Coronary artery disease (CAD), also called coronary heart disease, is the most common form of heart disease and affects 30 million Europeans.1
This condition is the result of plaque build-up in the arteries. It is also the leading cause of death in both men and women in Europe.2
Plaque is a deposit on the vascular walls, mainly made up of cholesterol, blood clots, connective tissue and calcium. These deposits interfere with blood flow. The heart muscle is no longer able to receive sufficient oxygen, which restricts cardiac performance. The build-up of plaque develops over many years and is often undiagnosed until a heart attack or angina pectoris (chest pain) occurs. Risk factors of coronary artery disease include age, family history and lifestyle choices such as smoking, unhealthy diet and physical inactivity.
“Coronary artery disease is caused by narrowing and/or blockage of the blood vessels that supply the heart with oxygen. It happens when cholesterol and other materials, called plaque, accumulate on the artery walls.”2
In men, the risk for coronary artery disease increases starting at age 40. In women, the risk for coronary artery disease increases starting at age 50.2
Dietary factors make a large contribution to the risk of cardiovascular diseases.2
The higher the blood cholesterol level, the greater the risk of coronary artery disease.2
Lack of physical activity can indirectly increase the risk, because it also increases the risk for diabetes and high blood pressure.2
The risk of getting the disease rises tremendously with previous cases in the family.2
Smoking remains a key public health issue in Europe and contributes to the build-up of plaque deposits.2
In Europe, 30 million people are currently living with coronary artery disease. In 2015 alone, 6 million were diagnosed with it. Heavily affected countries are Germany, Italy, Poland, the United Kingdom and France.1 Contrary to popular belief, it affects women and men equally.2 In addition to its mortality burden, coronary artery disease is a leading cause of loss of quality of life and working days. This makes cardiovascular disease a major public health problem with heavy economic costs. The disease cost the EU €19 billion in 2015, including €10 billion in inpatient hospital care.1
In Germany, in-patient care of coronary artery disease patients cost €3 billion in 2015, compared with €1.4 billion in France and €1.2 billion each in Italy and the United Kingdom. Meanwhile, the average in-hospital stay of people suffering from coronary artery disease varies tremendously among countries.1 Early diagnosis and effective, cost-efficient treatment would help lower the number of invasive operations, length of in-hospital stays and related costs.2
Coronary artery disease cannot be cured, but with today’s technology, early diagnosis and the right treatment it can be managed effectively. Coronary artery disease is often diagnosed following a physical examination, check of medical history and tests that can confirm a diagnosis. These include electrocardiogram (ECG), Computer Tomography (CT) scans, Optical Coherence Tomorgraphy (OCT) which is an invasive imaging technologies using near-infrared light providing higher resolution imaging, as well as Fractional Flow Reserve (FFR) - a guide wire-based procedure that can accurately measure blood pressure and flow through a specific part of the coronary artery.
Treatment options for coronary artery disease include changes in lifestyle, medication, minimally-invasive interventions such as angioplasty or Percutaneous Coronary Intervention (PCI), and invasive bypass surgery. The goal is to relieve symptoms, prevent future attacks and halt the progression of coronary artery disease as much as possible.3
Management of coronary artery disease usually starts with lifestyle changes to halt its progression.2
Patients with less severe coronary artery disease can often be treated by medication that reduces plaque and reduces risk factors.3
If medication is not sufficient or if coronary artery disease becomes acute, blocked and narrowed vessels can be reopened via interventions such as balloon angioplasty and stents. Both interventions only require local anaesthesia and are minimally invasive – meaning less impact on the patient, quicker recovery, shorter hospital stays and less re-hospitalisations.
Medical history will determine if a highly invasive bypass surgery (open heart surgical procedure) is appropriate. During this surgical procedure, a healthy artery or vein from the body is connected, or grafted, to the clocked coronary artery to circumvent the blockage.3
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1. Wilkins E, Wilson L, Wickramasinghe K, Bhatnagar P, Leal J, Luengo-Fernandez R, Burns R, Rayner M, Townsend N(2017). European Cardiovascular Disease Statistics 2017. European Heart Network, Brussels.
2. European Guidelines on Cardiovascular Disease Prevention in Clinical Practice, European Journal of Cardiovascular Prevention and Rehabilitation, 2016.
3. European Society of Cardiology. ESC guidelines on the management of stable coronary artery disease. European Heart Journal;34:2949–3003, 2013
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