Editing Coronary artery disease (section)

==Prevention==
Up to 90% of cardiovascular disease may be preventable if established risk factors are avoided.<ref>{{cite journal | vauthors = McGill HC, McMahan CA, Gidding SS | title = Preventing heart disease in the 21st century: implications of the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study | journal = Circulation | volume = 117 | issue = 9 | pages = 1216–27 | date = March 2008 | pmid = 18316498 | doi = 10.1161/CIRCULATIONAHA.107.717033 | doi-access = free }}</ref><ref>{{cite journal | vauthors = McNeal CJ, Dajani T, Wilson D, Cassidy-Bushrow AE, Dickerson JB, Ory M | title = Hypercholesterolemia in youth: opportunities and obstacles to prevent premature atherosclerotic cardiovascular disease | journal = Current Atherosclerosis Reports | volume = 12 | issue = 1 | pages = 20–28 | date = January 2010 | pmid = 20425267 | doi = 10.1007/s11883-009-0072-0 | s2cid = 37833889 }}</ref> Prevention involves adequate physical [[exercise]], decreasing [[obesity]], treating [[hypertension|high blood pressure]], eating a [[healthy diet]], decreasing [[cholesterol]] levels, and [[smoking cessation|stopping smoking]]. Medications and exercise are roughly equally effective.<ref>{{cite journal | vauthors = Naci H, Ioannidis JP | title = Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study | journal = BMJ | volume = 347 | issue = oct01 1 | pages = f5577 | date = October 2013 | pmid = 24473061 | pmc = 3788175 | doi = 10.1136/bmj.f5577 }}<!--|access-date=26 October 2015--></ref> High levels of physical activity reduce the risk of coronary artery disease by about 25%.<ref name=BMJ2016>{{cite journal | vauthors = Kyu HH, Bachman VF, Alexander LT, Mumford JE, Afshin A, Estep K, Veerman JL, Delwiche K, Iannarone ML, Moyer ML, Cercy K, Vos T, Murray CJ, Forouzanfar MH | display-authors = 6 | title = Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013 | journal = BMJ | volume = 354 | pages = i3857 | date = August 2016 | pmid = 27510511 | pmc = 4979358 | doi = 10.1136/bmj.i3857 }}</ref> Life's Essential 8 are the key measures for improving and maintaining cardiovascular health, as defined by the American Heart Association. AHA added sleep as a factor influencing heart health in 2022.<ref>{{Cite web |title=Life's Essential 8 |url=https://www.heart.org/en/healthy-living/healthy-lifestyle/lifes-essential-8 |access-date=2022-07-03 |website=www.heart.org |language=en}}</ref>

Most guidelines recommend combining these preventive strategies. A 2015 Cochrane Review found some evidence that counseling and education to bring about behavioral change might help in high-risk groups. However, there was insufficient evidence to show an effect on mortality or actual cardiovascular events.<ref>{{cite journal | vauthors = Ebrahim S, Taylor F, Ward K, Beswick A, Burke M, Davey Smith G | title = Multiple risk factor interventions for primary prevention of coronary heart disease | journal = The Cochrane Database of Systematic Reviews | issue = 1 | pages = CD001561 | date = January 2011 | volume = 2013 | pmid = 21249647 | pmc = 4160097 | doi = 10.1002/14651858.cd001561.pub3 }}</ref>

In [[diabetes mellitus]], there is little evidence that very tight [[blood sugar]] control improves cardiac risk although improved sugar control appears to decrease other problems such as [[kidney failure]] and [[blindness]].<ref>{{Cite web |last=Norman |first=James |date=2019-10-07 |title=Managing Diabetes with Blood Glucose Control |url=https://www.endocrineweb.com/conditions/diabetes/assessing-how-well-diabetes-controlled |website=Endocrineweb}}</ref>

