Coronary Artery Disease — the Causes, Symptoms and Treatments
Cardiovascular Health
Coronary artery disease is the most common type of heart disease in the United States (US). Coronary artery disease goes by other names, such as CAD, coronary heart disease, or ischemic heart disease.
Continue reading to learn more about CAD, what it feels like, and how it’s treated.
What Is CAD?
CAD occurs when the arteries that bring oxygen-rich blood to your heart (called coronary arteries) become narrowed or blocked.
CAD doesn’t always cause symptoms. In fact, you may not know you have CAD until there’s a complication, such as a blood clot that causes a heart attack.
Types of CAD
There are two types of CAD — stable ischemic heart disease and acute coronary syndrome.
- Stable ischemic heart disease — a chronic (long-term) type of CAD you can live with over many years.
- Acute coronary syndrome — a sudden (acute) medical emergency that causes a heart attack (also called a myocardial infarction). This can happen when the plaque in your coronary artery suddenly blocks the blood flow to your heart.
What Causes CAD?
CAD can be caused by a buildup of plaque in your coronary arteries or by problems with how your blood vessels work. Plaque buildup is the most common cause of CAD.
Plaque Buildup
Plaque is made of a number of different substances found in your blood, including fat, cholesterol, and calcium. When plaque builds up on the walls of your arteries, it gradually makes them harder and more narrow over time. This is known as atherosclerosis.
The plaque in your coronary arteries makes it harder to pump oxygen-rich blood to the muscles of your heart.
Problems With Your Blood Vessels
CAD can also be caused if your coronary arteries aren’t working the way they should be. Normally, your coronary arteries will become wider to allow more blood flow when your heart needs more oxygen — such as during physical exercise or emotional stress. In some people with CAD, the coronary arteries don’t respond to signals that your heart needs more oxygen. In some cases, the arteries may even become more narrow, allowing less blood to flow.
Although researchers don’t know why this occurs in some people, they think it may be related to damage to the artery walls or the tiny blood vessels around it. Medical conditions such as high blood pressure, diabetes, or other conditions that cause long-term inflammation may cause this damage.
If your coronary artery becomes damaged, it can cause the artery to suddenly become more narrow for a time — called a vasospasm.
Who Gets CAD?
CAD is a very common disease. In fact, CAD is the most common cause of death for adults in the US.
Some people have a higher risk of developing CAD. Risk factors for CAD can be divided into factors you don’t have control over (non-modifiable risk factors) and those you do have control over (modifiable risk factors).
Non-modifiable risk factors for CAD include:
- Age — your risk of CAD increases after age 35
- Gender — men have a higher risk of CAD than women
- Ethnicity — ethnic groups with an increased risk of CAD include Blacks, Hispanics, Latinos, and Southeast Asians
- Family history — your risk of CAD increases if you have a relative who was diagnosed with CAD, especially at a young age
Modifiable risk factors for CAD include lifestyle factors such as:
- Diet high in saturated fat and refined carbohydrates
- Sedentary lifestyle (lack of physical activity)
- Lack of sleep
- Smoking or vaping
- Stress
You may have an increased risk of CAD if you’ve been diagnosed with certain medical conditions, such as:
- High blood pressure (hypertension)
- High cholesterol (hyperlipidemia)
- Diabetes
- Obesity
- Non-alcoholic fatty liver disease (NAFLD)
- Chronic kidney disease (CKD)
- Autoimmune conditions — such as lupus, rheumatoid arthritis, or inflammatory bowel disease (IBD)
- Anemia
- HIV/AIDS
- Metabolic syndrome
- Sleep apnea
- Endometriosis
- Hypothyroidism
- Vitamin D deficiency
What Are the Symptoms of CAD?
CAD symptoms are caused when your heart has to work harder to deliver oxygen-rich blood around your body. Not everyone with CAD has symptoms. People with stable ischemic heart disease may have symptoms including:
- Angina (chest pain)
- Shortness of breath
- Fatigue (extreme tiredness)
Most people with CAD symptoms notice that angina gets worse with physical activity or emotional stress and gets better with rest.
