What Is Coronary Artery Disease (CAD)?

What Causes Coronary Artery Disease?

From early childhood, the process of coronary artery disease (CAD) begins with the formation of plaque – a mixture of cholesterol, fat, and other substances – adhering to the inner walls of blood vessels. Over time, this buildup, termed atherosclerosis by doctors, progressively narrows and hardens the arteries.

At times, the plaque can rupture, prompting platelets in the blood to initiate clot formation as they endeavor to mend the artery. This accumulation functions similarly to debris in a congested drainpipe, obstructing the free flow of blood through the arteries. Since blood carries oxygen and essential nutrients to the heart, restricted blood flow can lead to myocardial ischemia, characterized by symptoms like shortness of breath and chest pain (angina).

Insufficient oxygen supply to the heart muscle can also weaken its function, potentially causing irregular heartbeats (arrhythmias) and heart failure, where the heart struggles to pump enough blood throughout the body. When limited blood flow affects the arms or legs, this condition is termed peripheral artery disease.

In severe cases, if plaque growth completely halts blood flow to the heart muscle, a heart attack can occur. However, most heart attacks stem from the rupture of smaller plaques rather than complete blockages.

Symptoms of Coronary Artery Disease

In its initial stages, CAD may not present noticeable symptoms. As plaque accumulates and restricts blood flow to the heart muscle, symptoms such as shortness of breath or fatigue, particularly during physical exertion, may become evident. The primary symptom of CAD remains angina, or chest pain, which can sometimes be mistaken for heartburn or indigestion. Angina can manifest as tightness, discomfort, pressure, heaviness, squeezing, burning, aching, numbness, or a feeling of fullness in the chest, shoulders, arms, back, or jaw.

CAD Symptoms in Women

Women and individuals assigned female at birth may experience different symptoms of heart attacks compared to men or those assigned male at birth. Although chest pain remains a common indicator, women are more likely to exhibit additional symptoms such as shortness of breath, extreme fatigue, nausea, vomiting, and back or jaw pain.

When to Seek Medical Help

Immediate medical attention is necessary if experiencing:

• Chest pain, particularly in the center or left side, lasting a few minutes or recurring. Symptoms may resemble pressure, squeezing, fullness, or pain, often mistaken for indigestion or heartburn.
• Discomfort in the upper body, including one or both arms, shoulders, neck, jaw, or upper part of the stomach.
• Shortness of breath, with or without chest discomfort.
• Nausea or vomiting, accompanied by lightheadedness, dizziness, or sweating.

Risk Factors for Coronary Artery Disease

The likelihood of developing coronary artery disease increases with age and familial history. Other risk factors include:

• High cholesterol levels, particularly LDL (“bad” cholesterol) and triglycerides.
• High blood pressure.
• Atherosclerosis (artery hardening or thickening).
• Smoking or vaping.
• Metabolic syndrome.
• Diabetes.
• Autoimmune diseases like rheumatoid arthritis or inflammatory bowel disease.
• Kidney disease.
• HIV or AIDS.
• Obesity or being overweight.
• Lack of physical activity.
• Stress, depression, or anger.
• Unhealthy dietary habits.
• Excessive alcohol consumption.
• Sleep disorders, including sleep apnea.
• Anemia.

Men and individuals assigned male at birth face increased CAD risk after age 45, while for women and those assigned female at birth, risk rises after 55. Unique risk factors for women and those assigned female at birth include a history of eclampsia, preeclampsia, or gestational diabetes during pregnancy, use of hormonal birth control methods, early menopause, and endometriosis.

Coronary Artery Disease Disparities

Certain ethnic groups, including Black, Hispanic, and Southeast Asian populations, face higher risks of developing and dying from CAD compared to others. American Indians are 1.5 times more likely than White individuals to receive a CAD diagnosis. Factors contributing to these disparities include income disparities, limited access to quality healthcare, and societal and healthcare-related racism, leading to heightened stress levels.

Diagnosing Coronary Artery Disease

To diagnose CAD, doctors typically conduct a thorough checkup, reviewing symptoms, risks, and family medical history. Diagnostic tests may include:

• Electrocardiogram (EKG) to measure heart electrical activity and detect signs of heart damage.
• Stress test involving physical activity on a treadmill or stationary bike while monitoring heart rate and blood pressure.
• Chest X-ray.
• Blood tests to assess cholesterol, blood sugar, and triglyceride levels.
• Cardiac catheterization, where a thin tube (catheter) is guided through a blood vessel to inject dye and visualize heart arteries using X-ray videos.

Home Heart Health Checks

While no home tests definitively diagnose CAD, individuals can monitor heart health through:

• Heart rate measurement by counting pulses for 10 seconds and multiplying by 6 for the minute rate. A healthy range is typically 60-100 beats per minute.
• Blood pressure monitoring with a cuff to ensure levels remain within a healthy range.

Tests for Coronary Artery Disease

To evaluate heart health further, doctors may recommend tests such as:

• Blood tests to detect cholesterol, triglycerides, and high-sensitivity CRP.
• Computed tomography (CT) coronary angiogram with dye to obtain detailed artery images.
• Coronary calcium scan to identify calcium deposits blocking arteries.
• Echocardiogram (echo) using sound waves to assess blood flow in the heart.
• Electrocardiogram (EKG) for heart function assessment, sometimes using a portable device for extended monitoring.
• Exercise stress test to provoke CAD symptoms during physical activity.
• Cardiac catheterization for detailed artery inspection using a catheter.

Complications of Coronary Artery Disease

CAD can lead to severe, potentially life-threatening conditions such as:

• Angina (chest pain) due to narrowed arteries limiting blood flow to the heart during exertion.
• Heart failure from weakened or stiff heart walls impairing blood pumping efficiency.
• Heart attack, where plaque rupture triggers a blood clot, blocking heart blood flow and causing heart muscle damage.
• Arrhythmias from inadequate heart blood supply, potentially leading to life-threatening heart rhythms.

Treatment for Coronary Artery Disease

Treatment plans for CAD may include:

• Medications to manage heart health, including blood thinners, anti-clotting drugs, ACE inhibitors, beta-blockers, nitroglycerin, calcium channel blockers, immunosuppressants, statins, or PCSK9 inhibitors.
• Invasive procedures such as angioplasty to open blocked arteries or coronary artery bypass grafting (CABG) using blood vessels to bypass blockages.

Cardiac Rehabilitation and Lifestyle Changes

Following a heart attack or cardiac surgery, doctors often recommend cardiac rehabilitation programs comprising:

• Exercise training.
• Addressing cardiac risk factors.
• Heart health education.
• Nutritional guidance.
• Emotional support, shown to reduce future stroke, heart attack, depression, and heart-related death risks.

Additionally, lifestyle changes like adopting a heart-healthy diet, quitting smoking, maintaining physical activity, managing stress, and maintaining a healthy weight can significantly reduce CAD risk.

Preventing Coronary Artery Disease

Reducing CAD risk involves:

• Regular monitoring of cholesterol, blood pressure, and blood sugar levels.
• Maintaining a healthy weight, guided by medical advice.
• Avoiding tobacco smoke and excessive alcohol consumption.
• Consuming a balanced diet rich in fiber, whole grains, fruits, vegetables, and omega-3 fatty acids from fish.
• Engaging in regular physical activity, with medical consultation.
• Managing stress through exercise, meditation, and relaxation techniques.