An accumulation of plaques or wax-like substances in coronary blood vessels is a primary cause of coronary heart-based disease. A person’s cardiac arteries could become blocked due to the buildup, which would result in an unusually high amount of pressure across the affected arteries or veins (Putri & Budiarto, 2022). Thus, as a significant cause of death globally, coronary artery disease (CAD) affects people in industrialized nations and underdeveloped countries. Although the death rate from coronary artery disease (CAD) has decreased dramatically in industrialized nations due to efficient therapies and early diagnosis, it is still a serious health concern for the worldwide population, and it is termed a threat (CDC, 2019). Obesity and low physical activities are rising due to growing problems for those with CAD (Hajar, 2017). Evidence shows that maintaining a healthy community is hampered by the prevalence of CAD. The health-based maintenance program for CAD will address these issues.
Understanding the Pathophysiology of CAD Among Obese Individuals
Complex interrelations involving risk variables like artery cell walls, molecular communications, and blood circulation are primary factors in developing CAD. Blood leukocyte adherence to the internal surfaces of arterial cell walls is increased whenever the endothelial cell of cardiac arteries interacts with risk variables, including vasoconstrictor hormones, which causes the cells’ generation of adhesion-based molecules to be increased (Hajar, 2017). Further, for adhering leukocyte movement to occur, signals associated with atherosclerosis risk variables are crucial in regulating the production of chemoattractant types of cytokines (Riegel et al., 2017). Communication between T lymphocytes, mononuclear phagocytes, endothelial cells, and smooth muscles results in a significant exchange of information. Prostanoid acid-based derivatives, which are microscopic particles of lipid intermediates, have a role in developing atherosclerosis due to inflammation and immunology. Histamine and other antacid compounds increase capillary permeability via regulating vascular tones. Complementary elements and cytokines have received growing attention as protein transmitters of immunity and inflammatory as the primary focus of current studies.
In the initial stages of the atheroma, the transfer of SMCs from tunica-based media towards the intima seems to be a vital outcome of the ongoing inflammatory fermentation. Consequently, the cells often proliferate widely and produce an overall extracellular matrix that is sophisticated and rich in nutrients (CDC, 2019). When monocytes and endothelial cells secrete matrix metalloproteinases, it would be specific to numerous signals caused by inflammation or changes in dynamics. The secretion will be particular to those signals caused by oxidative stress or an extreme autoimmune reaction (Putri & Budiarto, 2022). It is believed that MMPs are fully accountable for modifying the function of vascular cells in a variety of areas, including cell division and stimulation, cellular damage and movement, vessel formation, and breakdown of the whole extracellular matrix surrounding the heart and arteries, plus recovery. MMPs work in conjunction with endogenous tissue-based modulators to reconfigure vascular cell function. (Putri & Budiarto, 2022). Thus, lipoproteins are typically bound by extracellular matrix components such as proteoglycans, resulting in an extending of their intima holding time, making them more sensitive to oxidative and glycation alteration, among other things.
Lipoprotein remodeling compounds, like enhanced glycation, oxidative phospholipids, and other compounds, contribute to the body’s amplification and persistence of inflammatory processes. Capillary calcification could occur due to the advancement of the existing lesions, following a similar approach to the one concerned with bone formation—besides, various modifications of the coronary artery trigger CAD among obese populations. In addition to multiplication, apoptosis (overall cell death) could happen throughout the development of atherosclerotic plaques. The demise of lipid-laden unique macrophages may culminate in the extracellular accumulation of tissue factors (TF), with several tissue factors forming in granular form leading to CAD (Shah, 2019). Eventually, extracellular lipids could collect within the intima, merging into a necrotic center that seems to be rich with lipids and termed atherosclerotic plaques through the medical community.
Health Maintenance Plan
Challenges Experienced by Caregivers and Obese Patients
After identifying potential risk variables and pathogenesis of the coronary artery-based disease, it becomes crucial to examine the difficulties in managing and preventing its onset. As a result of their lifestyles, obese patients, including those in danger, suffer many issues (Arnett et al., 2019). Thus, for example, one of several challenges regarding the management or control of CAD would be the growing number of people who are overweight or obese. Cardiovascular disease is very likely to strike this group or population of individuals.
For example, more than a third of the individuals in America are overweight. In addition to being overweight, bad eating habits, inadequate physical activities, and cigarette use increase the chance of developing coronary artery diseases and complicate effective prevention and treatment efforts. These concerns are considered risk factors for coronary artery disease (CAD) since they raise people’s likelihood of developing it (Riegel et al., 2017). Therefore, to reduce the risk of CAD and certain other cardiovascular-based diseases, the general public must adopt a healthier lifestyle. Adopting health promotions and illness preventive initiatives for coronary artery disease that assist raise the general public’s level of health awareness is the most effective strategy to reduce the prevalence of CAD throughout the population.
