With heart disease being the second leading killer disease in Hong Kong, maintaining good shape of this vital organ is crucial to a happy and healthy life. Dr Vincent Kwok, Director, Cardiology Centre, Hong Kong Sanatorium & Hospital, speaks to us about the causes, symptoms, and prevention of coronary artery disease – the commonest cause of heart attack and sudden death.

Get to Know Coronary Artery Disease – Causes and Symptoms

In 2011, about 12 persons died each day from coronary artery disease, with the patients predominantly being male, though the gender gap tends to narrow with the increase in age. In recent years, there is even an increasing trend in this deadly disease among younger population. What is the cause of this killer disease? Can it be prevented?

The word 'corona' means 'crown', and as the blood vessels supplying nutrients to the heart muscle wrap around the heart like a 'crown', these blood vessels are called coronary arteries. Coronary artery disease (also known as atherosclerotic heart disease, or ischemic heart disease), is the commonest type of heart disease and cause of heart attack and sudden death in the world," explained Dr Vincent Kwok. "Coronary artery disease is caused by the building up of plaque along the vessel wall of the coronary arteries which blocks the blood supply to the heart muscle. Heart attack occurs when there is sudden plaque rupture and clots clog up the artery within minutes."

With reduced blood flow to the heart muscle, the patient is likely to experience chest tightness (or angina), usually after exercise or heavy meal. The patient may also experience abnormal heart rhythm, malaise, shortness of breath, ankle swelling, syncope, or even sudden death.

"While advanced age, male gender, and a family history of coronary artery disease may contribute to the disease onset, coronary artery disease is also strongly associated with high blood pressure, stress, diabetes mellitus, lack of exercise, obesity, smoking, and high cholesterol," said Dr Kwok. In fact, about half of the coronary artery disease patients have average, but not excessively high, cholesterol level. Nevertheless, high cholesterol level is strongly associated with coronary artery disease and most important of all, it is a modifiable and reversible risk factor. "High cholesterol is the result of modern-day diet, which is usually high in saturated fat and trans-fat, and this could also lead to obesity. Apart from diet and lifestyle, inflammation also plays a role in the cause of coronary artery disease. For example, patients with rheumatoid arthritis, psoriasis or lupus erythematosus have increased risk of coronary artery disease."

Diagnosis and Preventive Measures

"There are currently many ways to diagnose coronary artery disease, such as exercise treadmill stress test, stress echocardiogram, cardiac stress MRI (magnetic resonance imaging) and CT (computed tomography) coronary angiogram, which are non-invasive tests that can help to evaluate the coronary artery status. If the patient is symptomatic of angina or ischemia (blood supply to the heart muscle is jeopardised) or having symptoms of heart attack, cardiac catheterisation is the gold standard to confirm the diagnosis. For chronic stable coronary artery disease, medicine is the first-line treatment. Medical treatment includes aspirin, cholesterol-lowering agents ('statins'), ACE (angiotensin-converting-enzyme) inhibitors, beta-blockers, nitrates, etc. Balloon angioplasty and stenting may be necessary when there is significant blockage with symptom/ischemia, or when acute heart attack ensues. Coronary artery bypass surgery is reserved for those with severe or multi-vessel coronary artery disease.

Prevention is always better than cure, and a healthy heart starts from healthy lifestyle and dietary habit. "Adopt a diet that is low in fat, salt, sugar, cholesterol but high in fiber – by all means stock up on olive oil, vegetables, lean meat, whole-grain bread and cereal, and avoid deep-fried food. Abstain from excessive drinking and smoking. Spend more time and energy on exercising – 30 minutes of exercise a day should suffice."

Love your heart and cherish your life with health and happiness!


Special Thanks:
Dr. Kwok On-Hing, Vincent, Director, Cardiology Centre, Hong Kong Sanatorium & Hospital