What Is Coronary Artery Disease?

Coronary Artery Disease (CAD) is the leading cause of death in the world, causing 16% of deaths globally, according to the World Health Organization (WHO).

For your heart and other organs in the body to stay healthy and work properly, they require ample blood supply. Blood carries oxygen and other nutrients to every part of your body through a network of blood vessels.

Coronary arteries are the blood vessels that supply oxygen-rich blood to your heart muscle, allowing it to pump blood to other vital body organs.

Your coronary arteries can become narrowed, damaged, or diseased, limiting the supply of oxygen-rich blood to your heart. As a result, you may develop coronary artery disease (CAD), also called coronary heart disease (CHD) or ischemic heart disease.

Causes of Coronary Artery Disease

Coronary artery disease usually results from plaque buildup in the walls of your coronary arteries (atherosclerosis). Plaque refers to fatty deposits that contain cholesterol, cellular waste products, and other substances.

Over time, plaque hardens and causes your arteries to narrow, restricting blood flow (and thus oxygen) to the heart.

The restriction of blood supply to the heart muscle is known as cardiac ischemia or myocardial ischemia. Cardiac ischemia, in turn, results in coronary artery disease, which puts you at risk of a heart attack.

Plaque could also cut off blood flow if it ruptures, causing a blood clot to form at the rupture site. Additionally, the piece that breaks off could get stuck in the artery, obstructing blood flow.

Symptoms and Complications of Coronary Artery Disease

Some people with coronary heart disease have no apparent symptoms. But for those who do, the two most common symptoms are:

• Angina (chest pain): a painful feeling of tightness or pressure, usually in the middle or left side of your chest. Common triggers of angina are physical activity and emotional stress. And the pain can spread to your arms, neck, jaw, or back.
• Shortness of breath: when your heart can’t pump enough blood to the rest of your body, you may experience shortness of breath, especially during physical activity.

Symptoms of CAD for women

Women are less likely to experience chest pain than men. They’re, however, more likely to experience:

• Shortness of breath
• Fatigue
• Nausea
• Lightheadedness
• Jaw, neck, and stomach pain

Complications

Coronary artery disease can lead to conditions that can be life-threatening, including:

• Heart attack (myocardial infarction)
• Heart failure
• Arrhythmia, i.e., an abnormal heart rhythm
• Sudden cardiac arrest

Risk Factors for Coronary Artery Disease

There are numerous risk factors for coronary heart disease, including:

• Tobacco use: cigarette smokers are at a higher risk of heart disease than nonsmokers. Exposure to secondhand smoke also raises your risk.
• High blood cholesterol: high LDL “bad” cholesterol levels and high blood triglycerides are associated with atherosclerosis, i.e., the buildup of plaque in the artery walls. And if your arteries become narrowed, your risk of coronary artery disease increases. On the other hand, high HDL “good” cholesterol levels lower your risk of CAD.
• High blood pressure: hypertension overworks your heart and blood vessels. The added stress on your coronary arteries, in particular, can damage them, increasing your risk of heart disease. Your risk near doubles if other CAD risk factors (e.g., smoking, high levels of cholesterol, and obesity) are also present.
• Being obese or overweight: having excess weight, especially around the waist, makes you more prone to cardiovascular diseases. Obesity is also associated with other heart disease risk factors like high blood sugar, high blood cholesterol, high blood pressure, and high triglyceride levels.
• Little to no physical activity: A sedentary lifestyle increases your risk of coronary heart disease.
• Diabetes: high blood glucose levels due to insulin resistance or insulin deficiency increase your risk of developing heart disease. Statistically, 68% of people diagnosed with diabetes aged over 65 die from heart disease, while 16% succumb to stroke.
• Age: men aged 45 or older and women aged 55 and above or in their postmenopause years are more likely to develop CAD than younger people.
• Gender: men tend to be at a greater risk for coronary artery disease than women.
• Heredity: you’re more likely to develop cardiovascular disease if either your parents or siblings are diagnosed with heart disease before their 55th birthday for men or their 65th birthday for women. Additionally, African-Americans have a higher risk of heart disease than Caucasians.
• Stress: how you respond to stress can increase your risk of a heart attack. For instance, some people may binge eat or start smoking to cope with stress. Stress can also cause your arteries to constrict.
• Unhealthy eating habits: include consuming refined carbohydrates and foods containing large amounts of saturated fats and trans fats. Such dietary choices can lead to weight gain, high blood cholesterol, and atherosclerosis, consequently putting you at risk of CAD.
• History of preeclampsia: preeclampsia is a pregnancy complication characterized by hypertension. The condition raises your lifetime risk of heart disease.

