CAD: Pathophysiology, Treatment Options and Clinical Implications

This report provides an overview of coronary artery disease (CAD), starting with the importance of zinc and nitric oxide in maintaining homeostasis in coronary arteries. It summarizes that CAD begins with atherosclerosis, an inflammatory condition accelerated by factors such as high blood pressure, genetics, diabetes, and high cholesterol, leading to the thickening of artery walls. The report highlights acetylsalicylic acid (ASA), found in aspirin, as a primary medication, explaining its mechanism of action in inhibiting prostaglandin production, thus reducing inflammation and blood pressure. It details the pharmacokinetics of aspirin, including its absorption and distribution, while also noting potential side effects like gastrointestinal issues. The conclusion emphasizes that CAD is a neurohormonal imbalance that can be managed, referencing the importance of physical exercise in prevention, although athletes can still experience cardiac events. The report cites various sources to support its claims regarding pathophysiology, treatment, and clinical considerations for CAD.

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CORONARY ARTERY DISEASE
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Coronary Artery Disease (CAD)
Introduction
Homeostasis in coronary arteries is maintained by zinc (Zn) and nitric oxide (NO) since
they are tightly coordinated (Rehman and Rehman, 2019). Zn ions are responsible for
dimerization of endothelial nitric oxide synthase. Thus, NO is generated causing rapid
mobilization of endothelial Zn stores to produce labile Zn, necessary for the action of NO in
vasodilation and vascular cytoprotection (Zalewski, et al. 2018).
Summary
CAD begins with atherosclerosis, an inflammatory state of medium-sized arteries
accelerated by factors like increased blood pressure, genetics, diabetes, and high cholesterol
(Klabunde, 2017). Coronary atherosclerosis causes the inner walls of the coronary arteries to
thicken hence narrowing their lumen (Ambrose and Singh 2015). Atherosclerosis is
characterized by a build-up of fats, fibrous materials and inflammatory particles in the arterial
walls (Sayols-Baixeras, et al. 2014). CAD has got various medications in its name with
Acetylsalicylic acid (ASA) as one of the main ones. ASA is found in painkillers like Aspirin
(Institute for Quality and Efficiency in Health Care, 2017), a nonsteroidal anti-inflammatory
drug (NSAID).
Conclusion
ASA in aspirin inhibits production of prostaglandin hence its analgesic effects.
Prostaglandin cause contraction in muscles, dilation, and constriction of blood vessels, lead to
elevated blood pressure and contributes to inflammation (Fritzel, 2019). ASA in aspirin gets
absorbed in the gastrointestinal tract after ingestion and then distributed to all body tissues. All

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doses of the drug can be administered orally and intravenously (Chýlová, et al. 2015). Aspirin is
associated with side effects like gastrointestinal ulcerations, heartburn, bleeding, headache and
gastritis (Cunha 2019). Various health benefits are attributed to frequent physical exercise thus,
is a recommended prevention of primary and secondary CV. However, athletes experience
clinical events like acute myocardial infarction and sudden cardiac death (Dores, et al. 2018).
Thus, since CAD is a neurohormonal imbalance, it can be managed.

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References
Ambrose, JA & Singh, M (2015). Pathophysiology of Coronary Artery Disease Leading to Acute
Coronary Syndromes. F100Prime Reports, 7(8).
Chýlová, M, Moťovská, Z, Osmančík, P, Procházka, B, & Kalvach, P (2015). The Effect of
Different Doses and Different Routes of Acetylsalicylic Acid Administration on Platelet
Aggregation in Healthy Volunteers and Ischemic Stroke Patients. Translational Stroke
Research, 6(2), pp. 160-165.
Cunha, J. P., 2019. Aspirin Side Effects Center.
Available at: https://www.rxlist.com/aspirin-side-effects-drug-center.htm
[Accessed 21 March 2019]
Dores, H, Gonçalves, P, Cardim, N, Neuparth, N (2018). Coronary Artery Disease in Athletes:
An Adverse Effect of Intense Exercise?. Portuguese Society of Cardiology, 37(1), pp. 77-
85.
Fritzel, J (2019). Aspirin. Available at: https://study.com/academy/lesson/aspirin-
pharmacokinetics-pharmacodynamics.html
[Accessed 21 March 2019].
Institute for Quality and Efficiency in Health Care, 2017. Medication for the Long-Term
Treatment of Coronary Artery Disease. Cologne: Institute for Quality and Efficiency in
Health Care.
Klabunde, RE (2017). Cardiovasclar Physiology Concepts. 2 ed. s.l.:Lippincott Williams and
Wilkins

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Rehman, S &Rehman, A (2019). Physiology, Coronary Circulation. Treasure Island: StatPearls
Publishing LLC
Sayols-Baixeras, S, Lluis-Ganella, C, Lucas, G, Elosua, R (2014). Pathogenesis of Coronary
Artery Disease: Focus on Genetic Risk Factors and Identification of Genetic Variants.
The Application of Clinical Genetics, Volume 7, pp. 15-32.
Zalewski, J F, Beltrame, AA, Wawer, AI, & Murgia, A (2018). Roles for Endothelial Zinc
Homeostasis in Vascular Physiology and Coronary Artery Disease. Critical Reviews in
Food Science and Nutrition