Chest pain, diabetes, and smoking: Factors that worsen the outcome in patients with coronary artery disease

This study investogated factors that are associated with poor prognosis (disease outcome or course) among coronary artery disease patients. 

Coronary artery disease is a common medical condition caused by the narrowing of blood vessels that supply the heart with blood, oxygen and nutrients. 

Coronary artery disease can be caused by cholesterol – a substance found in fatty foods. Cholesterol builds up in arteries, narrowing them and decreasing blood flow to the heart. The decreased blood flow can cause symptoms such as chest pain (angina) or shortness of breath. However, a complete blockage can result in a heart attack. 

Stable coronary artery disease refers to when there is a strong pattern of angina, a history of heart attack, or the presence of cholesterol build-up in arteries. It is hard to tell which patients will suffer from a heart event, such as a stroke or heart attack, and which patients won't. However, there are risk factors that can help predict the likeihood of heart events and the likelihood of death. 

This study looked at clinical measurements, such as high blood pressure and the presence of other diseases, in patients with stable coronary artery disease to see if they could predict the occurrence of a heart attack or death over a 4 year period. 

The study found that people who had the highest risk of heart attack or death were smokers, had high blood pressure, had a stroke, had high level of fat (lipids), had diabetes, heart failure, atrial fibrillation (abnormal heart rhythm), liver disease, chronic pulmonary disease (poor lung function), chronic kidney disease, cancer, depression, anxiety, high heart rate, and high white cell count, haemoglobin and creatinine levels. 

It was then found that managing these risk factors could save 13-16 life years from early death or provide 15-18 heart event-free years per 1000 patients. 

This study concluded that assessing the above clinical measurements helps to predict a person's risk of having a heart event or early death and therefore should be used to aid treatment decisions. 

Although each of the clinical measurements listed above are associated with a poorer prognosis among coronary artery disease patients, not all factors have the same predictive value and some are associated with higher risks than others.

If you, or someone you know, have coronary artery disease, talk to a doctor about measuring your individual risk of having a heart event and measuring the likely disease prognosis.