Heart Attack Symptoms
The first symptom of CAD in many people is a heart attack. Symptoms of a heart attack include:
- Chest pain — pain or discomfort that may feel like pressure, squeezing, aching, or fullness in the middle or left side of your chest
- Pain in your arms or shoulder
- Pain in your jaw, neck, or back
- Heartburn or indigestion
- Cold sweat
- Feeling weak
- Fatigue
- Shortness of breath
Women are more likely to experience unusual symptoms of a heart attack, such as unusual fatigue, nausea, or vomiting.
If you or someone close to you is experiencing these symptoms, don’t wait — call 911 immediately.
How Is CAD Diagnosed?
CAD is diagnosed with a combination of a physical exam, blood tests, and heart tests. Most people will start testing for CAD before they have any symptoms — known as screening tests.
CAD Screening Tests
Because CAD doesn’t always cause symptoms until there is a serious problem, your doctor may recommend you undergo some tests for heart disease before you experience symptoms. Testing done to detect a health problem before you have any symptoms is known as a screening test.
You may begin screening for CAD from the age of about 20 years if you don’t have any risk factors. Some people may be screened for CAD starting at a younger age if they have certain risk factors, such as obesity, a lack of physical activity, or a family history of heart disease.
To screen you for CAD, your healthcare provider may:
- Ask you questions about your family history and lifestyle habits to assess your risk factors for developing CAD
- Measure your waist circumference and calculate your body mass index (BMI) to determine if you have obesity
- Monitor your blood pressure to see if you have high blood pressure
- Order blood tests to check for other health conditions such as high cholesterol or diabetes
Calculating Your Risk of CAD
Your healthcare provider can use factors from screening tests to estimate your risk of CAD or related complications (such as a heart attack, stroke, or death) over the next 10 or more years. Understanding your risk of CAD can help you and your healthcare provider make decisions about the best way to prevent CAD.
One example of a risk calculator is the Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimator Plus from the American College of Cardiology. This risk calculator considers several factors to estimate your risk, such as:
- Age
- Sex
- Race
- Cholesterol levels
- Blood pressure
- If you smoke
- If you take medications to manage high blood pressure and cholesterol
CAD risk calculators may not be accurate in some situations where they can’t account for certain factors, such as in:
- Pregnancy
- Early menopause
- Metabolic syndrome (a group of conditions that increases your risk of CAD)
- Inflammatory or autoimmune conditions
- People who take statins for cholesterol
If you fall into one of the categories above, your healthcare provider may consider other factors or order additional tests to estimate your CAD risk.
CAD Diagnostic Tests
If you have symptoms of CAD or if your healthcare provider suspects you may have CAD based on screening tests, your provider may order diagnostic tests.
Diagnostic tests are tests or procedures that help your healthcare provider diagnose your medical condition. To diagnose CAD, you may undergo one or more of the following tests:
- Electrocardiogram (also known as an ECG or EKG) — A test that uses electrodes on your chest to measure the strength and timing of the electrical signals in your heart.
- Echocardiogram — An ultrasound test that uses sound waves to create an image of how blood moves through your heart.
- Exercise stress tests — This test checks how your heart works under stress. During a stress test, you will exercise on a treadmill or stationary bike to make your heart work harder. Your healthcare provider will monitor your heart using an ECG or echocardiogram while you exercise. If you’re unable to exercise, you may be given a medicine that makes your heart work harder.
- Nuclear stress tests — This test works the same as an exercise stress test with the addition of a radioactive tracer. The radioactive tracer is given directly into your veins to help your healthcare providers see your coronary arteries more clearly.
- Coronary calcium scan — This test uses a computed tomography (CT) scan of your heart to show the amount of calcium in your coronary arteries.
- Coronary CT angiography — An imaging test that uses a CT scan and a special dye to visualize the blood flow in your coronary arteries.
