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What Is Coronary Heart Disease? Narrowing of the coronary arteries that feed the heart causes heart disease. Like any muscle, the heart needs a constant supply of oxygen and nutrients, which are carried to it by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, the result is coronary heart disease (CHD). If not enough oxygen-carrying blood reaches the heart, you may experience chest pain called angina. If the blood supply to a portion of the heart is completely cut off by total blockage of a coronary artery, the result is a heart attack. This is usually due to a sudden closure from a blood clot forming on top of a previous narrowing. If you answer yes to any of these questions, you most probably have CHD. Have you ever had a heart attack? Do you suffer from chest pain that has been diagnosed as angina? Have you had heart surgery such as a bypass operation or a balloon or angioplasty procedure? Have you ever had an angiogram (a special x-ray picture of the heart) that showed a blockage in your coronary arteries? You should be sure to talk to your doctor about cholesterol if you have answered yes to any of these questions. Even if you don't have heart disease, having diabetes or a combination of several risk factors may put you at high risk for developing heart disease in the future. The risk of developing heart disease if you are diabetic is typically as high as the risk for a heart attack in a person with heart disease. A combination of several risk factors may put you at this same high risk of developing heart disease. Check with your doctor about cholesterol and how to lower your risk. What does cholesterol have to do with heart disease? The Framingham Heart Study established that high blood cholesterol is a risk factor for coronary heart disease (CHD). Results of the Framingham study showed that the higher the cholesterol level, the greater the CHD risk. On the other end of the spectrum, CHD is uncommon at total cholesterol levels below 150 milligrams per deciliter (mg/dL). A direct link between high blood cholesterol and CHD has been confirmed by the Lipid Research Clinics- Coronary Primary Prevention Trial (1984), which showed that lowering total and LDL ("bad") cholesterol levels significantly reduces CHD. A series of more recent trials of cholesterol lowering using statin drugs have demonstrated conclusively that lowering total cholesterol and LDL-cholesterol reduces the chance of having a heart attack, needing bypass surgery or angioplasty, and dying of CHD-related causes. Recent studies have shown that cholesterol lowering in people without heart disease greatly reduces their risk for developing CHD, including heart attacks and CHD-related death. This is true for those with high cholesterol levels and for those with average cholesterol levels. A 1995 study called the West of Scotland Coronary Prevention Study (WOSCOPS) found that cholesterol lowering reduced the number of heart attacks and deaths from cardiovascular causes in men with high blood cholesterol levels who had not had a heart attack. For 5 years, more than 6500 men with total cholesterol levels of 249 milligrams per deciliter (mg/dL) to 295 mg/dL were given either a cholesterol-lowering drug or a placebo (a dummy pill that looks exactly like the medication), along with a cholesterol lowering diet. The drug that was given is known as a statin (pravastatin), and it reduced total cholesterol levels by 20 percent and LDL ("bad") cholesterol levels by 26 percent. The study found that in those receiving the statin, the overall risk of having a nonfatal heart attack or dying from CHD was reduced by 31 percent. The need for bypass surgery or angioplasty was reduced by 37 percent and deaths from all cardiovascular causes by 32 percent. A very important finding is that a death from causes other than cardiovascular diseases were not increased, and the overall deaths from all causes were reduced by 22 percent. In 1998, the results of the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) showed that cholesterol lowering in generally healthy people with average cholesterol levels reduced their risk for a first-time major coronary event by 37 percent. Study participants had no obvious evidence of CHD and relatively usual total cholesterol levels (average of 221 mg/dL) and LDL-cholesterol levels (average of 150 mg/dL) and lower than usual HDL ("good") cholesterol levels (average of 36 mg/dL for men and 40 mg/dL for women). This study used a statin drug (lovastatin) along with a low- saturated fat, low-cholesterol diet to lower cholesterol levels. Study participants who received a placebo followed the same low-saturated fat, low-cholesterol diet. After one year, total cholesterol levels in the treatment group were lowered by 18 percent and LDL-cholesterol levels by 25 percent. The risk for a heart attack was reduced 40 percent, unstable angina 32 percent, the need for bypass surgery or angioplasty 33 percent, and cardiovascular events 25 percent. The cholesterol-lowering benefits in this study extended to men and women as well as older adults. There were no significant differences between treatment and placebo groups in non-cardiovascular disease deaths.

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