Coronary Artery Disease (CAD) is the biggest pandemic India is facing today, said Dr P. Manokar, Senior Consultant Interventional Cardiology, & Clinical Lead Heart Failure & Transplant Program, Kauvery Hospital, Chennai, Vadapalani. While CAD is on the decline in western nations, in India, it is on the rise. On the occasion of World Heart Day, with the theme, ‘Use Heart for Action,’ Dr Manokar outlines the imperative strategies India must take to bring down incidences of coronary artery disease.
Risk factors for CAD
“High incidence of diabetes is the foremost risk factor in India. Compared to other countries diabetes in India is more aggressive, strikes younger Indians and even those with lean phenotype,” says Dr Manokar, “We are the highest risk race in the world for CAD and diabetes is a major cause.”
While family history is an important risk factor, psychosocial stress is also a major cause for CAD. For most patients, the coronary event is preceded by a stressful social event such as job or financial loss, marital discord etc. Sedentary lifestyle and lack of healthy habits can also lead to CAD. Alcohol consumption among diabetics is an indirect risk factor for CAD.
Diagnosis
Clinical evaluation is the primary step for diagnosis of CAD. Investigation by treadmill test is the most reliable tool to rule out heart disease. Dr Manokar recommends treadmill test once every two years for those over 40 and every year for people with diabetes. Used with discretion, CT Angiogram is a foolproof diagnostic test to rule out CAD.
Treatment options
Cardiologists advocate lifestyle changes as the first step in the treatment of CAD. Patients are asked to reduce weight, exercise and make dietary changes. This is followed by medication to control risk factors such as diabetes, BP, high cholesterol etc. Patients are given blood thinners, cholesterol lowering drugs or drugs to increase blood flow to the heart, depending upon their condition. If these measures fail, invasive treatment such as angioplasty is the next option.
Angioplasty
Balloon angioplasty or percutaneous transluminal angioplasty is a minimally invasive procedure that uses a minuscule balloon to stretch open a narrowed or blocked artery. Several recent advances in angioplasty have improved outcomes remarkably.
Percutaneous Coronary Intervention is an angioplasty procedure that involves inserting a drug-eluting stent into the artery to open up blocks and allow blood to flow freely, with the drug preventing rejection of the stent by the body.
In the case of recalcitrant calcified plaque in the artery, Rotablation Angioplasty is performed, where a catheter with a rotating burr is inserted into the artery to grind away the plaque and widen the artery. Orbital atherectomy (OA) is yet another advanced minimally invasive procedure that removes plaque from artery walls to treat narrowed arteries and is used to prepare calcified plaque before percutaneous coronary intervention (PCI) and peripheral percutaneous endovascular interventions. Intravascular lithotripsy (IVL) uses acoustic pressure waves to break up calcium deposits in the arteries. Laser coronary angioplasty uses a laser to treat coronary artery disease (CAD). Interventional cardiologists also employ a retrograde technique to open a chronic total occlusion (CTO) by advancing a guidewire into the artery distal to the occlusion. Almost all types of complex blocks and heart diseases can be address by the technically advanced angioplasty today.