What is coronary artery disease?
Coronary artery disease (CAD), also known as coronary heart disease or ischemic heart disease, is the most common type of heart disease.
CAD occurs when plaque, a sticky substance made of fat, cholesterol, cell waste and other materials, builds up in the coronary arteries. These arteries supply your heart with vital blood, oxygen and nutrients. This plaque buildup, also called atherosclerosis, can cause arteries to narrow or harden, restricting blood flow. It can also break off and form clots that block the arteries, leading to a heart attack or stroke.
Coronary artery disease can weaken your heart muscle over time, contributing to many serious heart conditions, including heart failure. It is the number one cause of death in the United States in both men and women. Still, in many cases, you can prevent CAD or slow its progression by making healthy lifestyle changes.
Types of coronary artery disease
CAD often develops over many years without causing noticeable symptoms. For many years, the first sign of coronary artery disease is a heart attack. In other people, CAD causes shortness of breath, chest pain that worsens with exercise or emotional stress, or other signs, but it doesn’t necessarily cause a heart attack. People are increasingly diagnosed with coronary artery disease through non-invasive imaging tests, which allow your doctor to identify the condition in an earlier stage, often before symptoms appear.
Doctors may classify CAD by how you experience it and give it one of the following names:
- Acute coronary syndrome: Plaque breaks off and suddenly blocks blood flow. You may have a heart attack or sudden, severe chest pain that does not go away with rest.
- Stable ischemic heart disease: You have symptoms that typically last two months or more. Symptoms may appear with activity and go away when you rest.
- Pre-clinical ischemic heart disease: You may have no coronary artery disease symptoms, but an early form of the condition is present.
Coronary artery disease symptoms
CAD often does not cause symptoms until you have significant plaque buildup. Doctors often call it a “silent” disease. You may not know you have it until you have a severe heart event, such as a heart attack.
When coronary artery disease causes symptoms, chest pain (angina) is the most common. Stable ischemic heart disease causes stable angina, which means your chest pain (which may also feel like discomfort) comes and goes in regular patterns and usually gets better when you rest or take medications.
Acute coronary syndrome causes unstable angina, which is sudden intense chest pain or discomfort that happens whether you’re active or resting. There’s no predictable pattern to the pain, and it may last more than 15 minutes. Unstable angina is a symptom of a heart attack and needs emergency care.
Other CAD symptoms include shortness of breath or pain in the neck or jaw.
When to see a doctor
See a doctor if you experience any type of chest pain, shortness of breath or neck pain or think you could be at risk for coronary artery disease. You should also see your doctor for annual checkups. These visits allow your doctor to check your blood pressure, cholesterol levels and other markers of heart health that could suggest you have or are at risk for coronary artery disease.
You should call 911 immediately if you have or see someone having symptoms of a heart attack. Do not drive yourself to the hospital. Heart attack symptoms include:
- Chest pain, discomfort, squeezing, burning, pressure* or tightness*
- Cold sweats
- Dizziness*
- Feeling lightheaded or weak
- Feeling like you have indigestion*
- Heart palpitations
- Severe fatigue*
- Nausea or vomiting*
- Pain in your jaw, neck, shoulders,* back* or arms*
- Stomach pain*
- Shortness of breath
*These symptoms are more likely to occur in women.
Coronary artery disease risk factors
The atherosclerosis (plaque buildup) that causes CAD can be related to many factors, some of which you can control and some you cannot.
You cannot control your age, biological sex, genes or family history, which can increase your risk, but you can control your lifestyle. Your diet and exercise habits can contribute to the development of plaque and CAD. The main preventable risk factors are diabetes, unhealthy cholesterol levels, high blood pressure and smoking.
Risk factors for coronary artery disease include:
- Age: Men age 45 and up and women over age 55 are at higher risk.
- Alcohol: Regularly drinking too much can raise your blood pressure and cholesterol levels.
- Diabetes: High blood sugar levels damage your arteries.
- Diet: Eating a diet high in saturated fat, salt and refined carbohydrates can lead to high cholesterol and blood pressure.
- Excess weight: Being overweight or obese raises your risk of heart problems.
- Family history: You are more at risk if a close family member has cardiovascular disease, especially if it developed at an early age.
- Genes: Some genes have been linked to a higher risk of CAD.
- High blood pressure: Blood pressure is the force of blood against your artery walls. High blood pressure can damage them.
- High cholesterol levels: Having high LDL (or bad) cholesterol contributes to plaque buildup.
- Lack of sleep: Not getting enough good quality sleep may raise your risk of heart problems.
- Lack of physical activity: A sedentary lifestyle can worsen other risk factors, such as high blood pressure and high cholesterol.
- Menopause: Women are more at risk for CAD after menopause when their levels of the hormone estrogen drop.
- Other medical conditions: Many conditions, including autoimmune conditions, chronic kidney disease and HIV/AIDS, are linked to an increased risk of CAD.
- Pregnancy complications: Conditions such as gestational diabetes and pre-eclampsia (high blood pressure during pregnancy) can increase risk.
- Race or ethnicity: People who are Black, Native American or South Asian are at higher risk than white people.
- Sex: More men are affected than women, but CAD is a leading cause of death in both sexes. Women more commonly experience shortness of breath as a symptom compared to chest pain, which is more common among men.
- Smoking: Smoking and exposure to secondhand smoke can damage your blood vessels.
Complications
If your heart muscle does not get enough oxygen-rich blood or a blood clot completely blocks an artery, you can develop serious complications. A heart attack can happen without warning, even if you have had no symptoms before.
Complications of coronary artery disease include:
- Arrhythmia: The muscle cells that regulate your heart rate may become damaged, leading to a fast, slow or irregular heartbeat.
- Heart attack: A heart attack occurs when your heart does not get enough oxygen. Lack of oxygen causes tissue to die.
- Heart failure: Restricted blood flow can weaken your heart. Heart failure develops when your heart becomes too weak to work efficiently.
- Stroke: A blood clot can block the blood supply to your brain, causing a stroke. Some types of irregular heartbeat can also raise your risk of stroke.
How is coronary artery disease diagnosed?
Your doctor will diagnose coronary artery disease based on a physical examination, your medical history, symptoms, imaging tests and heart scans.
Since the condition does not always cause symptoms, your doctor might diagnose risk factors, such as high blood pressure or unhealthy cholesterol levels, before diagnosing CAD. Your doctor can diagnose these risk factors at routine checkups and help you find ways to lower your risk of developing CAD.
Coronary artery disease treatment
Your doctor will work with you to develop a treatment plan, depending on how serious your symptoms are and any other health conditions you have. They will normally recommend lifestyle changes and might prescribe medication to treat your symptoms and risk factors.
You should get your cholesterol levels and blood pressure checked regularly.
Find specialized coronary artery disease care
At Baylor Scott & White, we have multiple locations across North and Central Texas to provide you with access to expert cardiology care. Our specialized cardiovascular centers are designed to meet the unique needs of people who have been diagnosed with coronary artery disease. Whether you're seeking diagnostic testing, treatment options or need ongoing support, our teams are here to help you with coronary artery disease care.
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