SCAD: What’s Overlooked Can Be Fatal

Are There Stages Of Coronary Artery Disease?

A staging system for coronary artery disease, based on levels of plaque in the blood vessels, may help people begin treatment earlier and prevent cardiac events.

Coronary artery disease (CAD) occurs due to plaque buildup in the heart's arteries. The plaque causes a narrowing, or stenosis, of the arteries, which reduces or blocks blood flow. This is atherosclerosis, and it can increase the risk of heart attack.

Researchers are currently investigating a staging system for CAD, which measures the buildup of plaque to identify the risk of cardiac events, rather than the current strategy, which assesses risk factors.

This article looks at how staging may help CAD and adverse cardiac events, how the staging system might work, and when it may be in use.

According to a 2022 study, staging plaque in atherosclerosis may help doctors identify the type and extent of CAD, which may help predict the risk of major adverse cardiac events (MACE).

This may help people begin treatment earlier and prevent serious cardiac events.

Currently, the main prevention strategy for cardiovascular disease is identifying risk factors, including:

The problems this causes are:

Those with higher risk may begin preventive treatment even if they do not have atherosclerosis.

Individuals without risk factors may have significant atherosclerosis without receiving preventive treatment.

The current strategy is also unable to identify how well treatment is working.

There is an upward trend in the cardiovascular death rate in the United States.

Treatments that can prevent cardiovascular events are available, and there is also evidence that screening people with no symptoms reduces cardiovascular events.

Implementing a staging system to identify the level of atherosclerosis aims to better identify individuals with atherosclerosis who are at risk of cardiovascular events.

The TRANSFORM trial is currently underway to test whether care based on a CAD staging system reduces cardiovascular events compared to a risk-factor-based strategy.

The researchers estimate the trial will take 5 years and will end in 2029.

Doctors use a coronary computed tomography angiography (CCTA) scan to identify a narrowing of the blood vessels connecting to the heart. This can help doctors see how much plaque buildup there is.

A CCTA scan uses X-rays to create images of the heart and blood vessels. A computer then creates a 3D image of the heart.

Doctors use a contrast dye to show blood flow to the heart. This can show if there is any reduced or restricted blood flow in the heart arteries.

A 2022 study proposes using CCTA scans and computer software to measure total plaque volume to provide a CAD stage.

A 2022 study defined four stages of CAD based on the levels of coronary atherosclerotic plaque.

The researchers used CT scans and coronary computed tomography angiography (CCTA) to identify plaque levels.

The researchers found an increased link between stenosis, a narrowing of the arteries, and ischemia, reduced blood flow, with increased levels of plaque.

The table below outlines the stages of CAD the researchers propose based on their findings.

People with Stage 2 and Stage 3 CAD may have an increased risk of MACE over 10 years compared to individuals in stage 0 and stage 1.

The staging system may help doctors identify the long-term risk of MACE due to CAD, and people may be able to start preventive treatment earlier on.

Researchers hope the CAD staging system will allow individuals to implement care based on their risk factors for CAD, which is particularly important for people with no symptoms. This may help reduce cardiac events.

Researchers are currently investigating a new staging system for CAD, which measures total plaque volume to assess the extent of atherosclerosis and the risk of cardiac events.

This may help people begin preventive treatment earlier and prevent cardiac events due to atherosclerosis.

What Is Atherosclerosis?

Atherosclerosis is a narrowing of the arteries caused by a buildup of cholesterol plaque. It may lead to stroke, heart attacks, dementia, and other health challenges.

When plaque builds up and the arteries become hard and inflamed, blood has trouble flowing through them to the rest of the body. This prevents your organs and tissues from getting the oxygenated blood they need to function.

Atherosclerosis is preventable and treatable, although not reversible.

Atherosclerosis is a "silent" condition during its early stages, meaning it doesn't usually manifest with any evident symptoms until a significant blood flow blockage occurs.

Once symptoms develop, these may include:

chest pain (stable angina)

pain in your leg, arm, and other regions supplied by the blocked artery

cramping in the buttocks while walking

heart palpitations

shortness of breath

fatigue

mental confusion if the blockage affects circulation to your brain

weakness and loss of sensation on one side of the body (hemiparesis) if the blockage affects brain circulation

muscle weakness and cramps in your legs from lack of circulation

Read more on the signs of atherosclerosis.

Did you know?

Atherosclerosis is a form of arteriosclerosis, otherwise known as hardening of the arteries. The terms "atherosclerosis" and "arteriosclerosis" are sometimes used interchangeably, but they represent different conditions.

Read more about the difference between atherosclerosis and arteriosclerosis.

Atherosclerosis develops slowly and it's often related to lifestyle habits, including diet patterns and reduced physical activity. Aging may also be a factor in atherosclerosis, but it doesn't mean significant atherosclerosis always goes hand in hand with aging.

