Coronary Artery Disease

What is coronary artery disease?

Coronary artery disease (CAD) is a narrowing or blockage of your coronary arteries, which supply oxygen-rich blood to your heart. This happens because, over time, plaque (including cholesterol) buildup in these arteries limits how much blood can reach your heart muscle.

Picture two traffic lanes that merge into one due to construction. Traffic keeps flowing, just more slowly. With CAD, you might not notice anything is wrong until the plaque triggers a blood clot. The blood clot is like a concrete barrier in the middle of the road. Traffic stops. Similarly, blood can’t reach your heart, and this causes a heart attack.

You might have CAD for many years and not have any symptoms until you experience a heart attack. That’s why CAD is a “silent killer.”

Other names for CAD include coronary heart disease (CHD) and ischemic heart disease. It’s also what most people mean when they use the general term “heart disease.”

Coronary artery disease types

There are two main forms of coronary artery disease:

• Stable ischemic heart disease: This is the chronic form. Your coronary arteries gradually narrow over many years. Over time, your heart receives less oxygen-rich blood. You may feel some symptoms, but you’re able to live with the condition day to day.
• Acute coronary syndrome: This is the sudden form that’s a medical emergency. The plaque in your coronary artery suddenly ruptures and forms a blood clot that blocks blood flow to your heart. This abrupt blockage causes a heart attack.

How common is coronary artery disease?

Coronary artery disease is very common. Over 18 million adults in the U.S. have coronary artery disease. That’s roughly the combined populations of New York City, Los Angeles, Chicago and Houston.

In 2021, coronary artery disease killed 375,500 people in the U.S.

Coronary artery disease is the leading cause of death in the U.S. and around the world.

What are the symptoms?

You may have no symptoms of coronary artery disease for a long time. Plaque buildup takes many years, even decades. But as your arteries narrow, you may notice mild symptoms. These symptoms mean your heart is pumping harder to deliver oxygen-rich blood to your body.

Symptoms of chronic CAD include:

• Stable angina: This is the most common symptom. Stable angina is temporary chest pain or discomfort that comes and goes in a predictable pattern. You’ll usually notice it during physical activity or emotional distress. It goes away when you rest or take nitroglycerin (medicine that treats angina).
• Shortness of breath (dyspnea): Some people feel short of breath during light physical activity.

Sometimes, the first coronary artery disease symptom is a heart attack.

What causes coronary artery disease?

Atherosclerosis causes coronary artery disease. Atherosclerosis is the gradual buildup of plaque in arteries throughout your body. When the plaque affects blood flow in your coronary arteries, you have coronary artery disease.

Plaque consists of cholesterol, waste products, calcium and fibrin (a substance that helps your blood clot). As plaque collects along your artery walls, your arteries become narrow and stiff.

Plaque can clog or damage your arteries, which limits or stops blood flow to a certain part of your body. When plaque builds up in your coronary arteries, your heart muscle can’t receive enough blood. So, your heart can’t get the oxygen and nutrients it needs to work properly (myocardial ischemia). It leads to chest discomfort (angina) and puts you at risk of a heart attack.

People who have plaque buildup in their coronary arteries often have buildup elsewhere in their body, too. This can lead to conditions like carotid artery disease and peripheral artery disease (PAD).

Is it genetic?

Partly. Family history affects your risk of coronary artery disease, but many other risk factors have nothing to do with your genetics. The choices you make every day add up to a big impact on your risk of CAD.

What are the risk factors for coronary artery disease?

