnosed with heart disease before 55 years of age, or if a 1st degree female relative was diagnosed with heart disease before 65 years of age) [8]
Heavy alcohol drinking [5] Heavy drinking can damage the heart muscle and worsen other risk factors for atherosclerosis [5]
Intermittent claudication [3] Cramping pain in muscles ( most of the times, calf muscles) which typically occurs with walking and goes away with rest.Occur due to peripheral vascular disease.Can be present in patients with athersclerotic heart disease as they are likely to have peripheral vascular disease. [3]
References
  1. CHAIKRIANGKRAI KONGKIAT, KASSI MAHWASH, KHALEEL BALA SAYF, NABI FAISAL, CHANG SU MIN. Atherosclerosis Burden in Patients with Acute Chest Pain: Obesity Paradox. ISRN Obesity [online] 2014 December, 2014:1-7 [viewed 13 July 2014] Available from: doi:10.1155/2014/634717
  2. GEZMU T, SCHNEIDER D, DEMISSIE K, LIN Y, GIORDANO C, GIZZI MS. Lipid profiles and ischemic stroke risk: variations by sex within racial/ethnic groups Int J Womens Health [online] :585-595 [viewed 13 July 2014] Available from: doi:10.2147/IJWH.S61274
  3. GORNIK H. L.. Peripheral Arterial Disease. Circulation [online] 2005 April, 111(13):e169-e172 [viewed 13 July 2014] Available from: doi:10.1161/​01.CIR.0000160581.58633.8B
  4. SCHIFFRIN E. L., LIPMAN M. L., MANN J. F.E.. Chronic Kidney Disease: Effects on the Cardiovascular System. Circulation [online] 2007 July, 116(1):85-97 [viewed 13 July 2014] Available from: doi:10.1161/​CIRCULATIONAHA.106.678342
  5. VIERA AJ, SHERIDAN SL. Global risk of coronary heart disease: assessment and application. Am Fam Physician [online] 2010 Aug 1, 82(3):265-74 [viewed 12 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/20672791
  6. THOMPSON P. D.. 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). Circulation [online] 2003 June, 107(24):3109-3116 [viewed 12 July 2014] Available from: doi:10.1161/​01.CIR.0000075572.40158.77
  7. GOFMAN J. W., YOUNG W., TANDY R.. Ischemic Heart Disease, Atherosclerosis, and Longevity. Circulation [online] 1966 October, 34(4):679-697 [viewed 12 July 2014] Available from: doi:10.1161/​01.CIR.34.4.679
  8. HAYES SN. Preventing cardiovascular disease in women. Am Fam Physician [online] 2006 Oct 15, 74(8):1331-40 [viewed 12 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/17087427

