Author: Endonita Hajzeraj
Lifestyle and Drug Therapy
Although Coronary Artery Disease is a fatal disease with no known cure, it is a highly predictable, preventable, and treatable with the existing knowledge. From the information presented in the other themes, we know that CAD is a multi-factorial process that is due to the interactions of environment risk factors as well as various predisposing genes (1). This theme focuses on the environmental influences that contribute to CAD. The study of these risk factors is critical since the ability to predict the risk for CAD is individually based on individual choices and lifestyle. The various conventional risk factors of CAD include, but are not limited to, smoking, diabetes, poor diet, hypertension, and obesity (1). These lifestyle choices all have one thing in common; they are linked to causing excess oxidative stress in cells, thus damaging healthy cells into diseased states.
Smoking of cigarettes is a significant modifiable risk factor for coronary artery disease. Although the risk for CAD among smokers is related to dose, the risk for CAD increases with an increase in the number of cigarettes smoked per day. The result of smoking causes an increase in oxidation of low-density lipoprotein (1). As we learned from molecular basis of CAD from theme one, over oxidative stress is detrimental to the cell. Smoking causes stress on the cells, which causes an imbalance between the production of reactive oxygen and the cell’s ability to detoxify the reactive intermediates (1). Due to their highly reactive nature, reactive oxygen species can attack almost all biomolecules, which include lipid membranes.
In most cohort studies that have been done on coronary artery disease, they have contributed to further information about lifestyle choices on the risks of CAD. We talked mostly about the choices that one makes that may escalate the propensity of achieving that diseased state. Well, once someone has this disease, what do they do then? Drugs is the most common method of treating coronary artery disease. While some lifestyle changes should accompany this, drug therapy is more prevalent. As mentioned in previous literature, most people who have coronary artery disease suffer from hypercholesterolemia. Many of the drugs that lower cholesterol have been deemed to help lower plaque buildup in the arteries. In a study conducted by Joshi et al., they tested the efficacy of combination therapy of rosuvastatin and ezetimibe vs just the rosuvastatin monotherapy on lipid profile of patients with coronary artery disease (2). Although statins are established as first in line lipid lowering therapy, sometimes they may not be able to achieve treatment goals in significant number if patients.
They determined therapy of rosuvastatin and ezetimibe combination resulted in significantly higher change in all lipid parameters compared to rosuvastatin alone (2). In a similar study, the effect of atorvastatin treatment duration on oxidative stress markers and lipid profile in patients with CAD was researched (3). Since we know that oxidative stress is a marker and risk factor for many diseases including CAD, understanding how drugs can target and treat oxidative stress is helpful in maintaining low LDL cholesterol levels (3). This study determined the levels of oxidative substances decreased in patients who have been receiving atorvastatin, therefore atorvastatin contribute to the lowering of oxidative stress in these patients (3). These studies help push the field forward because it gives us other ways to prevent CAD, even if some of the risk factors are present.
- Keil, U. 2000. “Coronary Artery Disease: The Role of Lipids, Hypertension and Smoking.” Basic Research in Cardiology 95 (1): I52–58. https://doi.org/10.1007/s003950070010.
- Joshi, Sandeep, Ruby Sharma, Harbir Kaur Rao, Udit Narang, and Nitin Gupta. 2017. “Efficacy of Combination Therapy of Rosuvastatin and Ezetimibe vs Rosuvastatin Monotherapy on Lipid Profile of Patients with Coronary Artery Disease.” Journal of Clinical & Diagnostic Research 11 (12): 28–31. https://doi.org/10.7860/JCDR/2017/30458.11004
- Shahsavari, Gholamreza, Amir Raoufi, Aram Toolabi, Nahid Hosseninejadmir, Hassan Ahmadvand, and Mehdi Safariebrahimsarabie. 2017. “The Effect of Atorvastatin Treatment Duration on Oxidative Stress Markers and Lipid Profile in Patients with Coronary Artery Diseases: A Case Series Study.” ARYA Atherosclerosis 13 (6): 282–87. http://muhlenberg.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=127733084&login.asp&site=ehost-live&scope=site.
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