Stanford Center for Inherited Cardiovascular Disease

Coronary Artery Disease In Depth

Coronary disease is also known as:

Coronary artery disease (CAD)
Coronary heart disease (CHD)
Atherosclerotic coronary heart disease (ACHD)
Atherosclerosis or arteriosclerosis
“Hardening of the arteries”

The Problem:

Coronary disease causes 1 in 5 deaths in the United States and remains the single largest killer of men and women. Approximately half of men and a third of women in the US will develop coronary disease during their lifetime. It is even more common for people with conditions like FH. People with coronary disease are at increased risk of myocardial infarction (commonly known as a “heart attack”), angina (“chest pain’ caused by inadequate blood flow to the heart), stroke, sudden death and heart failure. 

The Causes:

Coronary disease is the result of a complex interplay of an individual’s genetic background (inherited from their parents) and the their environment or lifestyle. Coronary artery plaques begin to develop as early as the teenage years and progress throughout life. The progression of coronary disease in individuals is highly variable and a subset of individuals and their families are particularly prone to developing aggressive forms of coronary disease that lead to premature disease and death. Families with a history of early onset (premature) coronary disease deserve an aggressive approach to diagnosis and treatment.

Normal Coronary Artery

Coronary Artery Plaque Rupture

 

 

 

 

 

Risk Factors for Coronary Artery Disease

  • high cholesterol/hyperlipidemia
  • high blood pressure/hypertension
  • age/sex
  • insulin resistence
  • smoking
  • family history (including genetic conditions such as FH)

 

 

Many risk factors for coronary disease are known and include hyperlipidemia (‘high cholesterol’), high blood pressure (‘hypertension’), smoking, diabetes and insulin resistance. A family history of premature coronary disease is also a very important risk factor.  Some families, such as those with familial hypercholesterolemia (‘FH’) or Tangier disease, will have a very well defined disease pattern.  For other families, the mechanism of disease might not have been determined or may be genetically complex. Our goal in clinic is to be able to serve both populations. 

Our Approach:

One of the missions of the clinic is a ‘personalized’ approach to medical care. The last several years have brought a revolution in our understanding some of the genetic risk factors for coronary disease. In the near term, some of this information may become important in assessing an individual’s risk for coronary disease or potentially tailoring individual therapy. Investigators at Stanford have been at the forefront of these studies. There are some circumstances where we may recommend advanced genetic testing. Our team includes physicians and genetic counselors with experience in interpreting genetic information. Other patients should feel comfortable in bringing results of prior testing. We look forward to using our knowledge to helping patients bring ‘common sense’ to understanding genetic testing.

Diagnosis and Lifestyle:

For many patients with coronary disease, coronary disease risk or a family history of coronary disease, simple lifestyle changes or medications may be very useful in preventing progression of disease.  Through close connections with the Stanford Preventative Cardiology Clinic we offer a team based approach to lifestyle intervention including highly experienced dieticians and nurse practitioners with expertise in exercise, weight loss and diabetes prevention and treatment. 

Imaging:

For some patients at risk for coronary disease, we may recommend advanced imaging studies. Stanford is proud to offer state-of-the-art technology such as our gated, 128-slice CT scanner, which offers crisp pictures while minimizing radiation exposure.  We are also leading the way in developing MRI-based imaging of coronary arteries.

Procedures:

Some patients with coronary disease will ultimately require coronary intervention (or ‘catheterization’).  For over 25 years, Stanford has been a world leader in the development of new technologies and techniques to make this experience safer and more effective. Particularly important are the availability of the ‘radial artery’ approach to catheterization which leads to less bleeding complications and shorter hospital stays and the use of advanced coronary pressure measurements (‘FFR’) that reduces the need for unnecessary stenting procedures. A small subset of patients with advanced coronary disease may ultimately require coronary artery bypass surgery. Fortunately, Cardiothoracic Surgery at Stanford has had a track record of excellence for over 50 years and is consistently rated as one of the top programs in the country. 

The Future:

Finally, we aim to define the future management of this disease. Faculty in Stanford Cardiovascular Medicine are world renowned for research into the genetics of coronary disease as well as the study of vascular biology.  Many new diagnostic tools and therapies are being developed and Stanford patients are often the first to benefit from the application of new therapies in clinical trials.

In some cases, we may ask patients and their families if they would like to help in the fight against coronary disease through participation in research studies. Some of these studies may involve collection of patient and family information as well as collection of blood or saliva samples for DNA analysis. 

 

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