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Coronary Artery Disease

Coronary artery disease (CAD) is the most common type of heart disease and the leading cause of death in the U.S. and around the world. Also called coronary heart disease or ischemic heart disease occurs when plaque grows within the walls of the arteries and limits their ability to deliver enough oxygen-rich blood to the heart. 

 

Coronary Artery Disease Types

  • Stable ischemic heart disease is the chronic form. The coronary arteries gradually narrow and stiffen over many years, reducing the nutrients the heart receives. A person may feel some symptoms but can live with the condition daily. 

  • Acute coronary syndrome is the sudden form that’s a medical emergency. The plaque in the coronary artery suddenly ruptures and forms a blood clot that blocks blood flow to the heart, causing a heart attack.


Symptoms 

Coronary artery disease is often a “silent” disease.  People usually do not know they have it until they experience chest pain, a heart attack, or a cardiac arrest. Signs and symptoms can include:

  • Chest pain (angina): pressure or tightness in the chest, often in the middle or left side. Activity or strong emotions can trigger angina,  and the pain usually goes away within minutes of the end of the event. 

  • Shortness of breath

  • Fatigue and feeling unusually tired

  • Heart attack, including crushing chest pain or pressure, shoulder or arm pain, shortness of breath, and sweating. Women may have less typical symptoms, such as neck or jaw pain, nausea, and fatigue. 

Risk Factors

Risk factors often occur together and increase the likelihood of developing coronary artery disease. 

  • Age - the risk of damaged and narrowed arteries increases with age

  • Men are generally at greater risk, although the risk for women increases after menopause.

  • A family history of heart disease, especially if a close relative developed it at an early age (men before 55 and women before 65).

  • Smoking, tobacco use, vaping, and breathing in secondhand smoke

  • Uncontrolled high blood pressure 

  • High LDL (“bad”) cholesterol or low HDL (“ good”) cholesterol 

  • Type 2 diabetes and coronary artery disease share some risk factors..

  • Being overweight or obese

  • Chronic kidney disease

  • Not getting enough exercise

  • Stress

  • Unhealthy diet, including diets high in saturated fat, trans fat, salt, and sugar 

  • Heavy alcohol use

  • Too little and too much sleep or sleep disorders like sleep apnea

  • Having atherosclerosis

  • High triglycerides (hypertriglyceridemia)

  • Anemia

  • Autoimmune diseases, including lupus and rheumatoid arthritis

  • Metabolic syndrome

  • Endometriosis

  • History of gestational diabetes, eclampsia, or preeclampsia

Prevention and Management

Heart-healthy lifestyle changes, medicines, surgery, or a combination of these approaches can help prevent and manage coronary heart disease.  

  • Quit smoking

  • Control high blood pressure, high cholesterol and diabetes.

  • Exercise often

  • Maintain a healthy weight.

  • Eat a low-fat, low-salt diet rich in fruits, vegetables, and whole grains.

  • Reduce and manage stress.


Diagnosing

Tests to help diagnose or monitor coronary artery disease include:

  • Blood tests measure cholesterol, proteins, inflammation, and other substances in the blood.

  • Electrocardiogram (ECG or EKG) - a quick and painless test to measure the heart's electrical activity. 

  • Echocardiogram - using sound waves to create pictures of the beating heart, showing how blood moves through the heart and heart valves.

  • Exercise stress test - walking on a treadmill or riding a stationary bike during an ECG or using medications to stimulate the heart like exercise does.

  • Nuclear stress test - similar to an exercise stress test but with images- shows how blood moves to the heart muscle at rest and during stress.

  • Cardiac MRI uses radio waves and magnets to show how well the heart is working.

  • Heart CT or Coronary Calcium scan shows calcium deposits and blockages in the heart arteries.

  • CT coronary angiogram - similar to a CT scan, but dye is used to create detailed pictures. 

  • Cardiac catheterization and angiogram - a flexible tube (catheter) is inserted into a blood vessel, usually in the wrist or groin, and guided to the heart. 

 

Questions to Ask a Healthcare Provider

  • What are my risk factors for coronary artery disease?

  • What can I do to lower my risk or slow the progression?

  • What’s the best treatment plan for me?

  • What lifestyle changes are most important for me?

  • What medications would lower my risk, and what are the side effects? How long do I need to stay on these medications? 

  • Will I need a procedure or surgery? What does recovery look like?

  • Are there support groups or resources you can recommend?

Treatment

  • Medications include cholesterol drugs, aspirin, beta blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), nitroglycerin, and Ranolazine.

  • Surgeries and procedures such as coronary angioplasty and stent placement or coronary artery bypass graft surgery (CABG)

  • Lifestyle changes such as quitting smoking, controlling blood pressure, managing cholesterol, checking blood sugar, limiting alcohol, maintaining a healthy weight, managing stress, and getting regular check-ups.

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