Coronary heart disease, also called coronary artery disease (CAD), is a condition that affects the coronary arteries that are responsible for delivering blood, oxygen, and other nutrients to the heart muscle itself. Coronary heart disease results when a fibrous tissue, called plaque, builds up inside the arterial walls, causing a partial or complete obstruction of blood flow. This condition is more commonly called atherosclerosis. When the heart muscle is deprived of oxygen-carrying blood, a symptom called angina may occur. Angina is characterized by a sensation of pain, burning, pressure, or other type of discomfort, which is generally felt in the chest area and may radiate to the arms, neck, or jaw regions.

Angina may be the first indication that coronary artery disease is present. For this reason, chest pain should never be ignored, even when it seems to come and go. Other, less fortunate people with coronary heart disease often get no warning that they have the disease, until they suffer a full-blown heart attack.

When a heart attack, or myocardial infarction occurs, the heart muscle's supply of oxygen is completely cut off, resulting in permanent tissue death for a portion of the heart muscle.

Risk Factors for Coronary Heart Disease

Risk factors for coronary heart disease are circumstances or conditions that increase the likelihood of developing this disease. They are generally divided into two groups: controllable and uncontrollable.

• Controllable risk factors
• High blood pressure (hypertension)
• High blood cholesterol (hyperlipidemia)
• Smoking
• Obesity
• Sedentary lifestyle (too little physical activity)
• Diabetes
• Stress

• Gender (males are at greater risk initially than women. Once a woman reaches menopause however, her risk for heart disease eventually equals or surpasses that of a man. Experts believe that this may be in part due to a decrease in the production of estrogen, a female sex hormone that appears to offer some protection against heart disease)
• Heredity (family history of heart disease)
• Age (risk increases with age)

In rarer instances, coronary heart disease can result from other medical conditions. Some examples of these include the formation of a blood clot in the coronary artery due to an abnormal blood clotting condition, inflammation of the coronary arteries, spasms of the coronary arteries secondary to cocaine abuse, and congenital (meaning that a person is born with it) abnormalities of the heart.

There is a wide range of symptoms that may be experienced by a person affected by coronary heart disease. Some people experience no symptoms, and are not aware that they have heart disease. Others may experience mild chest discomfort or shortness of breath, while some persons with coronary heart disease have steady, uncontrolled chest pain that interferes with their daily activities.

The classic symptom associated with coronary heart disease is called angina. Angina is usually described as a chest discomfort that can be experienced as a "pressure", "squeezing", "burning", or "heaviness" sensation in the center of the chest area, underneath the rib cage. The discomfort can sometimes spread to the neck, jaw or arm regions. Other symptoms that may accompany angina include sweating, lightheadedness, nausea, shortness of breath, and palpitations.

Angina is sometimes classified into two types: stable and unstable based on the occurrence of symptoms. Stable angina is usually somewhat predictable. It may occur with increased exertion or extreme emotion, or following a large meal. The symptoms do not last long (usually one to five minutes) and are relieved by a period of rest.

Unstable angina is less predictable. It may occur with little exertion or during rest, it often comes and goes at frequent intervals, and may be accompanied by more severe symptoms. Since the extent of coronary heart disease does not always match the duration and severity of chest discomfort, it is important for all persons who experience chest pain to have their symptoms evaluated by a doctor.

Many deaths associated with heart disease are preventable. The key to prevention of coronary heart disease is related to many aspects of lifestyle. By modifying lifestyle factors, individuals themselves, hold the key to lowering their risk for developing and preventing illness and death from heart disease.

The American Heart Association offers the following recommendations for lowering the risk of heart disease:

1. Quit smoking. Cigarette smoking is considered the biggest risk factor for sudden cardiac death. Smokers' risk of heart attack is more than twice that of a nonsmoker. By quitting smoking, an individual can immediately reduce the risk for heart disease.
2. Control blood pressure. High blood pressure (hypertension) increases the workload of the heart. Over time, the heart muscle become weakened and begins to enlarge. This increases the risk of heart attack, congestive heart failure, stroke, and kidney failure. Adults should have their blood pressure checked regularly. Medication may be needed when lifestyle changes are ineffective in keeping the blood pressure within normal range. The goal for blood pressure is 140/90 or less.
3. Control blood cholesterol. As levels of cholesterol rise in the blood, the risk for coronary heart disease increases. By adopting a diet that is lower in saturated fat and cholesterol, coupled with an increase in physical activity, it is often possible to reduce cholesterol levels. When diet and exercise alone prove ineffective in reducing cholesterol level, medications may be needed. Optimal blood cholesterol levels are LDL (low density lipids or "bad cholesterol") less than 160 mg/dl if no more than 1 risk factor is present or LDL less than 130 mg/dl if 2 or more risk factors are present. HDL (high-density lipids or "good cholesterol") greater than 35 mg/dl and triglycerides less than 200mg/dl are recommended.
4. Increase physical activity. Regular, moderate to vigorous intensity exercise plays a significant role in preventing heart disease. Studies have shown that moderate exercise, when done regularly, is beneficial in reducing the risk for heart disease. Regular exercise can also help to reduce blood cholesterol levels and blood pressure, as well as decrease risk for developing diabetes and obesity. It makes sense to become more physically active.
5. Maintain and achieve a desirable body weight. Persons with excess body fat are more likely to develop coronary heart disease. Obesity not only puts undo strain on the heart muscle but it can adversely influence blood pressure, blood cholesterol levels, and increase the risk for developing diabetes. Even modest weight loss (10-20 pounds) can reduce the risk of heart disease. A body mass index of 21-25 is recommended.
6. Consider estrogen replacement. Postmenopausal women are advised to talk with their doctor about the risks and benefits of estrogen replacement therapy. A decision on whether or not to begin estrogen replacement therapy should be made jointly, by a woman and her doctor, based on a woman's overall risk factors for coronary heart disease and other existing health conditions.
7. Maintain normal glucose levels. Diabetes increases the risk of developing heart disease, even when the blood sugars are kept under control. If someone have diabetes, it is very important for him/her to monitor and control as many risk factors for coronary heart disease as he/she can. If diabetes is not present, the blood sugar should be checked regularly to screen for this disorder.
8. Attempt to control the amount of stress in life. Some researchers have noted a connection between coronary heart disease and stress. Although scientists still do not know exactly how stress might increase the risk for heart disease, it is generally considered wise to try to avoid stressful events, especially if they seem to contribute to other unhealthy behaviors like over-eating, smoking, or increased alcohol consumption.

Even though the treatments for heart disease have advanced a lot over the years, experts agree that lifestyle modifications remain the single most effective way to combat coronary heart disease. When lifestyle modifications are not enough, additional treatments like medication and perhaps surgery, may be needed to treat this form of heart disease. Lifestyle changes specifically shown to help in reducing the risk or improving the symptoms of heart disease include:

1. Quitting smoking
2. Maintaining a normal blood pressure
3. Keeping cholesterol levels within normal range
4. Engaging in regular physical activity
5. Maintaining as near normal body weight as possible
6. Keeping blood glucose levels within normal range when diabetes is present
7. Reducing the amount of stress in life
   

1. Nitrates: Nitroglycerin is one type of nitrate medication that is often prescribed to treat coronary artery disease. Nitrates dilate the arteries that supply the heart with blood. In doing so, they increase the flow of blood and oxygen to the heart itself. Nitrates also reduce the workload of the heart by decreasing the amount of blood returning to the heart for pumping to the rest of the body.
   
2. Beta-blockers: They slow the heart rate and decrease the force needed to contract the heart muscle. In doing so, beta-blockers reduce the workload of the heart. Atenolol is a commonly prescribed beta-blocker medication.
   
3. Calcium channel blockers: Nifedipine, verapamil, and diltiazem are examples of commonly prescribed calcium channel blockers. These medications open up the coronary arteries and may also decrease the heart muscle's needs for blood and oxygen.
   
4. Aspirin: It has the ability to stop blood clots from forming within the coronary arteries. It has been shown to reduce the risk of heart attack (myocardial infarction) in people who have coronary heart disease. However, doctor's advice is required before taking aspirin.

1. Cholesterol-lowering medications. When diet and exercise fail to lower cholesterol levels, medication may be needed. Some examples of cholesterol-lowering medications include atorvastatin, cholestyramine, gemfibrozil and niacin. Atorvastatin has a greater efficacy in lowering cholesterol level.
2. Blood pressure lowering medications. High blood pressure causes the heart to enlarge and weaken. If remains untreated, it increases the risk of stroke, heart attack, and kidney and heart failure. Many different types of medication are used to treat high blood pressure. The physician can determine which medications are best for an individual.
3. Estrogen replacement. Postmenopausal women, especially those with many risk factors for coronary heart disease, may benefit from estrogen therapy. Doctor's consultation will help in deciding if a woman is a good candidate for estrogen replacement therapy.