Examination

Fact Explanation
Patient in pain / dyspnoic [1] The coronary arteries supply oxygen-rich blood to heart. If plaque narrows or blocks these arteries, angina (chest pain or discomfort) occurs as the heart muscle doesn't get enough oxygen-rich blood [1]
Loss of consciousness [2] Patients will have other complications of atherosclerosis such as strokes. Carotid arteries supply oxygen-rich blood to brain. If plaque narrows or blocks these arteries (carotid artery disease), patients may have symptoms of a stroke [2]
Weakness of limbs [2] Patients will have other complications of atherosclerosis such as strokes. Carotid arteries supply oxygen-rich blood to brain. If plaque narrows or blocks these arteries (carotid artery disease), patients may have symptoms of a stroke [2]
Poor peripheral pulses [3] Patients will have other complications of atherosclerosis such as peripheral vascular disease.Plaque can build up in the major arteries that supply oxygen-rich blood to the legs, arms, and pelvis [3]
Signs of chronic renal failure (pallor,ankle odema, scratch marks etc) [4] The renal arteries supply oxygen-rich blood to kidneys. If plaque builds up in these arteries, patients may develop chronic kidney disease. Over time, chronic kidney disease causes a slow loss of kidney function.Early kidney disease often has no signs or symptoms. As the disease gets worse it can cause tiredness, changes in urination (more often or less often), loss of appetite, nausea, swelling in the hands or feet, itching or numbness, and trouble concentrating [4]
High blood pressure [5] Damage the inner layers of the arteries and plaque may begin to build up where the arteries are damaged. Over time, plaque hardens and narrows the arteries [5] Can also occur due to renal failure [4]
Nicotine stains [5] Smoking can damage the inner layers of the arteries and plaque may begin to build up where the arteries are damaged. Over time, plaque hardens and narrows the arteries [5]
Signs of diabetes ( retinopathy changes, dermopathy changes) [5] High blood sugar levels can damage the inner layers of the arteries and plaque may begin to build up where the arteries are damaged. Over time, plaque hardens and narrows the arteries [5]
High BMI [6] Obesity (BMI >30) is a risk factor for atherosclerotic heart disease [6]
Carotid bruit [2] Caused by turbulent blood flow in the narrowed carotid artery [2]
References
  1. CHAIKRIANGKRAI KONGKIAT, KASSI MAHWASH, KHALEEL BALA SAYF, NABI FAISAL, CHANG SU MIN. Atherosclerosis Burden in Patients with Acute Chest Pain: Obesity Paradox. ISRN Obesity [online] 2014 December, 2014:1-7 [viewed 13 July 2014] Available from: doi:10.1155/2014/634717
  2. GEZMU T, SCHNEIDER D, DEMISSIE K, LIN Y, GIORDANO C, GIZZI MS. Lipid profiles and ischemic stroke risk: variations by sex within racial/ethnic groups Int J Womens Health [online] :585-595 [viewed 13 July 2014] Available from: doi:10.2147/IJWH.S61274
  3. GORNIK H. L.. Peripheral Arterial Disease. Circulation [online] 2005 April, 111(13):e169-e172 [viewed 13 July 2014] Available from: doi:10.1161/​01.CIR.0000160581.58633.8B
  4. SCHIFFRIN E. L., LIPMAN M. L., MANN J. F.E.. Chronic Kidney Disease: Effects on the Cardiovascular System. Circulation [online] 2007 July, 116(1):85-97 [viewed 13 July 2014] Available from: doi:10.1161/​CIRCULATIONAHA.106.678342
  5. VIERA AJ, SHERIDAN SL. Global risk of coronary heart disease: assessment and application. Am Fam Physician [online] 2010 Aug 1, 82(3):265-74 [viewed 12 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/20672791
  6. THOMPSON P. D.. 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). Circulation [online] 2003 June, 107(24):3109-3116 [viewed 12 July 2014] Available from: doi:10.1161/​01.CIR.0000075572.40158.77

Differential Diagnoses

Fact Explanation
Heart disease due to hypertension [1] Systolic and/or diastolic BP is elevated (>140/90mm Hg) Echocardiogram / electrocardiogram will show left ventricular hypertrophy [1]
Heart disease due to diabetes [2] Fasting blood sugar >126 mg/dl with symptoms of high blood sugar (polydipsia, polyuria etc) Other micro and macro vascular changes of diabetes will be present . eg: dermatopathic changes such as loss of body hair,callosity [2]
Heart disease due to defects in conduction pathway [3] Present with episodes of faintness, palpitations.Electrocardiogram will show changes according to the conductive defect [3]
References
  1. 1) ROSENDORFF C., BLACK H. R., CANNON C. P., GERSH B. J., GORE J., IZZO J. L., KAPLAN N. M., O'CONNOR C. M., O'GARA P. T., OPARIL S.. Treatment of Hypertension in the Prevention and Management of Ischemic Heart Disease: A Scientific Statement From the American Heart Association Council for High Blood Pressure Research and the Councils on Clinical Cardiology and Epidemiology and Prevention. Circulation [online] 2007 May, 115(21):2761-2788 [viewed 24 June 2014] Available from: doi:10.1161/​CIRCULATIONAHA.107.183885
  2. GRUNDY S. M., BENJAMIN I. J., BURKE G. L., CHAIT A., ECKEL R. H., HOWARD B. V., MITCH W., SMITH S. C., SOWERS J. R.. Diabetes and Cardiovascular Disease : A Statement for Healthcare Professionals From the American Heart Association. Circulation [online] 1999 September, 100(10):1134-1146 [viewed 13 July 2014] Available from: doi:10.1161/​01.CIR.100.10.1134
  3. PARK D. S., FISHMAN G. I.. The Cardiac Conduction System. Circulation [online] December, 123(8):904-915 [viewed 13 July 2014] Available from: doi:10.1161/​CIRCULATIONAHA.110.942284

