The most common form of heart disease, coronary artery disease—also called coronary heart disease or coronary atherosclerosis—occurs when the coronary arteries, which supply oxygen-rich blood to the heart muscle, become narrowed and stiff due to a buildup of plaque inside them. You can imagine a garden hose filled with hardened dirt and mud, which narrows the opening through which the water may flow. The same thing happens in a narrowed coronary artery—the blood has a smaller path to follow, which can reduce blood flow and increase the risk of a blockage, resulting in a heart attack.
In the United States, coronary artery disease (CAD) is the number one cause of death in both men and women. Fortunately, lifestyle changes and medical interventions can help prevent, manage, or treat the condition, reducing the risk of heart attacks and related health problems.
Coronary arteries start out hollow, flexible, and smooth, allowing blood to flow through easily and normally. Over a period of many years, however, cholesterol and fatty deposits, along with cellular waste products, proteins, and calcium, can begin to stick to the insides of the arteries, gradually building up into more bulky "plaques." This condition is called atherosclerosis (artery hardening or clogging) and can start to occur as early as adolescence.
Plaque deposits change the artery, making it more "stiff" (like a garden hose left outside in the cold), and narrowing the opening, restricting blood flow to the heart muscle and increasing the risk of blood clots.
Symptoms and Risk Factors
Most people are not aware of developing CAD until they experience symptoms. These may include:
- chest pain: Also called angina, chest pain may develop as a result of reduced blood flow through the coronary arteries. You may experience pressure or tightness in the chest area, often in response to emotional or physical stress.
- shortness of breath: If your heart can't get enough blood out to the rest of the body, due to clogged arteries, you may become tired more easily, or experience shortness of breath.
- heart attack: The most severe result of CAD, a heart attack occurs when the coronary artery becomes completely blocked.
To avoid these serious symptoms, it's best to check with your doctor before CAD becomes too advanced. If you have any of the following risk factors, check with your doctor to help manage the disease before it becomes dangerous.
- Age: Men over 45 and women over 50 are more at risk.
- Family history: If a close relative like a mother, father, or sibling had heart disease, your risk is higher.
- Race: African Americans, Mexican Americans, American Indians, Hawaiians, and some Asian Americans have a higher risk for CAD.
- Smoking: Cigarette smoking damages blood vessels, and makes coronary arteries more susceptible to atherosclerosis.
- High blood pressure: If you have high blood pressure and you're not controlling it through medications or lifestyle changes, you have an increased risk of damaging the coronary arteries.
- High blood cholesterol: Scientists theorize that the more cholesterol you have in your blood, the more may build up on the inside of the coronary arteries.
- Diabetes: This disease is associated with a higher risk of CAD.
- Chronic kidney disease: This disease can also increase your risk.
- Obesity: Excess weight typically contributes to other risk factors for CAD.
- Sedentary lifestyle: Lack of exercise can lead to other risk factors, such as obesity and high blood pressure, and is also associated with a higher risk of CAD on its own.
- High stress: Individuals who are regularly under stress may be at a higher risk of artery damage.
Treatment for CAD depends on the severity of the disease and your risk factors. For example, if you have high blood pressure, your doctor will most likely recommend lifestyle changes and medications to manage the condition, which reduces the risk of further damage to the coronary arteries. Medications used to treat CAD may include:
- ACE inhibitors to lower blood pressure
- statins to reduce the amount of cholesterol in the blood
- aspirin to help "thin" the blood and reduce the risk of blood clots
- calcium channel blockers to relax arteries, help them open up, and lower blood pressure
- diuretics to drain fluid from the body and lower blood pressure
- nitrates to treat chest pain and improve blood flow to the heart
If medications don't work, or if the CAD is significantly advanced, surgery may be recommended. Surgical procedures may include:
Angioplasty and Stent Placement
The purpose of this procedure is to open up a narrowed artery. The doctor inserts a catheter into the narrowed section, inflates a balloon inside it (which flattens the plaque buildup), and then leaves a stent behind to keep the artery open.
Coronary Artery Bypass Surgery
During this procedure, the surgeon "goes around" the blocked arteries with a new artery to restore blood flow to the heart. He uses a vessel from another part of the body to serve as an artery substitute.
Healthy daily habits can help both manage and prevent CAD. These include:
- eating healthy foods, including mostly fruits, vegetables, and whole grains; choosing lean proteins and low-fat dairy
- avoiding cigarette smoking or quitting smoking
- limiting alcohol consumption; no more than two drinks a day for men, one for women
- engaging in regular exercise, at least 30 minutes a day on most days
- maintaining a healthy weight; shoot for a body mass index (BMI) of 18.5 to 24.9
- reducing and managing stress by adopting good coping mechanisms like meditation, yoga, regular exercise, and other relaxation techniques
- considering an omega-3 fatty acid supplement
- controlling conditions such as high blood pressure, high blood cholesterol, and diabetes