When lifestyle modifications and medications are unsuccessful in treating the symptoms of coronary heart disease, or when the physician determines that the risk of heart attack is too great due to severe blockages in the coronary arteries, surgical treatments may be advised. Surgical options include:

1. Coronary angioplasty. Often called balloon angioplasty, or percutaneous transluminal coronary angioplasty (PTCA).
   
2. Coronary artery bypass grafting (CABG).

All of the treatments for coronary artery disease are aimed at relieving symptoms and reducing the risk of complications. None of the treatments are considered a cure for heart disease. Optimal management of coronary heart disease will always include lifestyle changes aimed at reducing the overall risk factors.

Stroke is a type of cardiovascular disease. It affects the arteries leading to and within the brain. A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts. When that happens, part of the brain cannot get the blood (and oxygen) it needs, so it starts to die.

Stroke can be caused either by a clot obstructing the flow of blood to the brain or by a blood vessel rupturing and preventing blood flow to the brain.

The brain is an extremely complex organ that controls various body functions. If a stroke occurs and blood flow can't reach the region that controls a particular body function that part of the body won't work as it should.

Risk factors are traits and lifestyle habits that increase the risk of disease. Extensive clinical and statistical studies have identified several factors that increase the risk of stroke. Most of them can be modified, treated or controlled. Some can't.

• High blood pressure
• Tobacco use
• Diabetes mellitus
• Carotid or other artery disease
• Atrial fibrillation - This heart rhythm disorder raises the risk for stroke.
• Transient ischemic attacks (TIAs)
• Certain blood disorders - A high red blood cell count thickens the blood and makes clots more likely. Sickle cell disease (also called sickle cell anemia) is a genetic disorder.
• High blood cholesterol
• Physical inactivity and obesity
• Excessive alcohol
• Some illegal drugs - Intravenous drug abuse carries a high risk of stroke. Cocaine use has been linked to strokes and heart attacks.

• Increasing age
• Sex (gender) - Stroke is more common in men than in women.
• Heredity (family history) and race
• Prior stroke or heart attack
• Signs and symptoms

It's important to know the signs and symptoms of a stroke so that you or someone you know can get prompt treatment. The most common signs and symptoms include:

• Sudden numbness, weakness, or paralysis of the face, arm or leg - usually on one side of the body
• Loss of speech, or trouble talking or understanding speech (aphasia)
• Sudden blurred, double or decreased vision
• Dizziness, loss of balance or loss of coordination
• A sudden, severe
• bolt out of the blue
• headache or an unusual headache, which may be accompanied by a stiff neck, facial pain, pain between the eyes, vomiting or altered consciousness
• Confusion, or problems with memory, spatial orientation or perception

For most people, a stroke gives no warning. But one possible sign of an impending stroke is a transient ischemic attack (TIA). A TIA is a temporary interruption of blood flow to a part of your brain. The signs and symptoms of TIA are the same as for a stroke, but they appear for a shorter period - several minutes to 24 hours - and then disappear, without leaving apparent permanent effects. You may have more than one TIA, and the recurrent signs and symptoms may be similar or different. A TIA indicates a serious underlying risk that a full-blown stroke may follow. People who have had a TIA are nine times as likely to have a stroke as are those who haven't had a TIA.

If you notice any signs of a stroke or TIA, get medical help right away. A TIA may seem like a passing event. But it can be an important warning sign - and a chance to take steps that may prevent a stroke. If someone appears to be having a stroke, watch the person carefully while waiting for an ambulance. You may need to take additional actions in the following situations:

• If breathing ceases, begin resuscitation.
• If vomiting occurs, turn the person's head to the side. This can prevent choking.

Every minute counts when it comes to treating a stroke. The longer a stroke goes untreated, the greater the damage and potential disability. The success of most treatments depends on how soon a person is seen by a doctor in a hospital emergency room after signs and symptoms begin.

Knowing your risk factors and living healthfully are the best steps you can take to prevent a stroke. In general, a healthy lifestyle means that you:

• Control high blood pressure (hypertension)
• Lower your cholesterol and saturated fat intake
• Take B vitamins
• Don't smoke
• Control diabetes
• Maintain a healthy weight
• Exercise regularl