A 2024 study published in ''The Lancet Diabetes & Endocrinology'' found that the oral glucose tolerance test (OGTT) is more effective than hemoglobin A1c (HbA1c) for detecting dysglycemia in patients with coronary artery disease.<ref>{{Cite journal |last1=Ferrannini |first1=Giulia |last2=Tuomilehto |first2=Jaakko |last3=De Backer |first3=Guy |last4=Kotseva |first4=Kornelia |last5=Mellbin |first5=Linda |last6=Schnell |first6=Oliver |last7=Wood |first7=David |last8=De Bacquer |first8=Dirk |last9=Rydén |first9=Lars |date=2024 |title=Dysglycaemia screening and its prognostic impact in patients with coronary artery disease: experiences from the EUROASPIRE IV and V cohort studies |url=https://linkinghub.elsevier.com/retrieve/pii/S2213858724002018 |journal=The Lancet Diabetes & Endocrinology |volume=12 |issue=11 |pages=790–98 |language=en |doi=10.1016/S2213-8587(24)00201-8|pmid=39326426 }}</ref> The study highlighted that 2-hour post-load glucose levels of at least 9 mmol/L were strong predictors of cardiovascular outcomes, while HbA1c levels of at least 5.9% were also significant but not independently associated when combined with OGTT results.<ref>{{Cite web |date=2024-10-16 |title=Oral Glucose Tolerance Test Superior to HbA1c in Coronary Artery Disease |url=https://www.endocrinologyadvisor.com/news/oral-glucose-tolerance-test-superior-to-hba1c/ |access-date=2024-10-19 |website=Endocrinology Advisor |language=en-US}}</ref>

===Diet===
{{Main|Diet and heart disease}}
A diet high in fruits and vegetables decreases the risk of cardiovascular disease and death.<ref>{{cite journal | vauthors = Wang X, Ouyang Y, Liu J, Zhu M, Zhao G, Bao W, Hu FB | title = Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies | journal = BMJ | volume = 349 | pages = g4490 | date = July 2014 | pmid = 25073782 | pmc = 4115152 | doi = 10.1136/bmj.g4490 }}</ref> [[Vegetarianism|Vegetarians]] have a lower risk of heart disease,<ref>{{cite journal | vauthors = Li D | title = Effect of the vegetarian diet on non-communicable diseases | journal = Journal of the Science of Food and Agriculture | volume = 94 | issue = 2 | pages = 169–73 | date = January 2014 | pmid = 23965907 | doi = 10.1002/jsfa.6362 | bibcode = 2014JSFA...94..169L }}</ref><ref>{{cite journal | vauthors = Huang T, Yang B, Zheng J, Li G, Wahlqvist ML, Li D | title = Cardiovascular disease mortality and cancer incidence in vegetarians: a meta-analysis and systematic review | journal = Annals of Nutrition & Metabolism | volume = 60 | issue = 4 | pages = 233–40 | date = 2012 | pmid = 22677895 | doi = 10.1159/000337301 | doi-access = free }}</ref> possibly due to their greater consumption of fruits and vegetables.<ref>{{cite journal | vauthors = Ginter E | title = Vegetarian diets, chronic diseases and longevity | journal = Bratislavske Lekarske Listy | volume = 109 | issue = 10 | pages = 463–66 | date = 2008 | pmid = 19166134 }}</ref> Evidence also suggests that the [[Mediterranean diet]]<ref>{{cite journal | vauthors = Walker C, Reamy BV | title = Diets for cardiovascular disease prevention: what is the evidence? | journal = American Family Physician | volume = 79 | issue = 7 | pages = 571–78 | date = April 2009 | pmid = 19378874 }}<!--|access-date=26 October 2015--></ref> and a [[high fiber diet]] lower the risk.<ref name="pmid24355537">{{cite journal | vauthors = Threapleton DE, Greenwood DC, Evans CE, Cleghorn CL, Nykjaer C, Woodhead C, Cade JE, Gale CP, Burley VJ | display-authors = 6 | title = Dietary fibre intake and risk of cardiovascular disease: systematic review and meta-analysis | journal = BMJ | volume = 347 | pages = f6879 | date = December 2013 | pmid = 24355537 | pmc = 3898422 | doi = 10.1136/bmj.f6879 }}</ref><ref>{{cite journal | vauthors = Reynolds A, Mann J, Cummings J, Winter N, Mete E, Te Morenga L | title = Carbohydrate quality and human health: a series of systematic reviews and meta-analyses | journal = Lancet | volume = 393 | issue = 10170 | pages = 434–45 | date = February 2019 | pmid = 30638909 | doi = 10.1016/S0140-6736(18)31809-9 | s2cid = 58632705 | doi-access = free }}</ref>

