Coronary heart disease: incidence, prevalence, symptoms, risk factors, diagnosis, treatment

Filed in: Health Care Tips.

Coronary heart disease (CHD), sometimes described as coronary heart disease (CAD) or ischemic heart disease (IHD), is a condition in which the vascular supply to the heart is impeded by atheroma, thrombosis, or spasm of the coronary arteries.

Coronary heart diseaseCoronary heart disease

This can alter the supply of oxygenated blood to the heart tissue enough to cause myocardial ischemia, which, if severe or prolonged, can cause the death of cardiac muscle cells. The similarities in the development of atheromatous plaques in other vasculature, in particular, the carotid arteries, with the resulting cerebral ischemia, have resulted in the adoption of the term cardiovascular disease (CVD) to incorporate CD, cerebrovascular disease and peripheral vascular disease.

Heart diseaseHeart disease


Nearly 200,000 people die of cardiovascular disease in the United Kingdom each year and CHD accounts for almost half of these. 30% of premature deaths (under 75 years) in men and 22% of premature deaths in women are due to CVD.


About 3.5% of adults in the United Kingdom have symptomatic CHD. One third of men aged 50 to 59 have evidence of coronary heart disease, and this proportion increases with age. In the United Kingdom, there are approximately 1.3 million people who have survived a myocardial infarction and approximately 2 million who have or have had angina, equivalent to approximately 5% of men and 3% of women. Approximately 260,000 people suffer a myocardial infarction in any year, of which 40 to 50% die.

Risk factor's

Traditionally, the main potentially modifiable risk factors for CHD have been considered hypertension, smoking, increased serum cholesterol and diabetes. More recently, psychological stress and abdominal obesity have gained greater prominence.

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Patients with a combination of all these risk factors are at risk of suffering a myocardial infarction about 500 times greater than people without any of the risk factors.

Stopping smoking, moderate alcohol consumption, regular exercise and consumption of fresh fruits and vegetables were independently and additionally associated with reducing the risk of myocardial infarction.

Diabetes mellitus is a positive risk factor for CHD in developed countries with high levels of CHD, but it is not a risk factor in countries with little CHD.

Signs and symptoms

The main clinical manifestation of coronary heart disease is chest pain. Thoracic pain resulting from a stable coronary atheromatous disease leads to stable angina and usually arises when the coronary artery narrowing exceeds 50% of the original luminal diameter. Stable angina is characterized by chest pain and shortness of breath during exertion; The symptoms are relieved quickly with rest. A stable coronary atheromatous plaque may become unstable as a result of plaque erosion or rupture.


Research is needed to confirm the diagnosis and evaluate the need for intervention. The resting electrocardiogram (ECG) is normal in more than half of patients with angina. However, an abnormal ECG substantially increases the likelihood of coronary heart disease; in particular, it may show signs of previous myocardial infarction.

Non-invasive tests are useful.

Exercise tests are useful both to confirm the diagnosis and to provide a guide to the prognosis. Alternatives such as myocardial scintigraphy (isotopic scanning) and stress echocardiography (ultrasound) provide similar information.

Coronary angiography is considered the gold standard for the evaluation of CAD and involves the passage of a catheter through the arterial circulation and the injection of radiopaque contrast media into the coronary arteries.

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The X-ray images obtained allow to confirm the diagnosis, help to evaluate the prognosis and guide the therapy, particularly with respect to the suitability for the coronary artery bypass graft and angioplasty.

Non-invasive techniques, including magnetic resonance imaging (MRI) and CT scanning of multiple slices, are being developed and tested as alternatives to angiography.


The treatment of stable angina is based on two principles.

Improve prognosis by preventing myocardial infarction and death.

Relieve or prevent symptoms.

Pharmacological therapy

It can be considered a viable alternative to invasive strategies, providing similar results without the complications associated with percutaneous coronary intervention (PCI). In addition, diabetes, hypertension and dyslipidemia in patients with stable angina should be well controlled. Try to stop smoking, without or with pharmacological support, and lose weight.

Pharmacological therapyPharmacological therapy

Drug therapy

Antithrombotic drugs: One of the main complications derived from atheromatous plaque is the formation of thrombi. This causes an increase in the size of the plaque and can result in a myocardial infarction. Antiplatelet agents, in particular, aspirin, are effective in preventing the activation of platelets and, therefore, the formation of thrombi. Aspirin has a proven benefit in all forms of established CHD, although the risk-benefit ratio in people at risk for CHD is less clear.

ACE inhibitors: are established treatments for hypertension and heart failure and have been shown to be beneficial after myocardial infarction.

Statins: studies have repeatedly shown the benefit of lowering cholesterol, especially low-density lipoprotein cholesterol (LDL-C), in patients with CHD.

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