Despite medical advances in the past few decades, rates of PCAD in patients with diabetes, hypertension, obesity continue to rise.
Heart disease is a broad term that covers several conditions, such as arrhythmias, congenital heart defects, coronary artery disease (CAD), disease of the heart muscles, and disease of the heart valves. Heart disease is the leading cause of death in men, women, and individuals of most ethnic and racial groups in the United States. This includes individuals who are Black, Alaska Native, Hispanic, and Indigenous, as well as White men. For women who are Alaska Native, Asian American, Hispanic, Indigenous, or Pacific Islander, heart disease is second only to cancer.1
To understand the risks for heart disease, it is important to review how the heart works. The heart is divided into 4 chambers: 2 upper chambers (atria) and 2 lower chambers (ventricles). The right side of the heart moves blood into the lungs through pulmonary arteries, where it picks up oxygen. The blood then returns to the left side of the heart through pulmonary veins, where it gets pumped out to the rest of the body.2 To keep blood flowing in the right direction, 4 valves open to let blood flow 1 way. These valves are the aortic, mitral, pulmonary, and tricuspid valves. They must open all the way and close tightly for the heart to function fully.2
The muscles of the heart contract and relax in a continuous cycle. During contraction (systole), the ventricles squeeze tight, which forces blood out of the heart and into the body and lungs. During relaxation (diastole), the ventricles fill with the blood from the atria.2
The heart’s electrical system keeps it beating regularly, ensuring the continuous exchange of oxygen-poor and oxygen-rich blood. Electrical signals begin in the right atrium, then travel through specialized pathways to the ventricles, prompting contraction.2
PREMATURE HEART DISEASE
Premature heart disease is defined as heart disease occurring in men younger than 45 years and women younger than 55 years. These cutoffs tend to vary among studies, ranging from ages 45 to 65 years.3
Between 4% and 10% of all heart attacks occur before age 45, and most strike men. CAD is responsible for approximately 80% of these heart attacks. Approximately 4% are triggered by inborn abnormalities of the coronary artery system anatomy, 5% are attributable to blood clots blocking a coronary artery, and 5% are the result of blood clotting disorders. Finally, 6% are caused by a wide range of problems, including chest trauma, illicit drug use, inflammation of the coronary arteries, and radiation therapy in the chest area.4
CORONARY ARTERY DISEASE
Coronary artery disease is defined as the reduction of blood flow to the heart muscle due to buildup of atherosclerosis in the arteries of the heart. Unfortunately, the incidence of premature CAD (PCAD) with 3 major known risk factors—diabetes, hypertension, and obesity—increased between 2000 and 2016.5 Risk factors for premature heart disease include the following:
Pharmacists can help ensure modifiable risk factors that are associated with premature heart disease are controlled by verifying that patients are filling their cholesterol, diabetes, hypertension, and weight management medications in a timely manner. Pharmacists can also troubleshoot adherence issues and counsel patients about different methods of smoking cessation and weight loss. In addition, pharmacists can provide patients with other resources to find more information on their conditions.
The good news is that most risk factors for premature heart disease are modifiable. The bad news is that lifestyle changes are incredibly difficult for many individuals, as they have been practicing these unhealthy habits all their lives. Pharmacists can contribute to helping make positive changes by actively listening to patients and offering small but important steps to help them on their journeys.
ABOUT THE AUTHOR
Kathleen Kenny, PharmD, RPh, is a clinical medical writer for Healthline Media in Colorado Springs, Colorado.
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