Coronary Artery Disease Guide: Symptoms, Causes, and Treatments

What is coronary artery disease?

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.

Heart Attack: Your GoodRx Guide

Written by Michael Dreis, MD

What causes coronary artery disease?

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:

• High cholesterol

• High blood pressure

• Diabetes

• Obesity

• 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

A Guide to Good Fats vs. Bad Fats for Your Heart

Written by Cherilyn Davis, MD

What are symptoms of coronary artery disease?

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

• Indigestion

• Nausea

• Sweating

• Dizziness

• Fatigue

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

Can You Have a Heart Attack Without Knowing It? Learn the Signs of a Silent Heart Attack

Written by Sarah A. Samaan, MD

How is coronary artery disease diagnosed?

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: 

• Coronary artery calcium (CAC) scan

• Coronary computed tomographic angiography (CCTA)

• Stress testing 

• Coronary angiography 

Is All Chest Pain Serious? How to Know If You Should Go to the ER

Written by Michael Dreis, MD

Coronary artery disease 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).

• 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.

What Medications Are Typically Prescribed After Having a Heart Attack (Myocardial Infarction)?

Written by Sarah A. Samaan, MD

Treatments for coronary artery disease

Medications and lifestyle changes are an important part of treatment for 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 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. 

Cardiac Catheterization: Everything You Need to Know About This Common Heart Procedure

Written by Sarah Studyvin, DO, MPH

Ways to prevent coronary artery disease

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.

How Can I Reduce My Risk for Heart Disease?

Written by Christina Palmer, MD