Understanding Coronary Artery Disease

Coronary artery disease, or CAD, is the most common type of heart disease and the leading cause of death worldwide. While those numbers can sound scary, the good news is that CAD is both treatable and often preventable. Over the past 40 years of treating patients, I’ve seen how early action and lifestyle changes can make a major difference in how this condition progresses.

In this blog post, I’ll explain what coronary artery disease is, what causes it, how it’s diagnosed, and most importantly, what you can do about it. Whether you’ve just been diagnosed or are trying to prevent it, this is the knowledge you need to protect your heart.

What Is Coronary Artery Disease?

Your heart is a muscle, and like any muscle, it needs a constant supply of oxygen-rich blood to function. The coronary arteries are the blood vessels that supply this blood to the heart muscle.

Coronary artery disease occurs when these arteries become narrowed or blocked due to a buildup of plaque. Plaque is made up of cholesterol, fatty substances, calcium, and other materials found in the blood. Over time, this buildup causes the arteries to harden and narrow, a process known as atherosclerosis.

When the arteries are narrowed, blood has a harder time reaching the heart muscle. This can cause symptoms such as chest pain or discomfort, shortness of breath, and fatigue. If a plaque ruptures, it can cause a blood clot to form, which can completely block the artery and result in a heart attack.

What Causes Coronary Artery Disease?

CAD develops slowly over time, often over decades. It usually starts with damage or injury to the inner layer of a coronary artery. This damage can be caused by several risk factors, including:

• High blood pressure: Over time, the force of blood pushing through your arteries can damage the walls.
• High cholesterol: Too much low-density lipoprotein (LDL or "bad" cholesterol) in the blood can lead to plaque formation.
• Smoking: Chemicals in tobacco can damage blood vessels and increase plaque buildup.
• Diabetes: High blood sugar can damage arteries and make plaque more likely to form.
• Obesity: Excess weight strains your heart and often comes with other risk factors like high blood pressure or diabetes.
• Lack of physical activity: A sedentary lifestyle contributes to many heart disease risk factors.
• Unhealthy diet: Diets high in saturated fats, trans fats, sugar, and sodium promote plaque development.
• Stress: Chronic stress may damage arteries and worsen other risk factors like blood pressure or cholesterol.

Family history and age also play a role. If close family members had heart disease at a young age, your risk may be higher. And as we age, the risk naturally increases.

Symptoms of Coronary Artery Disease

The symptoms of CAD depend on how much the arteries are narrowed and how much blood flow is restricted. In the early stages, there may be no symptoms at all.

As the disease progresses, common symptoms include:

• Chest pain or discomfort (angina): Often triggered by physical activity or emotional stress. It may feel like pressure, squeezing, or fullness in the chest.
• Shortness of breath: Especially during exertion or climbing stairs.
• Fatigue: Feeling unusually tired, especially with activity.
• Heart attack: If a plaque ruptures and completely blocks a coronary artery, it can cause a heart attack. Symptoms include chest pain, pain in the jaw or arm, sweating, nausea, and shortness of breath.

Not everyone experiences the classic symptoms. Women, in particular, may have more subtle signs like indigestion, dizziness, or neck and back pain.

How Is Coronary Artery Disease Diagnosed?

If your doctor suspects CAD, several tests can help confirm the diagnosis:

• Electrocardiogram (EKG or ECG): Measures the electrical activity of the heart and can show signs of a previous or current heart attack.
• Stress test: Monitors the heart during physical activity to detect problems with blood flow.
• Echocardiogram: Uses ultrasound to create images of the heart and evaluate how well it’s pumping.
• Coronary angiogram: A dye is injected into the arteries, and X-rays are taken to see if there are blockages.
• CT coronary angiography: A non-invasive imaging test that creates detailed pictures of the heart and its blood vessels.

The choice of test depends on your symptoms, risk factors, and overall health.

Treatment Options for Coronary Artery Disease

The goal of CAD treatment is to restore or maintain good blood flow to the heart and prevent heart attacks. Treatment usually involves a combination of lifestyle changes, medication, and sometimes procedures or surgery.

Lifestyle Changes

These are the foundation of treatment and prevention:

• Quit smoking
• Eat a heart-healthy diet: Focus on fruits, vegetables, whole grains, lean protein, and healthy fats.
• Exercise regularly: Aim for 150 minutes of moderate activity each week.
• Maintain a healthy weight
• Manage stress
• Limit alcohol

These changes not only help reduce symptoms but can also slow or even reverse the progression of the disease.

Medications

Doctors may prescribe medications to:

• Lower cholesterol (statins or other lipid-lowering drugs)
• Reduce blood pressure
• Prevent blood clots (aspirin or other antiplatelet drugs)
• Relieve chest pain (nitrates, beta-blockers, calcium channel blockers)

Medication is often a lifelong part of managing CAD.

Procedures and Surgery

When lifestyle changes and medications are not enough, procedures may be necessary:

• Angioplasty and stenting: A balloon is used to open the artery, and a stent is placed to keep it open.
• Coronary artery bypass grafting (CABG): A surgical procedure where a blood vessel is used to create a new route around a blocked artery.

These treatments can greatly improve quality of life and reduce the risk of a heart attack, but they are not a cure. Ongoing care and lifestyle changes are still critical.

Living with Coronary Artery Disease

Being diagnosed with CAD is a wake-up call, but it’s also an opportunity to take charge of your health. Many people live long, active lives with CAD by managing their risk factors and following their treatment plan.

Regular follow-ups with your doctor, sticking to prescribed medications, and making heart-healthy choices every day can help keep your condition stable and improve your future outlook.

Cardiac rehab programs are also available. These are medically supervised programs that include exercise, education, and support to help you recover from a heart event and reduce your risk of future problems.

Final Thoughts

Coronary artery disease is serious, but it’s also manageable. Early detection and smart lifestyle changes make a tremendous difference. The heart is a resilient muscle. When you take care of it, it responds.

If you’re concerned about your heart or have a family history of heart disease, don’t wait. Talk to your doctor, get your numbers checked, and make small changes today. You have more control than you might think—and your heart will thank you for it.

‍