James de Lemos, M.D. Answers Questions On: Coronary Artery Disease

Coronary artery disease develops slowly over decades, in response to the deposit of cholesterol into the walls of the arteries in the heart.

In the presence of elevated cholesterol or other risk factors – such as high blood pressure, diabetes, smoking, and family history – these atherosclerotic cholesterol-filled plaques may progress and enlarge. They may enlarge to the point where they block the flow of blood down an artery that feeds blood back to the heart.

The manifestations of coronary artery disease may remain silent and not obstruct the flow of blood until, at some point, a plaque ruptures and you have a heart attack. Or the disease may progress gradually and then block the blood flow, in which case you may develop symptoms of angina.

First, we want to prevent the plaque from developing in the first place. Second, if the plaque is present, we want to prevent it from getting any larger and possibly shrink it. And then finally, if plaque is there, we want to prevent it from rupturing and causing a heart attack.

If a heart attack does occur, we are trying to develop better treatments to minimize the amount of permanent damage to the heart and to prevent complications of the heart attack.

We think the best test to predict coronary artery disease or to detect it very early is a test called coronary calcium scan. It’s for people at risk for atherosclerosis who are not already otherwise taking preventive therapies like statins and aspirin, but would be willing to take these drugs if they were found to have calcified plaque in the arteries.

Middle-aged men and women (or older) may benefit from having one of these low-cost scans that detects plaque in the arteries.

At UT Southwestern, we are actively researching additional tests, including blood-based biomarkers, imaging tests, and genetics to make cardiac risk prediction even more accurate.