Coronary Artery Disease: Prevention

To prevent coronary heart disease (CHD), attention must be paid to reducing individual risk factors. The risk profile is positively influenced mainly by fat reduction, exercise, and stress management. Behavioral risk factors

  • Diet
    • Malnutrition and overeating, viz:
      • Too high calorie intake
      • High-fat diet (high intake of saturated fatty acids, trans fatty acids – found especially in convenience foods, frozen foods, fast foods, snacks – and cholesterol)
      • Low intake of unsaturated fatty acids (monounsaturated and polyunsaturated fatty acids such as omega-3 fatty acids (marine fish)); CHD is also inversely associated (linked) with intake of linoleic acid
      • Too high intake of animal protein (protein), including especially processed meat.
      • Diet low in fiber – fiber lowers total and LDL cholesterol levels, and thereby reduces the risk of developing coronary heart disease (CHD). Individuals who consume more than 35 g of dietary fiber daily have a more than 30% lower risk of developing CHD than those who consume less than 15 g of fiber per day. This is due in part to the fact that increased fiber intake simultaneously leads to decreased fat and carbohydrate intake.The soluble fiber found in guar gum (seed mucilage), as well as pectin (found in most fruits) and ß-glucans (found in oats and barley) can directly lower cholesterol: In the gastrointestinal tract, they bind bile acids and ensure their elimination. Since bile acids consist of about 80% cholesterol, soluble fiber thus contribute to the reduction of total and LDL cholesterol levels.
      • Low intake of fruits and vegetables
    • Micronutrient deficiency (vital substances) – see Prevention with micronutrients.
  • Consumption of stimulants
    • Alcohol – (woman: > 20 g/day; man: > 30 g/day).
    • Tobacco (smoking, passive smoking)
  • Drug use
    • Cannabis (hashish and marijuana) (88% more common than among non-users).
    • Cocaine
  • Physical activity
    • Lack of physical activity (lack of exercise).
    • Intensive physical activity (450 minutes of moderate-intensity physical activity per week) (Whites: 80% higher risk of coronary artery calcification score (CACS > 0).
    • Excessive endurance exercise
      • Higher coronary plaque burden
      • Clinically relevant coronary artery calcification (CAC; arteries that surround the heart in a coronary shape and supply blood to the heart muscle)
  • Psycho-social situation
    • Stress; men who were particularly rapidly stressed as adolescents had a 17% higher risk of CHD in adulthood than those who were found to have high stress tolerance; stress tolerance was determined at the time of muster for military service (age 18 to 19 years)
    • Health anxiety: 3% of those without anxiety disorder versus 6.1% with health anxiety (sex-adjusted doubling of risk (hazard ratio, HR 2.12))
    • Sleep duration: <5 hours and >9 hours showed significantly worse scores on coronary artery calcium score (CAC) and pulse wave velocity; participants with 7 hours of sleep did best
    • Alternating shifts with night duty; nurses who worked alternating shifts with night duty for more than 5 years
    • Loneliness and social isolation (29% increased risk (pooled relative risk 1.29; 1.04 to 1.59)
  • Overweight (BMI ≥ 25; obesity).
    • With a body mass index (BMI) of 25 to 29.9 is associated with a 32% increased risk of CHD (still 17% after adjustment for risks from hypertension and hyperlipidemia)
    • BMI above 30 is associated with an 81% increased risk of CHD (adjusted for the risks due to hypertension (high blood pressure) and hyperlipidemia (dyslipidemia) still increased by 49%)
  • Android body fat distribution, that is, abdominal/visceral, truncal, central body fat (apple type) – high waist circumference or waist-to-hip ratio (waist-to-hip ratio) is present When measuring waist circumference according to the International Diabetes Federation guideline (IDF, 2005), the following standard values apply:
    • Men < 94 cm
    • Women < 80 cm

    The German Obesity Society published somewhat more moderate figures for waist circumference in 2006: < 102 cm for men and < 88 cm for women.

Environmental pollution – intoxications (poisonings).

  • Noise
    • Road noise: 8% increase in risk of CHD for every 10 decibel increase in road traffic noise
    • Workplace noise: 15% higher risk of CHD if exposed to noise levels of moderate magnitude (75-85 dB) compared with those exposed to noise levels below 75 dB (age-adjusted))
  • Air pollutants
    • Diesel dust
    • Particulate matter
  • Heavy metals (arsenic, cadmium, lead, copper).

Prevention factors

  • Genetic factors:
    • Genetic risk reduction depending on gene polymorphisms:
      • Genes/SNPs (single nucleotide polymorphism; English : single nucleotide polymorphism):
        • Gene: APOA2, PAPR1
        • SNP: rs5082 in gene APOA2
          • Allele constellation: CC (0.57-fold).
        • SNP: rs1136410 in the gene PAPR1
          • Allele constellation: CC (0.16-fold).
  • Nutrition:
    • Egg consumption: daily egg consumption (0.76 eggs/day) reduced the risk of ischemic heart disease by 12%; hemorrhagic stroke by 26%; risk of hemorrhagic stroke decreased by 26%.
    • Consumption of a handful of nuts (cashews, hazelnuts, almonds, pecans, pistachios, walnuts) a day resulted in a CHD risk reduction of 29%.
  • Acetylsalicylic acid (ASA).
    • Genetic risk reduction dependent on gene polymorphisms:
      • Genes/SNPs (single nucleotide polymorphism; English : single nucleotide polymorphism):
        • Gene: GUCY1A3
        • SNP: rs7692387 in gene GUCY1A3
          • Allele constellation: GG (ASA decreases risk of cardiac event by 0.79-fold).
          • Allele constellation: AG (ASA increases risk of a cardiac event by 1.39-fold).
          • Allele constellation: AA (ASA increases risk of a cardiac event by 1.39-fold)

Secondary prevention

  • All-cause mortality (total death rate) and cardiovascular mortality (death rate) in CHD patients were lowest when patients consumed between 5 and 25 g of alcohol daily.
  • Physical activity is more important than weight control:
    • No significant associations were found between weight trends and mortality in overweight and obese CHD patients.
    • There was a clear association between physical activity and mortality. Recommend 30 minutes of moderate (sweaty) activity five times a week or 20 minutes of strenuous (exhaustive) activity three times a week.
  • Achievement of the following six prevention goals resulted in a 73% lower mortality risk (risk of death) than patients who achieved none of these goals or only one of them:
    • American Heart Association Diet 2, ie, provide <7% of daily energy requirements via saturated fat and <200 mg/day of dietary cholesterol
    • If smoker, stop smoking
    • Physical activity: at least 150 minutes a week of physical activity.
    • BMI < 25 kg/m2
    • Blood pressure: < 130/85 mmHg
    • LDL-C level: < 85 mg/dl

    Over the 6.8-year observation period, 8% of patients who achieved all 6 goals died versus 36% mortality rate of patients who achieved none of these goals or only one of them.