Overview

Coronary artery disease is a common heart condition. The major blood vessels that supply the heart (coronary arteries) struggle to send enough blood, oxygen and nutrients to the heart muscle. Cholesterol deposits (plaques) in the heart arteries and inflammation are usually the cause of coronary artery disease.

Signs and symptoms of coronary artery disease occur when the heart doesn't get enough oxygen-rich blood. If you have coronary artery disease, reduced blood flow to the heart can cause chest pain (angina) and shortness of breath. A complete blockage of blood flow can cause a heart attack.

Coronary artery disease often develops over decades. Symptoms may go unnoticed until a significant blockage causes problems or a heart attack occurs. Following a heart-healthy lifestyle can help prevent coronary artery disease.

Coronary artery disease may also be called coronary heart disease.

What is coronary artery disease? A Mayo Clinic cardiologist explains.

Stephen Kopecky, M.D., talks about the risk factors, symptoms and treatment of coronary artery disease (CAD). Learn how lifestyle changes can lower your risk.

I'm Dr. Stephen Kopecky, a cardiologist at Mayo Clinic. In this video, we'll cover the basics of coronary artery disease. What is it? Who gets it? The symptoms, diagnosis and treatment. Whether you're looking for answers for yourself or someone you love, we're here to give you the best information available. Coronary artery disease, also called CAD, is a condition that affects your heart. It is the most common heart disease in the United States. CAD happens when coronary arteries struggle to supply the heart with enough blood, oxygen and nutrients. Cholesterol deposits, or plaques, are almost always to blame. These buildups narrow your arteries, decreasing blood flow to your heart. This can cause chest pain, shortness of breath or even a heart attack. CAD typically takes a long time to develop. So often, patients don't know that they have it until there's a problem. But there are ways to prevent coronary artery disease, and ways to know if you're at risk and ways to treat it.

Anyone can develop CAD. It begins when fats, cholesterols and other substances gather along the walls of your arteries. This process is called atherosclerosis. It's typically no cause for concern. However, too much buildup can lead to a blockage, obstructing blood flow. There are a number of risk factors, common red flags, that can contribute to this and ultimately lead to coronary artery disease. First, getting older can mean more damaged and narrowed arteries. Second, men are generally at a greater risk. But the risk for women increases after menopause. Existing health conditions matter, too. High blood pressure can thicken your arteries, narrowing your blood flow. High cholesterol levels can increase the rate of plaque buildup. Diabetes is also associated with higher risk, as is being overweight. Your lifestyle plays a large role as well. Physical inactivity, long periods of unrelieved stress in your life, an unhealthy diet and smoking can all increase your risk. And finally, family history. If a close relative was diagnosed at an early age with heart disease, you're at a greater risk. All these factors together can paint a picture of your risk for developing CAD.

When coronary arteries become narrow, the heart doesn't get enough oxygen-rich blood. Remember, unlike most pumps, the heart has to pump its own energy supply. It's working harder with less. And you may begin to notice these signs and symptoms of pressure or tightness in your chest. This pain is called angina. It may feel like somebody is standing on your chest. When your heart can't pump enough blood to meet your body's needs, you might develop shortness of breath or extreme fatigue during activities. And if an artery becomes totally blocked, it leads to a heart attack. Classic signs and symptoms of a heart attack include crushing, substernal chest pain, pain in your shoulders or arms, shortness of breath, and sweating. However, many heart attacks have minimal or no symptoms and are found later during routine testing.

Diagnosing CAD starts by talking to your doctor. They'll be able to look at your medical history, do a physical exam and order routine blood work. Depending on that, they may suggest one or more of the following tests. An electrocardiogram, or ECG, an echocardiogram, or soundwave test of the heart, stress test, cardiac catheterization and angiogram, or a cardiac CT scan.

Treating coronary artery disease usually means making changes to your lifestyle. This might be eating healthier foods, exercising regularly, losing excess weight, reducing stress or quitting smoking. The good news is these changes can do a lot to improve your outlook. Living a healthier life translates to having healthier arteries. When necessary, treatment could involve drugs like aspirin, cholesterol-modifying medications, beta-blockers, or certain medical procedures like angioplasty or coronary artery bypass surgery.

