Coronary Artery Disease

What is coronary artery disease?

Coronary artery disease (CAD) is the most common type of heart disease in the United States and a leading cause of death for both men and women.

CAD affects the coronary arteries, which are the blood vessels that carry blood and oxygen to your heart muscle. When these arteries are damaged or diseased, your heart does not get the blood it needs.

CAD develops slowly over time when plaque builds up inside your coronary arteries. Plaque is a waxy, sticky substance made of fat, cholesterol, calcium, and other materials found in your blood. This buildup is called atherosclerosis.

As plaque grows, it narrows the arteries and reduces blood flow to your heart muscle. Over time, this can partly or fully block the flow of blood and oxygen your heart needs to work properly.

• Obstructive CAD is when a large coronary artery is narrowed by 50% or more, significantly reducing blood flow.
• Nonobstructive CAD is when a large coronary artery is narrowed by less than 50%.
• Coronary microvascular disease affects the heart's tiny blood vessels. Damage to the walls of these small vessels reduces blood flow to your heart. This type is more common in women.

You may be more likely to develop CAD if you:

• Eat a diet high in saturated fat
• Smoke or use tobacco products
• Are not physically active
• Are overweight or have obesity
• Have high blood pressure, high cholesterol, or high blood glucose (diabetes)
• Have a family history of heart disease, especially in a parent or sibling who had it before age 50
• Are getting older, especially men, who tend to develop CAD earlier in life than women

Your health care provider may use a risk calculator to estimate your chance of having a heart attack or stroke in the next 10 years. Talk with your provider about your personal risk.

Symptoms of CAD vary from person to person. Some people have no symptoms at all. Others do not know they have CAD until they have a heart attack or their heart suddenly stops beating (cardiac arrest).

When symptoms do occur, they may include:

• Chest pain, pressure, tightness, or discomfort that may spread to your neck, jaw, shoulder or arm
• Shortness of breath
• Feeling unusually fatigued

These symptoms may start or get worse when you are active or under stress and may go away with rest. They can also get worse over time as plaque continues to build up.

Get emergency help right away if you have chest pain or discomfort that does not go away or happens while you are resting. This may be a sign of a heart attack. Call 911.

Over time, reduced blood flow from CAD can lead to serious heart problems, including:

• Angina, which is chest pain or discomfort caused by reduced blood flow to your heart
• Heart attack, which occurs when a blood clot suddenly blocks blood flow to part of your heart, causing permanent damage to your heart muscle
• Heart failure, which occurs when your heart can't pump enough blood to meet your body's needs
• Arrhythmia, which is a problem with the rate or rhythm of your heartbeat

To find out if you have CAD, your provider may:

• Ask about your symptoms
• Ask about your personal and family health history
• Review your risk factors and lifestyle habits
• Do a physical exam, including checking your blood pressure
• Order blood tests, including checking your cholesterol and blood glucose
• Order heart health tests

If you have CAD, your provider will work with you to create a treatment plan based on which arteries are affected, how much blood flow is blocked, and what other health conditions you have. Treatments may include:

• Heart-healthy lifestyle changes, such as eating a heart-healthy diet, being more active, and quitting smoking
• Medicines to lower blood pressure, reduce cholesterol, control blood glucose, or prevent blood clots
• Procedures or surgery, such as angioplasty, or coronary artery bypass grafting (CABG), to open or bypass blocked arteries
• Cardiac rehabilitation, to improve your quality of life and help prevent future heart problems

You may be able to lower your risk of CAD or slow its progress by managing risk factors and making healthy lifestyle choices. Steps that may help include:

• Choosing heart-healthy foods
• Being physically active on a regular basis
• Reaching or maintaining a healthy weight
• Not smoking and avoiding secondhand smoke
• Limiting alcohol
• Managing stress
• Getting enough good-quality sleep

NIH: National Heart, Lung, and Blood Institute

Dementia

What is dementia?

Dementia is a loss of mental functions that is severe enough to affect your daily life and activities. These functions include:

• Memory
• Language skills
• Visual perception (your ability to make sense of what you see)
• Problem solving
• Trouble with everyday tasks
• The ability to focus and pay attention

It is normal to become a bit more forgetful as you age. But dementia is not a normal part of aging. It is a serious disorder that interferes with your daily life.