- Invasive coronary angiography — During this test, your healthcare provider inserts a dye into your coronary arteries using a flexible tube called a catheter. The dye creates a clear picture of your blood vessels and coronary arteries.
How Is CAD Treated?
Your CAD treatment will be personalized based on the severity of your symptoms and your other medical conditions. Treatment for CAD ranges from making a few healthy lifestyle changes to emergency treatment for a heart attack.
The treatment options for CAD are discussed below but talk to your healthcare provider to decide on the CAD treatment plan that’s best for you.
Lifestyle Changes for CAD
Making changes to your lifestyle habits can help to keep your coronary arteries healthy and slow down the progression of CAD. You don’t have to wait until you’re diagnosed with CAD to make these heart-healthy lifestyle changes:
- Eat a heart-healthy diet — A heart-healthy diet should include plenty of fruits, vegetables, and whole grains and limit saturated fat, salt, sugar, and alcohol.
- Exercise — Regular physical activity can help you manage CAD risk factors such as high cholesterol, high blood pressure, and obesity. It’s recommended to get at least 150 minutes of moderate aerobic activity each week.
- Don’t smoke — Smoking, vaping, or using other tobacco products are major risk factors for CAD because nicotine can make your blood vessels tighten and become more narrow. Talk to your healthcare provider about how to quit if you smoke.
- Maintain a healthy weight — Your risk of CAD is higher if you have overweight or obesity. Reaching and maintaining a healthy weight can help manage CAD risk factors.
- Get enough sleep — Your body works to repair your heart and blood vessels while you sleep. If you don’t get enough sleep, your risk of CAD increases. It’s recommended that adults get about 7 to 9 hours of sleep every day.
- Manage your stress — Emotional stress can impact your physical health. Talk to your healthcare provider to learn about ways you can manage stress, such as exercise, mindfulness and meditation, and social support.
Heart-healthy lifestyle habits can help you reduce your risk of CAD and other risk factors for CAD, such as high blood pressure, high cholesterol, and diabetes. Talk to your healthcare provider about the best way to manage your risk factors.
Medications for CAD
Medications for CAD can help you manage your risk factors or treat the symptoms of CAD.
Medications that help lower your blood pressure and reduce how hard your heart has to work include:
- Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) — help lower your blood pressure.
- Beta-blockers — help to reduce how hard your heart is working by slowing your heart rate and lowering your blood pressure.
- Calcium channel blockers — help decrease your blood pressure by relaxing your blood vessels.
If you have angina, your healthcare provider may prescribe you a medication to relieve or prevent angina, such as:
- Nitroglycerin — helps to dilate (widen) your coronary arteries to relieve sudden episodes of chest pain.
- Ranolazine — helps to treat chronic chest pain.
Medications to treat or prevent medical conditions that increase your risk of CAD may also be part of your treatment plan, including medications to manage your:
- Cholesterol
- Blood sugar
- Weight
Procedures and Surgeries for CAD
If you have serious symptoms of CAD, you may need a procedure or heart surgery, such as:
- Percutaneous coronary intervention (PCI) — This procedure helps to open a blocked or narrowed coronary artery using shock waves or a tiny balloon to break up the plaque on the artery wall. Your healthcare provider may insert a mesh tube called a stent to prevent the artery from narrowing again. This procedure is also known as a coronary angioplasty.
- Coronary artery bypass grafting (CABG) — This surgery helps to improve blood flow in people with severe blockages in multiple coronary arteries. Surgeons create a new path for blood to flow around the blocked arteries using healthy arteries from your chest wall and your legs to go around the blockage.
Reducing Your Risk of CAD
Talk to your healthcare provider about the best treatment plan to reduce your risk of CAD based on your unique risk factors and lifestyle habits. Your healthcare provider can help you set goals and develop an appropriate treatment plan to help you reach them. It’s never too early or too late to start your journey to better heart health.