There are many risk factors for coronary artery disease. You can’t change all of them, but you can manage some of them by making lifestyle changes or taking medications. Talk with your provider about what you can do about these risk factors:

• Being older than 45 if you’re male or over 55 if you’re female.
• Having a biological family member with heart disease, especially a father or brother with a diagnosis before age 55 or mother or sister before age 65.
• Eating a lot of saturated fat or refined carbohydrates.
• Not exercising enough.
• Not getting enough sleep.
• Smoking, vaping or other tobacco use.
• Having atherosclerosis.
• High blood pressure.
• High LDL (“bad”) cholesterol.
• Low HDL (“good”) cholesterol.
• High triglycerides (hypertriglyceridemia).
• Anemia.
• Autoimmune diseases, including lupus and rheumatoid arthritis.
• Chronic kidney disease.
• Diabetes.
• HIV/AIDS.
• Metabolic syndrome.
• A body mass index (BMI) higher than 25.
• Sleep disorders like sleep apnea.
• Early menopause (before age 40).
• Endometriosis.
• History of gestational diabetes, eclampsia or preeclampsia.
• Use of hormonal birth control.

What are the complications of coronary artery disease?

The main complication of coronary artery disease is a heart attack. This is a medical emergency that can be fatal. Your heart muscle starts to die because it’s not receiving enough blood. You need prompt medical attention to restore blood flow to your heart and save your life.

Over the years, CAD can also weaken your heart and lead to complications, including:

• Arrhythmias (abnormal heart rhythms like atrial fibrillation).
• Cardiac arrest.
• Cardiogenic shock.
• Heart failure.

How is coronary artery disease diagnosed?

Healthcare providers diagnose coronary artery disease through a physical exam and testing.

During your physical exam, your provider will:

• Measure your blood pressure.
• Listen to your heart with a stethoscope.
• Ask what symptoms you’re experiencing and how long you’ve had them.
• Ask you about your medical history.
• Ask you about your lifestyle.
• Ask you about your family history. They’ll want to know about heart disease among your biological parents and siblings.

All of this information will help your provider determine your risk for heart disease.

What tests will be done?

Your provider may also recommend one or more tests to assess your heart function and diagnose CAD. These include:

• Blood tests.
• Cardiac catheterization.
• Computed tomography (CT) coronary angiogram.
• Heart MRI (magnetic resonance imaging).
• Coronary calcium scan.
• Echocardiogram (echo).
• Electrocardiogram (EKG/ECG).
• Exercise stress test.
• Chest X-ray.

How is coronary artery disease treated?

Coronary artery disease treatment often includes lifestyle changes, risk factor management and medications. Some people may also need a procedure or surgery.

Your healthcare provider will talk with you about the best treatment plan for you. It’s important to follow your treatment plan so you can lower your risk of serious complications from CAD.

Lifestyle changes

Lifestyle changes play a big role in treating coronary artery disease. Such changes include:

• Don’t smoke, vape or use any tobacco products.
• Eat heart-healthy foods low in sodium, saturated fat, trans fat and sugar. The Mediterranean diet is a proven way to lower your risk of a heart attack or stroke.
• Exercise: Aim for 30 minutes of walking (or other activities) five days a week.
• Limit alcohol.

Be sure to talk with your provider before starting any new exercise program. Your provider can also offer guidance on lifestyle changes tailored to your needs. They may recommend smoking cessation options or meeting with a dietitian to discuss healthy eating plans.

Risk factor management

Managing your risk factors for CAD can help slow down the progression of your disease. Work with your provider to manage the following conditions:

• Diabetes.
• High blood pressure.
• High cholesterol.
• High triglycerides (hypertriglyceridemia).
• Having a BMI higher than 25.

Medications

Medications can help you manage your risk factors and treat symptoms of coronary artery disease. Your provider may prescribe one or more medications that:

1. Lower your blood pressure.
2. Lower your cholesterol.
3. Manage stable angina, like nitroglycerin and ranolazine.
4. Reduce your risk of blood clots.

Procedures and surgeries

Some people need a procedure or surgery to manage coronary artery disease, including:

• Percutaneous coronary intervention (PCI): This minimally invasive procedure has another name — coronary angioplasty. Your provider reopens your blocked artery to help blood flow through it better. They may also insert a stent to help your artery stay open.
• Coronary artery bypass grafting (CABG): This surgery creates a new path for your blood to flow around blockages. This “detour” restores blood flow to your heart. CABG helps people who have severe blockages in several coronary arteries.

