Coronary artery disease (CAD) develops when plaque builds up in the coronary arteries and they become narrow or blocked. It can lead to a heart attack, but statins and other treatment options can help.

CAD, or coronary heart disease, tends to develop when cholesterol builds up on the artery walls, creating plaques. These plaques can narrow the arteries, reducing blood flow to the heart, or cause inflammation in and hardening of the blood vessel walls. A clot can sometimes obstruct blood flow, causing serious health problems.

Coronary arteries form the network of blood vessels on the surface of the heart that provides oxygen to it. If these arteries narrow, the heart may not receive enough oxygen-rich blood, especially during physical activity.

High cholesterol, smoking, and other factors increase the risk of developing the condition.

CAD can sometimes lead to a heart attack. According to the Centers for Disease Control and Prevention (CDC), CAD is the most common type of heart disease in the U.S. and accounted for 382,820 deaths in 2020.

Causes

Underlying health conditions, such as high cholesterol and diabetes, and physical damage to arteries can cause plaque buildup and lead to CAD. The condition has many other risk factors as well.

The plaque deposits consist of cholesterol and other inflammatory products from cells. The buildup of plaque is called atherosclerosis. Plaque deposits can narrow the arteries over time, restricting or stopping blood flow.

If pieces of plaque break off or rupture, platelets cluster in the area, forming a blood clot. Blood clots can block the artery and reduce or block blood flow. This may lead to a heart attack.

Risk factors

The following factors increase a person’s risk of developing CAD:

• high blood pressure (hypertension)
• high levels of low-density lipoprotein (LDL), or “bad,” cholesterol
• low levels of high-density lipoprotein (HDL), or “good,” cholesterol
• diabetes
• obesity
• smoking
• sedentary lifestyle
• high stress levels

• family history of CAD
• early menopause
• increasing age

Symptoms

CAD can lead to angina, a type of chest pain that has a link to heart disease.

Angina may cause shortness of breath and the following sensations across the chest:

• squeezing
• pressure
• heaviness
• tightening
• burning
• aching

Angina might also cause the following symptoms:

• indigestion
• heartburn
• weakness
• sweating
• nausea
• cramping
• dizziness

Complications

A heart attack occurs when the heart muscle does not have enough blood or oxygen, such as when a blood clot develops due to plaque in one of the coronary arteries.

The formation of a blood clot is called coronary thrombosis. If a clot is big enough, it can completely stop the supply of blood to the heart in that blood vessel.

A heart attack is a medical emergency that can result in death or permanent heart damage. If a person is showing symptoms of a heart attack, it is vital to call emergency services immediately.

Treatment

CAD has no cure, but a person can take steps to manage the condition.

Treatment tends to involve making lifestyle changes such as quitting smoking, adopting a healthy diet, and getting regular exercise. Doctors may also prescribe medications to prevent the progression of CAD.

However, some people may need to undergo medical procedures.

Medications

Medications that people can take to reduce the risk and manage the symptoms of CAD include:

• Statins: Statins significantly reduce overall mortality in people who have CAD or are at risk of it. They also reduce the risk of nonfatal vascular events such as blood clots and heart attacks.
• Beta-blockers: A doctor may prescribe beta-blockers to reduce blood pressure and heart rate, especially among people who have already had a heart attack. This helps to “rest” the heart.
• Nitroglycerin patches, sprays, or tablets: These relax the arteries, reduce the heart’s demand for blood, and soothe chest pain.
• Angiotensin-converting enzyme (ACE) inhibitors: These bring down blood pressure and improve outcomes in many people with CAD.
• Calcium channel blockers: Calcium channel blockers can help dilate blood vessels, slow the heart rate, and lower the blood pressure. All these effects are beneficial for people with CAD.

Prevention

Managing blood cholesterol levels can help reduce the risk of CAD. To better regulate their blood cholesterol levels, people can consider:

• being more physically active
• limiting alcohol intake
• avoiding tobacco
• adopting a diet with less sugar, salt, and saturated fat

In addition to making any necessary lifestyle changes, it is crucial that a person continue to take all cholesterol and blood pressure medications that their doctor prescribes.

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Diagnosis

A doctor can perform a physical examination, take a thorough medical history, and order several tests to diagnose CAD and other types of heart disease. These tests may include:

• Electrocardiogram: This records the electrical activity and rhythm of the heart.
• Echocardiogram: This is an ultrasound scan that monitors the pumping heart. It uses sound waves to provide a video image.
• Stress test: This may involve using a treadmill or medication that stresses the heart to find out how it functions when a person is active. Healthcare professionals can perform these tests using imaging techniques such as echocardiograms and nuclear imaging to assess areas of blockages.
• Coronary catheterization: A specialist will inject dye through a catheter threaded through an artery, often in the leg or arm. The dye shows narrow spots or blockages on an X-ray.
• CT scans: These help a doctor view the arteries, detect calcium within fatty deposits, and identify any heart anomalies.
• Blood tests: Doctors can order these to measure blood cholesterol levels.

Summary

CAD occurs when cholesterol deposits develop on the walls of the coronary arteries. The condition causes blockages in the arteries that feed oxygen-rich blood to the heart. The arteries also stiffen, and inflammation increases.

CAD can be difficult to treat and may lead to a heart attack. However, people can help reduce their risk of CAD by getting regular exercise, maintaining a nutritious diet, and avoiding or stopping the use of tobacco products.

People should seek immediate medical attention if they experience chest pain and breathlessness, as these symptoms could indicate a heart attack.

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