Ischemic heart disease is a form of heart disease. Usually abbreviated IHD, ischemic heart disease often results from blockages in the arteries of the heart and is marked by the heart not getting sufficient blood flow and oxygen. IHD also affects cardiac metabolism in several ways.
Understanding Ischemic Heart Disease
Causes and Mechanisms
In ischemic heart disease, the heart is forced to work without sufficient blood flow or oxygen. In most cases, this is caused by plaque buildup within the arteries that feed the heart through a process called atherosclerosis. Atherosclerosis occurs when fatty substances, cholesterol, cellular waste products, calcium, and fibrin accumulate in your artery walls, hardening over time and narrowing the coronary arteries that supply blood to your heart muscle.
However, it can also be caused by a demand for oxygen that exceeds what blood can supply, coronary artery vasospasm (sudden tightening of the arteries), or problems with the smaller blood vessels in the heart called microcirculation dysfunction. If the condition is caused by plaque buildup, the complete blocking of an artery by plaque can cause coronary artery disease (CAD) – also known as coronary heart disease (CHD) – or a heart attack (myocardial infarction).
Impact on Cardiac Metabolism
Ischemic heart disease also affects cardiac metabolism and heart function. Ischemic events can change fuel metabolism by causing a switch from lactate uptake to lactate production within the heart. It can also cause a decline in FAs and carbohydrate oxidation and increase glycolysis.
The glucose used for glycolysis comes from two places. First, uptake from the blood. Second, it can also come from the breakdown of myocardial glycogen stores. Over time, this leads to higher proton levels. When combined with increased lactate production, it can cause myocardial ischemia or myocardial injury. This acidic cellular environment, combined with oxygen shortage, can damage heart muscle cells and impair the heart’s ability to contract effectively.
Treatment Potential
Thankfully, patients suffering from ischemic heart disease can take steps to mitigate their risk and reduce or eliminate the plaques responsible for constricting blood flow.
Symptoms of Ischemic Heart Disease
While some patients may not notice symptoms of ischemic heart disease or changing cardiac metabolism, many do. The most common symptoms include chest pain, particularly after physical activity, dizziness, heart palpitations, shortness of breath, and swollen feet or ankles. If you’re experiencing any of these symptoms, contact your doctor to make an appointment.
Interventions for Ischemic Heart Disease Prevention and Treatment
Understand that any strategy to reduce the risk of heart disease and restore normal cardiac metabolism must be highly personalized. There is no “one-size-fits-all” solution available. Nevertheless, all successful strategies employ at least a few similar tactics, such as the following:
Tobacco Use
Patients should stop all tobacco use. That’s particularly important for smokers but also applies to smokeless tobacco products and may extend to vapes. Smoking cessation aids can be employed to help reduce the stress caused by quitting tobacco use, which in itself can lead to additional negative outcomes.
Underlying Health Conditions
Patients should properly care for any underlying health conditions that may contribute to developing ischemic heart disease and/or irregular cardiac metabolism. Some conditions known for this include high blood pressure, high cholesterol, and diabetes.
Weight Loss
While obesity does not directly affect ischemic heart disease, it increases the risk for a range of diseases that do, including high blood pressure and high cholesterol. Weight loss options vary depending on age and physical condition, and patients should speak with their doctor to determine which would be appropriate for them.
Exercise
Even moderate exercise a few times per week can be enough to change your cardiovascular health dramatically. You don’t even have to do something strenuous, like running. Just getting out for a 20-minute walk a few times per week has a lot of benefits and can make a major difference in all areas of cardiovascular health. However, speak with your doctor before beginning an exercise regimen to ensure it’s safe for your health.
Heart Healthy Diet and Nutrition
Following a healthy diet is one of the most important steps to take to prevent or even begin reversing ischemic heart disease. Such a diet is low in saturated fat and high in fresh fruits, vegetables, and whole grains.
Know Your Numbers
Regularly test and track your cholesterol and blood sugar. Know your ideal levels and work with your care provider to create a strategy that helps you reach those levels.