Investigations - for Diagnosis

Fact Explanation
Lipid profile - cholesterol levels [1] Optimal/near-optimal serum concentration (mg/dl) : -Total cholesterol <200 -High-Density Lipoprotein Cholesterol ≥60 -Low-Density Lipoprotein Cholesterol <100 optimal (100-129 near-optimal) Borderline serum concentration (mg/dl): -Total cholesterol 200-239 -High-Density Lipoprotein Cholesterol 40-59 (men) 50-59 (women) -Low-Density Lipoprotein Cholesterol 130-159 High-risk/very high-risk serum concentration (mg/dl) : -Total cholesterol ≥240 -High-Density Lipoprotein Cholesterol <40 men <50 women -Low-Density Lipoprotein Cholesterol 160-189 high ≥190 very high [1]
Lipid profile - Triglycerides [1] Optimal/near-optimal serum concentration (mg/dl) : <150 Borderline serum concentration (mg/dl): 150-199 High-risk/very high-risk serum concentration (mg/dl) : 200-499 high ≥500 very high [1]
Electrocardiogram (ECG) [2] Will show ST segment changes according to the areas which are supplied by the blocked coronary arteries [2]
Exercise ECG [3] Patient will not be able to complete, as the blood requirement is high during physical activity and the blocked vessels are unable to reach the demand. A stress test can show possible signs and symptoms of coronary heart disease, such as, abnormal changes in your heart rate or blood pressure Shortness of breath or chest pain Abnormal changes in your heart rhythm or your heart's electrical activity [3]
Echocardiogram [2] Can identify areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally [2]
Angiogram [4] Can show whether plaque is blocking the arteries and how severe the blockage is [4]
References
  1. RAVNSKOV U.. Is atherosclerosis caused by high cholesterol?. [online] 2002 June, 95(6):397-403 [viewed 13 July 2014] Available from: doi:10.1093/qjmed/95.6.397
  2. CHAIKRIANGKRAI KONGKIAT, KASSI MAHWASH, KHALEEL BALA SAYF, NABI FAISAL, CHANG SU MIN. Atherosclerosis Burden in Patients with Acute Chest Pain: Obesity Paradox. ISRN Obesity [online] 2014 December, 2014:1-7 [viewed 13 July 2014] Available from: doi:10.1155/2014/634717
  3. THOMPSON P. D.. 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). Circulation [online] 2003 June, 107(24):3109-3116 [viewed 13 July 2014] Available from: doi:10.1161/​01.CIR.0000075572.40158.77
  4. RAVNSHOV U.. Coronary atherosclerosis on angiography--progress or regress, and why?. Circulation [online] 1993 September, 88(3):1358-1360 [viewed 13 July 2014] Available from: doi:10.1161/01.CIR.88.3.1358

Investigations - Fitness for Management

Fact Explanation
Lipid profile - cholesterol levels [1] Optimal/near-optimal serum concentration (mg/dl) : -Total cholesterol <200 -High-Density Lipoprotein Cholesterol ≥60 -Low-Density Lipoprotein Cholesterol <100 optimal (100-129 near-optimal) Borderline serum concentration (mg/dl): -Total cholesterol 200-239 -High-Density Lipoprotein Cholesterol 40-59 (men) 50-59 (women) -Low-Density Lipoprotein Cholesterol 130-159 High-risk/very high-risk serum concentration (mg/dl) : -Total cholesterol ≥240 -High-Density Lipoprotein Cholesterol <40 men <50 women -Low-Density Lipoprotein Cholesterol 160-189 high ≥190 very high [1]
Lipid profile - Triglycerides [1] Optimal/near-optimal serum concentration (mg/dl) : <150 Borderline serum concentration (mg/dl): 150-199 High-risk/very high-risk serum concentration (mg/dl) : 200-499 high ≥500 very high [1]
Electrocardiogram (ECG) [2] Will show ST segment changes according to the areas which are supplied by the blocked coronary arteries [2]
Exercise ECG [3] Patient will not be able to complete, as the blood requirement is high during physical activity and the blocked vessels are unable to reach the demand. A stress test can show possible signs and symptoms of coronary heart disease, such as, abnormal changes in your heart rate or blood pressure Shortness of breath or chest pain Abnormal changes in your heart rhythm or your heart's electrical activity [3]
Fasting blood sugar [4] High blood sugar levels can damage the inner layers of the arteries and plaque may begin to build up where the arteries are damaged. Over time, plaque hardens and narrows the arteries [4]
References
  1. RAVNSKOV U.. Is atherosclerosis caused by high cholesterol?. [online] 2002 June, 95(6):397-403 [viewed 13 July 2014] Available from: doi:10.1093/qjmed/95.6.397
  2. CHAIKRIANGKRAI KONGKIAT, KASSI MAHWASH, KHALEEL BALA SAYF, NABI FAISAL, CHANG SU MIN. Atherosclerosis Burden in Patients with Acute Chest Pain: Obesity Paradox. ISRN Obesity [online] 2014 December, 2014:1-7 [viewed 13 July 2014] Available from: doi:10.1155/2014/634717
  3. THOMPSON P. D.. 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). Circulation [online] 2003 June, 107(24):3109-3116 [viewed 13 July 2014] Available from: doi:10.1161/​01.CIR.0000075572.40158.77
  4. VIERA AJ, SHERIDAN SL. Global risk of coronary heart disease: assessment and application. Am Fam Physician [online] 2010 Aug 1, 82(3):265-74 [viewed 12 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/20672791