Health Maintenance Plan within the Primary Care Practice
Increasing Support in Rehab
Coronary artery disease affects people of all ages, therefore measures are required to protect the population from infants to the elderly.The first step in a plan to support patients with CAD is to expand rehabilitation measures for patients. Early motor activation of patients contributes to the development of collateral circulation, has a beneficial effect on patients’ physical and mental state, and shortens the period of hospitalization (Squires et al., 2018). In addition, early motor activation can slow down the progression of coronary artery disease and reduce the likelihood of relapses. Motor recovery exercises are more suitable for adults and the elderly, newborns and older children should be provided with rehabilitation massages. The organization of competent rehabilitation requires equipment and trained personnel.
Increasing the Level of Psychological Help
The negative impact of depressive disorders in the course of coronary artery disease is due to two mechanisms: pathophysiological and behavioral. Among patients with coronary artery disease, depression occurs three times more often than in the general population (Vaccarino et al., 2020). The pathophysiological mechanism is realized through activation of the hypothalamic-pituitary and sympathoadrenal systems and suppression of the activity of the serotonergic system (Popovic et al., 2022). The behavioral mechanism determines physical inactivity, social isolation, overeating and non-compliance with the diet, smoking, and alcoholism. Psychosocial risk factors for CAD include low socioeconomic status, social isolation and low social support, chronic work and family stress, depression, and anxiety.
After an illness, the patient feels vulnerable, losing control of his body. To maintain patients with coronary artery disease, constant psychological assistance is needed along with drug therapy. Psychological support is required for patients of all ages, but special attention should be paid to the morale of older adults, as they are the most morally vulnerable. Middle-aged people also especially need psychological support, since the loss of working capacity is morally difficult for them. This stage of the project involves introducing mandatory psychological support for patients with such a diagnosis, ensuring the quality of this support, and assessing favorable outcomes for the patient’s health.
Activities Aimed at Raising Awareness
Prevention of coronary artery disease is the simplest way to improve the population’s health. To prevent coronary artery disease, it is necessary to carry out activities aimed at increasing the awareness of the population about the risks. Such activities should be aimed at people of all ages. Events can be open lectures, booklets, leaflets, or events in educational institutions. Activities in educational institutions are designed to instill a careful attitude to the health of children, but the greatest attention should be paid to raising awareness among middle-aged people and older adults.
Maintaining Public Health
It is possible to prevent the development of coronary artery disease by conducting frequent diagnostics. Simple checks include taking blood pressure, which not everyone can do at home. The organization of public spaces in which a person can check blood pressure and receive other simple medical manipulations will significantly contribute to the prevention of coronary artery disease. Such areas can be deployed at clinics and in public parks or shopping centers. Diagnostics is required for middle-aged people, since they often do not monitor their health, being busy with their careers and families. Diagnostic tools should be organized not only for adults, but also for children of all ages and older adults.
The proposed initiatives require timely critical evaluation after implementation. Since public health can only improve in the long term, quantitative criteria must be considered. The organization can understand the plan’s effectiveness by reducing the number of hospitalizations with CAD and deaths. Psychological assessment of the condition of patients with CAD can also be indicative of the effectiveness. Evaluation activities should be carried out regularly to decide on changing initiatives or introducing new ones quickly.
Self-care Practices for the Management and Prevention of CAD
Healthcare professionals must educate and inform the public about CAD to improve their effectiveness in managing, controlling, and preventing this condition. Management and preventive measures for coronary artery disease should maintain health among individuals at risk of developing the condition (Liu et al., 2018). This step includes all health-based maintenance plans or programs, along with management and monitoring operations, that could promote a healthy lifestyle throughout the society via control and preventive measures for the disease (Arnett et al., 2019). Further, for caregivers or patients to fulfill their health-based maintenance responsibilities, they must engage in overall self-care activities outside the healthcare institution environment.
In the case of CAD, the American-based Heart Association (AHA) recommendations describe the cornerstone of self-care practices as consisting of seven straightforward stages. These seven stages are centered upon the AHA guidelines for managing and preventing coronary artery diseases. These steps include physical activity, smoking cessation, maintaining normal blood pressure and plasma glucose levels, eating healthy, keeping cholesterol levels low, and keeping BMI within normal limits.
Individual‐Levels Self‐Care Conduct
Autonomy, Understanding Self-care, and Self-responsibility
The primary commitments needed for effective CAD overall management and prevention are self-responsibility and autonomy. Self-care coaching and instruction must be tailored to people from diverse backgrounds to improve health outcomes (Arnett et al., 2019). Individuals and society need to be educated, inspired, and involved by healthcare providers so that they are more open to making lifestyle changes. The important steps are discussed below;
Knowledge of Health Status and Dietary Habits
The ability to recognize one’s health status or condition and the possible dangers alongside solutions associated with CAD cannot be overstated. A societal health needs assessment based on epidemiological information is crucial for concerned patients and members to comprehend or assess their present trends and health status.As part of self-care practices, the capacity to tackle communal eating habits is essential for successful instruction and training on nutrition-related preventive behaviors. Overweight conditions and obesity are the primary risk variables leading to CAD, and both could get mitigated with a healthy diet.
