Coronary artery disease (CAD) is the most common type of heart disease. Although it’s the top cause of death in the U.S., there is a lot you can do to prevent or treat it.
The trouble starts when a waxy substance called plaque builds up inside the arteries that supply blood to the heart muscle. It can take decades to block the blood flow, but it can eventually cause a heart attack or failure.
How common is coronary artery disease?
An estimated 18.2 million Americans have coronary artery disease, or about one in 20 adults, making it the most common form of heart disease in the country.
The condition is also the leading cause of death in the U.S. In 2021 alone, 375,476 people died of coronary artery disease, and 20% were younger than 65.
Coronary artery disease vs. heart attack
Coronary artery disease is a form of heart disease, and most heart attacks are caused by coronary artery disease. Some people only discover they have coronary artery disease after they've had a heart attack.
Forms of Coronary Artery Disease
Coronary artery disease isn’t just one disease, but several different conditions.
- Stable ischemic heart disease: If you have this type of CAD, blood and oxygen have to work harder than normal to flow to your heart. This condition can be managed with medicines that reduce your heart’s workload and/or surgery.
- Acute coronary syndrome (ACS): Blood flow is sometimes suddenly reduced to your heart. Because that can lead to a heart attack, ACS is treated like an emergency. If you have severe chest pain, seek help right away.
- Atherosclerotic coronary artery disease: Over time, a sticky, fatty substance called plaque can build up in your arteries. That makes it harder for blood to get through and raises your risk for a heart attack or stroke.
What Causes Coronary Artery Disease (CAD)?
Starting as early as childhood, plaque – a combination of cholesterol, fat, and other substances – starts to stick to the walls lining your blood vessels.
It builds up over time. That makes arteries harder and narrower, which doctors call “atherosclerosis.“
In some cases, plaque can break or rupture. As a result, blood cells called platelets will try to repair the artery, forming a blood clot.
Like gunk in a clogged drainpipe, this buildup prevents a free flow of blood through the arteries. Blood carries oxygen and nutrients to the heart. Myocardial ischemia is when your heart muscle don’t get enough blood, and it can lead to shortness of breath and chest pain (angina).
Without enough oxygen, the heart can become weaker. This can lead to an irregular heartbeat (arrhythmia). It can also cause heart failure, which means the heart can’t pump enough blood throughout the body to meet the body's needs. If you have limited blood flow to your arms or legs, this condition is called peripheral artery disease.
If a plaque grows so large that it stops blood flow to the heart muscle, you could have a heart attack. But most of the time, heart attacks happen from the smaller plaques that rupture.
Coronary Artery Disease Symptoms
In the early stages, you may not have any symptoms. But as the plaque continues to build up and curbs blood flow to the heart muscle, you may notice that you’re short of breath or fatigued, especially during exercise.
The most common symptom of CAD is angina, or chest pain. Some people mistake it for heartburn or indigestion.
With angina, your chest feels uncomfortable. You may also have that feeling in the shoulders, arms, back, or jaw. You may feel:
Symptoms of CAD for women
Women and those assigned female at birth often have different heart attack symptoms than men or those assigned male at birth. While the most common red flag is still chest pain, women are more likely to have other symptoms, such as shortness of breath, extreme fatigue, nausea, vomiting, and back or jaw pain.
When to call 911
If you have any of the following symptoms, call 911 right away:
- Chest pain, especially in the center or left side of the chest, which lasts for a few minutes or goes away and comes back. It can feel like pressure, squeezing, fullness, or pain. Some people mistake it for indigestion or heartburn.
- Discomfort in any part of your upper body. It could be in one or both arms, the shoulders, neck, jaw, or upper part of the stomach.
- Shortness of breath with or without chest discomfort
- Nausea or vomiting with lightheadedness, dizziness, or a cold sweat
Coronary Artery Disease Risk Factors
Coronary artery disease becomes more likely as you get older or if it runs in your family. Other risk factors include
- High cholesterol (especially LDL, or “bad” cholesterol) and triglycerides
- High blood pressure
- Atherosclerosis (hardening or thickening of the arteries)
- Smoking or vaping
- Metabolic syndrome
- Autoimmune diseases like rheumatoid arthritis or inflammatory bowel disease
- Kidney disease
- HIV or AIDS
- Obesity and being overweight
- Lack of exercise
- Stress, depression, and anger
- Unhealthy diet
- Too much alcohol
- Sleep disorders, including sleep apnea
- Sleep loss
Men, and people assigned male gender at birth, have a higher risk for CAD after age 45. For women and people who were assigned female gender at birth, the risk goes up after 55.
Some risk factors that affect women (and those assigned female at birth) in particular are:
- Having eclampsia, preeclampsia, or gestational diabetes while pregnant
- Use of hormonal birth control methods like the pill
- Menopause before age 40
Coronary Artery Disease Disparities
You’re more likely to have coronary artery disease, sometimes called coronary heart disease, if you’re over 35 or male.
Black, Hispanic, and Southeast Asian people are more likely to get sick from CAD and to die from it than other ethnic groups. American Indians are 1.5 times more likely to be diagnosed with CAD than White people.
In fact, minorities are at higher risk from all types of heart disease. Among Black people, 47% are diagnosed with some type of cardiovascular (heart and blood vessel) disease. For White people, the rate is 36%. Overall, Black people are more than twice as likely as White people to die from heart disease.
Black, Hispanic, and American Indian people are also more likely to have conditions that contribute to heart disease, like high blood pressure, obesity, and diabetes.
There are many possible reasons for these disparities. They include:
- Income differences
- Lack of access to quality health care
- Racism in health care and society, and the stress that results from it
Coronary Artery Disease Diagnosis
Your doctor will give you a checkup and talk with you about your symptoms, risks, and family history. You may also get tests such as:
- Electrocardiogram (EKG), which measures the heart’s electrical activity and can assess heart damage
- Stress test, which usually involves walking on a treadmill or pedaling a stationary bike in a doctor’s office while your heart rate and blood pressure are monitored
- Chest X-ray
- Blood tests to check on your levels of blood sugar, cholesterol, and triglycerides (a type of fat in the blood)
- Cardiac catheterization, in which a doctor guides a very thin, flexible tube (called a catheter) through a blood vessel in your arm or leg to reach your heart. The doctor injects dye through the catheter and then uses X-ray videos to see inside your heart.
How to check for heart blockage at home
There’s no home test that can determine whether you have coronary artery disease. But if you’re concerned about your heart health in general, there are steps you can take to keep tabs on it:
Heart rate measurement. Check your pulse to figure out how fast your heartbeat is:
- Put two fingers on the inside of your wrist, in a spot where you can feel your pulse.
- Set your phone timer or a stopwatch for 10 seconds, then count the number of pulses you feel during that time.
- Multiply this number by 6 to calculate your heart rate for a full minute.
A healthy rate is between 60 and 100 beats per minute. If yours is much higher or lower than that, tell your doctor.
Blood pressure cuff. Because high blood pressure raises your risk for heart disease, it’s important to keep blood pressure in a healthy range. For most people, that’s less than 120/80. But ask your doctor what your numbers should be. Some monitors let you upload your readings into an app or website for easy tracking. You can also print them out to share with your doctor.
The stair test. If you can’t climb four flights of stairs within 90 seconds, that may be a sign that your heart isn’t as healthy as it should be. Talk to your doctor about your concerns.
Coronary Artery Disease Tests
Your doctor can order many tests to get a better sense of your heart health. That can include:
A sample of your blood can be checked for issues that raise your risk of coronary artery disease. Among them are high cholesterol, high triglycerides (a type of blood fat), and high-sensitivity CRP, a special protein that signals heart inflammation.
Computed tomography (CT) coronary angiogram
Sometimes, doctors want a close-up look of your arteries. If so, a special dye is put into your vein before a CT scan.
Coronary calcium scan
Also called a heart calcium scan or cardiac calcium scan, this test looks for calcium deposits that are blocking your arteries and making it hard for blood to get through.
Sound waves can be used to show how well blood flows to and from your heart.
Small painless devices called electrodes can be put on your skin to check how well your heart is working. If this test is done in your doctor’s office, it will give a snapshot of your heart health. To get more info about your heart patterns, you may be given a special device to wear for up to a week.
Sometimes, CAD symptoms only show up when you’re active. For this type of test, you’ll be asked to walk or run on a treadmill or pedal a stationary bike during an EKG.
If your doctor chooses to do this more complex procedure, a very thin tube called a catheter is put into one of your blood vessels and guided to your heart. Then dye is put into the tube so your doctor can see your blood vessels better and check for blockages.
Coronary Artery Disease Complications
Coronary artery disease can lead to other serious – and sometimes life-threatening – conditions, such as:
- Angina (chest pain). Over time, coronary artery disease will cause plaque to build up inside your arteries and make them more narrow. As a result, your heart might not get enough blood when it needs it, such as during exercise, and you may feel chest pain and shortness of breath.
- Heart failure. This is when your heart can’t pump enough blood. If you have narrowed arteries or high blood pressure, the walls of your heart might become weak or stiff, making it harder for your heart to work as well as it should.
- Heart attack. This is the most common complication of coronary artery disease. Heart attacks occur when a piece of cholesterol plaque breaks off and causes a blood clot that blocks blood flow to the heart. The lack of blood damages the heart muscle, and if left untreated, a heart attack can be fatal. If you have symptoms of a heart attack, call 911.
- Arrhythmias. If your heart isn’t getting enough blood, it may start to beat irregularly. Some types of arrhythmias can be life-threatening.
Coronary Artery Disease Treatment
Depending on your case, your treatment plan may include one or a combination of the following treatments:
You may need to take medicines to help your heart be healthier. They can include blood thinners (anticoagulants), aspirin and other anti-clotting medicines, ACE inhibitors, beta-blockers, nitroglycerin, calcium channel blockers, certain immunosuppressants, statins, or PCSK9s.