Chronic high cholesterol is the main contributing factor to atherosclerosis. Cholesterol is found naturally in the body and in certain foods.

If cholesterol levels in the blood are persistently elevated, it may lead to artery clogging. Over time, cholesterol in the arteries becomes a hard plaque that starts to restrict blood circulation and may damage blood vessels leading to blood clots.

Blood clots may move through blood flow and travel to other regions of the body. When they block blood flow to vital organs, like the brain, they can lead to serious complications.

Read more about the effects of cholesterol on the body.

Other contributing factors for atherosclerosis may include:

Family history: If atherosclerosis runs in your family, you may have a higher chance of narrowing of the arteries. You can inherit this condition, as well as other heart-related problems.

Lack of exercise: Regular exercise helps your cardiovascular system, including blood vessels, stay in optimal shape. It keeps your heart muscle strong and encourages oxygen and blood flow throughout your body. Low physical activity increases your chance of a host of medical conditions, including heart disease.

High blood pressure: Hypertension may damage your blood vessels by making them weak in some areas.

Smoking: Tobacco products may damage your blood vessels and heart.

Diabetes: People with diabetes have a much higher incidence of coronary artery disease.

A physical exam is the first step toward diagnosing atherosclerosis. A medical professional may check for:

a weakened pulse

signs of an aneurysm, or an abnormal bulging or widening of an artery due to weakness of the arterial wall

slow wound healing, which may indicate restricted blood flow

a bruit, or whooshing sound the blood makes as it travels through a blocked artery

Learn more about the difference between a stroke and an aneurysm.

A cardiologist may listen to your heart to check for atypical sounds and order more tests if they suspect atherosclerosis.

These tests may include:

blood tests to check cholesterol levels

a Doppler ultrasound, which uses sound waves to create an image of arteries and would show a blockage

an ankle-brachial index, which looks for a blockage in your arms or legs by comparing the blood pressure in each limb

a magnetic resonance angiography or a computed tomography angiography, which create pictures of the large arteries in your body

a cardiac angiogram, which is a type of chest X-ray that's taken after your heart arteries are injected with radioactive dye. There are two types of cardiac angiography: Coronary CT angiography (CCTA) and left heart catheterization.

an electrocardiogram (ECG or EKG), which measures the electrical activity in your heart

a stress test, or exercise tolerance test, which monitors your heart rate and blood pressure while you exercise on a treadmill or stationary bicycle

You cannot reverse atherosclerosis, but management may help slow its progression.

Treatment for atherosclerosis typically involves lifestyle changes. Depending on its severity, risk factors, and symptoms, you may also need medications and surgery.

Medications

Medications can slow down the progression of atherosclerosis. These may include:

Aspirin can be particularly effective for people with a history of atherosclerotic cardiovascular disease, including heart attack and stroke.

Discussing aspirin use for cardiovascular risk with a healthcare professional is highly advisable. Taking aspirin without the guidance of a doctor may lead to internal bleeding in some people.

Surgery

If symptoms are severe or if muscle or skin tissue is in jeopardy, a healthcare professional may recommend surgery.

Possible surgeries for treating atherosclerosis include:

bypass surgery, which involves using a vessel from somewhere else in your body or a synthetic tube to divert blood around your blocked or narrowed artery

thrombolytic therapy, which involves dissolving a blood clot by injecting a drug into your affected artery

angioplasty and percutaneous coronary intervention, which involves using a catheter and a balloon to expand your artery, sometimes inserting a stent to keep the artery open

atherectomy, which involves removing plaque from your arteries by using a catheter with a sharp blade at one end

endarterectomy, which involves surgically removing fatty deposits from the carotid artery

Lifestyle changes

Helpful lifestyle changes to slow down atherosclerosis may include:

eating a heart-healthy diet that's low in saturated fats and cholesterol

avoiding fatty foods

adding fish to your diet twice per week instead of red meat

getting at least 75 minutes of vigorous exercise or 150 minutes of moderate exercise each week

doing strength training for at least 2 hours every week

quitting smoking if you use tobacco

managing your weight

managing stress

treating conditions associated with atherosclerosis, such as hypertension, high cholesterol, sleep apnea, obesity, and diabetes

Atherosclerosis is the narrowing of your arteries by the accumulation of plaque. This plaque buildup is the result of chronic high cholesterol levels.

Once you develop atherosclerosis, the condition isn't reversible. However, lifestyle changes, medications, and sometimes surgery may slow down its progression and prevent complications.

Common complications associated with atherosclerosis include strokes and heart attacks.

Coronary Artery Disease

Coronary artery disease (CAD; also 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 one.

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 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).

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