Coronary Artery Disease

Smoking a bigger player in STEMI for younger patients

Ann Arbor, MI – Smoking seems to play a bigger role in acute ST-segment-elevation MI (STEMI) in patients younger than 35 years compared with older age groups. A study based on Michigan data suggests that cigarette smoking remains common overall in patients who undergo PCI for STEMI, but the likelihood is 11-fold higher in that youngest adult age group [1]. Prevalence of smoking among STEMI patients also tapered down with increasing age, report the authors, led by Dr Gail K Larsen (University of Michigan, Ann Arbor).

“Notably, our study estimates that a reduction in the smoking rate down to 12%, an objective laid out by People 2020, would translate to more than 450 STEMIs prevented per year in Michigan alone,” they write in their report, published online May 27, 2013 in JAMA Internal Medicine.

In their analysis of 2010-2012 data from 44 hospital participants in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) registry, which enters “all patients undergoing PCI at nonfederal hospitals” in the state, the prevalence of smokers among all 6892 patients undergoing PCI for STEMI was 46.4%—which contrasts with 20.5% of the general population, according to the group.

Compared with the general population, the odds ratio for smoking among the STEMI patients was 11.4 (95% CI 10.0-12.8) for the 18-34 age group; it was significantly increased for all other age groups as well but declined steadily with every four-year increment in age, from 8.9 (95% CI 7.7-10.0) for age 35-39 down to only 2.7 (95% CI 2.4-3.0) for >65 years.

“Aggressive efforts should be made to promote smoking cessation for primary prevention of major cardiovascular events, with a specific focus in younger age groups.”

What Is Coronary Artery Disease ?

Coronary artery disease (CAD), also called coronary heart disease, is a condition in which plaque (plak) builds up inside the coronary arteries. These arteries supply your heart muscle with oxygen-rich blood.

Plaque is made up of fat, cholesterol (ko-LES-ter-ol), calcium, and other substances found in the blood. When plaque builds up in the arteries, the condition is called atherosclerosis (ATH-er-o-skler-O-sis).

Figure A shows a normal artery with normal blood flow. Figure B shows an artery with plaque buildup.

Plaque narrows the arteries and reduces blood flow to your heart muscle. It also makes it more likely that blood clots will form in your arteries. Blood clots can partially or completely block blood flow.

Drinking Water Scientifically at Night Is Essential for CAD Patients

Usually a sudden attack of coronary disease in daily time is able to be treated in time, but those who suffered angina pectoris, coronary occlusion or cerebral thrombosis at night may not be lucky enough to be saved. It is endorsed that if the patients pay enough attention to the night health care especially in drinking, the incidence of the disease could be decreased.

Water should always be provided on the bedside tables for the patients. They should drink a glass of warm boiled water half an hour before go to bed so as to assure that the blood viscosity is under the proper level. An additional glass of water is also of great importance especially for those who are troubled by diarrhea or sweat more. Beyond this, the patients should drink more water as soon as they get up since the risk of coronary heart disease is extremely high in the morning due to the lack of water. At this time, timely water supplement could promote the circulation of the blood, accelerating the body’s metabolism. It is for these reasons that why drinking three glasses of water plays so important a part in the patients’ life is understandable

Coronary Artery Disease Introduction

Coronary artery disease (CAD)(or atherosclerotic heart disease) is the end result of the accumulation of atheromatous plaques within the walls of the coronary arteries that supply the myocardium (the muscle of the heart) with oxygen and nutrients. It is sometimes also called coronary heart disease (CHD), although CAD is the most common cause of CHD, it is not the only cause.

CAD is the leading cause of death worldwide. While the symptoms and signs of coronary artery disease are noted in the advanced state of disease, most individuals with coronary artery disease show no evidence of disease for decades as the disease progresses before the first onset of symptoms, often a “sudden” heart attack, finally arises. After decades of progression, some of these atheromatous plaques may rupture and (along with the activation of the blood clotting system) start limiting blood flow to the heart muscle. The disease is the most common cause of sudden death, and is also the most common reason for death of men and women over 20 years of age. According to present trends in the United States, half of healthy 40-year-old males will develop CAD in the future, and one in three healthy 40-year-old women. According to the Guinness Book of Records, Northern Ireland is the country with the most occurrences of CAD. By contrast, the Maasai of Africa have almost no heart disease.

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 artery disease typically have suffered from one or more myocardial infarctions (heart attacks), and may have signs and symptoms of chronic coronary ischemia, including symptoms of angina at rest and flash pulmonary edema.

A distinction should be made between myocardial ischemia and myocardial infarction. Ischemia means that the amount of blood 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 a lack of sufficient oxygen-rich blood.

An individual may develop a rupture of an atheromatous plaque at any stage of the spectrum of coronary artery disease. The acute rupture of a plaque may lead to an acute myocardial infarction (heart attack).

All Necessary Examinations for Coronary Heart Disease

Rest ECG
Advantages: noninvasive, re-usable, convenient and inexpensive.
Disadvantages: poor sensitivity and specificity; only able to reflect temporary heart condition; unable to find the problem if the patient behave normally during the checking process; fail to diagnosis sometimes.

Exercise EKG Stress Testing
Advantages: noninvasive, able to induce myocardial ischemia attack so as to achieve better diagnosis even there is nothing wrong with the Rest ECG; practical for the patients with angina pectoris caused by continual strain.
Disadvantages: cannot be tested with the aged and patients with movement disorders.

Coronary Angiography
Advantages: effective in diagnosing coronary artery disease and reflecting areas of involvement; able to show the details of stenosis clearly if there is any.

Disadvantages: invasive, only reflect the lumen contour of the contrast agent-related areas; fail to show the situation of atheromatous plaque, unable to find early lesions and judge the stability of plaque.

64-Slice Spiral CT
Advantages: noninvasive, able to judge coronary artery disease based on vessel calcification imaging; highly sensitive and specific; able to be used as screening method; accurate negative predictive.
Disadvantages: higher demands on the heart rate (below 70/min at present)
Costs: around 1000 RMB.

Intravascular Ultrasound
Advantages: clearly show the histological features of coronary artery wall through ultrasound imaging; able to find early vascular lesions and judge the stability of atherosclerotic plaque.
Disadvantages: invasive, expensive.
Costs: around 10000 RMB.