How Is Coronary Artery Disease Diagnosed?

To determine whether you have coronary artery disease or have other conditions that may put you at risk of CAD, your doctor will:

• Ask about your medical and family history.
• Do a physical exam.
• Run blood tests to assess your levels of cholesterol, triglycerides, glucose, and or C-reactive protein (CRP).

To help confirm a CAD diagnosis, your doctor may additionally order some diagnostic tests for cardiovascular diseases, including:

• Electrocardiogram (ECG): detects and records the electrical signals your heart produces each time it beats. An ECG can help detect arrhythmias, evidence of an ongoing or previous heart attack, coronary artery disease, and an enlarged heart.
• Echocardiogram: uses high-frequency sound waves (ultrasound) to produce live images of your heart. An echocardiogram checks your heart’s pumping activity by examining how different parts of your heart are working. The test can reveal damage from a heart attack, which can be a sign of CAD.
• Exercise stress test: uses an ECG or echocardiogram to monitor how your heart functions during physical activity. To stimulate your heart, your doctor may ask you to walk or run on a treadmill, pedal a stationary bike, or give you medication to make your heart work harder.
• Cardiac catheterization and angiography: doctors use these two tests to examine your blood vessels for any blockages. First, a thin, flexible tube called a catheter is inserted through a blood vessel in your neck, arm, or groin and guided to your heart. Your doctor may then inject a dye into your coronary arteries through the catheter to make them visible. And lastly, angiograms (X-ray images) are taken.
• Heart CT scan: an imaging test that uses X-rays to provide detailed images of your heart and its blood vessels. It helps determine if you have CAD by detecting the presence, location, and amount of calcified plaque in your coronary arteries.

Treatment for Coronary Artery Disease

CAD treatment generally involves healthy lifestyle changes, medicines, and medical procedures. The choice of treatment depends on the severity of your disease and symptoms and the presence of additional conditions.

Heart-healthy lifestyle changes

Making the following lifestyle change can help promote healthier arteries and reduce your risk of further heart-related problems:

• Quit smoking
• Become physically active
• Lose excess weight
• Eat heart-healthy foods, which include vegetables and whole grains
• Learn how to manage stress

Medicines

Drugs your doctor may recommend to treat coronary heart disease include:

• Beta-Blockers: reduce your blood pressure and lower your heart rate.
• Nitroglycerin: widen your coronary arteries, which helps relieve angina. They’re available in patches, sprays and tablets.
• Angiotensin-converting enzyme (ACE) inhibitors: treat high blood pressure, which reduces your heart’s workload.
• Calcium channel blockers: reduce blood pressure by limiting the amount of calcium entering the cells of your heart and blood vessels, allowing your arteries to relax.
• Statins: lower the levels of LDL “bad” cholesterol in your blood.

Learn More: Heart Medications: Drugs to Treat Heart Disease

Medical procedures

Depending on how severe your CAD is, you may require a non-surgical procedure or heart surgery.

Coronary angioplasty (percutaneous coronary intervention (PCI))

The procedure involves inserting a balloon catheter into a blocked or narrowed artery and then inflating it to restore blood flow by pushing plaque against the artery walls.

A stent is usually positioned in the blood vessel to help keep it open. It may be a drug-eluting stent that releases medication that prevents scar tissue from forming in the artery lining, consequently preventing it from narrowing again.

Coronary artery bypass grafting (CABG)

A surgeon uses a graft made from a healthy blood vessel from another part of your body to allow blood to bypass the narrowed or blocked section of your coronary artery.

The surgeon sews one end of the artery or vein graft to your aorta and the other end to your coronary artery. CABG, which is the most performed heart surgery, is typically used to treat people with multiple blocked coronary arteries.

Heart transplant

A patient with severe CAD may require a heart transplant if other medications and procedures aren’t successful. A heart transplant involves removing the diseased or failing heart and replacing it with a healthy donor heart.

Prevention of Coronary Artery Disease

Coronary artery disease is preventable with the same lifestyle changes that can help slow its progression. These include:

• Avoid smoking or stop if you already do.
• Eating a heart-healthy diet, i.e., one that restricts the intake of saturated fats and trans fats and reduces sugar consumption.
• Regularly exercising helps you maintain a healthy weight, lowers your blood pressure, improves your blood cholesterol levels, and controls diabetes. Remember, these are all risk factors for CHD.
• Shed off extra pounds and maintain a healthy weight. Your body mass index (BMI) can help you determine your healthy weight.
• Keep conditions that are risk factors for coronary artery disease under control. These include diabetes, hypertension, and high cholesterol levels.
• Avoid or limit your alcohol consumption. Ideally, women should drink one drink max a day and men two drinks.