Everything you need to know about coronary heart disease

While it’s true that more Canadians die of coronary heart disease (CHD) than any other illness, things are changing. You're now far less likely to succumb to a fatal CHD-related heart attack, thanks to better medicines and real surgical innovations.

• Your heart is a giant muscle that needs lots of fuel (oxygen and various nutrients) to operate. A web of blood vessels called coronary arteries surround it just to provide this vital service.
• In a healthy heart, freshly oxygenated, nutrient-rich blood flows freely through smooth, flexible arteries. A diagnosis of coronary heart disease (CHD), however, means that the insides of the vessels have become clogged with fatty streaks called plaque. Blood can no longer flow so effortlessly.
• Sometimes, arteries get so plaque-riddled and narrowed that your heart receives an insufficient amount of oxygen-rich blood. Exert yourself — shovel snow, mow the lawn, climb onto the treadmill your kids gave you on your last birthday — and your heart may nearly scream out for more oxygen.

Below your breastbone, deep in your chest, come warning signs:

• an uncomfortable tightness and the sense that an elephant is standing on your chest. This is angina, a wave of crushing pain that may spread down your arms and up to your jaw.
• And if one of the coronary arteries has become completely blocked, that part of your heart will get no oxygen at all. This is a heart attack.

Luckily, there are many things you can do to stop — and even reverse — this alarming progression of events. In taking charge of your CHD, you'll not only be able to prevent a heart attack but also reduce your chances of developing conditions associated with heart disease, such as congestive heart failure and heart rhythm disturbances like atrial fibrillation.

• Lifestyle changes (low-fat diet, exercise, weight loss, smoking cessation, stress reduction) to naturally halt or even reverse the disease.
• In tandem with lifestyle measures, medications (such as antiplatelets, beta-blockers, cholesterol-lowering drugs) to slow the disease, prevent complications and control angina.
• For more severe disease, surgery (coronary artery bypass, angioplasty) to relieve symptoms and prevent impending heart attack or stroke.

• Ask about your odds (for a longer life, a stroke, a fatal complication) before committing to bypass surgery or angioplasty. Many people never bother to check.
• Eat more fish. Recent trials show that people with CHD can dramatically lower their risk of dying by regularly eating fish rich in omega-3 fatty acids.
• Be cautious about supplements. Popular herbs and vitamins, such as ginkgo biloba, garlic, vitamin E, fish oil and coenzyme Q10, can thin blood. If you're taking a heart drug that does the same thing — aspirin, warfarin (Coumadin), clopidogrel (Plavix) — serious bleeding problems could develop. Ask your doctor about interactions.
• Remember your daily aspirin. If you don't take it routinely, you are twice as likely to die from CHD. A 1999 study found that one in five people with CHD fails to take aspirin regularly. If aspirin upsets your stomach, discuss effective alternatives with your doctor.
• Deal with marital stress. A 2000 study found that tension with a spouse hurts women’s hearts in particular (while men react more to work stress). If you've got problems at home, work them out with the appropriate counselling and support.

• The Heart and Stroke Foundation of Canada can be reached at 613-569-4361 or www.heartandstroke.ca.
• The Canadian Cardiovascular Society (613-569-3407) offers The Canadian Journal of Cardiology online at www.ccs.ca.

Keep this guide in mind and protect your heart by making healthy choices. For more information, be sure to contact your doctor.