Heart News

What Causes Coronary Artery Disease?

As seen in the New York Times* (March 21, 2004):

Cleveland Clinic Heart Center researchers are questioning widely held concepts about coronary artery disease, and coming to new conclusions on the best ways to prevent and treat this frequently deadly condition. As the Times wrote, "the new model of heart disease shows that the vast majority of heart attacks do not originate with obstructions that narrow arteries."

Previously, it was thought that heart attacks occurred when fatty matter in the coronary arteries built up to such a severe degree that it would eventually close off the artery or that a blood clot, traveling through the blood stream, could lodge in the narrowed section and a heart attack would occur. Now we know that many plaques (made of fatty matter, calcium, and stray cells) of different sizes attach to the walls of the arteries. Many of the plaques are hard on the outside and soft and mushy on the inside. When the plaque’s hard, outer shell ruptures (cracks or tears), platelets (disc-shaped particles in the blood that aid clotting) come to the area, and blood clots form around the plaque. These blood clots can occlude or block the artery and cause a heart attack (Click here to learn more). In many cases the size of these plaques would not be thought significant enough to treat by surgery or angioplasty.

The article questions the use of traditional therapies to "fix" a blocked artery to prevent a heart attack. While Dr. Topol believes that recent and continuing studies show that a more powerful way to prevent heart attacks in patients at high risk is to adhere rigorously to lifestyle modification — "giving up smoking, for example, and taking drugs to get blood pressure under control, drive cholesterol levels down and prevent blood clotting." He also states that patients who have symptoms of heart disease or those with an abnormal functional test (such as a stress test) should proceed with further diagnostic testing such as cardiac catheterization. The decision to treat with an interventional procedure (angioplasty or stent or coronary artery bypass surgery) is based on the patient's symptoms and the results of diagnostic studies.

Over the past several months, Cleveland Clinic Heart Center researchers have been making international news with a series of startling discoveries about the common medical treatments for coronary artery disease, and its genetic causes (Click here to learn more about these news stories).

Eric Topol, M.D., co-chairman of the Heart Center and chairman of Cardiovascular Medicine at The Cleveland Clinic, announced the discovery of the first gene confirmed as a cause of coronary heart disease in humans.

Steven Nissen, M.D., released the results of a study that suggested that coronary artery disease could be reversed, using a newly developed synthetic form of HDL (the "good" cholesterol). Following this, Dr. Nissen released a separate study comparing two varieties of statin drugs (commonly used to treat coronary artery disease). This study not only revealed which of the varieties was most effective, it showed that administering this drug at what was then the maximum allowable dose over a period of time, brought the buildup of plaque in the coronary arteries, to a halt.

These and other discoveries represent a "sea change" in the treatment of coronary artery disease. In an editorial in the New England Journal of Medicine*, Dr. Topol addressed the medical world on the importance of these changes and their implications for the profession.

Discovery, innovation, and breakthroughs in heart care are nothing new at The Cleveland Clinic Heart Center. Over the past 50 years, The Cleveland Clinic has been the site of some of the most significant moments in the history of heart care, from the discovery of moving coronary cine-angiography, to the first published coronary artery bypass.

The Cleveland Clinic Heart Center has been ranked number one in America for nine years in a row by U.S. News & World Report in its annual "America's Best Hospitals" survey. Visit the Cleveland Clinic Heart Center website for the latest breaking news, and a wealth of information about the heart, heart disease, and the physicians and services of The Cleveland Clinic Heart Center.

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