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The heart’s like a pump work consisting of several rooms. Heart organ covered with muscles and with a variety of blood vessels in and out. The flow of blood from the lungs, where blood in the oxygen, flowing into the heart and pumped out to all parts of the body.

When the blood has been sent that contain oxygen to body tissues, they will return to the heart and is pumped back into the lungs.

The heart needs more oxygen to function optimally. But there is blood in the heart of the room itself is not functioning to supply oxygen to the heart muscle.

Special blood vessels in the outer parts of the heart, called coronary arteries, in charge of supplying the oxygen-rich blood and nutrients to the heart muscle to function properly. Three major blood vessels and blood vessels are much smaller this task.

When one or more blood vessels are blocked (usually due to the formation of blood clots in the lumen of blood vessels), blood will not reach the heart muscle at the bottom of the blockage, preventing the supply of oxygen to the heart muscle.

Coronary Heart Disease

Coronary heart disease usually caused by the emergence of “atherosclerosis (hardening of the arteries), a process in which deposits of fatty material containing cholesterol (plaque) formed along the artery walls. When plaque is formed, blood vessels become narrowed.

The Causes of Coronary Heart Disease

Although Coronary Heart Disease seems to be a part of natural aging on arterial blood vessels, but he’d formed at different speeds on each person, based on a variety of factors as follows:

• High blood pressure
• Blood cholesterol levels are abnormal
• The habit of smoking
• Diabetes
• Men
• Obesity
• Lack of exercise
• Family history with Coronary Heart Disease

Each of these factors can damage blood vessels and / or accelerate the formation of plaque.

Consequences

Narrowing of blood vessels, are not capable of delivering oxygen-rich blood to the heart muscle is required for activity, and this will lead to a situation that is called angina.Angina usually occurs after the patient perform physical activity or stress, when the heart muscle must work harder and requires more oxygen, such as:

• Exercising
• Physical activity is more severe
• Eat (fatty and alcoholic beverages)
• Experiencing stress is accompanied by a sudden spike in blood pressure

Angina is not the same as a heart attack, but a symptom of a heart disease in general and occurs when the arteries have narrowed by plaque that is not capable of supplying oxygen to the heart muscle (blood flow is reduced). If the coronary artery becomes blocked total (there was no blood flow), blood flow to the heart muscle will stop, and a heart attack (Myocardial Infarction) can occur, which would cause damage to our heart.

The doctor will perform various tests to diagnose Coronary Heart Disease, through:

• An electrocardiogram (EGG or EKG) that measures the electrical activity of our heart. This test can show a part of the heart muscle that have experienced damage from a heart attack.
• Stress Test, to record the electrical activity when our physical activity and can be the basis of information abgi doctor if part of the heart has been damaged.
• Heart Catheterization (Angiography) is an act performed by a cardiologist in Catheteriazation Lab. This action requires a contrast dye squirted into the arteries that will appear at the time of X-rays emitted. This procedure can show if there has been a blockage or narrowing of heart arteries. So that the doctor can determine what actions should be implemented.

Management of Coronary Heart Disease.

Management of Coronary Heart Penyakti can be done through a combination of lifestyle changes and physical activity, diet, and Action Medical. Nitroglycerin generally be granted if the patient complains of pain arising in the chest, but please note this drug is not intended to treat the blockage itself:

1. Dilation with balloon / balloon dilatation (PTCA)
2. Installation of heart stents (PCI)
3. Arterial vein graft Shortcuts (CABG)

Determining which actions to be taken, based on the general condition of the patient and the level of damage, and the number of blockages that occur in heart arteries.

1. Balloon dilatation (PTCA)

Development of coronary artery heart is invasive measures undertaken to widen a clogged artery. PTCA is the medical term most often used.

At the time of PTCA, a catheter (very small tube, and subtle) is equipped with a balloon diujungnya, will be inserted through a vein (usually in the groin area) and are encouraged to enter into the heart arteries are narrowed. The balloon will be developed gradually, so as to suppress the fat tissue that causes narrowing of blood vessels and arteries dilate.

2. Installation of heart stents (PCI)

Many patients who have been executed with balloon dilation (PTCA) will experience a narrowing of the back or called restenosis, the treated area. Heart stent could reduce the risk of blockage or narrowing again after PTCA.

Heart stent is a cinicin that can be developed and made of metal (non-stainless steel or cobalt-chromium metal). This stent will be attached to a balloon and inserted similar to the action PTCA. When the balloon expanded, a stent will also be widened, and then locked in a blockage and will serve as a permanent buffer. Stent is what will keep narrowing of the arteries that remain open. So a stent in the artery will be permanently, holding the blood vessels so that blood flow to the heart muscle no longer disrupted.