The most common types of dementia are known as neurodegenerative disorders. These are diseases in which the cells of the brain stop working or die. They include:

• Alzheimer's disease, which is the most common form of dementia among older people. People with Alzheimer's have plaques and tangles in their brain. These are abnormal buildups of different proteins. Beta-amyloid protein clumps up and forms plaques in between your brain cells. Tau protein builds up and forms tangles inside the nerve cells of your brain. There is also a loss of connection between nerve cells in the brain.
• Lewy body dementia, which causes movement symptoms along with dementia. Lewy bodies are abnormal deposits of a protein in the brain.
• Frontotemporal disorders, which cause changes to certain parts of the brain:
  • Changes in the frontal lobe lead to behavioral symptoms
  • Changes in the temporal lobe lead to language and emotional disorders
• Vascular dementia, which involves changes to the brain's blood supply. It is often caused by a stroke or atherosclerosis (hardening of the arteries) in the brain.
• Mixed dementia, which is a combination of two or more types of dementia. For example, some people have both Alzheimer's disease and vascular dementia.

Other conditions can cause dementia or dementia-like symptoms, including:

• Creutzfeldt-Jakob disease, a rare brain disorder
• Huntington's disease, an inherited, progressive brain disease
• Chronic traumatic encephalopathy (CTE), caused by repeated traumatic brain injury
• HIV-associated dementia (HAD)

Certain factors can raise your risk for developing dementia, including:

• Aging. This is the biggest risk factor for dementia.
• Smoking
• Uncontrolled diabetes
• High blood pressure
• Drinking too much alcohol
• Having close family members who have dementia

The symptoms of dementia can vary, depending on which parts of the brain are affected. Often, forgetfulness is the first symptom. Dementia also causes problems with the ability to think, problem solve, and reason. For example, people with dementia may:

• Get lost in a familiar neighborhood
• Use unusual words to refer to familiar objects
• Forget the name of a close family member or friend
• Forget old memories
• Need help doing tasks that they used to do by themselves

Some people with dementia cannot control their emotions and their personalities may change. They may become apathetic, meaning that they are no longer interested in normal daily activities or events. They may lose their inhibitions and stop caring about other peoples' feelings.

Certain types of dementia can also cause problems with balance and movement.

The stages of dementia range from mild to severe. In the mildest stage, it is just beginning to affect a person's functioning. In the most severe stage, the person is completely dependent on others for care.

Your health care provider may use many tools to make a diagnosis:

• A medical history, which includes asking about your symptoms
• A physical exam
• Tests of your thinking, memory, and language abilities
• Other tests, such as blood tests, genetic tests, and brain scans
• A mental health evaluation to see whether a mental disorder is contributing to your symptoms

There is no cure for most types of dementia, including Alzheimer's disease and Lewy body dementia. Treatments may help to maintain mental function longer, manage behavioral symptoms, and slow down the symptoms of disease. They may include:

• Medicines, which may temporarily improve memory and thinking or slow down their decline. They only work in some people. Other medicines can treat symptoms such as anxiety, depression, sleep problems, and muscle stiffness. Some of these medicines can cause strong side effects in people with dementia. It is important to talk to your health care provider about which medicines will be safe for you.
• Occupational therapy to help find ways to more easily do everyday activities
• Speech therapy to help with swallowing difficulties and trouble speaking loudly and clearly
• Mental health counseling to help people with dementia and their families learn how to manage difficult emotions and behaviors. It can also help them plan for the future.
• Music or art therapy to reduce anxiety and improve well-being

Researchers have not found a proven way to prevent dementia. Living a healthy lifestyle might influence some of your risk factors for dementia.

Depression

What is depression?

Depression is more than a feeling of being sad or irritable for a few days. It's a serious mood disorder. As one of the most common mental disorders in the United States, depression can affect how you think, feel, and your everyday life. You may not know why you feel this way, but even basic daily activities such as sleeping, eating, or working may become difficult. Depression often needs long-term treatment but getting help at the earliest sign of a problem can help manage your symptoms.

The most common types of depression are major depression and persistent depressive disorder.

• Major depression symptoms include a depressed mood or a loss of interest. Symptoms affect your daily activities and last for at least two weeks.
• Persistent depressive disorder (also called dysthymia or dysthymic disorder) has less severe depressive symptoms, but they last longer, usually for at least two years.

Other types of depression can include:

• Seasonal affective disorder comes and goes with the seasons. It usually starts in late fall and early winter and goes away during the spring and summer.
• Bipolar disorder is sometimes called manic depression. This mood disorder can cause intense mood swings.
• Depression with symptoms of psychosis is a severe form of depression that also has delusions (false beliefs) or hallucinations (seeing, hearing, or feeling something that isn't there).

There are a variety of things that may cause depression, including genetic, biological, environmental, and psychological factors. Depression can happen at any age and can affect anyone, but it's more common in women. This is often due to the physical and hormonal changes that women have during menstruation, pregnancy, the postpartum period, and menopause. Other mental disorders or chronic medical conditions such as diabetes, cancer, or heart disease may occur with depression. This may make the chronic condition or depression worse.

In some cases, there is no clear cause for depression.

