February is National Heart Month, which started in the USA in 1964 but is now gaining coverage in the UK. The aim is to raise awareness about heart disease and encourage people to take responsibility for improving their own heart health. This article briefly looks at coronary heart disease, and the key steps that can be taken to reduce the risk.

What is coronary heart disease?

Coronary heart disease (CHD) is the term used to describe the narrowing and subsequent blockage of the heart’s own arteries, the coronary arteries. This usually happens over time as fatty deposits build up in the arteries that supply the heart muscle with the blood it needs to pump. If these arteries are furred up, known as atherosclerosis, then the blood supply is reduced.

Reduced oxygen levels can lead to pain in the heart known as angina, and sometimes a clot will develop on the areas of atherosclerosis, which can then break off and cause a complete blockage of the artery. This in turn can lead to a myocardial infarction, or heart attack, where the heart muscle may be irreversibly damaged.

How is coronary heart disease diagnosed?

If a patient is at risk of CHD, exercise testing, CT scans, MRI scans, or angiography, where a dye is injected into the coronary arteries, may be recommended to identify any narrowing or blockages. However, as with many diseases, the long-term prognosis is better if any problems can be identified at an early stage.

A GP can discuss the risk factors with a patient, and will consider the family history, smoking and alcohol consumption, blood pressure, and cholesterol levels, all of which can identify a patient’s risk of developing CHD. Perhaps surprisingly, a patient’s mental health can also have a significant impact, with people suffering from depression or social isolation being at greater risk.

Can CHD be treated?

CHD cannot be cured, but the symptoms can be managed in order to reduce the risk of heart attack. Lifestyle changes such as stopping smoking and reducing alcohol intake can be very effective, and with time, the risk of ex-smokers can reduce to the same level as non-smokers. Increasing exercise levels and eating healthily can also have a significant impact.

In addition to lifestyle changes, medical interventions may be required for some patients, including statins to reduce circulating cholesterol levels, antiplatelet drugs which reduce the risk of a clot, beta blockers which improve blood flow, and nitrates to widen the blood vessels. Other drugs can help reduce blood pressure and slow the heart down, giving it less work to do.

Coronary angioplasty is a keyhole procedure that involves a stent being inserted into the coronary artery to widen it and allow blood to flow more freely. Technology has developed to the point where this is now often performed while the patient is conscious, as an outpatient procedure. Coronary bypass grafting involves using a healthy blood vessel from elsewhere in the body to replace a diseased cardiac artery, and ultimately, some patients may be required to undergo a heart transplant if the heart is severely damaged.

What can I do?

There are a number of NHS recommendations for improving heart health and awareness of potential problems, for instance:

  • visiting your GP for advice on reducing or stopping smoking;
  • having a cholesterol test;
  • having your blood pressure checked;
  • increasing your levels of physical activity;
  • healthy weight loss;
  • improving your diet by reducing salt and unsaturated fats;
  • limiting alcohol intake; and
  • looking after your mental health.

Nick Haley, an associate in the clinical negligence team at Penningtons Manches and member of the specialist cardiology subteam, said: “We support any initiative that aims to highlight the dangers of heart disease and the potentially simple steps that can be taken to improve heart health. Unfortunately, we do sometimes come across cases where patients have undergone procedures that have not gone to plan, or where they have not received appropriate advice from their GP, but in general, doctors are well informed about the risks of heart disease and able to advise patients who are looking to reduce their risk of having to undergo more invasive treatments.”