Heart Disease Study
A study published in the American Journal of Lifestyle Medicine stated, “Daily habits and actions powerfully affect the risk of cardiovascular disease in general, and coronary heart disease, in particular. Regular physical activity, sound nutrition, weight management, and not smoking cigarettes have all been demonstrated to significantly reduce the risk of CVD.”
Fighting Back Against Ischemic Heart Disease and Irregular Cardiac Metabolism
When caught early enough and treated promptly, ischemic heart disease is reversible. However, doing so requires understanding the lifestyle factors that allowed the condition to occur in the first place, coupled with a commitment to changing your life by losing weight, following a healthy diet, exercising, quitting smoking, and managing underlying health conditions.
Investigations Underway at CVRTI
At the Nora Eccles Harrison Cardiovascular Research and Training Institute (CVRTI), there are several labs developing a greater understanding of ischemic heart disease and altered cardiac metabolism. These scientific insights are also leading to new therapies for both. The Shaw Lab, together with the Hong Lab and Dosdall Lab , and in collaboration with the Selzman Lab, Drakos Lab, and Palatinus Labs are developing several new gene therapies for heart failure due to ischemic heart disease as well as protecting the metabolism of the failing hearts. In addition, the Drakos Lab , Chaudhuri Lab , Franklin Lab , Hong Lab and Shaw Lab are developing new mechanistic insights into the fundamental reasons why heart metabolism is altered during disease. The CVRTI has the largest group of investigators focused on failing heart muscle (ischemic cardiomyopathy) and cardiac metabolism in the country.
Additional Questions About Cardiovascular Ischemic Disease
What is angina, and how does it relate to the chest pain mentioned in ischemic heart disease?
Angina pectoris, commonly called angina, is the medical term for chest pain caused by reduced blood flow to the heart muscle. It’s often the first symptom people notice with ischemic heart disease. Unlike a heart attack, angina doesn’t cause permanent heart damage, but it’s a warning sign that your heart isn’t getting enough oxygen. The chest pain you experience during physical activity, as mentioned in our symptoms section, is typically angina – your heart demanding more oxygen than your narrowed arteries can supply.
Are there risk factors for ischemic heart disease that I can’t control?
Yes, several non-modifiable risk factors can increase your likelihood of developing ischemic heart disease, regardless of your lifestyle choices. These include your age (risk increases as you get older), biological sex (men typically develop heart disease earlier than women), family history of heart disease, and genetic factors. While you can’t change these factors, knowing about them helps you and your healthcare provider create a more aggressive prevention strategy for the modifiable risk factors you can control.
What’s the difference between angina and a heart attack?
While both involve insufficient blood flow to the heart, they differ in severity and permanence. Angina occurs when blood flow is temporarily reduced, causing chest pain that typically goes away with rest or medication. A heart attack (myocardial infarction) happens when blood flow is completely blocked for an extended period, causing permanent damage or death to part of the heart muscle. Think of angina as a warning signal, while a heart attack represents actual tissue damage.
How quickly can the lifestyle interventions mentioned actually improve my heart health?
The timeline varies depending on the intervention. Benefits such as improved blood flow from exercise can appear within weeks, while changes in blood pressure or cholesterol from diet and weight loss may be noticeable in a month or two. Slowing plaque progression or improving heart metabolism can take months to years. Using multiple approaches together—exercise, healthy diet, weight management, and stress control—produces the fastest and most lasting benefits.
Does having a family history of heart disease mean I’m destined to develop ischemic heart disease?
Not at all. While family history is a significant non-modifiable risk factor that increases your likelihood of developing heart disease, it doesn’t guarantee you’ll develop the condition. Think of genetic predisposition as loading the dice rather than determining the outcome. The lifestyle interventions we discussed – proper diet, regular exercise, avoiding tobacco, managing blood pressure and cholesterol – can often overcome genetic predisposition and prevent ischemic heart disease even in high-risk individuals.