You may be at a higher risk of depression if you have a close relative who has it or another mental health disorder. Going through trauma or stressful life events may raise your risk even more.

Depression doesn't look the same on everyone. The type and number of symptoms of depression can vary and don't always appear like sadness. Depression may affect you differently based on your:

• Age. The symptoms of depression may be different in a child, who may appear more irritable than sad. Teens may act out or have excessive sleepiness. The symptoms for an older adult may not be as obvious as other age groups.
• Sex. Men often show symptoms and coping behaviors differently than women. Rather than sad, men may appear angry or irritable.
• Medical conditions. Some medicines and medical conditions may cause symptoms that look like depression. Chronic conditions may make depression worse.

Symptoms of depression are ongoing and affect your day-to-day life. They can include:

• Feeling sad or "empty"
• Losing interest in favorite activities
• Overeating, or not wanting to eat at all
• Sleeping too much, or not enough
• Feeling very tired
• Feeling hopeless, irritable, anxious, or guilty
• Having aches and pains, headaches, cramps, or digestive problems
• Having thoughts of death or suicide
• Changing moods or behaviors
• Increasing use of alcohol or drugs
• Isolating from family and friends

If you think you have depression, talk to your health care provider or a mental health provider. To be diagnosed with depression, your provider may use many tools:

• A medical history will include asking about your symptoms and family history. To be diagnosed with depression, your symptoms must occur most of the day, nearly every day, for at least two weeks. One of the symptoms must be a depressed mood or a loss of interest in most activities.
• Medical tests may be done to rule out other medical conditions. Certain medicines and medical conditions (such as viruses or thyroid disorders) may cause symptoms like depression.
• A physical exam to make sure another issue isn't causing your symptoms.
• A mental health evaluation by your provider or a mental health provider.

Depression may need long-term treatment. Most treatments include medicines and/or psychotherapy (talk therapy):

• Medicines such as antidepressants may help control your symptoms. You may need to try several medicines to find which works best for you. Medicine may take time to work and can have side effects. Don't stop taking your medicine without first talking with your provider. Contact your provider if you have any concerns about side effects from the medicine.
• Psychotherapy (talk therapy) under the care of a mental health provider can help you recognize and change troubling emotions, thoughts, and behaviors. This may be done one-on-one or in a group setting. It can give you and your family support, education, skills, and coping strategies.
• Light therapy has been shown to be effective for seasonal affective disorder (SAD).
• Other treatments options may be considered if treatment isn't working or if depression is severe. These may include:
  • Electroconvulsive therapy (ECT) is a brain stimulation procedure that uses a mild electric current when you are under general anesthesia. ECT is most often used for severe depression that is not getting better with other treatments.
  • Repetitive transcranial magnetic stimulation (rTMS) is a brain stimulation procedure that uses magnetic waves to relieve depression. It's not as powerful as ECT, but with rTMS, you don't need anesthesia. It also has a low risk of negative effects on your memory and thinking.

Most cases of depression can't be prevented, but healthy lifestyle changes can have long-term benefits for your mental health. These can include:

• Getting regular exercise
• Having a consistent sleep schedule
• Controlling stress

If you, or someone you love is depressed, see your provider or a mental health provider. It's important to get treatment at the earliest sign of a problem.

If you or someone you know has thoughts of hurting themselves or attempting suicide, get help right away. If it is an emergency, dial 911.

NIH: National Institute of Mental Health

Dietary Fiber

Fiber is a substance in plants. Dietary fiber is the kind you eat. It's a type of carbohydrate. You may also see it listed on a food label as soluble fiber or insoluble fiber. Both types have important health benefits.

Good sources of dietary fiber include:

• Whole grains
• Nuts and seeds
• Fruit and vegetables

Dietary fiber adds bulk to your diet and makes you feel full faster, helping you control your weight. It helps digestion and helps prevent constipation. Most Americans don't eat enough dietary fiber. But add it to your diet slowly. Increasing dietary fiber too quickly can lead to gas, bloating, and cramps.

Centers for Disease Control and Prevention

Dietary Supplements

Dietary supplements are vitamins, minerals, herbs, and many other products. They can come as pills, capsules, powders, drinks, and energy bars. Supplements do not have to go through the testing that drugs do.

Some supplements can play an important role in health. For example, calcium and vitamin D are important for keeping bones strong. Pregnant women can take the vitamin folic acid to prevent certain birth defects in their babies.

To take a supplement as safely as possible:

• Tell your health care provider about any dietary supplements you use
• Do not take a bigger dose than the label recommends
• Check with your health care provider about the supplements you take if you are going to have any type of surgery
• Read trustworthy information about the supplement

NIH: National Institutes of Health Office of Dietary Supplements