3. Arterial vein graft Shortcuts (CABG)

Arterial vein graft Shortcuts (CABG) surgery is performed for patients with Coronary Heart Disease, to overcome angina and reduce the risk of heart attack.

A vein or artery from another part of the patient’s body will be grafted from the aorta to the heart arteries, to be a shortcut blockage caused by atherosclerosis and will increase blood flow to the myocardium (heart muscle)

Reference:
B. Braun Melsungen AG – Germany

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What actually starts the process of clogged arteries is a lack of vitamin C or ascorbate. Technically, this is called subclinical scurvy. Tiny cracks form in the arteries due to a lack of ascorbate. The body uses cholesterol to bandage over and patch these cracks. This is a protective measure on the body’s part to overcome the existence of these cracks. Otherwise, there would be internal bleeding. So it is not actually the cholesterol that starts the process of clogged arteries, it is the lack of ascorbate that begins the process of plaque being created in the arteries. Plaque is the name given to cholesterol as it builds up to cover the arterial cracks and then hardens in the arteries to form clogged arteries.

What can be done to clean clogged arteries? Give the body ascorbate. The body knows how to clean clogged arteries when given the proper substances. Buffered mineral ascorbates can be used to help heal the clogged arteries. There are other synergistic substances that can be used as well to help clean and restore clogged arteries.

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How to Lower Your Cholesterol
Cholesterol is a waxy, fat like substance that your body needs to function normally. Cholesterol is naturally present in cell walls or membranes everywhere in the body, including the brain, nerves, muscles, skin, liver, intestines, and heart.

Your body uses cholesterol to produce many hormones, vitamin D, and the bile acids that help to digest fat. It takes only a small amount of cholesterol in the blood to meet these needs. If you have too much cholesterol in your bloodstream, the excess may be deposited in arteries, including the coronary (heart) arteries, where it contributes to the narrowing and blockages that cause the signs and symptoms of heart disease. Normally all of the colesterol the body need made on liver, but cholesterol also enter to body from food, such as animal-based foods likes milk, eggs, meat. Too much cholesterol in your body is a major risk factor for heart disease.

How Does High Cholesterol Cause Heart Disease?
When there is too much cholesterol in your blood, it builds up in the walls of your arteries, causing a process called atherosclerosis, a form of heart disease. The arteries become narrowed and blood flow to the heart muscle is slowed down or blocked. The blood carries oxygen to the heart, and if enough blood and oxygen cannot reach your heart, you may suffer chest pain. If the blood supply to a portion of the heart is completely cut off by a blockage, the result is a heart attack.

There are two forms of cholesterol:
1. Low-density lipoprotein (LDL or “bad” cholesterol)

• LDLs have litle protein and high levels of cholesterol
• LDL is the main source of artery clogging plaque

2. High-density lipoprotein (HDL or “good” cholesterol).

• HDLs have high level protein and very litle cholesterol
• HDL actually works to clear cholesterol from the blood

Triglycerides are another fat in our bloodstream. Research is now showing that a high levels of triglycerides is also linked to heart disease. What Are the Symptoms of High Cholesterol?
High cholesterol itself does not cause any symptoms; so many people are unaware that their cholesterol levels are too high. Therefore, it is important to find out what your cholesterol numbers are because lowering cholesterol levels that are too high lessens the risk for developing heart disease and reduces the chance of a heart attack or dying of heart disease, even if you already have it.

What Numbers Should I Look For?
Some recommend that everyone over the age of 20 should get their cholesterol levels measured at least once every 5 years. The test that is performed is a blood test called a lipoprotein profile. That includes:

• Total cholesterol level
• LDL (the “bad” cholesterol)
• HDL (the “good” cholesterol)
• Triglycerides

Here is how to interpret your cholesterol level:
*/ HDL (good) cholesterol protects against heart disease, so higher HDL number is better

What Affects Cholesterol Levels?
A variety of factors can affect your cholesterol levels. They include:

• Diet. Saturated fat, trans fat, and cholesterol in the food you eat increase cholesterol levels. Reducing the amount of saturated fat and trans fats and cholesterol in your diet helps lower your blood cholesterol level. Increasing the amount of fiber and plant derived sterols can also help lower LDL cholesterol.
• Weight. In addition to being a risk factor for heart disease, being overweight can also increase your cholesterol. Losing weight can help lower your LDL, total cholesterol levels, and triglyceride levels, as well as raise your HDL.
• Exercise. Regular exercise can lower LDL cholesterol and raise HDL cholesterol. You should try to be physically active for 30 minutes on most days.
• Age and Gender. As we get older, cholesterol levels rise. Before menopause, women tend to have lower total cholesterol levels than men of the same age. After menopause, however, women’s LDL levels tend to rise.
• Heredity. Your genes partly determine how much cholesterol your body makes. High blood cholesterol can run in families.
• Medical conditions. Occasionally a medical condition may cause an elevation of cholesterol levels in the blood. These include hypothyroidism (an underactive thyroid gland), liver disease and kidney disease.
• Medications. Some medicines, like steroids and progestins may increase the “bad” cholesterol and decrease the “good” cholesterol.

How Is High Cholesterol Treated?
The main goal in treating high cholesterol is to lower your LDL. To lower cholesterol, eat a heart-healthy diet, exercise regularly, and maintain a healthy weight. Some may also need to take cholesterol lowering drugs.

Doctors determine your “goals” for lowering LDL based on the number of risk factors you have for heart disease.

Major risk factors include: age (men 45 years and older, women 55 years and older), cigarette smoking, high blood pressure, an HDL less than 40 mg/dL, family history of premature heart disease in a male first degree relative less than 55 years and female first degree relative less than 65 years of age.

• If you have 0-1 risk factor for heart disease, you are at low-to-moderate risk. Generally, lifestyle changes are effective in keeping the cholesterol in check.
• If you have 2 or more risk factors for heart disease, you are at moderate risk, depending on what heart disease risk factors you have. Sometimes your doctor will try lifestyle changes, but most people require cholesterol-lowering drugs or drugs to raise HDL plus an appropriate diet and exercise program.
• If you have known heart disease, diabetes, or multiple risk factors, you are at high risk. Most people in this group will require a combination of cholesterol-lowering drugs and lifestyle changes to control their cholesterol levels.

LDL cholesterol goals include the following:

• Category I, Highest Risk (ten-year risk greater than 20%*): your LDL goal is less than 100 mg/dL. For those w

  ith a very high risk (those who have had a recent heart attack, those with cardiovascular disease or peripheral artery disease combined with diabetes or poorly controlled risk factors, or those with metabolic syndrome), it may be most effective for the LDL goal to be less than 70 mg/dL.

• Category II, Next Highest Risk (ten-year risk 10-20%*): your LDL goal is less than 130 mg/dL. Your doctor may set your LDL goal at less than 100 mg/dl if your LDL is 100-129.
• Category III, Moderate Risk (ten-year risk less than 10%*): your LDL goal is less than 130 mg/dL. Your doctor may set your LDL goal at less than 100 mg/dl if your LDL is 100-129.
• Category IV, Low Risk (0-1 risk factor*): your LDL goal is less than 160 mg/dL.
• Risk categories are based on the Framingham Heart Study to estimate 10-year risk for coronary heart disease (heart attack and coronary death). It is based on adults aged 20 and older who do not have heart disease or diabetes. The risk factors included in the Framingham calculation are age, total cholesterol, HDL cholesterol, systolic blood pressure, treatment for high blood pressure, and cigarette smoking.

To reduce your risk for heart disease or keep it low, it is very important to:

• Control any other risk factors you may have, such as high blood pressure and smoking.
• Follow a low saturated fat, low cholesterol eating plan
• Maintain a desirable weight.
• Participate in regular physical activity.
• Begin medication therapy as directed by your physician.

What Drugs Are Used to Treat High Cholesterol?
Cholesterol-lowering drugs include:

• Statins
• Niacin
• Bile-acid resins
• Fibric acid derivatives
• Selective cholesterol absorption inhibitors

Cholesterol-lowering medicine is most effective when combined with a low-cholesterol diet and exercise program.

Statins
Statins block the production of cholesterol in the liver itself. They lower LDL, the “bad” cholesterol, and triglycerides and have a mild effect in raising HDL, the “good” cholesterol. These drugs are the first line of treatment for most people with high cholesterol. Side effects can include intestinal problems, liver damage, and in a few people, muscle tenderness or weakness.
Examples of statins include:

• Altocor
• Crestor
• Lipitor (atorvastatin)
• Lescol (Fluvastatin)
• Mevacor (lovastatin)
• Pravachol (pravastatin)
• Zocor (simvastatin)

Advicor is a combination of a statin and niacin (see below).
Caduet is a new drug that is a combination of a statin (Lipitor or atorvastatin) and a blood pressure-lowering drug called amlodipine (Norvasc). Vytorin is a combination of a statin and a cholesterol absorption inhibitor((simvastatin + ezetimibe).

