Coronary Artery Disease: Risk Factors, Symptoms and New Technologies to Know

By Michelle Palmer Jones

An active woman under 50, a 37-year-old former model and a 60-year-old man in reasonably good shape wouldn’t typically have a lot in common. Yet, in this story they do. They all survived massive heart attacks and afterward received diagnoses of Coronary Artery Disease (CAD).

During a trip to Arizona to go skydiving with friends in fall 2022, Rob Herndon rides to an exit altitude of 13,000 feet. “It’s all about living life to the fullest,” he says.

Mended Hearts member Diana Lee Rose knew she had a family history of CAD and had been taking preventative meds for a decade prior to her heart attack when she was about to turn 50. “My three major coronary arteries were 100%, 99% and 80% blocked even though I was riding my bike about 100 miles per week,” she says.

Kerry Horrigan had her heart attack at 37. As a former model, she always had a healthy diet and exercised. “I have no history of heart disease in my family,” Horrigan says. “I’m not the face of heart attacks.”

Rob Herndon needed five stents after having his heart attack at age 60. He says he was not overweight and was in reasonably good shape.

These stories show coronary artery disease can affect anyone, and the journey is different for each of them.

CAD is caused by cholesterol buildup in the wall of heart arteries. When a person is born, their artery interiors are smooth. Over time, the inside of the blood vessels can become irritated through high blood pressure, smoking, high cholesterol or high blood sugar.

“Just like when you cut yourself, you get a scratch and then a scab and a scar. The same thing happens inside your heart; except instead of a scar, you get cholesterol build up,” says Dr. Jimmy Kerrigan, an interventional cardiologist at Ascension St. Thomas Hospital in Nashville, Tennessee.

“That cholesterol, if you keep irritating it, can get thicker and thicker,” he continues. “If there’s a blockage that builds up and clogs more than 70% of the blood vessel, it can cause chest pain, shortness of breath or fatigue when exerting your- self. If the blockage gets over 90%, that chest pain, fatigue or shortness of breath can come even at rest.”

CAD typically presents in two different ways. Stable Coronary Disease means a patient has cholesterol build up that slowly gets worse over time. Acute Coronary Syndrome is a sudden change where a blockage becomes severe and causes sudden, reduced blood flow to the heart. This could be caused by cholesterol rupturing in the heart arteries or a clot forming that causes a heart attack.

Risk Factors: We Can’t Pick Our Parents

DNA is one factor that can contribute greatly to CAD. Unfortunately, this means no matter if patients make healthy lifestyle choices, they could be at high risk for this disease.

Dr. Jimmy Kerrigan, Interventional Cardiologist, Ascension St. Thomas Hospital, Nashville, Tenn.

“I have vegan marathon runners who come in with heart attacks because of their DNA, and we can’t change that,” Dr. Kerrigan says. “So, I’m a believer in controlling the things that we can control.”

Unlike DNA, there are risk factors that people can control; this includes smoking, exercise, body weight and diet. Dr. Kerrigan recommends avoiding tobacco products entirely, including dipping and chewing. Thirty minutes of exercise a day where you break a sweat and become short of breath is currently recommended, and a healthy body weight is considered having a body mass index (BMI) of less than 25.

“The Mediterranean diet has been studied and found to reduce the chances of future heart attacks and blockages forming,” Dr. Kerrigan says. “Base a diet around fruits and vegetables, lean meats like chicken, turkey and fish, and olive oil.”

Processed carbohydrates, red meat and pork are contributors to heart artery disease. Dr. Kerrigan tells his patients to stay away from food that comes out of a box, bag or can as these foods are typically full of salt and chemicals that can inflame and irritate the heart.

Other risk factors for CAD include high blood pressure, high cholesterol and high blood sugar.

Dr. Kerrigan likes to see a top blood pressure number less than 130. Recommended cholesterol levels are different for people with and without known heart artery disease.

For people with heart artery disease, medications can help keep LDL or “bad cholesterol” levels below 70. If there is no known heart artery disease, keeping LDL below 100 is recommended. As for high blood sugar, those with heart artery disease should aim for triglyceride levels of 135, and for those without, a level below 150 is preferred.

When to See a Cardiologist

If a patient has a family history of CAD, they are likely at risk for it, too.

Fortunately, today, there is a test called a coronary artery calcium score that patients can take around the age of 50.

“That score is a simple, cheap, low-risk test using a CAT scan of the chest to look for hardening of the arteries, and this can tell us whether you have heart artery blockages even before becoming symptomatic,” Dr. Kerrigan says.

If test results are abnormal, doctors can intervene early by prescribing medications such as statins to reduce cholesterol while monitoring the patient closely.

“All doctors do in this case is recommend a baby aspirin regimen, cholesterol medication and double-down on addressing all the other risk factors,” Dr. Kerrigan says.

When patients don’t respond to medication alone, cardiologists may need to go inside the body and open up blockages.

