Coronary Artery Disease

Coronary artery disease (CAD) develops when the arteries that supply blood to the heart muscle become narrowed by a gradual build-up of fatty deposits called plaque — a process known as atherosclerosis. As the arteries narrow, the heart muscle may not get enough oxygen-rich blood, especially during exertion.

CAD is the most common type of heart disease and a leading cause of death worldwide. It can lead to angina (chest pain), heart attack, heart failure and dangerous rhythm problems. The encouraging news is that it is largely preventable and, once diagnosed, very treatable.

The classic symptom is chest pain or pressure (angina), often brought on by physical effort or stress and eased by rest. Other symptoms include breathlessness and unusual fatigue. CAD can also be 'silent'. Seek emergency medical care immediately if chest pain occurs suddenly, is severe, or is accompanied by shortness of breath, cold sweats, or pain radiating to the shoulder, arm, or jaw.

The underlying cause is atherosclerosis. Major risk factors include high cholesterol, high blood pressure, smoking, diabetes, being overweight, physical inactivity, an unhealthy diet, increasing age and a family history of heart disease. Several of these can be changed or controlled.

After reviewing your symptoms and risk factors, a doctor may arrange an ECG, blood tests, an exercise stress test, an echocardiogram, a CT scan of the coronary arteries (CT coronary angiography), or an invasive coronary angiogram — the most detailed test, which shows narrowings directly and can guide treatment.

Treatment combines lifestyle changes with medicines such as statins to lower cholesterol, drugs to control blood pressure, and antiplatelet medicines like aspirin. When a major narrowing is found, it may be opened with a balloon and stent (angioplasty, or PCI) or bypassed with coronary artery bypass surgery (CABG). Your heart team weighs these options together.

To a large degree, yes. Not smoking, eating a balanced diet low in salt and saturated fat, staying physically active, keeping a healthy weight, and controlling blood pressure, cholesterol and blood sugar all sharply reduce your risk — and slow the disease even after it has been diagnosed.