Coronary Artery Disease – or CAD

More than 6% of adults suffer from ischaemic heart disease, which results from coronary artery disease – or CAD. Ischaemic heart disease is the most common single cause of death worldwide. Atherosclerosis is a systemic disease characterized by the formation of plaques in the arteries. Depending on the arteries affected this can lead to stroke, myocardial infarction or acute limb ischemia. Atherosclerotic plaque formation in the coronary arteries is characteristic of CAD, a progressive condition that causes restricted blood flow to the heart. Rupture of one of these plaques can lead to the formation of a blood clot in the lumen of the artery, known as atherothrombosis. This blood clot can grow to further limit – or even completely block – blood flow through the artery, potentially resulting in myocardial infarction. The degree of stenosis (or narrowing) of the arteries and characteristics of the plaque determine the symptoms that a patient may experience. There may be no symptoms until significant stenosis has occurred. Apart from event prevention through lifestyle modifications such as smoking cessation and dietary changes, guidelines for the treatment of CAD recommend risk factor management for hypertension, diabetes or dyslipidemia, antithrombotic therapy with antiplatelet agents and, in some cases, revascularization using a stent to widen the artery and restore blood flow. Despite antiplatelet therapy, the residual risk of atherothrombotic events remains high. In one clinical study, there was a 7% residual risk of stroke, myocardial infarction or cardiovascular death despite dual antiplatelet treatment in patients with, or at high risk of, cardiovascular disease. In another clinical study, dual antiplatelet therapy with ticagrelor and acetylsalicylic acid in patients with previous myocardial infarction reduced the risk of adverse cardiovascular events but increased the risk of bleeding. Despite this, 8% of patients still experienced adverse cardiovascular events over 3 years. To help reduce this residual risk, clinical trials are investigating optimal treatment strategies in patients with CAD. The results of these studies hold great interest for physicians and patients alike.