“I go in through people’s wrists or — rarely — the groin, and put tubes into the heart and open up blockages with stents, which are little metal straws that prop open the blood vessel,” Dr. Kerrigan says. “There have been several studies of patients with known blockages where half of them get stents or bypass surgery and half of them get medicine. The patients on the medication who still weren’t feeling well then received stents or bypass surgery. We found that it’s safe to wait and only do stents or bypass surgery for patients who fail medicinal therapy.”

When cardiologists find several severe blockages or if the patient has a history of diabetes and has blockages in certain locations, a heart surgeon may come in to perform open heart surgery to reroute the blood around the blockages.

Treating CAD

When cardiologists started using drug- coated stents, the percentage of patients who saw scar tissue form inside the stents dropped from 20% to 5%. Taking what they learned from that success, cardiologists are now studying the effects of drug-coated balloons where the devices are covered in medication that helps prevent scar tissue from forming.

Doctors in the U.S. are currently awaiting the results of the AGENT clinical trial that began in 2021. By next year, preliminary results should be available that will indicate whether regular or drug-coated balloons were better at treating patients who had previous stent collapses.

Currently, only permanent stents that cannot be removed are available, but researchers are now evaluating bio- absorbable stents that dissolve into the body over time as another option. In fact, there is a new bioabsorbable stent being used right now outside of the U.S. that shows promise in being as effective as metal stents.

There’s also an old treatment from years ago that is now being used in about 40 U.S. hospitals: It involves using radiation inside the heart arteries to blast scar tissue. When stents fail or fill in with scar tissue, radiation can be used to open the artery back up.

Find Your Support System

For patients with coronary artery disease, it’s important to catch it early and treat it with exercise, healthy eating habits and medication. It’s also important to find emotional and social support.

“Depression is incredibly common after being diagnosed with coronary artery disease,” says Dr. Kerrigan. “Trials show short courses of medication for depression can help improve outcomes. So do support groups and cognitive therapy. If you have depressive thoughts, know it is common. It is treatable, and there’s nothing to be ashamed of because it’s not your fault.”

Today, post heart attack, Rose spends her time traveling the world and visiting national parks. “My advice to others is: Never give up,” she says. “Set your goals and dreams, and go for it.”

Horrigan eats a strict Mediterranean diet and incorporates cardio and strength training into her daily exercise routine. “Limiting stress is huge,” she says. “Creating and standing by boundaries may be one of the most important changes I made.”

And Rob Herndon found a hobby that keeps him active and motivated. “After two heart attacks, six stents and triple bypass, I’m an active member of Skydivers Over Sixty.”

Living Life With CAD

By Lisa Horn

In 2013, Diana Lee Rose was in cardiac rehab at Scripps Memorial Hospital after having a heart attack. She was 49, and the recovery was not easy even though she was an avid cyclist. “I vowed to ride my bike 32 miles in a ride 10 months after triple bypass,” she says. “With proper training, I was able to ride it successfully at a pace that was faster than I rode before my myocardial infarction. A year later, I completed the 56-mile ride in San Diego at the same pace.”

And she hasn’t stopped moving since. Each year, Rose sets goals to accomplish, whether it’s traveling across the nation or participating in physical activities. In 2021, she visited 47 states and 40-plus national parks in eight months. In 2022, she vowed to walk 100 miles during the Mended Hearts World of Support fundraiser in September. “I walked almost 200 miles by September 29,” she says.

If that wasn’t enough, she spent 3.5 months traveling through Europe with her best friend, Tiffany, in 2022. The whirlwind tour included stops in The Netherlands, England, Germany, Czech Republic, Austria, Hungary, Slovenia, Croatia, Italy, Switzerland, France, Spain, Portugal and Morocco.

Her advice to others? “Talk to your doctor to get advice on an exercise program that is appropriate to your fitness level,” she says. “Ask for a referral to a nutritionist to adjust or start a healthy diet. Meet with others that have CAD by attending a Mended Hearts meeting. And never give up. Set your goals and dreams, and go for it. Having a triple bypass is like an oil and lube; get ’er done and get back into life.”

The Mental Side of CAD

By Lisa Horn

Like many people after the shock of a heart attack, Rob Herndon says it took a while to regain confi- dence in his body. Not only did he have to rebuild strength and stamina physically, he also had to address the mental aspects of living with CAD.

“I have focused on not letting CAD define who I am,” he says. “I work at focusing on the solution and not the problem. There is no physical solution to the CAD, but there is a positive mental solution. I watch for the way the fears and insecurities can manifest as impatience and intolerance and how these affect my relationships with others.”

Today, Herndon says that he continues to work on acknowl- edging that he has a disease that requires certain adjustments to his lifestyle. “I don’t go crazy changing my diet because extreme changes don’t last for me,” he says. “I’m not a focused exercise person, but I try not to sit around constantly. It takes time to find a balance, and I’m constantly adjusting mentally and physically.”