Investigations - Followup

Fact Explanation
Lipid profile - cholesterol levels [1] Optimal/near-optimal serum concentration (mg/dl) : -Total cholesterol <200 -High-Density Lipoprotein Cholesterol ≥60 -Low-Density Lipoprotein Cholesterol <100 optimal (100-129 near-optimal) Borderline serum concentration (mg/dl): -Total cholesterol 200-239 -High-Density Lipoprotein Cholesterol 40-59 (men) 50-59 (women) -Low-Density Lipoprotein Cholesterol 130-159 High-risk/very high-risk serum concentration (mg/dl) : -Total cholesterol ≥240 -High-Density Lipoprotein Cholesterol <40 men <50 women -Low-Density Lipoprotein Cholesterol 160-189 high ≥190 very high [1]
Lipid profile - Triglycerides [1] Optimal/near-optimal serum concentration (mg/dl) : <150 Borderline serum concentration (mg/dl): 150-199 High-risk/very high-risk serum concentration (mg/dl) : 200-499 high ≥500 very high [1]
Electrocardiogram (ECG) [2] Will show ST segment changes according to the areas which are supplied by the blocked coronary arteries [2]
Exercise ECG [3] Patient will not be able to complete, as the blood requirement is high during physical activity and the blocked vessels are unable to reach the demand. A stress test can show possible signs and symptoms of coronary heart disease, such as, abnormal changes in your heart rate or blood pressure Shortness of breath or chest pain Abnormal changes in your heart rhythm or your heart's electrical activity [3]
Echocardiogram [2] Can identify areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally [2]
Angiogram [4] Can show whether plaque is blocking the arteries and how severe the blockage is [4]
Ankle/Brachial Index [5] Compares the blood pressure in ankle with the blood pressure in arm to see how well blood is flowing. This test can help diagnose peripheral vascular disease [5]
References
  1. RAVNSKOV U.. Is atherosclerosis caused by high cholesterol?. [online] 2002 June, 95(6):397-403 [viewed 13 July 2014] Available from: doi:10.1093/qjmed/95.6.397
  2. CHAIKRIANGKRAI KONGKIAT, KASSI MAHWASH, KHALEEL BALA SAYF, NABI FAISAL, CHANG SU MIN. Atherosclerosis Burden in Patients with Acute Chest Pain: Obesity Paradox. ISRN Obesity [online] 2014 December, 2014:1-7 [viewed 13 July 2014] Available from: doi:10.1155/2014/634717
  3. THOMPSON P. D.. 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). Circulation [online] 2003 June, 107(24):3109-3116 [viewed 13 July 2014] Available from: doi:10.1161/​01.CIR.0000075572.40158.77
  4. RAVNSHOV U.. Coronary atherosclerosis on angiography--progress or regress, and why?. Circulation [online] 1993 September, 88(3):1358-1360 [viewed 13 July 2014] Available from: doi:10.1161/01.CIR.88.3.1358
  5. GORNIK H. L.. Peripheral Arterial Disease. Circulation [online] 2005 April, 111(13):e169-e172 [viewed 13 July 2014] Available from: doi:10.1161/​01.CIR.0000160581.58633.8B

