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Can you help me with the cause of my coronary disease?

I am 34, lead an active/healthy lifestyle, do not smoke and had cholesterol between 180-190...yet was diagnosed with heart disease back in July. There's a family history, but never in anyone so young. I have a 100% occluded right coronary artery with "grade 3 or 4" collaterals and a 40-70% occluded left coronary artery. I've seen numerous cardiologists since my catheterization who all recommend medicinal therapy. I experience some angina and do not feel at peace with their recommendations primarily because they are treating the symptoms, not the problem. I'm learning the Dr. Dean Ornish program, but am concerned it won't be enough for someone with a genetic predisposition. Does THI have a program to examine the causes of my disease? 

submitted by Chris from Sarasota, Florida on 10/15/2012


Michael J. Mihalick, MDby Texas Heart Institute cardiologist, Michael J. Mihalick, MD  

Dear Chris: You do seem to be way off the bell-shaped curve for coronary artery disease. If those lipid values are correct, you do not apparently have familial hypercholesterolemia. You may be the victim of an uncommon genetic disorder involving arteriosclerosis, blood clotting, or lipids. Genetic studies of  you and your immediate family may be valuable from a research point of view. In your case, I would want to look for signs of a systemic inflammatory disease that might be treated with immunosuppressive therapy. A detailed clotting evaluation should be undertaken to evaluate your platelet function as well as other clotting factors. If you are found to have a hypercoagulable condition, anti-platelet therapy and/or warfarin may be beneficial. A detailed study of your lipids should be done that may provide insight into a possible treatable lipid disorder. Dietary therapy should be a part of the program, but whether to follow an Ornish-type diet vs. a Mediterranean diet is somewhat controversial. (I favor the latter.)

As far as your anatomic disease is concerned, I think that the recommendation of medical therapy is appropriate unless the disease in the left coronary is limiting the blood flow to a large portion of your heart. This can be estimated by a nuclear stress test. If a significant amount of heart muscle is ischemic (having inadequate blood flow), then revascularization is indicated. Whether this is best done by surgery or stenting depends on the location and number of the blockages, and your surgical risk. One other thing: In young individuals your age, smoking may play a very important role in triggering the disease. Other less common causes such as marijuana, cocaine and metamphetamine use as well as previous radiation therapy for cancer may be aggravating factors. Except perhaps for radiation, avoiding continued exposure to these substances may be quite effective in minimizing further problems.

At the Texas Heart Institute, we have an ongoing genetic study to help determine the causes of coronary and other heart diseases which is headed by Dr. James Willerson. You might direct further questions to him via this same website.

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Updated October 2012
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