Coronary Artery Disease
(CAD; Coronary Atherosclerosis; Coronary Heart Disease; Ischemic Heart Disease; Atherosclerosis of the Coronary Arteries)
Coronary artery disease (CAD) is 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. Slowed or stopped blood flow will lead to damage of the heart muscle.
Copyright © Nucleus Medical Media, Inc.
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 paths for blood flow.
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:
- Strong family history of heart disease
- Obesity and being overweight
- High blood pressure
- Not being active often
- High cholesterol—especially low-density lipoprotein (LDL) (bad) cholesterol
- Low high-density lipoprotein (HDL) (good) cholesterol
- Metabolic syndrome—when high blood pressure, high cholesterol, too much belly fat, and insulin resistance are all present
Other risk factors may include:
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.
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:
- Electrocardiogram (ECG)—shows electrical action in your heart
- Exercise stress test—test your heart under stress
- Echocardiogram—image of your heart
- Coronary angiography—exam of blood vessels
- CT scan
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.
The goals of treatment include:
- Slow or stop growth of plaque in blood vessels. Decrease build-up 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:
Diet and exercise can play a role in heart and blood vessel healthy. Goals may include
- Heart healthy diet:
- Limit saturated and trans fats, red meat, and processed meats.
- Increase fruits, vegetables, fish, and fiber.
- Limit or avoid alcohol. This means no more than 2 drinks per day for men and no more than 1 per day for women.
- 30 to 60 minutes of physical activity on most days.
- Reach and keep a healthy weight.
Smoking can also make plaque worse. It also increases risk of heart disease. There are many tools to help quit.
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
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:
- 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 may be needed to remove very bad blocks. Options include:
- Percutaneous coronary interventions (PCI)—A tube is passed to the blockage. A wire mesh may also be used to hold the artery open.
- Coronary artery bypass grafting (CABG)—Part of a blood vessel is taken from other areas of the body. It is then placed near the blockage. The blood can then flow around the block through this new path.
The risk of CAD may be lower with:
- Healthy weight.
- Heart healthy diet
- Regular exercise program.
- Never smoking or quit smoking
- Stress management
American Heart Association
National Heart, Lung, and Blood Institute
Heart and Stroke Foundation of Canada
Public Health Agency of Canada
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. Accessed September 13, 2020.
Coronary artery disease (CAD). EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T116156/Coronary-artery-disease-CAD. Accessed September 13, 2020.
Explore coronary artery disease. National Heart, Lung, and Blood Institute website. Available at: https://www.nhlbi.nih.gov/health/health-topics/topics/cad. Accessed September 13, 2020.
Management of stable angina. DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T114265/Management-of-stable-angina. Accessed September 13, 2020.
9/29/2016 DynaMed Plus Systematic Literature Surveillance http://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 September 2020 by EBSCO Medical Review Board Michael J. Fucci, DO, FACC Last Updated: 8/14/2020