Angina pectoris, or angina in short, is a clinical syndrome characterised by pain or discomfort in the chest, which may spread to the jaw, shoulder, back, or arm. Although angina is typically brought on by physical exertion, its presentation is variable. At one extreme, angina occurs predictably with strenuous exercise; on the other hand, angina can also develop unexpectedly when resting.
Patients who have a reproducible pattern of angina that is associated with a certain level of physical activity have chronic stable angina or exertional angina. In contrast, patients with unstable angina often experience new-onsets of angina or a change in the intensity, frequency, or duration of the angina attack.
Both chronic stable angina and unstable angina often reflect underlying atherosclerotic (accumulation of fatty deposits and calcium) narrowing of coronary arteries (blood vessels supplying the heart).
Prinzmetal’s variant angina or vasospastic angina occurs in patients without coronary heart disease (CHD). It is caused by a spasm of the coronary artery, leading to decreased blood flow to the heart.
Risk Factors for Angina
The major risk factors for angina symptoms include:
Unhealthy cholesterol levels
Cholesterol is a major part of the deposits that can narrow arteries throughout your body, including those that supply your heart. Low-density lipoprotein (LDL) cholesterol, commonly known as the “bad” cholesterol, is most likely to narrow the arteries. A high level of triglycerides, a type of fat related to your diet, is also undesirable.
However, a high level of high-density lipoprotein (HDL) cholesterol, or the “good” cholesterol, is desirable and lowers your risk of angina and heart attacks.
High blood pressure
“Blood pressure” is the force of blood pushing against the walls of the arteries as the heart pumps blood. If this pressure stays persistently high (commonly known as high blood pressure), it can damage arteries by accelerating atherosclerosis. High blood pressure can eventually lead to CHD, heart failure, stroke, kidney failure, and other health problems.
Smoking and long-term exposure to second-hand smoke damages the interior walls of arteries, including the arteries to your heart, hence allowing deposits of cholesterol to collect and block blood flow.
Insulin resistance or diabetes
Insulin resistance (or in its more severe form, type 2 diabetes) is a condition in which the body produces insulin but could not use it effectively to control blood sugar level. Insulin resistance or diabetes increases the chance of developing heart disease by speeding up blood vessel damage and atherosclerosis.
Overweight or obesity
Being overweight or obese puts you at risk of angina and heart disease because it’s associated with high blood cholesterol levels, high blood pressure, and diabetes.
The risk for heart disease, diabetes, and stroke increases with the number of metabolic risk factors. Metabolic syndrome is defined as having three or more of the following factors: elevated waist circumference, elevated levels of triglycerides, low levels of HDL (good) cholesterol, elevated blood pressure levels, or elevated fasting blood glucose levels.
In general, a person who has metabolic syndrome is twice as likely to develop heart disease and five times as likely to develop diabetes compared to someone without metabolic syndrome.
Lack of physical activity
An inactive lifestyle contributes to high blood cholesterol levels and obesity which then increases the risk of angina.
Men older than 45 and women older than 55 are at greater risk.
You may respond to stress in ways that can increase your risk of angina and heart attacks. If you’re under stress, you may overeat or smoke from nervous tension. Too much stress, as well as anger, can also raise your blood pressure. Surges of hormones produced during stress can narrow your arteries and worsen angina.
Personal or family history of heart disease
If you or any of your 1st degree relatives have a history of heart disease, you are at a greater risk of getting angina.
People sometimes think that men suffer from angina more often as they are more prone to heart attacks than women. In actual fact, angina occurs equally among men and women. Regardless of gender, if you have one or more of the risk factors and have symptoms similar to an angina attack, do consult your doctor for further evaluation.