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Cardiovascular disease (CVD), which encompasses coronary artery disease (CAD), stroke, and peripheral artery disease, is a significant global health burden, affecting men and women. CVD is the leading cause of death worldwide, accounting for more than 17.3 million deaths per year, a rate that is expected to increase to more than 23.6 million by 2030.1 The mortality rate of CVD is higher than the rate of all cancers combined and represents about 31% of global deaths.1 About 801,000 people in the US died from heart disease, stroke, and other cardiovascular diseases in 2013, and about 2,200 Americans die each day from these diseases, one every 40 seconds.1

CAD is the most common type of CVD, accounting for 370,000 annual deaths and 1 in 7 deaths in the US.1 About 17.5 million Americans have CAD.2 CAD is characterized by accumulation of atherosclerotic plaques in the coronary arteries that progressively narrow the arterial lumen, resulting in impaired blood flow to the myocardium. The reduction of blood flow depends on the severity of arterial narrowing and may result in symptoms. A myocardial infarction is often the result of CAD due to the blockage of coronary arteries and rupture of atherosclerotic plaques. According to the CDC,3 735,000 Americans have a myocardial infarction annually, with 525,000 being first-time myocardial infarctions and 210,000 involving people who have previously had a myocardial infarction. Patients with CAD may be asymptomatic or present with angina or shortness of breath. Angina is typically classified based on the Canadian Cardiovascular Society grading system (Table 1). Patients presenting with an acute myocardial infarction present with angina, shortness of breath, nausea, vomiting, dizziness, diaphoresis, pallor, and pain that radiates to the upper extremity or jaw.

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Which of the following is the strongest risk factor for coronary artery disease?

A health and economic burden

CAD not only poses a significant impact on morbidity and mortality in the US but also a significant financial impact regarding management of the disease. Hospital use expenditures related to managing and treating CAD in the US exceed $100 billion per year, and expenditures for all US adults older than age 55 with CAD exceed $60 billion per year, according to the Center for Financing, Access, and Cost Trends’ Agency for Healthcare Research and Quality’s Medical Expenditure Panel Survey 2010 and analysis by Frost and Sullivan.4 Management of CAD encompasses combined efforts with lifestyle/behavioral changes, pharmacologic management, and revascularization procedures such as percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG). PCI has become a first-line procedure in the management of CAD in the US. The procedure is performed 600,000 times annually in the US at a cost of more than $12 billion.

Preventing CAD

Considering the morbidity, mortality, and economic impact of CAD, healthcare providers must make a strong effort to effectively treat patients and help control the overall disease burden. The cornerstone in the treatment of CAD is prevention of the disease by reducing risk factors and addressing them along the course of treatment. Risk factors associated with CAD include dyslipidemia, hypertension, diabetes mellitus, weight, smoking, diet, exercise, and alcohol consumption.

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Lifestyle modification to reduce the risk of CAD includes smoking cessation, exercise, weight control, and alcohol consumption. Tobacco use induces endothelial dysfunction, reduces coronary vasoreactivity, increases circulatory carbon monoxide levels, impairs functional status, and increases blood pressure.6 Educating patients on health risks associated with tobacco use and offering tobacco cessation have been shown to lessen the risk of disease development.