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Coronary Artery Disease: What Are the Dangers to Humans

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Coronary artery disease is one of the many forms of cardiovascular disease. It is a serious condition in which blood does not properly circulate through the blood vessels that carry oxygen to the heart muscle, the coronary arteries. It presents a significant burden in the developed world, as it is one of the most prevalent diseases and is the leading cause of death in developed Countries, surpassing other important diseases such as cancer, stroke and diabetes, and is also a significant source of morbidity and disability. It affects both men and women and is also present in multiple age groups, not just among the elderly, as demonstrated by the mortality rates for the disease of approximately 1/10,000 for white males aged 25-34 years, and almost 1/100 for white males aged 55-64 years. There are a wide range of risk factors for coronary artery disease, including both risk factors that can be modified and others that can not be modified. Sedentary behaviour, cigarette smoking, hyperlipidemia, hypertension, obesity, poor dietary choices and diabetes are some of the major risks factors that can be modified. On the other hand, individual genetics as quantified by a family history of coronary artery disease, most notably premature cases of the disease in first-degree relatives aged 55 years and 65 years for males and females, respectively, male sex and age represent risk factors that can not be modified.

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There are two main causes for coronary artery disease. The first cause, which is also the most frequent cause, is due to the buildup of lipidic plaques called atheromas at the subintimal level of the coronary arteries, which leads to coronary artery atherosclerosis. There are two main structural components of an atheromatous plaque: the lipid core and the fibrous capsule. The lipid core is formed by lipid-filled macrophages, also referred to as foam cells, that were recruited to the intima of the artery. The fibrous cap surrounds the lipid core and is formed by smooth muscle cells that were also recruited to the intima and were subject to a phenotypic change in order to assume their new capsular function. This buildup of atheromas is dangerous as it reduces the diameter of the lumen of the affected coronary arteries by which oxygenated blood flows through, and in severe cases if left untreated, may even cause complete blockage of the vessel. This may lead to a condition known as angina pectoris, characterized by chest pain or discomfort, which is caused by the inadequate oxygen supply to the heart muscle due to this reduction in lumen diameter. Furthermore, if the atheromatous plaque is left to develop even longer, it may end up rupturing; effectively precipitating the formation of a spontaneous thrombus following the activation of the coagulation cascade triggered by factors exposed by the ruptured plaque, such as collagen. Blood flow through the coronary arteries is therefore further compromised, causing acute myocardial ischemia, which, in turn, may lead to a host of subsequent conditions called acute coronary syndromes such as ST-elevation myocardial infarction, heart failure, transmural infarction and even sudden cardiac death.

The second main cause of coronary artery disease, although less frequent, is coronary artery spasm. Similar to the consequences of an atheromatous plaque, coronary artery spams reduce the diameter of the lumen following a spontaneous and significant vasoconstriction of the artery. The subsequent compromise in blood flow may lead to variant angina, and if the spasm is very intense, a thrombus may form and lead to one of the acute coronary syndromes such as transmural infarction. The precise mechanisms involved in coronary artery spasm are not well understood. Potential mechanisms include a dysfunction of the artery endothelium, which in normal circumstances produces important vasodilators such as nitric oxide, and is therefore an important structure for vasoregulation. Also, the presence of an atheromatous plaque may lead the artery to vasoconstrict, potentially from a reduced reactivity to vasodilators in the area of the plaque, as the latter’s presence also leads to endothelial dysfunction.

I learned the specifics of how important the proper function of blood is to the human body and how the heart functions to ensure that humans stay functional and healthy. Next, I found how coronary artery disease impacts the human body and how harmful it can be if left untreated. 

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