Ischaemic heart disease
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Understanding Ischaemic Heart Disease: Causes, Prevention, and Management
Overview of Ischaemic Heart Disease
Ischaemic heart disease (IHD), primarily caused by atherosclerotic coronary artery disease, is a leading cause of death in industrialized nations, accounting for a significant proportion of mortality . The disease predominantly affects individuals aged 50-60, leading to substantial disability during the prime of life .
Causes and Risk Factors
Atherosclerosis and Other Causes
The primary cause of IHD is atherosclerosis, a condition characterized by the buildup of plaques in the coronary arteries. Other less common causes include connective tissue disorders, coronary embolism, and various types of arteritis, which together account for less than 1% of cases .
Environmental Tobacco Smoke
Exposure to environmental tobacco smoke significantly increases the risk of IHD. Non-smokers living with smokers have a 30% greater risk of developing IHD, which is almost half the risk of smoking 20 cigarettes per day. This increased risk is attributed to mechanisms such as platelet aggregation, which can lead to acute cardiac events.
Genetic Factors
Genetic variants, particularly those affecting the ATP-sensitive potassium channel (KATP), have been linked to IHD susceptibility. Specific single nucleotide polymorphisms (SNPs) in the KCNJ11 gene, which encodes the Kir6.2 subunit of the KATP channel, have been identified as potential protective or risk factors for IHD.
Prevention Strategies
Population-Level Interventions
Preventing IHD requires a multifaceted approach. At the population level, interventions should focus on controlling tobacco use, promoting healthy diets rich in fruits, vegetables, legumes, and nuts, and reducing the intake of unhealthy foods such as saturated fats, trans fats, and excessive salt. Encouraging physical activity and controlling pollution are also crucial.
Individual-Level Interventions
For individuals at high risk, primary prevention strategies include managing hypertension, LDL cholesterol, and diabetes through guideline-driven approaches. Improving adherence to healthy lifestyles and medication regimens is essential and can be supported through education, technology, and personalized care.
Sex Differences in IHD
Presentation and Outcomes in Women
Women often present with IHD later in life compared to men, typically 7-10 years later. Despite this delayed onset, women have worse outcomes, particularly younger, premenopausal women who experience higher rates of adverse events following acute myocardial infarction . These differences may be due to a higher prevalence of non-obstructive coronary artery disease, stress cardiomyopathy, and microvascular dysfunction in women.
Inequalities in Treatment
There are documented inequalities in the referral and treatment of IHD between men and women. Women are less likely to receive timely and appropriate care, which may contribute to their poorer outcomes . Addressing these disparities requires more female-specific data from clinical trials and a focus on improving the quality of care for women with IHD .
Global Burden and Trends
Mortality Rates
IHD remains the leading cause of death worldwide, with significant variations in mortality rates between countries. High-income countries have seen a decline in age-standardized IHD mortality rates, while low-and-middle-income countries have experienced increasing rates, now accounting for over 80% of global IHD deaths. This shift is attributed to lifestyle changes in these regions that mirror those of high-income countries.
Conclusion
Ischaemic heart disease is a complex condition with multifactorial causes and significant global impact. Effective prevention and management require a combination of population-level interventions, individual risk management, and addressing sex-specific differences in presentation and treatment. Continued research and targeted strategies are essential to reduce the burden of IHD worldwide.
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