Part of your treatment plan may involve surgery. Some of the most commonly performed procedures for coronary artery disease include:
- Angioplasty. This procedure can open blocked or narrowed arteries without opening up your chest. In angioplasty, a doctor threads a thin, flexible tube with a balloon through your blood vessels until it reaches the blocked artery. The doctor then inflates the balloon, which stretches the artery open so more blood can flow. In many cases, a tiny tube called a stent is also inserted to keep the blood vessel open. You’ll typically be in and out of the hospital in a day.
- Coronary artery bypass grafting. During this surgery, doctors use blood vessels from other parts of your body to make a detour around blockages in your coronary arteries. It’s a major operation, and you’ll probably need to be in the hospital for at least 5 days.
Cardiac rehabilitation and recovery
If you've had a heart attack or cardiac surgery, your doctor will likely recommend that you complete a cardiac rehab program to help you recover. Cardiac rehab will start while you're in the hospital, then you can attend outpatient appointments once you go home. Most insurance companies will cover 12 weeks of cardiac rehab. Typically, these programs include the following:
- Exercise training
- Addressing cardiac risk factors
- Heart health education
- Nutritional guidance
- Emotional support
Studies have shown that cardiac rehab can help lower your future risk of stroke, heart attack, depression, and cardiac-related death.
These time-tested methods sound familiar for a reason -- they work!
- Favor foods that are low in trans fats, saturated fats, simple sugars, and sodium.
- If you smoke, quit.
- Be active, ideally for 30 minutes or more a day. (First, ask your doctor if there are any limits on what you can do.)
- Work to stick to a healthy weight.
- Learn effective ways to manage your stress.
Prevention of Coronary Artery Disease
Fortunately, there are a number of things you can do to reduce your chances of getting CAD.
Get wise to your risk. Speak to your doctor about getting your cholesterol, blood pressure, and blood sugar checked. If you have high cholesterol, high blood pressure, or diabetes, it’s important to manage those conditions.
Aim for a healthy weight. If you’re not sure what your target weight should be, ask your doctor. And if you have a lot of weight to lose, remember that even a modest amount of weight loss helps.
Avoid cigarette smoke. If you smoke, quit. Steer clear of secondhand smoke.
Limit your alcohol. One or two drinks may have some heart benefits, but too much is risky. Men should have no more than two alcoholic drinks a day, and women should have no more than one per day.
Eat smart. Eat whole foods and avoid trans fats, which can be found in many baked goods and deep-fried and processed foods. Get plenty of fiber-rich foods, such as fruits and veggies, whole grains, and beans. Limit salt and aim to have two servings of fatty fish, such as salmon, tuna, or mackerel, a week. They’re high in heart-healthy omega-3 fats.
Exercise regularly. You’ll want to get at least 30 minutes of moderate-intensity exercise (like hiking or going for a bike ride that makes your heart beat faster but not race) on 5 or more days a week. Speak with your doctor before you begin a new exercise routine.
Manage your stress level. Use strategies such as exercise, meditation, and other healthy activities that relax you.
Outlook With Coronary Artery Disease
There is no cure for coronary artery disease. Your prognosis will depend on your age, symptoms, and other health conditions and risk factors you have.
But you may be able to improve your prognosis or slow the progression of the disease by changing your lifestyle and following your doctor’s treatment plan. Take any medications your doctor prescribes to treat your coronary artery disease as consistently as possible.
When Should I Call My Health Care Provider?
If you have coronary artery disease, you will have regular check-ups with your doctor and any specialists they refer you to, like a cardiologist.
But if you notice any changes in your symptoms or if you have side effects related to your medications between those visits, reach out to your doctor. They can also discuss any questions or concerns you have about your treatment plan.
If you are having symptoms of a heart attack or stroke, call 911 right away. Both are medical emergencies that require medical attention as quickly as possible.
Coronary Artery Disease Takeaways
Coronary artery disease is the most common form of heart disease in the U.S. If you've been diagnosed with the condition, your doctor will help you find the treatment plan that's right for you. Coronary artery disease can lead to serious complications, including heart attack and arrhythmia, but quitting smoking, eating a low-sodium diet, and maintaining a healthy weight are steps you can take right away to help lower your risk. Always talk with your doctor if your symptoms change, and ask them before making any major changes to your exercise routine.
Coronary Artery Disease FAQs
What is the life expectancy of someone with coronary artery disease?
The life expectancy of someone with CAD will vary, depending on their age, medical history, and lifestyle choices. If you’ve been diagnosed with coronary artery disease, talk with your doctor about your prognosis.
What are the coronary arteries?
There are two main coronary arteries. The left main coronary artery supplies blood to the left ventricle and left atrium, while the right coronary artery sends blood to the right ventricle, right atrium, and the sinoatrial and atrioventricular nodes. Both sides divide into smaller branches to supply blood to all parts of the heart.