Niacin
Niacin is a B-complex vitamin. It’s found in food, but is also available at high doses by prescription. It lowers LDL cholesterol and raises HDL cholesterol. These drugs also lower elevated triglycerides. The main side effects are flushing, itching, tingling, and headache, yet aspirin can reduce many of these symptoms. However, speak with your doctor first. Niacin or nicotinic acid, includes the brand names Niacor, Niaspan, or Slo-niacin. Over-the-counter preparations include extended-release, timed-release, and controlled-release. Niacin found in dietary supplements should not be used to lower cholesterol. Your doctor or lipid specialist will let you know what type of niacin is best for you.

Bile Acid Sequestrants
These drugs work inside the intestine, where they bind to bile and prevent it from being reabsorbed into the circulatory system. Bile is made largely from cholesterol, so these drugs work by reducing the body’s supply of cholesterol, thus lowering total and LDL cholesterol. The most common side effects are constipation, gas, and upset stomach. Examples of bile acid resins include:

• Questran and Questran Light (cholestyramine)
• Colestid (colestipol)
• WelChol (colesevelam)

Fibrates
Fibrates lower triglyceride levels and can increase HDL and lower LDL cholesterol. The mechanism of action is not clear but it is thought that fibrates enhance the breakdown of triglyceride-rich particles and decrease the secretion of certain lipoproteins. In addition, they induce the synthesis of HDL.
Examples of fibrates include:

• Tricor (fenofibrate)
• Lopid (gemfibrozil)
• Lofibra (fenofibrate)

Selective cholesterol absorption inhibitors
Zetia (ezetimibe) works to lower LDL by inhibiting the absorption of cholesterol in the intestines. Vytorin is a newer drug that is a combination of Zetia (ezetimibe) and a statin (simvastatin), and can decrease total and LDL cholesterol and raise HDL levels.
In some cases, patients may be prescribed more than one cholesterol-lowering drug to achieve the desired results.

What Are the Side Effects of Cholesterol-Lowering Drugs?
The side effects of cholesterol-lowering drugs include:

• Muscle aches*
• Abnormal liver function
• Allergic reaction (skin rashes)
• Heartburn
• Dizziness
• Abdominal pain
• Constipation
• Decreased sexual desire
• Memory problems

*/ If you have muscle aches, call your doctor immediately. This could be a sign of a life-threatening condition.

Are There Foods or Other Drugs I Should Avoid While Taking Cholesterol-Lowering Drugs?
Ask your doctor about the other drugs you are taking, including herbals and vitamins, and their impact on cholesterol-lowering drugs. You should not drink grapefruit juice while taking cholesterol-lowering drugs, as it can interfere with the liver’s ability to metabolize these medications.

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Experts from the Framingham Heart Study have determined that high blood cholesterol is one of the factors for a coronary heart disease or CHD. The result of their study showed that the ones who have a higher cholesterol level is the most likely he will have a coronary heart disease or CHD. Coronary heart disease is unusual at low cholesterol levels. A connection between high blood cholesterol and heart disease was also confirmed by another group of experts. Their studies showed that lowering the total LDL cholesterol (bad cholesterol) levels drastically reduces coronary heart disease. Recently, a series of trials of cholesterol using statin drugs showed that lowering the total cholesterol and LDL-cholesterol greatly reduces the chance of experiencing a heart attack, angioplasty (a bypass that requires surgery) and dying of coronary heart disease-related causes.

What are the risk factors that increases the risk of developing heart disease? The risk factors are the condition that one has. Even though some risk factors can be modified some risk factor can not be changed. All in all, the more risk factor that you have the more chances you will be experiencing a heart disease. Here are some of the risk factor that can not be modified:

Here are some known risk factors that one can change:

• High total cholesterol and high LDL (bad) cholesterol
• Low HDL (good) cholesterol
• Smoking
• High blood pressure
• Diabetes ( the risk of developing a heart disease is high if you are diabetic)
• Physical inactivity
• Obesity or overweight

It is advisable to go to a physician if you are not sure if you have a high blood cholesterol.
Although some expert agree that the high blood cholesterol and heart disease is somewhat connected; there are also a few expert who tend to disagree that too much animal fat or high cholesterol and heart disease go together. They argued that there is no such thing as “bad” or “good” cholesterol. They believe that mental stress, physical activity and change of body weight may influence the level of the blood cholesterol and that a high blood cholesterol is not dangerous but only reflects an unhealthy condition. There lots of factors that some experts disagree with each other. Whatever causes of high cholesterol and heart disease are. The only sure thing is… to live a healthy life.

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