Coronary Artery Disease Guide: Symptoms, Causes, and Treatments
Comprehensive information for you or a loved one — including treatment options and discounts on popular medications.
Coronary artery disease (CAD) is a type of heart disease. There are different types of heart disease — such as heart failure and abnormal heart rhythms (arrhythmias). But CAD is the most common type. It can affect anyone. In fact, over 20 million adults in the U.S. over age 20 have CAD. This is about 7% of the population.
CAD is the type of heart disease that leads to heart attacks. 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 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 these are all considered risk factors for CAD.
Health conditions that can increase your risk for CAD include:
Certain autoimmune conditions
Smoking
Heavy alcohol use
Low level of physical activity
Diets high in saturated fats, salt, sugar, and processed foods
Other risk factors are related to your age, sex, and genes, such as:
Increasing age
Male sex
Non-Hispanic white, Hispanic, or Black race
Family history of CAD
CAD is usually diagnosed at the onset of symptoms, like chest pain. But CAD — especially in the early stages — doesn’t usually cause many symptoms. That’s why it’s so important to get screened if you’re at risk and to know the symptoms (even if they’re mild).
When CAD causes symptoms, 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
There are different causes and types of chest pain. So, it helps to know the characteristics of angina. Here are some things to know about the discomfort of angina:
It feels like pressure, heaviness, or tightness in the center of the chest.
It can move to the arms, shoulders, neck, jaw, or back.
It lasts under 5 minutes at a time.
It 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
Sweating
Dizziness
Fatigue
These “atypical” symptoms are more common in women and people with diabetes.
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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 healthcare professional check your symptoms so you can get the right diagnosis. This can happen in the emergency room (ER) if your 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 sound like they could be coming from CAD. They may also refer you to a cardiologist (a heart specialist) for more in-depth testing.
The type of testing that’s right for you will depend on your history and risk of having CAD. These include:
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).
Angiotensin-converting enzyme (ACE) inhibitors: These are medications that help keep your blood pressure in normal range and protect the heart. Common examples include lisinopril (Prinivil, Zestril) and ramipril (Altace). People who can’t take ACE inhibitors usually take ARB angiotensin II receptor blockers (ARBs), a related medication.
Nitrates: These treat angina by dilating the blood vessels. Long-acting forms come in a pill — like isosorbide mononitrate (Monoket). Or they come in a nitroglycerin patch (Nitro-Dur) that you apply to the skin. If you only need treatment some of the time, a short-acting nitrate like sublingual nitroglycerin (Nitrostat) can help.
Antiplatelets: These prevent blood clots from forming, which could cause a heart attack. Examples include over-the-counter (OTC) aspirin and prescription clopidogrel (Plavix).
Statins: These lower low-density lipoprotein (LDL) cholesterol and also decrease the risk of heart attacks. Examples include atorvastatin (Lipitor) and rosuvastatin (Crestor).
If you have CAD, it doesn’t mean you’ll necessarily be on all these medications. Each person is different. Your primary care provider or cardiologist will help you understand the best plan for you.
Medications and lifestyle changes are an important part of treatment for CAD. Lifestyle changes include:
Following a heart-healthy diet
Avoiding heavy alcohol use
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 too. 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 cardiac catheterization and coronary artery bypass graft (CABG) surgery.
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 one third 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, any physical activity can still be beneficial.
Eat a healthy diet: A heart-healthy diet is high in fruits, vegetables, and whole grains. And it’s low in saturated fat, sugar, and salt.
Find a healthy weight for you: High amounts of body fat can put you at higher risk for CAD. Weight loss can help lower your risk.
Be proactive about your health: It’s important to keep an eye on your blood pressure, cholesterol, and blood sugar. Seeing your primary care 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. Small changes are good changes.
No, there’s no cure for CAD. But there’s a lot you can do to prevent it. If you’ve been diagnosed with CAD, lifestyle changes can still help you keep your heart healthy over time. It’s never too late to start making changes. Medications and other treatments for CAD can improve symptoms and help prevent complications like heart attacks and strokes.
No, there’s no cure for CAD. But there’s a lot you can do to prevent it. If you’ve been diagnosed with CAD, lifestyle changes can still help you keep your heart healthy over time. It’s never too late to start making changes. Medications and other treatments for CAD can improve symptoms and help prevent complications like heart attacks and strokes.
How long you can live with CAD depends on many factors, including the specifics of your CAD, your treatment, and other health issues. But here’s the good news: CAD doesn’t mean you can’t live a full and long life. Keeping in touch with your healthcare team, taking prescribed medications, and being mindful of your lifestyle can all help you live longer.
The cause of CAD is atherosclerosis, which can also happen in other parts of the body. Carotid artery disease is atherosclerosis in the neck’s blood vessels. In the legs, it’s called peripheral artery disease. And, in the kidneys, it’s called renal artery stenosis.
CAD is associated with other health issues like:
Obesity
High blood pressure
High blood sugar
Abnormal cholesterol
Together, these conditions make up metabolic syndrome. People with metabolic syndrome have an increased risk for CAD.
Aspirin is an NSAID (nonsteroidal anti-inflammatory drug). It prevents platelets — a type of blood cell — from sticking together. This prevents clots from forming in the coronary arteries that could cause a heart attack.
It’s not clear if aspirin actually reduces plaque. There’s some evidence that aspirin decreases inflammation in blood vessels. In mice studies, it’s been shown to make plaques more stable (less likely to break off into a clot). But it’s not clear exactly what effect it has on atherosclerosis in humans.
CAD doesn’t always cause symptoms. But screening for CAD in people without symptoms isn’t recommended for everyone. Whether you need testing for CAD depends on your risk factors and other health conditions. To find out if you would benefit from testing, talk to your primary care provider or consider seeing a cardiologist (heart specialist).
American Heart Association. (n.d.). Coronary arteries.
American Heart Association. (n.d.). What is a coronary angiogram?
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