The consumption of [[trans fat]] (commonly found in [[Hydrogenation|hydrogenated]] products such as [[margarine]]) has been shown to cause a precursor to [[atherosclerosis]]<ref name="Lopez-Garcia-2005">{{cite journal | vauthors = Lopez-Garcia E, Schulze MB, Meigs JB, Manson JE, Rifai N, Stampfer MJ, Willett WC, Hu FB | display-authors = 6 | title = Consumption of trans fatty acids is related to plasma biomarkers of inflammation and endothelial dysfunction | journal = The Journal of Nutrition | volume = 135 | issue = 3 | pages = 562–66 | date = March 2005 | pmid = 15735094 | doi = 10.1093/jn/135.3.562 | doi-access = free }}<!--|access-date=26 October 2015--></ref> and increase the risk of coronary artery disease.<ref>{{cite journal | vauthors = Mozaffarian D, Katan MB, Ascherio A, Stampfer MJ, Willett WC | title = Trans fatty acids and cardiovascular disease | journal = The New England Journal of Medicine | volume = 354 | issue = 15 | pages = 1601–13 | date = April 2006 | pmid = 16611951 | doi = 10.1056/NEJMra054035 }}<!--|access-date=26 October 2015--></ref>

Evidence does not support a beneficial role for [[omega-3 fatty acid]] supplementation in preventing [[cardiovascular disease]] (including [[myocardial infarction]] and [[sudden cardiac death]]).<ref name="JAMA2012">{{cite journal | vauthors = Rizos EC, Ntzani EE, Bika E, Kostapanos MS, Elisaf MS | title = Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and meta-analysis | journal = JAMA | volume = 308 | issue = 10 | pages = 1024–33 | date = September 2012 | pmid = 22968891 | doi = 10.1001/2012.jama.11374 }}<!--|access-date=26 October 2015--></ref><ref>{{cite journal | vauthors = Kwak SM, Myung SK, Lee YJ, Seo HG | title = Efficacy of omega-3 fatty acid supplements (eicosapentaenoic acid and docosahexaenoic acid) in the secondary prevention of cardiovascular disease: a meta-analysis of randomized, double-blind, placebo-controlled trials | journal = Archives of Internal Medicine | volume = 172 | issue = 9 | pages = 686–94 | date = May 2012 | pmid = 22493407 | doi = 10.1001/archinternmed.2012.262 | doi-access = free }}<!--|access-date=26 October 2015--></ref>

===Secondary prevention===
Secondary prevention is preventing further sequelae of already established disease. Effective lifestyle changes include:
* [[Weight control]]
* [[Smoking cessation]]
* Avoiding the consumption of [[trans fat]]s (in partially hydrogenated oils)
* Decreasing psychosocial [[stress (psychological)|stress]]<ref>{{cite journal | vauthors = Linden W, Stossel C, Maurice J | title = Psychosocial interventions for patients with coronary artery disease: a meta-analysis | journal = Archives of Internal Medicine | volume = 156 | issue = 7 | pages = 745–52 | date = April 1996 | pmid = 8615707 | doi = 10.1001/archinte.1996.00440070065008 }}<!--|access-date=26 October 2015--></ref><ref name="Richards-2017" />
* [[Exercise]]

[[Aerobic exercise]], like walking, jogging, or swimming, can reduce the risk of mortality from coronary artery disease.<ref>{{cite journal | vauthors = Swardfager W, Herrmann N, Cornish S, Mazereeuw G, Marzolini S, Sham L, Lanctôt KL | title = Exercise intervention and inflammatory markers in coronary artery disease: a meta-analysis | journal = American Heart Journal | volume = 163 | issue = 4 | pages = 666–76.e1–3 | date = April 2012 | pmid = 22520533 | doi = 10.1016/j.ahj.2011.12.017 }}</ref> Aerobic exercise can help decrease blood pressure and the amount of blood cholesterol (LDL) over time. It also increases HDL cholesterol.<ref>{{cite web|title=Coronary Heart Disease (CHD)|url=http://www.credoreference.com/entry/penguinbio/coronary_heart_disease_chd|location=Penguin Dictionary of Biology|year=2004}}</ref>

