Coronary artery disease (CAD) is a reduction in blood flow through the coronary arteries, which carry blood to the heart muscle. Also called coronary heart disease (CHD), CAD affects about 16.5 million Americans ages 20 and over.

Having high cholesterol — especially high levels of unhealthy low-density lipoprotein (LDL) cholesterol — can increase your risk of CAD.

What causes CAD?

CAD is caused by a buildup of sticky cholesterol and other substances inside the artery walls. This buildup is called plaque. It hardens and narrows the arteries so that less blood can flow through them. Hardening of the arteries is called atherosclerosis.

You’re more likely to develop CAD if you:

  • have a family history of heart disease
  • are overweight or obese
  • eat a diet high in saturated fat, trans fat, sugar, and salt
  • have high levels of LDL cholesterol or low levels of healthy high-density lipoprotein (HDL) cholesterol in your blood
  • smoke tobacco
  • are inactive
  • have uncontrolled high blood pressure
  • have diabetes

Risks of living with CAD

Your heart muscle needs a steady supply of blood to pump properly. When too little blood reaches the heart muscle, it can cause a type of chest pain called angina.

A complete blockage in one or more coronary arteries can cause a heart attack. Areas of the heart muscle that don’t get enough blood can die, causing permanent heart damage or even death.

A few changes to your daily routine could protect your arteries and prevent CAD. Here are eight lifestyle changes that can help.

1. Eat a heart-healthy diet

Certain foods protect your heart, while others contribute to the formation of artery-clogging plaques. Eat more protective foods like fruits, vegetables, whole grains, lean protein, fish, nuts, and olive oil. Limit or avoid sweets, fried foods, red and processed meats, and full-fat dairy products.

Eat no more than a teaspoon of salt per day. Too much sodium can raise your blood pressure.

2. Get more active

Aerobic exercise strengthens the heart muscle. It also trims fat, lowers blood pressure, and increases protective HDL cholesterol levels. Weight loss from working out might also reduce your LDL cholesterol levels.

Try to get 150 minutes a week of moderate-intensity aerobic exercise. Or, do 75 minutes of high-intensity aerobic exercise a week. If you’re new to exercise, check with your doctor first to make sure it’s safe for you.

3. Lose weight

Excess weight puts extra strain on your heart and blood vessels. Losing just 5 to 10 percent of your body weight will help lower your blood pressure and LDL cholesterol. It could also help reduce your risk of CAD.

If you have a hard time losing weight and want help, your doctor can refer you to a nutritionist or dietitian. You can also use a phone app to help you track your progress and keep you motivated. A few to try are:

4. Stop smoking

The thousands of chemicals released in each puff of tobacco smoke narrow your arteries and damage your heart. If you smoke cigarettes, you can lower your risk of getting a heart attack by quitting.

Quitting isn’t easy, but your doctor has a variety of methods to help you. Medications, counseling, and nicotine replacement products can all help reduce your urge to smoke.

Also, the American Lung Association is a great resource for finding support or counseling if you’re committed to quitting smoking.

5. Lower blood pressure

Blood pressure is the force of blood moving against the artery walls as the heart beats. The higher your blood pressure, the more force is exerted against those walls. Over time, high blood pressure can damage the arteries and make them more likely to develop atherosclerosis.

A normal blood pressure reading is 120 over 80. Ask your doctor what your numbers should be based on your age and health. If you’re out of range, work with your doctor to come up with a plan to lower your blood pressure.

6. Limit alcohol

A glass of red wine with dinner might help lower HDL cholesterol, but too much alcohol can be dangerous to the heart. In excess, alcohol can contribute to high blood pressure, obesity, and heart failure.

Drink in moderation — one drink a day for women, and one to two a day for men. Of course, ask your doctor if it’s safe for you to drink at all.

7. Keep blood sugar under control

CAD is the leading cause of death in people with diabetes. The two conditions share many of the same risk factors, including high blood pressure, high LDL cholesterol, and obesity.

