Coronary artery disease
Coronary Artery Disease (CAD) continues to be the leading cause of death and a major cause of morbidity and loss of quality of life. It is evident that the growing cause of death and disability in South Africa is CAD – accounting for 10% of total deaths.
Cardiovascular disease can be defined as a group of various conditions in which the heart and all related structures such as blood vessels are diseased. This would indicate that the cardiovascular system and the blood flow supplying it are not functioning optimally since the coronary arteries provide functional supply of the heart, and a blockage caused by artherosclerotic plaque often result in tissue death and myocardial infarction.
Causes and risk factors
One can break down the risk factors for CAD into unalterable and alterable risk factors.
Unalterable risk factors
- Family history
Alterable risk factors
|risk factor||defining criteria||lifestyle modification|
|1. Dyslipidemia||· TC>5.18 mmol/l
· LDL>3.37 mmol/l
· HDL<1.04 mmol/l
· TC>2.3 mmol/l
|· Statin therapy
· Regular exercise (30-60 min/5 days per week)
· Smoking cessation
|2. Prediabetes||Fasting glucose >5.5 mmol/l and < 6.94 mmol/l||· Insulin therapy
· Regular exercise (20-30 min / 5 days per week)
· Smoking cessation
|3.Hypertension||SBP> 140 mmHg
DBP> 90 mmHg
|· Antihypertensive therapy
· Exercise (30-60 min /4-5 days per week; low-moderate intensity)
· Weight loss if overweight
· Adequate dietary potassium, calcium, magnesium
· Limit alcohol intake
|4. Smoking||Current smoker or those who quit within 6 months||· Nicotine replacement therapy
· Prescription medication
· Hypnotherapy, acupuncture
|5. Physical inactivity||< 30 min moderate intensity physical activity 3 days of the week for 3 months||· Regular exercise (low intensity at least 30 min 5 days per week progressing to moderate intensity
· Time management
|6. Obesity & overweight||BMI>30 kg/m2
Waist > 102 (male)
Waist >88 (female)
|· Regular exercise (goal: increase calorie expenditure
· Weight reduction
|7. Stress & depression||Distress||· exercise
· lifestyle change
Controlling CAD largely depends upon prevention or treatment of its known risk factors and can be treated both medically and surgically, with surgery only considered when internal medicine does not effectively improve health.
- QUIT SMOKING
- EAT HEALTHILY
- EXERCISE REGULARLY
- LOSE EXCESS WEIGHT
- STRESS REDUCTION
- DRUG THERAPY
Effects of exercise
Cardio protective effects of exercise training:
- Improved endothelial function – the membrane that lines the inside of the heart and blood vessels which control vascular relaxation and contraction as well as enzymes that control blood clotting and platelet adhesion.
- Reduction in systemic inflammation – a reduction in activation of the innate immune system
- Improvement in risk factor control
- Reduction in body weight
- Improved glucose metabolism
- Reduction in blood pressure
- Reduction in heart rate
- Increase in HDL-C concentration – this is your ‘good’ cholesterol and assists in removing ‘bad’ cholesterol from where it doesn’t belong.
- Reductions in triglyceride concentration
- Decreased platelet aggregation
- Increased fibrinolytic activity – breaking down of clots
- Reduced myocardial damage during prolonged ischemia
- Supply of oxygenated blood to heart at rest and during exercise
As mentioned above, there are certain risk factors that are not in our control, these include age, gender and family history. However, there are certain risk factors that are in our control i.e. Physical inactivity, smoking, diet, high blood pressure, diabetes, obesity and overweight, and stress. By making the necessary lifestyle modifications, one can reduce the risk for coronary artery disease.
For more information on how we can assist with the exercise and rehabilitation please CONTACT US.
Durstine, J.L., Moore, G.E. & Painter, P.L., 2016. ACSMs exercise management for persons with chronic diseases and disabilities, Human Kinetics.
Author: Jenna-Lee Field at Fish and Field Biokineticists