Although exercise is beneficial, it is unclear whether doctors should spend time counseling patients to exercise. The [[U.S. Preventive Services Task Force]] found "insufficient evidence" to recommend that doctors counsel patients on exercise but "it did not review the evidence for the effectiveness of physical activity to reduce chronic disease, morbidity, and mortality", only the effectiveness of counseling itself.<ref name="pmid12160370">{{cite journal | title = Behavioral counseling in primary care to promote physical activity: recommendation and rationale | journal = Annals of Internal Medicine | volume = 137 | issue = 3 | pages = 205–07 | date = August 2002 | pmid = 12160370 | doi = 10.7326/0003-4819-137-3-200208060-00014 | s2cid = 38338385 | author1 = U.S. Preventive Services Task Force }}<!--|access-date=26 October 2015--></ref> The [[American Heart Association]], based on a non-systematic review, recommends that doctors counsel patients on exercise.<ref>{{cite journal |author6-link=Bess Marcus | vauthors = Thompson PD, Buchner D, Pina IL, Balady GJ, Williams MA, Marcus BH, Berra K, Blair SN, Costa F, Franklin B, Fletcher GF, Gordon NF, Pate RR, Rodriguez BL, Yancey AK, Wenger NK | display-authors = 6 | title = Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity) | journal = Circulation | volume = 107 | issue = 24 | pages = 3109–16 | date = June 2003 | pmid = 12821592 | doi = 10.1161/01.CIR.0000075572.40158.77 | doi-access = free }}</ref>

Psychological symptoms are common in people with CHD. Many psychological treatments may be offered following cardiac events. There is no evidence that they change mortality, the risk of revascularization procedures, or the rate of non-fatal myocardial infarction.<ref name="Richards-2017">{{cite journal | vauthors = Richards SH, Anderson L, Jenkinson CE, Whalley B, Rees K, Davies P, Bennett P, Liu Z, West R, Thompson DR, Taylor RS | display-authors = 6 | title = Psychological interventions for coronary heart disease | journal = The Cochrane Database of Systematic Reviews | volume = 4 | issue = 2 | pages = CD002902 | date = April 2017 | pmid = 28452408 | pmc = 6478177 | doi = 10.1002/14651858.CD002902.pub4 | collaboration = Cochrane Heart Group }}</ref>

'''Antibiotics for secondary prevention of coronary heart disease'''

Early studies suggested that antibiotics might help patients with coronary disease to reduce the risk of heart attacks and strokes.<ref name="Sethi-2021">{{cite journal | vauthors = Sethi NJ, Safi S, Korang SK, Hróbjartsson A, Skoog M, Gluud C, Jakobsen JC | title = Antibiotics for secondary prevention of coronary heart disease | journal = The Cochrane Database of Systematic Reviews | volume = 2 | issue = 5 | pages = CD003610 | date = February 2021 | pmid = 33704780 | pmc = 8094925 | doi = 10.1002/14651858.CD003610.pub4 | collaboration = Cochrane Heart Group }}</ref> However, a 2021 Cochrane meta-analysis found that antibiotics given for secondary prevention of coronary heart disease are harmful to people with increased mortality and occurrence of stroke.<ref name="Sethi-2021" /> So, antibiotic use is not currently supported for preventing secondary coronary heart disease.

===Neuropsychological assessment===
A thorough systematic review found that indeed there is a link between a CHD condition and brain dysfunction in females.<ref>{{cite journal | vauthors = Narvaez Linares NF, Poitras M, Burkauskas J, Nagaratnam K, Burr Z, Labelle PR, Plamondon H | title = Neuropsychological Sequelae of Coronary Heart Disease in Women: A Systematic Review | journal = Neuroscience and Biobehavioral Reviews | volume = 127 | pages = 837–51 | date = August 2021 | pmid = 34062209 | doi = 10.1016/j.neubiorev.2021.05.026 | s2cid = 235245540 }}</ref> Consequently, since research is showing that cardiovascular diseases, like CHD, can play a role as a precursor for dementia, like Alzheimer's disease, individuals with CHD should have a neuropsychological assessment.<ref>{{Cite journal |last1=Deckers |first1=Kay |last2=Schievink |first2=Syenna H. J. |last3=Rodriquez |first3=Maria M. F. |last4=Oostenbrugge |first4=Robert J. van |last5=Boxtel |first5=Martin P. J. van |last6=Verhey |first6=Frans R. J. |last7=Köhler |first7=Sebastian |date=2017-09-08 |title=Coronary heart disease and risk for cognitive impairment or dementia: Systematic review and meta-analysis |journal=PLOS ONE |language=en |volume=12 |issue=9 |pages=e0184244 |doi=10.1371/journal.pone.0184244 |issn=1932-6203 |pmc=5590905 |pmid=28886155|bibcode=2017PLoSO..1284244D |doi-access=free }}</ref>