Uncontrolled high blood sugar damages arteries. In time, this damage can lead to heart disease. Because of how diabetes affects blood sugar levels, people with it are twice as likely to die from heart disease than people without it.

To lower your risk of CAD, manage high blood pressure, obesity, and high cholesterol with lifestyle changes and medication. Also, work with your doctor to keep your blood sugar levels under good control.

8. Reduce stress

Some stress is inevitable in this fast-paced world. But if you’re stressed out day after day, it can increase blood pressure and damage your artery walls.

To combat stress in your daily life, choose a relaxation technique that suits you, and do it often. You can meditate, practice yoga, breathe deeply, or listen to music while you walk.

If lifestyle changes aren’t enough to protect your blood vessels, your doctor might prescribe one or more of these medications. Drugs used to prevent CAD work by lowering cholesterol, preventing blood clots, and reducing blood pressure.

1. Cholesterol-lowering drugs

Too much LDL cholesterol in your blood can speed the formation of sticky plaques. These medications can help lower your LDL cholesterol and increase your HDL cholesterol.

Statins block a substance that your body needs to make cholesterol. Examples include:

  • atorvastatin (Lipitor)
  • fluvastatin (Lescol XL)
  • lovastatin (Altoprev)
  • pitavastatin (Livalo)
  • pravastatin (Pravachol)
  • rosuvastatin (Crestor)
  • simvastatin (Zocor)

Bile acid sequestrants help your body remove more cholesterol from your blood. Examples include:

  • cholestyramine (Prevalite)
  • colesevelam (Welchol)
  • colestipol (Colestid)

Fibric acid derivatives (fibrates) increase HDL cholesterol and lower triglycerides. Examples include:

  • clofibrate (Atromid-S)
  • fenofibrate (Tricor)
  • gemfibrozil (Lopid)

Niacin is a B vitamin that can help raise HDL cholesterol. It’s available as the brand-name drugs Niacor and Niaspan.

2. Clot-preventing drugs

Plaque buildup in your arteries makes blood clots more likely to form. A clot can partially or totally block blood flow to your heart.

These drugs make it harder for your blood to clot:

  • apixaban (Eliquis)
  • aspirin
  • clopidogrel (Plavix)
  • dabigatran (Pradaxa)
  • edoxaban (Savaysa)
  • enoxaparin (Lovenox)
  • rivaroxaban (Xarelto)
  • ticagrelor (Brilinta)
  • ticlopidine (Ticlid)
  • warfarin (Coumadin)

3. Blood pressure-lowering drugs

These medications bring down blood pressure to lower CAD risk. You have several options in this category.

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) help relax your blood vessels to let more blood through. Examples include:

  • enalapril (Vasotec)
  • lisinopril (Prinivil, Zestril)
  • losartan (Cozaar)
  • ramipril (Altace)
  • valsartan (Diovan)

Calcium channel blockers relax blood vessels by preventing calcium from moving into muscle cells in the heart and blood vessels. Examples include:

  • amlodipine (Norvasc)
  • bepridil (Vascor)
  • diltiazem (Cardizem, Dilacor XR)
  • nicardipine (Cardene, Cardene SR)
  • nifedipine (Adalat CC, Afeditab CR, Procardia)
  • verapamil (Calan, Covera-HS)

Beta-blockers slow the heartbeat to reduce the force of blood moving through the arteries. Examples include:

  • atenolol (Tenormin)
  • metoprolol (Lopressor, Toprol-XL)
  • nadolol (Corgard)

To prevent CAD and avoid a heart attack, first know your risks. Talk to your doctor about your weight, blood pressure, blood sugar, and other factors that could damage your blood vessels.

Then take steps to protect yourself. Start with lifestyle changes like diet and exercise. If those aren’t enough, ask your doctor about medications to lower your blood pressure or cholesterol and prevent blood clots.