Coronary Heart Disease: an Evolutionary Medicine Perspective

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Although heart disease has decreased by 30 percent over the last few decades, it is still an ailment that affects over 14 million Americans and the leading cause of death according to the CDC. While there are different forms of heart disease, its single most common cause is coronary heart disease. Coronary heart disease (CHD) develops when the coronary arteries responsible for delivering oxygen and nutrients to the heart muscle (myocardium) become blocked due to atherosclerosis, a build-up of deposits containing a combination of fatty material, calcium, and scar tissue called plaques (atheromata). The deposits primarily occur on coronary arteries on the outer surface of the heart (epicardial). Thus, the major risk factors for CHD are the same as those for atherosclerosis—namely, high levels of low-density lipoprotein (LDL) in the blood plasma, low levels of high-density lipoprotein (HDL), cigarette smoking, hypertension, and diabetes mellitus. Specifically, these factors can be detrimental because of their interference with the functioning of normal vascular endothelium. These functions include local control of vascular tone, maintenance of an anticoagulant surface, and defense against inflammatory cells. The loss of these defenses leads to inappropriate constriction, luminal clot formation, and abnormal interactions with blood monocytes and platelets. This last consequence results in the subintimal collections of fat, smooth-muscle cells, fibroblasts, and intercellular matrix that constitute the aforementioned plaques. Plaques develop at irregular rates in the different branches of the epicardial coronary tree and eventually lead to reductions in cross-sectional area of the blood vessels, called stenoses. When a stenosis reduces the cross-sectional area by approximately 75%, the required blood flow necessary to meet myocardial demand can no longer be

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