Coronary artery disease—known as CAD for short—affects more than 15 million American adults, making it the most common type of heart disease. It's also the leading cause of death in men and women in the United States.
But because CAD usually progresses over many decades, you may not know you have it until it starts causing symptoms.
CAD develops when your coronary arteries, which act like fuel lines to supply blood to the heart, become damaged or diseased. Most often, CAD develops from a buildup of plaque—fat, cholesterol, collagen, inflammatory cells and other substances—that collect in the walls of the coronary artery, which is called atherosclerosis.
Over time, this plaque can calcify and harden, and the arteries can become narrow or blocked. When this happens, blood supply to the heart becomes restricted. As a result, the heart doesn't get the oxygen and nutrients it needs. This can lead to chest pain, heart attack, heart failure and some heart rhythm problems. CAD is sometimes called atherosclerotic heart disease or coronary heart disease.
Really anyone with risk factors for heart disease can develop CAD. But it's more likely as you get older and if you:
"Although you can't pick your parents to change your genetic risk for heart disease—and your age is what it is—there are many risk factors for heart disease that you can change to help protect yourself. Talk with your health care team about what's right for you."
— Dr. Martha Gulati, CardioSmart.org editor in chief
The signs of CAD can vary. Some people have no symptoms at all, which is fairly typical during the early stages of the disease. For others, chest pain or chest pressure—or even a heart attack—might be the first sign of blockages in the heart's arteries.
Chest pain or discomfort is the most common symptom of reduced blood flow to the heart (also known as angina). It occurs when the heart isn't getting enough oxygen or blood. People describe it as pain, pressure, squeezing or fullness in their chest. But this feeling can also be very subtle. Chest pain or discomfort can be brought on by activity or extreme emotion, but it usually subsides with rest. You may also feel short of breath, generally weak or unusually tired. Women more often than men may not have chest pain; their symptoms may be limited to pain in their neck, jaw or back.
Severe narrowing or blockage of an artery can also lead to heart attack, which can happen when plaque ruptures into the artery and a clot forms to heal the injury.
When to call for help
A heart attack can feel different for men and women. If you think you are having a heart attack, don't question it. Act fast and dial 911 if you or a loved one has any of these symptoms.
|Differences in Symptoms of Heart Attack/Angina Based on Sex|
|Men–usually more classic signs||Women–may be more subtle|
Your doctor will take a medical history, ask about your symptoms and listen to your heart with a stethoscope. He/she may order tests to determine whether you have CAD and to what extent (for example, doing an angiography can tell your provider exactly how much of the inner part of the vessel is blocked). The results of these tests can also help guide treatment decisions.
Tests may include:
What do the results mean?
Your doctor might tell you that you have "less than 70% blockage in an artery." That means that you have non-obstructive CAD. In other words, blood flow to the heart muscle is not reduced at rest, but may be limited during intense exercise or exertion. In this case, risk reduction through lifestyle and medication is the best treatment.
Or your doctor might say you have "over 70% blockage in one artery." This means that you have severe blockages in both coronary arteries. Blood flow to the heart muscle is significantly reduced and would likely explain any chest pain or shortness of breath you may have been feeling. In this case, your doctor might recommend more aggressive medical treatment, and possibly recommend a procedure or surgery.
|Degree of CAD||How much the artery is blocked|
|Mild||Less than 49%|
|Severe||More than 70%|
There are a number of treatment options for CAD, including lifestyle changes, medications, surgery and/or medical procedures.
Lifestyle changes include:
Medications may be recommended to treat high cholesterol, high blood pressure, and high blood sugar. Sometimes medications for chest pain that comes on with activity are recommended. Aspirin or other blood thinners may also be recommended.
Procedures or surgeries may be recommended if you have a severely narrowed coronary artery to reduce the risk of a heart attack. For example:
Your treatment will depend on:
Cardiac rehab is beneficial to all patients with angina (chest pain) or after a heart attack, coronary procedure, valve surgery or heart failure. Cardiac rehab is a 12-week program that includes a mix of supervised exercise, nutrition counseling, stress management, smoking cessation assistance and education about the disease process, including how you can better take control of your health and improve outcomes.
To learn more about CAD, visit CardioSmart's condition center. In addition to the resources on CardioSmart.org, you can find out more about CAD at: