What Is Coronary Artery Disease?
Your heart is a muscle, and like all muscles, it needs a constant supply of oxygen-rich blood to work properly. The coronary arteries are the vessels that deliver that blood. Coronary artery disease (CAD) occurs when these arteries become narrowed or blocked by a buildup of plaque — a sticky mixture of cholesterol, fat, calcium, and other substances.
This process is called atherosclerosis, and it develops slowly over decades — often starting in young adulthood. As plaque accumulates, it narrows the artery and reduces blood flow to the heart muscle. If a plaque ruptures, a blood clot can form suddenly and completely block the artery — causing a heart attack.
How Plaque Builds Up in Arteries
This happens over decades: Plaque builds gradually as cholesterol, fat, and calcium deposit in artery walls. The danger zone is when plaque ruptures, triggering a blood clot that blocks the artery suddenly — causing a heart attack.
CAD is the #1 killer in the United States. About 20 million American adults have it, and it causes roughly 1 in every 5 deaths. The good news: it's largely preventable, and once diagnosed, very treatable.
Symptoms
CAD can be completely silent for years. The first symptom in many people is a heart attack. When symptoms do occur, the most common is angina — chest discomfort caused by reduced blood flow to the heart.
Angina typically feels like:
- Pressure, squeezing, tightness, or heaviness in the chest
- Pain that may spread to the left arm, shoulder, jaw, neck, or back
- Discomfort that comes on with exertion or stress and goes away with rest
- Episodes that last a few minutes and resolve
Other symptoms of CAD or reduced heart blood flow include:
- Shortness of breath with activity
- Unusual fatigue
- Dizziness or lightheadedness
Women are more likely to experience atypical symptoms like nausea, jaw pain, back pain, or extreme fatigue — without the classic chest pressure. These symptoms deserve the same medical attention.
How Is It Diagnosed?
Your doctor will assess your risk factors, symptoms, and test results to determine how much CAD you may have and how severe it is.
- EKG: Can show signs of a prior heart attack or reduced blood flow
- Stress test: You exercise on a treadmill while your heart is monitored — reduced blood flow shows up as EKG changes or symptoms. Can be combined with imaging (nuclear stress test or stress echo) for more detail.
- Coronary CT angiography (CCTA): A CT scan that produces detailed images of the coronary arteries, showing how much plaque is present and whether arteries are narrowed. Increasingly used as a first-line test.
- Cardiac catheterization (coronary angiogram): The gold standard. A thin tube is guided to the coronary arteries and dye is injected to show blockages in real time. Also allows for treatment at the same time.
- Coronary artery calcium (CAC) score: A CT scan that measures calcified plaque — a strong predictor of future heart attack risk. Helpful for guiding treatment in people with borderline risk.
- Blood tests: Cholesterol panel, blood sugar, and inflammatory markers help assess overall cardiovascular risk.
Treatment Options
Treatment depends on the severity of CAD. The goals are to relieve symptoms, slow or reverse plaque buildup, and prevent heart attacks.
Lifestyle Changes (Essential for Everyone)
- Heart-healthy diet: Mediterranean or plant-forward diet reduces plaque progression. Limit saturated fat, trans fat, red meat, and refined sugars.
- Exercise: At least 150 minutes of moderate activity per week improves heart function and reduces risk.
- Quit smoking: The single most impactful change you can make. Smoking dramatically accelerates atherosclerosis.
- Manage blood pressure and diabetes: Both accelerate artery damage.
- Reach a healthy weight: Reduces strain on the heart and improves cholesterol and blood pressure.
Medications
- Statins (e.g., atorvastatin, rosuvastatin): Lower LDL cholesterol and stabilize plaque. Proven to reduce heart attacks and death in CAD patients.
- Aspirin or other antiplatelets: Prevent blood clots from forming on plaque. Used selectively based on individual risk/benefit.
- Beta-blockers: Reduce heart rate and workload; help with angina and post-heart attack.
- ACE inhibitors / ARBs: Protect the heart and kidneys; often used after heart attack.
- Nitrates (e.g., nitroglycerin): Relieve angina episodes by dilating blood vessels.
- PCSK9 inhibitors: Injectable medications for very high cholesterol not controlled by statins.
Procedures
- PCI (Percutaneous Coronary Intervention / stenting): A catheter with a tiny balloon opens a blocked artery; a stent (small mesh tube) is placed to keep it open. Done in the cath lab — minimally invasive.
- CABG (Coronary Artery Bypass Grafting): Open-heart surgery that creates new routes around blocked arteries using vessels from elsewhere in the body. Recommended for severe multi-vessel disease.
📺 Video Resources
Watch Dr. Pollock explain coronary artery disease, its risk factors, and treatment options.
When to Seek Care
- Chest pain, pressure, tightness, or squeezing lasting more than a few minutes
- Pain spreading to the arm, shoulder, jaw, neck, or back
- Sudden shortness of breath
- Cold sweat, nausea, or lightheadedness with chest discomfort
- Sudden extreme fatigue (especially in women)
Time is muscle. Every minute during a heart attack, more heart tissue is damaged. Don't drive yourself — call 911. Don't wait to see if the pain goes away on its own.
Schedule an appointment with your doctor if: you have risk factors (high blood pressure, high cholesterol, diabetes, smoking, family history) and have never had a cardiovascular risk assessment; or you notice any new chest discomfort, shortness of breath, or reduced exercise capacity.