From the Guidelines
Yes, Coronary Artery Disease (CAD) is a type of atherosclerotic cardiovascular disease (ASCVD). CAD specifically refers to the buildup of plaque in the coronary arteries that supply blood to the heart muscle. ASCVD is a broader term that encompasses various conditions where atherosclerosis (plaque buildup) affects arteries throughout the body, including the coronary arteries, cerebral arteries, and peripheral arteries. The atherosclerotic process involves the accumulation of cholesterol, calcium, and other substances in the arterial walls, leading to narrowing and potential blockage of these vessels. This shared pathophysiology is why CAD is classified as an ASCVD, as supported by the 2024 standards of care in diabetes, which defines ASCVD as a history of an acute coronary syndrome or MI, stable or unstable angina, coronary heart disease with or without revascularization, other arterial revascularization, stroke, or peripheral artery disease assumed to be atherosclerotic in origin 1.
Key Points
- CAD is a condition where plaque builds up in the coronary arteries, leading to potential blockage and heart muscle damage.
- ASCVD is a broader term that includes CAD, as well as other conditions where atherosclerosis affects arteries throughout the body.
- The atherosclerotic process is a shared pathophysiology between CAD and other ASCVD conditions, involving the accumulation of substances in the arterial walls.
- Recognizing CAD as an ASCVD is important for guiding treatment approaches and emphasizing the systemic nature of atherosclerosis, as noted in the 2013 ACC/AHA cholesterol treatment guideline, which expanded the focus to ASCVD 2.
- Management of CAD typically includes lifestyle modifications, medications, and potentially revascularization procedures, depending on severity, with the goal of reducing morbidity, mortality, and improving quality of life.
Management and Treatment
- Lifestyle modifications, such as diet, exercise, and smoking cessation, are essential for managing CAD and reducing the risk of ASCVD events.
- Medications, including statins, antiplatelet agents, beta-blockers, and ACE inhibitors, are commonly used to manage CAD and prevent ASCVD events, as supported by the 2021 evidence-based guide for primary care physicians on coronary artery calcium scoring 3.
- Revascularization procedures, such as angioplasty, stenting, or bypass surgery, may be necessary for severe CAD cases, with the goal of improving blood flow to the heart muscle and reducing the risk of ASCVD events.
From the Research
Definition of CAD and ASCVD
- Coronary Artery Disease (CAD) is a condition in which the coronary arteries, the major blood vessels that supply blood to the heart, become damaged or diseased, usually due to atherosclerosis 4.
- Atherosclerotic Cardiovascular Disease (ASCVD) refers to a group of conditions that affect the arteries, including coronary artery disease, cerebrovascular disease, and peripheral artery disease, all of which are caused by atherosclerosis 5, 6, 7.
Relationship between CAD and ASCVD
- CAD is a type of ASCVD, as it is caused by atherosclerosis of the coronary arteries 4, 8.
- The risk factors for CAD, such as hypertension, diabetes mellitus, and hyperlipidemia, are also risk factors for ASCVD 4, 8, 6.
- The presence of CAD is a strong predictor of ASCVD events, including myocardial infarction, stroke, and death 5, 7.
Predicting ASCVD Risk
- Coronary artery calcium (CAC) scoring is a useful tool for predicting ASCVD risk, with higher scores indicating a greater risk of events 5, 7.
- The association between CAC and ASCVD risk is independent of standard risk factors, such as age, sex, and lipid levels 7.
- CAC scoring can be used to identify individuals at high risk of ASCVD events, who may benefit from preventive therapies 7.