Weight Management, Physical Activities and Smoking Cessations
Overweight and obesity have to be dealt with to maintain a healthier lifestyle for individuals. This step could be done by eating a healthy diet and engaging in regular physical exercise to combat obesity. Self-care behaviors such as engaging in physical activity and exercising contribute to maintaining a healthy and comfortable lifestyle by reducing cholesterol buildup within blood vessels or capillaries and hazards of the obesity epidemic. Reducing one’s CAD risk by quitting or stopping smoking is an essential self-care habit. An interdisciplinary-based collaborative group is needed to help those who want to quit smoking because this is regarded as a potentially challenging procedure.
Lifestyle-related habits are connected with the potential to significantly enhance living standards in individuals with CAD and the desire to prevent or block the disease in people in danger of CAD. These techniques help tackle the root causes of cardiovascular illness, such as coronary artery-based disease (CAD). Naturalistic or naturalism decision-making processes are commonly used to evaluate self-care or individual management techniques, including a person’s devotion to sustaining healthy behaviors to control and treat chronic conditions, as well as prevention and control of critical illness. Therefore, self-care management choices are typically directed by healthcare experts to guarantee both patients and individuals at risk receive appropriate training and information on the need to adopt a healthier lifestyle. Consequently, healthcare practitioners must be involved through an interdisciplinary approach to health improvement and preventive illness commitments for overall lifestyle-related disorders like coronary artery disease to become effective.
Arnett, D. K., Blumenthal, R. S., Albert, M. A., Buroker, A. B., Goldberger, Z. D., Hahn, E. J., Himmelfarb, C. D., Khera, A., Lloyd-Jones, D., McEvoy, J. W., Michos, E. D., Miedema, M. D., Muñoz, D., Smith, S. C., Virani, S. S., Williams, K. A., Yeboah, J., &Ziaeian, B. (2019). 2019 ACC/AHA Guideline on the primary prevention of cardiovascular disease: The American College of Cardiology/American heart-based association task force report on clinical practice guidelines. Circulation, 140(11), 596-646.
CDC. (2019). Coronary Artery Disease (CAD).
Hajar, R. (2017). Risk factors for coronary artery disease: Historical perspectives. Heart Views, 18(3), 109.
Liu, B., Pjanic, M., Wang, T., Nguyen, T., Gloudemans, M., Rao, A.,… & Quertermous, T. (2018). Genetic regulatory mechanisms of smooth muscle cells map to coronary artery disease risk loci. The American Journal of Human Genetics, 103(3), 377-388.
Medistya Putri, E. S., Adi S, S., & Budiarto, M. (2022). Risk factors of coronary heart disease in patients with type 2 diabetes mellitus. Majalah Biomorfologi, 32(1), 13.
Popovic, D., Bjelobrk, M., Tesic, M., Seman, S., Jayasinghe, S., Hills, A. P., Babu, A.S., Jakovjevic, D.G., Stoner, L., Ozemek, C., Bond, S., Faghy, M.A., Pronk, N.P., Lavie, C.J., Arena, R., & PIVOT Network. (2022). Defining the importance of stress reduction in managing cardiovascular disease-the role of exercise. Progress in Cardiovascular Diseases.
Riegel, B., Moser, D. K., Buck, H. G., Dickson, V. V., Dunbar, S. B., Lee, C. S., Lennie, T. A., Lindenfeld, J., Mitchell, J. E., Treat‐Jacobson, D. J., & Webber, D. E. (2017). Self‐Care for the prevention and management of cardiovascular disease and stroke. Journal of the American Heart Association, 6(9), 43-59.
Shah, S. N. (2019). Coronary Artery Atherosclerosis.
Squires, R. W., Kaminsky, L. A., Porcari, J. P., Ruff, J. E., Savage, P. D., & Williams, M. A. (2018). Progression of exercise training in early outpatient cardiac rehabilitation. Journal of Cardiopulmonary Rehabilitation and Prevention, 38(3), 139-146.
Vaccarino, V., Badimon, L., Bremner, J. D., Cenko, E., Cubedo, J., Dorobantu, M., Duncker, D.J., Manfrini, O., Milicic, D., Padro, T., Pries, A.R., Quyyumi, A.A., Tousoulis, D., Trifunovic, D., Vasiljevic, Z., Wit, C., Bugiardini, R., & ESC Scientific Document Group Reviewers Lancellotti Patrizio Carneiro António Vaz. (2020). Depression and coronary heart disease: 2018 position paper of the ESC working group on coronary pathophysiology and microcirculation. European heart journal, 41(17), 1687-1696.