Investigations - Screening/Staging

Fact Explanation
Lipid profile - cholesterol levels [1] Optimal/near-optimal serum concentration (mg/dl) : -Total cholesterol <200 -High-Density Lipoprotein Cholesterol ≥60 -Low-Density Lipoprotein Cholesterol <100 optimal (100-129 near-optimal) Borderline serum concentration (mg/dl): -Total cholesterol 200-239 -High-Density Lipoprotein Cholesterol 40-59 (men) 50-59 (women) -Low-Density Lipoprotein Cholesterol 130-159 High-risk/very high-risk serum concentration (mg/dl) : -Total cholesterol ≥240 -High-Density Lipoprotein Cholesterol <40 men <50 women -Low-Density Lipoprotein Cholesterol 160-189 high ≥190 very high [1]
Lipid profile - Triglycerides [1] Optimal/near-optimal serum concentration (mg/dl) : <150 Borderline serum concentration (mg/dl): 150-199 High-risk/very high-risk serum concentration (mg/dl) : 200-499 high ≥500 very high [1]
Electrocardiogram (ECG) [2] Will show ST segment changes according to the areas which are supplied by the blocked coronary arteries [2]
Exercise ECG [3] Patient will not be able to complete, as the blood requirement is high during physical activity and the blocked vessels are unable to reach the demand. A stress test can show possible signs and symptoms of coronary heart disease, such as, abnormal changes in your heart rate or blood pressure Shortness of breath or chest pain Abnormal changes in your heart rhythm or your heart's electrical activity [3]
Echocardiogram [2] Can identify areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally [2]
Angiogram [4] Can show whether plaque is blocking the arteries and how severe the blockage is [4]
Ankle/Brachial Index [5] Compares the blood pressure in ankle with the blood pressure in arm to see how well blood is flowing. This test can help diagnose peripheral vascular disease [5]
References
  1. RAVNSKOV U.. Is atherosclerosis caused by high cholesterol?. [online] 2002 June, 95(6):397-403 [viewed 13 July 2014] Available from: doi:10.1093/qjmed/95.6.397
  2. CHAIKRIANGKRAI KONGKIAT, KASSI MAHWASH, KHALEEL BALA SAYF, NABI FAISAL, CHANG SU MIN. Atherosclerosis Burden in Patients with Acute Chest Pain: Obesity Paradox. ISRN Obesity [online] 2014 December, 2014:1-7 [viewed 13 July 2014] Available from: doi:10.1155/2014/634717
  3. THOMPSON P. D.. 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). Circulation [online] 2003 June, 107(24):3109-3116 [viewed 13 July 2014] Available from: doi:10.1161/​01.CIR.0000075572.40158.77
  4. RAVNSHOV U.. Coronary atherosclerosis on angiography--progress or regress, and why?. Circulation [online] 1993 September, 88(3):1358-1360 [viewed 13 July 2014] Available from: doi:10.1161/01.CIR.88.3.1358
  5. GORNIK H. L.. Peripheral Arterial Disease. Circulation [online] 2005 April, 111(13):e169-e172 [viewed 13 July 2014] Available from: doi:10.1161/​01.CIR.0000160581.58633.8B

Management - General Measures

Fact Explanation
Regular exercise [1] At least 30 minutes of moderate intensity physical activity (consuming 4-7 kcal/min) 4 to 6 times weekly, with an expenditure of at least 200 kcal/day. Suggested activities include brisk walking, riding a stationary bike, water aerobics, cleaning/scrubbing, mowing the lawn, and sporting activities. Target heart rate: Moderate exercise intensity: 50 to 70 percent of the maximum heart rate Vigorous exercise intensity: 70 to 85 percent of the maximum heart rate (maximum heart rate: subtract age from 220) [1]
Patient education (precautions) regarding exercise [1] Always perform a proper warm-up and cool-down activity, such as walking slowly (e.g., two miles per hour) five to seven minutes before and after exercise. Never exercise to the point of chest pain or angina. Exercise with a friend and/or always carry a cell phone to ensure emergency personnel can be contacted quickly if necessary. If prescribed, always carry nitroglycerin, especially when exercising. Exercise should be stopped immediately if dizziness, nausea, unusual shortness of breath or irregular heart beats occur during or immediately after exercise. A physician should be contacted immediately. Do not exceed the target heart rate [1]
Cessation of cigarette smoking [2] Smoking damage the inner layers of the arteries and plaque may begin to build up where the arteries are damaged. Over time, plaque hardens and narrows the arteries [2]
Control other co morbid factors - hypertension, diabetes [2] High blood sugar levels and high blood pressure damage the inner layers of the arteries and plaque may begin to build up where the arteries are damaged. Over time, plaque hardens and narrows the arteries [2]
Diet [3] Avoid food with high lipids. Avoid : Poultry with skin, fried chicken,Fried fish, fried shellfish,Egg yolks,Coconut oil, palm oil,Butter,Commercially baked biscuits, pastries, muffins containing whole milk, saturated oils. Eat healthy foods, such as fruits, vegetables, and whole grains that are low in saturated fat and high in fiber [3]
References
  1. THOMPSON P. D.. 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). Circulation [online] 2003 June, 107(24):3109-3116 [viewed 13 July 2014] Available from: doi:10.1161/​01.CIR.0000075572.40158.77
  2. VIERA AJ, SHERIDAN SL. Global risk of coronary heart disease: assessment and application. Am Fam Physician [online] 2010 Aug 1, 82(3):265-74 [viewed 12 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/20672791
  3. AHMED SM, CLASEN ME, DONNELLY JE. Management of dyslipidemia in adults. Am Fam Physician [online] 1998 May 1, 57(9):2192-2204, 2207-8 [viewed 13 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/9606309

