What is coronary artery disease?

Coronary artery disease (CAD) affects the coronary arteries, the blood vessels that supply blood to your heart muscle. These arteries become narrowed or blocked due to fat (cholesterol) and calcium buildup inside of them, which forms a plaque . This process is called hardening of the arteries, or atherosclerosis . (See an illustration of atherosclerosis .) Plaque buildup in the coronary arteries reduces blood flow to your heart muscle. Poor blood flow to the heart muscle is called ischemia.

What causes coronary artery disease?

The process of plaque buildup in your coronary arteries, which reduces blood flow to the heart muscle, is called atherosclerosis. Certain risk factors can increase your chances of developing CAD due to atherosclerosis. Smoking, uncontrolled high blood pressure, high cholesterol, diabetes, increased age, male sex, and a family history of heart disease are strong risk factors for coronary artery disease. If you are overweight, respond poorly to stress, and do not exercise regularly, you may also be at an increased risk for coronary artery disease. See the What Increases Your Risk section for more information.

How will I know if I have coronary artery disease?

Chest pain or discomfort is the most common symptom of coronary artery disease (CAD), although it can have many different causes. The chest pain or discomfort associated with CAD is caused by poor blood flow and reduced oxygen delivery to the heart muscle (ischemia) and is called angina . See the Symptoms section for more information.

Not everyone with coronary artery disease has symptoms. A recent study found that as many as a third of people diagnosed with heart attack did not experience chest discomfort. ¹

What can I expect if I have coronary artery disease?

You may be able to manage your coronary artery disease (CAD) with medications and lifestyle changes. Sometimes a procedure is needed to help restore normal function of the coronary arteries. Coronary artery bypass surgery is the most invasive type of procedure that may be used. Other common treatment options are angioplasty (which usually includes stenting ) or atherectomy .

If CAD progresses, you may develop additional problems. Over time, reduced blood flow may weaken your heart muscle so that it is not able to pump effectively. This may result in serious complications, such as heart failure or arrhythmias .

If a plaque breaks open (ruptures), a blood clot may form and suddenly block the blood flow to your heart muscle, causing a heart attack (myocardial infarction). When deprived of blood, oxygen, and nutrients, heart muscle cells die. See the topic Heart Attack and Unstable Angina .

Atherosclerosis can affect other arteries throughout your body. Arteries that are commonly affected include those that supply blood to your heart, brain (cerebrovascular disease), and limbs (peripheral vascular disease). See the topics Stroke and Peripheral Vascular Disease of the Legs for more information.

How will a doctor diagnose coronary artery disease?

Your doctor will evaluate your risk factors and symptoms with a medical history and physical exam. If coronary artery disease (CAD) is suspected, you may have additional tests to determine the diagnosis. The most common initial tests to evaluate possible CAD are electrocardiography (EKG or ECG) , chest X-ray, and exercise electrocardiography.

You may have additional tests if more information is needed or if you are at a high risk for having a heart attack.

What can I do to live with coronary artery disease?

If coronary artery disease (CAD) is detected and treated early, it may be reversible to some degree. You can also take measures to prevent a heart attack.

Many studies support lowering average to high cholesterol levels to help reduce your risk of heart attack, stroke, and death. ² Lowering cholesterol levels appears to benefit you most when you also have heart disease or if you are at increased risk for heart disease.

If you already have coronary artery disease that is causing problems, medication or surgery may help relieve symptoms. These treatments may also prevent a heart attack, the development of heart failure, and early death.

Who can treat my coronary artery disease?

Call your primary care doctor (such as a family practitioner or internal medicine doctor) or a cardiologist if you think you have symptoms of coronary artery disease or if your symptoms worsen. Seek emergency medical care if you have signs of a heart attack , stroke , or sudden heart failure .