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Uncontrolled high cholesterol levels can lead to a build-up of fatty plaque in the walls of the body’s larger arteries. This process is known as atherosclerosis and has different consequences depending on where these plaques develop.
As plaque builds up in the arteries, blood flow is reduced. In the arteries to the heart, this process is known as coronary heart disease (CHD) or coronary artery disease (CAD). In the main arteries to the brain, it is called carotid atherosclerosis. If the arteries become completely blocked, or the plaque becomes unstable, blood flow to the heart or brain is blocked, causing a heart attack or stroke. While other factors such as high blood pressure, diabetes, smoking, or a family history contribute to CHD, more than half of all heart diseases are associated with lipid abnormalities. (The lipid profile is a group of tests that are often ordered together to determine the risk of coronary heart disease.) The tests that make up a lipid profile are tests that have been shown to be good indicators of whether someone is likely to have a heart attack or stroke caused by a blockage of blood vessels (hardening of the arteries).
Symptoms of CHD
The earliest symptoms of CHD are chest pain, called angina, or shortness of breath. CHD varies widely in severity, ranging from people with no symptoms at all to those with such steady pain that everyday activities are difficult.
Episodes of angina occur when the heart's need for oxygen increases beyond what is being provided by the blood flow. It is most commonly triggered by physical exertion, when the heart has to work harder. It usually feels like a pressing or squeezing pain, usually in the chest under the breastbone, but sometimes in the shoulders, arms, neck, jaw or back. Angina will usually subside with rest, or sometimes anti-angina medication is prescribed to control the pain.
Sometimes the symptoms of angina are unusual, and it is often confused with other disorders such as a stomach upset or indigestion. The presence of angina does not necessarily mean that a heart attack is happening, or about to happen. However, it does mean that CHD is present.
How is CHD diagnosed?
Because CHD affects different people in different ways, the approach that doctors use to diagnose and treat it also vary widely. There is no single test to diagnose it − instead, your doctor will select one or more of the following, depending on your history and his or her findings on your physical examination: