Carl R. Darnall Army Medical Center - Health Library

Coronary Artery Disease

(CAD; Coronary Atherosclerosis; Coronary Heart Disease; Ischemic Heart Disease; Atherosclerosis of the Coronary Arteries)

Definition  ^

Coronary artery disease (CAD) is a the most common type of heart disease. The coronary arteries begin to narrow. This will slow or stop blood flow.

These arteries bring blood to the heart muscle. It supplies the busy heart with oxygen and other nutrients. Slow or stopped blood flow will lead to damage of the heart muscle.

Coronary Artery Disease
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Causes  ^

Damage to blood vessel walls causes CAD. Most common factors include:

  • Smoking, high blood pressure, and inflammation can all irritate and damage blood vessel walls.
  • Certain types of fat and cholesterol in the blood can cause a build-up on the walls. This build up is called plaque.

When plaque hardens it can tear blood vessel walls and cause bleeding. A blood clot will form to help the area heal. However, it can also add to plaque and further shrink path for blood flow.

Risk Factors  ^

The risk for CAD is greater in:

  • Men (mostly those who are over 45 years of age)
  • Women who are over 55 years of age

Factors that may increase your risk of CAD include:

Other risk factors may include:

Symptoms  ^

CAD itself may not have any signs or symptoms. Often the first sign is a problem with the heart. Weak or blocked blood flow to the heart can cause:

  • Angina—chest pain caused by low blood flow to heart muscle
  • Heart attack—loss of blood flow that has caused severe damage to heart muscle
  • Heart failure—the heart muscle is permanently harmed after years of poor blood flow

Call for emergency services right away if you think you may be having a heart attack. Early care can stop further harm.

Diagnosis  ^

The doctor may suspect CAD based on your family and health past. If you have a high risk of CAD, these tests may be done:

Blood tests to check:

  • Cholesterol levels in blood
  • Glucose levels
  • Signs of inflammation

CAD may not be found until after angina appears or a heart attack occurs.

Treatment  ^

The goals of treatment include:

  • Slow or stop growth of plaque in blood vessels. Decrease buildup if possible.
  • Decrease risk of complications like blood clots or heart attack.
  • Relieve symptoms, if there are any.

Options to help reach these goals include:

Lifestyle Habits

  • Focus on heart healthy diet which includes:
    • Limit saturated and trans fats, red meat, and processed meats.
    • Increase fruits, vegetables, fish, and fiber.
  • Do not drink too much alcohol. This means no more than 2 drinks per day for men and no more than 1 per day for women.
  • Increase your activity levels. Aim for 30 to 60 minutes of activity on most days. Increase your activity bit by bit over time.
  • If you smoke, talk to your doctor about ways to help you quit. Avoid being around others who smoke.
  • Reach and keep a healthy weight.

Medicine

Medicine can help to manage issues that can make CAD worse. It can also help decrease the risk of complications. Options include:

  • Statin therapy—to help manage cholesterol
  • Ace inhibitors or Beta blockers—may help to prevent angina and lower the risk of heart attack
  • Antiplatelet (aspirin or other)—to decrease risk of blood clots

Medical Care

Early care may decrease damage to the heart. Routine follow up care will be part of the care plan. Other steps that may be recommended include:

  • Keep control of your high blood pressure—may include medicine
  • Diabetes care plan—high blood glucose can damage blood vessels
  • Flu shot every year

Depression, anxiety, and stress can occur with CAD. Talk to your doctor if you need help.

There are also programs to help you make heart healthy changes. It includes help with your food and activity plans.

Surgery

Surgery may be needed to remove very bad blocks. Options include:

Prevention  ^

To reduce your risk of CAD:

RESOURCES:

American Heart Association
http://www.heart.org

National Heart, Lung, and Blood Institute
https://www.nhlbi.nih.gov

CANADIAN RESOURCES:

Heart and Stroke Foundation of Canada
http://www.heartandstroke.ca

Public Health Agency of Canada
https://www.canada.ca

REFERENCES:

Boden WE, O'Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356:1503-1516.

Coronary artery disease–Coronary heart disease. American Heart Association website. Available at:http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Coronary-Artery-Disease---Coronary-Heart-Disease_UCM_436416_Article.jsp#.WblGd7KGNQI. Updated April 26, 2017. Accessed September 13, 2017.

Coronary artery disease (CAD). EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T116156/Coronary-artery-disease-CAD. Updated June 7, 2017. Accessed September 13, 2017.

Explore coronary artery disease. National Heart, Lung, and Blood Institute website. Available at: https://www.nhlbi.nih.gov/health/health-topics/topics/cad. Updated June 22, 2016. Accessed September 13, 2017.

Management of stable angina. DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T114265/Management-of-stable-angina. Updated April 10, 2017. Accessed September 13, 2017.

4/10/2007 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T114265/Management-of-stable-angina: Boden WE, O'Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356(15):1503-1516.

11/7/2007 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T901116/Revascularization-for-coronary-artery-disease-CAD: Bravata DM, Gienger AL, McDonald KM, et al. Systematic Review: The comparative effectiveness of percutaneous coronary interventions and coronary artery bypass graft surgery. Ann Intern Med. 2007;147(10):703-716.

1/6/2009 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T113766/Coronary-artery-disease-possible-risk-factors: Surtees PG, Wainwright NW, Luben RN, Wareham NJ, Bingham SA, Khaw KT. Depression and ischemic heart disease mortality: evidence from the EPIC-Norfolk United Kingdom prospective cohort study. Am J Psychiatry. 2008;165(4):515-523.

6/5/2009 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T116156/Coronary-artery-disease-CAD: Sinha R, Cross AJ, Graubard BI, Leitzmann MF, Schatzkin A. Meat intake and mortality: a prospective study of over half a million people. Arch Intern Med. 2009;169(6):562-571.

7/6/2009 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T113884/Physical-activity-for-cardiovascular-disease-prevention: Kodama S, Saito K, Tanaka S, et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA. 2009;301(19):2024-2035.

7/6/2009 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T113766/Coronary-artery-disease-possible-risk-factors: Fung TT, Malik V, Rexrode KM, Manson JE, Willett WC, Hu FB. Sweetened beverage consumption and risk of coronary heart disease in women. Am J Clin Nutr. 2009;89(4):1037-1042.

11/26/2012 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T113766/Coronary-artery-disease-possible-risk-factors: Kivimaki M, Nyberg S, Batty G, et al. Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data. Lancet. 2012;380(9852):1491-1497.

7/21/2014 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T115449/Dietary-considerations-for-cardiovascular-disease-prevention: Afshin A, Micha R, Khatibzadeh S, Mozaffarian D. Consumption of nuts and legumes and risk of incident ischemic heart disease, stroke, and diabetes: a systematic review and meta-analysis. Am J Clin Nutr. 2014;100(1):278-288.

9/29/2016 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T113766/Coronary-artery-disease-possible-risk-factors: Batelaan NM, Seldenrijk A, Bot M, van Balkom AJ, Penninx BW. Anxiety and new onset of cardiovascular disease: critical review and meta-analysis. Br J Psychiatry. 2016;208(3):223-231.

Last reviewed July 2018 by EBSCO Medical Review Board Michael J. Fucci, DO, FACC  Last Updated: 7/31/2018