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Dx Coronary Artery Disease Treatment:

Coronary Artery Disease

The Merck Manual Home Edition states:
"coronary artery disease is a condition in which the blood supply to the heart muscle is partially or completely blocked. The heart muscle needs a constant supply of oxygen-rich blood. The coronary arteries (see Blood Supply of the Heart), which branch off the aorta just after it leaves the heart, deliver this blood. Coronary artery disease that narrows one or more of these arteries can block blood flow, causing chest pain (angina) or a heart attack (also called myocardial infarction, or MI). Coronary artery disease was once widely thought to be a man's disease. On average, men develop it about 10 years earlier than women because, until menopause, women are protected by high levels of estrogen. After menopause coronary artery disease becomes more common among women. Among people aged 75 and older, a higher proportion of women have the disease, because women live longer. In developed countries, coronary artery disease is the leading cause of death in both men and women. Coronary artery disease, specifically coronary atherosclerosis (literally “hardening of the arteries,” which involves fatty deposits in the artery walls and may progress to narrowing and even blockage of blood flow in the artery), occurs in about 5 to 9% (depending on sex and race) of people aged 20 and older. The death rate increases with age and overall is higher for men than for women, particularly between the ages of 35 and 55. After age 55, the death rate for men declines, and the rate for women continues to climb. After age 70 to 75, the death rate for women exceeds that for men who are the same age. Coronary artery disease affects people of all races, but the incidence is extremely high among blacks and Southeast Asians. The death rate is higher for black men than for white men until age 60 and is higher for black women than for white women until age 75."

*[Editor] Every man over the age of 45 and woman over the age of 60 should have a Coronary Artery Calcium Score (C.A.C.S.). This is a 30-second rapid C.T. scan of the chest that documents the presence, size, and volume of calcification. If he/she has calcification strongly predicted future major adverse cardiac events." On the positive side, having a score of zero or even a C.A.C.S. score less than 100, says the John Hopkin's group, "will find that individual is at virtually no risk of having a heart attack and "for older individuals without calcium in their arteries, it means they do not need routinely prescribed cholesterol lowering medications or aspirin because they are at a lower risk of a hear attack."

Medications Used in the Treatment:
1. Statins: Zocor®, Lipitor®, Pravachol®
2. ACE Inhibitors: Altace®, Aceon®
3. Calcium Channel: Norvasc®
4. ARBs: Micardis®
5. Fibrates: Lopid®
6. Nicotinic Acids: Niaspan®, Niacor®
7. see iDoctor article

Suggested Links
*N.H.S. Choice

* Medscape on Risk Factors

*[Editor] The British Andrology Group treat men with Low-T with and without heart disease. They establish that testosterone replacement (injections not creams/gels) not only strengthen the heart muscle, improves ejection fraction, but also dilates the coronary arteries. References
*Malkin showed that in short-term studies, testosterone replacement significantly increased the time before affected men experienced angina (129 vs 12 seconds), they loss body mass and increased their hemoglobin [all positive]. The impression was the Carotid Artery Intima-media Thickness (plaque) lessened as well with high dose statins .

*[Editor] What is important is not the cholesterol level but whether there are plaques in the coronary arteries. Only plaques can cause a heart attack-- not cholesterol or lipids. C.A.C.S.(Coronary Artery Calcium Scoring) performed by a 30-second C.T. of the chest, is the only non-invasive test that documents the existence of coronary artery calcification (plaques). The C.A.C.S. studies found differences between Acute Coronary Syndrome and stable angina pectoris. The British did not find that statin therapy reduced Coronary Artery Plaque.
*The CT-Chest determination of the Coronary Artery Calcium Score (C.A.C.S.)  is reproducible.
*CACS greater than 400 encourages patients to take their medications, diet and exercise
. *It has been suggested by Cholesterol Critics that statin therapy not be prescribed until there is evidence of coronary obstruction (heart attack) or a C.A.C.S. of greater than 100-400.
* No study "has been performed on older adults (greater than 80). Considering the patient's functional and cognitive status, comorbidities and other therapies to avoid drug interactions, use [statins] should be based on individual decision."

*[Editor] The use of antiplatelet therapy As compared with placebo or aspirin, OAC with or without aspirin does not reduce mortality or reinfarction, reduces stroke, but is associated with significantly more major bleeding.

*[Editor] The addition of
low dose warfarin 1.25mg to 75mg aspirin reduced the occurrence of stroke but was associated with increased bleeding.
BR> *[Editor] Warfarin is indicated for the prevention of thromboembolism in patients with anterior-wall Acute Myocardial Infarction and should be given for three months in most cases...longer term therapy for patients with additional risk factors for thromboembolism.

While dabigatran 150mg (Pradaxa) twice daily was shown to be superior to warfarin in preventing stroke with non-valvular atrial fibrillation (SPAF) and in the (RE-LY) trial, more myocardial infarctions occurred in the dabigatran group.

*[Editor] Not only does the ingestion of DHEA and 3000mg of a 3:1 EPA/DHA ratio omega-3 fish oil daily reduce the progression of coronary artery plaques, but also
original research 30 years ago showed that a mixture of iodine and niacin was able to reduce atherlosclerotic plaques in the retinal arteries.
Why it was never pursued is unknown.

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