The heart receives a blood supply of its own from the coronary arteries, blood vessels that deliver oxygenated blood to the muscle of the heart. The principal manifestations of coronary heart disease include the chronic form resulting from the narrowing of the coronary arteries - angina - or the acute forms resulting from the blocking of the coronary arteries - heart attack or sudden death. Heart failure is a likely accompaniment of coronary heart disease in either the short or long term.
Angina: This term is used to describe pain in the chest due to a reduced blood supply to the heart (ischaemia). It results from atherosclerosis in the coronary circulation. Typically angina causes central chest pain, which often radiates to the left arm, shoulder or jaw. The pain is related to exertion and is relieved by rest. Shortness of breath and sweating are commonly associated with angina. If the responsible plaque of atheroma is causing a severe narrowing of the vessel, then angina symptoms may rapidly worsen and occur at rest, and may warn of an impending heart attack.
Heart attack: Atherosclerosis can lead to a heart attack if the coronary arteries become blocked. The onset of a heart attack is usually heralded by severe central chest pain, which may also radiate to the left arm, shoulder or jaw. Severe shortness of breath, sweating and feeling faint are common additional symptoms.
Sudden death: Sudden death can occur as a consequence of an abrupt loss of the heart's ability to pump blood. It may result from a massive heart attack or a severe abnormality of the rhythm of the heartbeat.
Heart failure: This occurs when damage to the heart muscle is severe enough to prevent it functioning adequately as a pump. It manifests itself either acutely with shortness of breath or, more chronically, with shortness of breath, reduced exercise tolerance and swelling of the ankles.
Data on the incidence of coronary heart disease are now available for many developed countries through the WHO-sponsored MONICA Project, but unfortunately such data are not available for developing nations. Consequently, to obtain an idea of the global distribution of the disease it is necessary to examine the available mortality data.
The data in the charts below reflect the most recent mortality rates for coronary heart disease. However substantial changes have taken place over time. In some developed nations where rates were extremely high by world standards - including the US, many western European countries and Australasia - mortality has plunged by as much as 50% in the last 30 years. In other developed countries where rates were low, such as Japan, the mortality has remained low. In others, particularly in eastern Europe, rates have been climbing. In many developing nations, particularly in the Pacific and the Middle East, rates have risen to those previously found only in the West. On the whole, these trends reflect changes in the prevalence of the risk factors. For example, there has been a decline in cholesterolA waxy, fat-like substance used by the body to build cell walls. It is either produced in the liver or absorbed from the animal fats we eat. Cholesterol is carried in the blood stream by particles called lipoproteins. When total cholesterol is measured in the blood, it includes cholesterol carried by low-density lipoproteins (LDL) and high-density lipoproteins (HDL). levels in the US and other previously high-risk countries such as Finland. Population-based levels of treatment for hypertension and a falling smoking prevalence have also occurred in many of the countries which have witnessed a reduction in coronary heart disease mortality. Availability of improved treatment for established disease has also been significant.
| Country | Mortality (per 100,000 population per year) |
|---|---|
| Belarus, Republic of |  754.2 |
| Latvia | 745.0 |
| Ukraine | 735.2 |
| Kazakhstan | 658.6 |
| Azerbaijan Republic | 646.8 |
| Turkey | 608.9 |
| Russian Federation | 602.3 |
| Moldova, Republic of | 592.2 |
| Estonia | 553.3 |
| Uzbekistan | 505.9 |
| Country | Mortality (per 100,000 population per year) |
|---|---|
| Moldova, Republic of | 368.4 |
| Ukraine | 332.0 |
| Uzbekistan | 316.0 |
| Azerbaijan Republic | 308.7 |
| Turkmenistan | 307.1 |
| Belarus, Republic of | 292.8 |
| Kazakhstan | 269.5 |
| Tajikistan | 235.0 |
| Latvia | 228.0 |
| Trinidad and Tobago | 227.3 |