Building Healthy Communities through Medical-Religious Partnerships

4. Coronary Heart Disease

4 Coronary Heart Disease Coronary heart disease is the leading cause of death in the United States. Each year approximately 1.5 million Americans suffer a heart attack and nearly half a million die as a result of the attack. Heart attacks (myocardial infarctions) occur when arterial (blood vessel) blockages stop blood and oxygen from reaching the heart muscle—as when a clogged fuel line stops a car engine. The blockage is generally due to atherosclerosis, or the build-up of plaque in the arteries. The process of plaque building up and causing a thickening and narrowing of the arteries begins long before a heart attack occurs. In fact, it is a gradual process that may start as early as childhood. It is increasingly recognized that some heart attacks occur due to rupture of atherosclerotic plaques—even those that before rupturing do not obstruct the flow of blood through the affected artery. When a plaque ruptures, the rapid formation of a clot occurs and the artery can become completely blocked. Whatever the underlying physiology, rapid medical treatment in a hospital with “clot-busting” drugs and angioplasty (where a balloon catheter can be used to open the clogged coronary artery) not only saves lives but also lessens the heart muscle damage that follows the event. Risk Factors for Coronary Heart Disease The major risk factors for coronary artery disease are age, sex, family history, high cholesterol, hypertension, diabetes mellitus, and smoking. Heart disease is more common among older adults. In fact, of all the known risk factors for heart disease, older age is the most potent. Not only does 46 suggested topics for congregational programs plaque form more readily in older arteries, but the arteries of older adults have been exposed to the other important risk factors (e.g., hypertension, high cholesterol, and smoking) for a longer period of time. Finally, the incidence rates of hypertension and diabetes, two common late-life conditions among people in the United States, increase dramatically among older age groups and may further accelerate the worsening of coronary artery disease . In addition, older adults are also more vulnerable to heart disease and regularly have more complications and worse outcomes as compared to younger patients. For these reasons, knowledge of the risk and early recognition and treatment of heart disease are especially important among older people. Heart disease is more common in men than in women during early and middle adulthood, but the risk of heart disease rises dramatically in postmenopausal women after the age of 50. Although many women fear breast cancer as the number one cause of death, heart disease affects and kills many more women than all forms of cancer combined. For both women and men, heredity also plays an important role because the risk of heart disease is greater for those with a family history of premature heart attacks. For individuals who do not know their family history, efforts at establishing such a family health record is recommended. High levels of blood cholesterol can also run in families, and many medical studies now support the identification and treatment of high cholesterol as an effective strategy in the prevention and treatment of coronary artery disease. One of the most common risks for heart disease, particularly in older adults, is hypertension, or high blood pressure. As we age, our arteries naturally get stiffer. Thus, hypertension often develops after 50 years of age, even among those with good exercise and nutritional habits. Women develop hypertension with aging but about a decade later than men. Up to 70 percent of 70-year-olds and 80 percent of 80-year-olds have high blood pressure. The type of hypertension that develops in older age is different from hypertension that is diagnosed at younger ages; it is far more risky. Treatment of hypertension associated with the aging process markedly reduces the risk of stroke, heart attack, death, heart failure, kidney disease, and even dementia. Therefore, it is important to have blood pressure checked on a regular basis to avoid or lessen the risk of developing these conditions. People also become more sensitive to salt in older age. Because coronary heart disease 47 salt increases blood pressure, learning to lower the salt in one’s diet by cooking and choosing food products with less salt can also help to lower blood pressure. Developing diabetes is a potent predictor of future heart disease. Because obesity is a significant risk...