Management - Specific Treatments

Fact Explanation
Cholesterol Lowering Drugs - Statins (eg:Atorvastatin, simvastatin) [1] HMG-CoA reductase inhibitors, or statins, inhibit cholesterol synthesis. To varying degrees, all of these agents lower total, LDL and triglyceride cholesterol components and slightly raise the HDL fraction. While these agents are generally well tolerated, a small percentage of patients (fewer than 1 percent) may develop elevated hepatic transaminase levels, which may necessitate discontinuation of the drug [1]
Cholesterol Lowering Drugs- Bile acid sequestrants (eg:cholestyramine) [3] bind cholesterol-containing bile acids in the intestines, producing an insoluble complex that prevents reabsorption [1]
Cholesterol Lowering Drugs- Nicotinic acid [3] Decreases the synthesis of LDL cholesterol by reducing the hepatic synthesis of VLDL cholesterol, by increasing the synthesis of HDL cholesterol, by inhibiting lipolysis in adipose tissue and by increasing lipase activity [1]
Cholesterol Lowering Drugs- Fibric acid derivatives [3] Increase the clearance of VLDL cholesterol by enhancing lipolysis and reducing hepatic cholesterol synthesis [1]
Antiplatelet agents- Asprin [2] Recommended for the secondary prevention of coronary artery disease. Aspirin - irreversibly inhibits the enzyme COX, resulting in reduced platelet production of TXA2 (thromboxane - powerful vasoconstrictor that lowers cyclic AMP and initiates the platelet release reaction). Reduces risk of transient ischemic attack (TIA), stroke, and heart attacks [2]
Antiplatelet agents- Clopidogrel [2] Recommended for the secondary prevention of coronary artery disease. Clopidogrel- affects the ADP-dependent activation of IIb/IIIa complex [2]
Angioplasty [2] Used to widen narrowed arteries. Inserts a catheter with a deflated balloon into the narrowed part of the artery. The balloon is inflated, widening the blood vessel so blood can flow more easily. The balloon is then deflated, and the catheter is removed. A permanent stent (wire mesh) may be put in to hold the artery open and improve blood flow [2]
Surgical methods - Coronary Artery Bypass Grafting [2] Uses a blood vessel from another part of body or an artificial tube to reroute blood around narrowed arteries [2]
References
  1. AHMED SM, CLASEN ME, DONNELLY JE. Management of dyslipidemia in adults. Am Fam Physician [online] 1998 May 1, 57(9):2192-2204, 2207-8 [viewed 13 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/9606309
  2. HALL SL, LORENC T. Secondary prevention of coronary artery disease. Am Fam Physician [online] 2010 Feb 1, 81(3):289-96 [viewed 13 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/20112887
  3. STONE N. J., ROBINSON J. G., LICHTENSTEIN A. H., BAIREY MERZ C. N., BLUM C. B., ECKEL R. H., GOLDBERG A. C., GORDON D., LEVY D., LLOYD-JONES D. M., MCBRIDE P., SCHWARTZ J. S., SHERO S. T., SMITH S. C., WATSON K., WILSON P. W. F.. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation [online] December, 129(25_suppl_2):S1-S45 [viewed 21 September 2014] Available from: doi:10.1161/01.cir.0000437738.63853.7a