Complications/side effects of the treatment

Complications or side effects of coronary artery disease treatments may include:

1. Bleeding.
2. Diarrhea.
3. Dizziness.
4. Cough.
5. Blood clot.
6. Coronary artery puncture.
7. Infection.
8. Abnormal heart rhythms.
9. Cardiac tamponade.

How long does it take to recover from this treatment?

After PCI (angioplasty), you can usually get back to normal activities within a week. After CABG (bypass surgery), you’ll be in the hospital for more than a week. After that, it’ll take six to 12 weeks for a full recovery.

Can coronary artery disease be prevented?

You can’t always prevent coronary artery disease because some risk factors are out of your control. But you can lower your risk of coronary artery disease and help prevent it from getting worse in these ways:

• Commit to quitting smoking and all tobacco use.
• Eat heart-healthy foods.
• Get enough sleep.
• Stay at a weight that’s healthy for you.
• Learn your risk for heart disease.
• Limit alcohol use.
• Move around more.
• Keep taking your medications.

What can I expect if I have coronary artery disease?

Your provider is the best person to ask about your prognosis. Outcomes vary based on the person. Your provider will look at the big picture, including your age, medical conditions, risk factors and symptoms. Lifestyle changes and other treatments can improve your chances of a good prognosis.

Can coronary artery disease be reversed?

You can’t reverse coronary artery disease. But you can manage your condition and prevent it from getting worse. Work with your healthcare provider and follow your treatment plan. Doing so will give you the strongest possible chance of living a long and healthy life.

How do I take care of myself?

The most important thing you can do is keep up with your treatment plan. This may include lifestyle changes and medications. It may also involve a procedure or surgery and the necessary recovery afterward.

Along with treatment, your provider may recommend cardiac rehab. A cardiac rehab program is especially helpful for people recovering from a heart attack or living with heart failure. Cardiac rehab can help you with exercise, dietary changes and stress management.

Coronary artery disease and mental health

A CAD diagnosis may make you think about your heart and arteries more than ever before. This can be exhausting and overwhelming. You may worry a lot about your symptoms or what might happen to you. Many people with coronary artery disease experience depression and anxiety. It’s normal to worry when you’re living with a condition that can be life-threatening.

But the worry shouldn’t consume your daily life. You can still live an active, fulfilling life while having heart disease. If your diagnosis is affecting your mental health, talk with a counselor. Find a support group where you can meet people who share your concerns. Don’t feel you need to keep it all inside or be strong for others. CAD is a life-changing diagnosis. It’s OK to devote time to processing it all and figuring out how to feel better, both physically and emotionally.

When should I see my healthcare provider?

Your provider will tell you how often you need to come in for testing or follow-ups. You may have appointments with specialists (like a cardiologist) in addition to your primary care visits.

Call your provider if you:

• Experience new or changing symptoms.
• Have side effects from your medication.
• Have questions or concerns about your condition or your treatment plan.

When should I go to the ER?

Call 911 or your local emergency number if you have symptoms of a heart attack or stroke. These are life-threatening medical emergencies that require immediate care. It may be helpful to print out the symptoms and keep them where you can see them. Also, share the symptoms with your family and friends so they can call 911 for you if needed.

What questions should I ask my doctor?

If your provider hasn’t diagnosed you with coronary artery disease, consider asking:

• What are my risk factors for coronary artery disease?
• What can I do to lower my risk?
• 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?

If you have coronary artery disease, some helpful questions include:

• What can I do to slow down disease progression?
• What’s the best treatment plan for me?
• What lifestyle changes should I make?
• What medications do I need, and what are the side effects?
• Will I need a procedure or surgery? What does the recovery look like?
• Are there support groups or resources you can recommend?