Coronary Artery Disease: Causes, Symptoms & Treatment

Coronary artery disease (CAD), also called coronary heart disease or ischemic heart disease, occurs when the arteries that supply blood to the heart muscle become narrowed or blocked by a buildup of fatty deposits called plaque. This process, known as atherosclerosis, develops gradually over decades and can eventually reduce blood flow to the heart, causing chest pain (angina) or leading to a heart attack.

CAD is the most common type of heart disease and the leading cause of death for both men and women worldwide. In the United States, approximately 20 million adults live with CAD, and it accounts for roughly one in every five deaths.

CAD results from atherosclerosis, which is driven by a combination of modifiable and non-modifiable risk factors:

Non-modifiable risk factors:

• Age (men over 45, women over 55)
• Male sex (though women catch up after menopause)
• Family history of early heart disease (father or brother before 55, mother or sister before 65)
• Genetic predisposition

Modifiable risk factors:

• High LDL cholesterol and low HDL cholesterol
• High blood pressure (hypertension)
• Cigarette smoking
• Diabetes mellitus
• Obesity and physical inactivity
• Unhealthy diet high in saturated fats, trans fats, and sodium
• Chronic stress and depression

CAD symptoms depend on the severity of the blockage:

Stable angina -- the most common symptom:

• Chest pressure, tightness, squeezing, or burning during physical activity or emotional stress
• Pain that may radiate to the shoulders, arms, neck, jaw, or back
• Shortness of breath with exertion
• Symptoms that resolve with rest or nitroglycerin

Unstable angina and heart attack (medical emergencies):

• Chest pain at rest or with minimal exertion
• New or worsening chest pain
• Pain lasting more than a few minutes
• Accompanying nausea, cold sweats, lightheadedness, or shortness of breath

Doctors use several tests to diagnose CAD:

• Electrocardiogram (ECG/EKG): Records heart's electrical activity; may show evidence of prior or current heart damage
• Stress test: Monitors heart during exercise (treadmill) or pharmacological stress to detect reduced blood flow
• Echocardiogram: Ultrasound showing heart structure and function
• Coronary CT angiography: CT scan with contrast dye to visualize coronary arteries
• Cardiac catheterization (coronary angiography): Gold standard -- a catheter is inserted into the coronary arteries to directly visualize blockages
• Blood tests: Lipid panel, blood glucose, troponin (if heart attack suspected)

Treatment depends on the severity of CAD and symptoms:

Lifestyle modifications (foundation for all patients):

• Smoking cessation
• Heart-healthy diet (Mediterranean or DASH diet)
• Regular aerobic exercise (at least 150 minutes per week of moderate activity)
• Weight management (BMI under 25)
• Stress management

Medications:

• Statins (e.g., atorvastatin) to lower LDL cholesterol
• Aspirin or other antiplatelet drugs to prevent blood clots
• Beta-blockers to reduce heart rate and blood pressure
• ACE inhibitors or ARBs to lower blood pressure and protect the heart
• Nitroglycerin for angina relief

Procedures and surgery:

• Percutaneous coronary intervention (PCI/angioplasty): A balloon is inflated inside the blocked artery, and a stent is placed to keep it open
• Coronary artery bypass grafting (CABG): Surgery to reroute blood around blocked arteries using grafts from other blood vessels

Preventing CAD centers on controlling risk factors:

• Maintain healthy cholesterol and blood pressure levels
• Do not smoke or quit if you currently smoke
• Exercise regularly and maintain a healthy weight
• Manage diabetes effectively
• Eat a balanced, heart-healthy diet
• Limit alcohol consumption
• Get regular health check-ups and screenings

See a doctor if you experience chest pain or discomfort with exertion, unexplained shortness of breath, or if you have multiple risk factors for heart disease. Seek emergency care immediately for sudden or severe chest pain, especially with associated symptoms like sweating, nausea, or arm/jaw pain.