Coronary Artery Disease: Your GoodRx Guide

Heart disease is the leading cause of death in the U.S. There are different types of heart disease — such as heart failure and abnormal heart rhythms (arrhythmias) — but coronary artery disease (CAD) is the most common type. It can affect anyone. In fact, about 20 million or nearly 7% of American adults over age 20 have CAD. 

CAD occurs when plaque builds up in the coronary arteries — the blood vessels that bring blood to the heart. The plaque buildup can narrow the blood vessels, making it harder for blood to flow through. Plaques can also break or rupture, causing a blood clot to form. When a clot blocks blood from getting to the heart, it damages the heart muscle and causes a heart attack.

CAD is usually diagnosed at the onset of symptoms, like chest pain. But it’s also possible to have CAD without any symptoms. That’s why it’s so important to know about it. In 2019, nearly 361,000 Americans died from CAD. In comparison, about 659,000 people die each year from all types of heart disease in the U.S.

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Causes

CAD happens when plaque made of fat and cholesterol builds up in the heart’s arteries — a process called “atherosclerosis.” Atherosclerosis can start early in life and progress over time.

The exact cause is unknown, but it may start when there’s damage to the inside layer of arteries. Things like high blood pressure, inflammation, and high levels of blood sugar can cause this damage. That’s why they’re risk factors for CAD.

Risk factors are things that make someone more likely to develop a condition. The risk factors for CAD fall into two categories: those you can change or improve and those you can’t change. 

Risk factors you can’t change are linked to your age, sex, and genes, including:

• Increasing age

• Male sex

• Non-Hispanic white, Hispanic, or Black race

• Family history of CAD

Risk factors you can change or improve include certain behaviors:

• Smoking

• Heavy alcohol use

• Low level of physical activity

• Unhealthy diet

You may be able to modify certain medical conditions, such as:

• High cholesterol

• High blood pressure

• Diabetes

• Obesity

• Certain autoimmune conditions

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Symptoms

Again, sometimes CAD doesn’t cause any symptoms. But when there are symptoms with CAD, the classic one is chest pain or discomfort, known as “angina.” Angina is chest discomfort that gets worse with certain triggers and better when the trigger goes away. 

Common triggers include:

• Physical activity

• Cold temperatures

• Emotional stress

• Sexual activity

• Meals

• Lying down

Since there are different causes and types of chest pain, it helps to know the characteristics of angina. The discomfort of angina:

• Feels like pressure, heaviness, or tightness in the center of the chest

• Can move to the arms, shoulders, neck, jaw, or back

• Lasts under 5 minutes at a time

• Occurs repeatedly with the same trigger

Some people with CAD may not have symptoms of classic angina. Instead, they may have other symptoms that are less “typical,” including:

• Shortness of breath

• Indigestion

• Nausea

• Sweating

• Dizziness

• Fatigue

These “atypical” symptoms are more common in women and people with diabetes.

If you have these symptoms, contact your healthcare provider right away. 

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Diagnosis

CAD is usually diagnosed when symptoms like chest discomfort start. Sometimes a heart attack is the first sign that someone has CAD. 

Conditions that aren’t related to the heart can also cause symptoms similar to CAD. So, it’s important to have a provider check your symptoms so you can get the right diagnosis.

You’ll need an evaluation in the emergency room if symptoms start suddenly, change, or are severe. 

Your primary care provider can usually evaluate ongoing and stable (unchanging) symptoms. They may do some initial testing on your heart if your symptoms are concerning for CAD. They may also refer you to a cardiologist, a heart specialist, for more in-depth testing.

According to recent guidelines, the type of testing that’s right for you will depend on your history and risk of having CAD. Tests providers use to diagnose CAD include: 

• Coronary artery calcium (CAC) scan

• Coronary computed tomographic angiography (CCTA)

• Stress testing 

• Coronary angiography 

In the event of a CAD diagnosis, you should see your healthcare provider routinely for follow-up and anytime your symptoms change.

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Medications

The main treatment for CAD is prescription medications. These medications help treat symptoms and prevent complications. They include:

• Beta blockers: These treat angina by lowering your blood pressure and heart rate. If you’ve had a heart attack, they help prevent future heart attacks and improve survival. Examples include metoprolol (Lopressor) and carvedilol (Coreg). 

• Calcium channel blockers: These also treat angina and can be used instead of or with beta blockers. Examples include diltiazem (Cardizem) and amlodipine (Norvasc).

• Nitrates: These treat angina by dilating the blood vessels. Long-acting forms come in a pill — like isosorbide mononitrate (Monoket) — or in a nitroglycerin patch (Nitro-Dur) that you apply to the skin. Both are daily treatments. If you only need treatment some of the time, a short-acting nitrate like sublingual nitroglycerin (Nitrostat) can help. It dissolves under the tongue and works quickly to treat chest discomfort. 

• Ranolazine (Ranexa): This can treat angina that doesn’t get better with other treatments like beta blockers or when other treatments can’t be used.

• Antiplatelets: These prevent blood clots from forming, which could cause a heart attack. Examples include over-the-counter aspirin and prescription clopidogrel (Plavix).

• Statins: These lower LDL cholesterol and also decrease the risk of heart attacks. Examples include atorvastatin (Lipitor) and rosuvastatin (Crestor). 

Your healthcare provider can help you understand your treatment options and make recommendations. Together you can decide the best plan for you.

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Treatments

Medications and lifestyle changes are an important part of treating anyone with CAD. Lifestyle changes include:

• Following a heart-healthy diet

• Avoiding heavy alcohol use

• Quitting smoking

• Doing regular exercise

• Maintaining a healthy weight or losing weight

• Managing stress

It’s important to treat high blood pressure, diabetes, or high cholesterol because they also affect your heart.

Cardiac rehabilitation programs can help in many ways. They can help you make lifestyle changes, build endurance, and understand your medications — all with the goal of making your heart healthier.

Treatment can also include coronary artery revascularization for some people. These are procedures on the heart to treat blockages in the coronary arteries. They include percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery. 

Whether you need a procedure depends on what areas and how much of your heart CAD affects. It also depends on whether your symptoms are adequately treated with medications and lifestyle changes. Other health conditions, like diabetes and chronic kidney disease, also factor into the treatment plan. Your healthcare team can help you decide what is right for you.

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Prevention

The good news is you can control many of the risk factors for CAD with a healthy lifestyle. To keep your heart healthy and prevent CAD, here are a few things you can do:

• Don’t smoke: Nearly ⅓ of CAD deaths are from smoking or secondhand smoke exposure. Quitting smoking and avoiding secondhand smoke is key to heart health.

• Exercise: The American Heart Association recommends 150 minutes per week of moderate-intensity physical activity or 75 minutes per week of vigorous physical activity. Even if you don’t meet these goals, lower amounts of activity can still be beneficial.

• Eat a healthy diet: A heart-healthy diet is high in fruits, vegetables, whole grains — and low in saturated fat, sugar, and salt.

• Keep a healthy weight: People with overweight and obesity are at higher risk for CAD. Weight loss can help lower your risk.

• Control your blood pressure, cholesterol, and blood sugars: Seeing your healthcare provider and taking your medications as prescribed will keep your numbers in a healthy range.

It may feel overwhelming to think about making lots of changes all at once. If so, you can try one at a time and build from there. It will be worth it in the long run.

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