Discovering you have coronary artery disease can be overwhelming. But be encouraged. There are things you can do to manage and live with this condition. Reducing cholesterol, lowering blood pressure, quitting tobacco, eating healthier, exercising and managing your stress can make a world of difference. Better heart health starts by educating yourself. So don't be afraid to seek out information and ask your doctors about coronary artery disease. If you'd like to learn even more about this condition, watch our other related videos or visit Mayoclinic.org. We wish you well.

Symptoms

Symptoms may go unrecognized at first, or they may only occur when the heart is beating hard like during exercise. As the coronary arteries continue to narrow, less and less blood gets to the heart and symptoms can become more severe or frequent.

Coronary artery disease signs and symptoms can include:

  • Chest pain (angina). You may feel pressure or tightness in your chest. Some people say it feels like someone is standing on their chest. The chest pain usually occurs on the middle or left side of the chest. Activity or strong emotions can trigger angina. The pain usually goes away within minutes after the triggering event ends. In some people, especially women, the pain may be brief or sharp and felt in the neck, arm or back.
  • Shortness of breath. You may feel like you can't catch your breath.
  • Fatigue. If the heart can't pump enough blood to meet your body's needs, you may feel unusually tired.
  • Heart attack. A completely blocked coronary artery will cause a heart attack. The classic signs and symptoms of a heart attack include crushing chest pain or pressure, shoulder or arm pain, shortness of breath, and sweating. Women may have less typical symptoms, such as neck or jaw pain, nausea and fatigue. Some heart attacks don't cause any noticeable signs or symptoms.

When to see a doctor

If you think you're having a heart attack, immediately call 911 or your local emergency number. If you don't have access to emergency medical services, have someone drive you to the nearest hospital. Drive yourself only as a last option.

Smoking or having high blood pressure, high cholesterol, diabetes, obesity or a strong family history of heart disease makes you more likely to get coronary artery disease. If you're at high risk of coronary artery disease, talk to your health care provider. You may need tests to check for narrowed arteries and coronary artery disease.

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Causes

Coronary artery disease starts when fats, cholesterols and other substances collect on the inner walls of the heart arteries. This condition is called atherosclerosis. The buildup is called plaque. Plaque can cause the arteries to narrow, blocking blood flow. The plaque can also burst, leading to a blood clot.

Besides high cholesterol, damage to the coronary arteries may be caused by:

  • Diabetes or insulin resistance
  • High blood pressure
  • Not getting enough exercise (sedentary lifestyle)
  • Smoking or tobacco use

Risk factors

Coronary artery disease is common. Age, genetics, other health conditions and lifestyle choices can affect the health of the heart arteries.

Coronary artery disease risk factors include:

  • Age. Getting older increases the risk of damaged and narrowed arteries.
  • Sex. Men are generally at greater risk of coronary artery disease. However, the risk for women increases after menopause.
  • Family history. A family history of heart disease makes you more likely to get coronary artery disease. This is especially true if a close relative (parent, sibling) developed heart disease at an early age. The risk is highest if your father or a brother had heart disease before age 55 or if your mother or a sister developed it before age 65.
  • Smoking. If you smoke, quit. Smoking is bad for heart health. People who smoke have a significantly increased risk of heart disease. Breathing in secondhand smoke also increases the risk.
  • High blood pressure. Uncontrolled high blood pressure can make arteries hard and stiff (arterial stiffness). The coronary arteries may become narrow, slowing blood flow.
  • High cholesterol. Too much bad cholesterol in the blood can increase the risk of atherosclerosis. Bad cholesterol is called low-density lipoprotein (LDL) cholesterol. Not enough good cholesterol — called high-density lipoprotein (HDL) — also leads to atherosclerosis.
  • Diabetes. Diabetes increases the risk of coronary artery disease. Type 2 diabetes and coronary artery disease share some risk factors, such as obesity and high blood pressure.
  • Overweight or obesity. Excess body weight is bad for overall health. Obesity can lead to type 2 diabetes and high blood pressure. Ask your health care provider what a healthy weight is for you.
  • Chronic kidney disease. Having long-term kidney disease increases the risk of coronary artery disease.
  • Not getting enough exercise. Physical activity is important for good health. A lack of exercise (sedentary lifestyle) is linked to coronary artery disease and some of its risk factors.
  • A lot of stress. Emotional stress may damage the arteries and worsen other risk factors for coronary artery disease.
  • Unhealthy diet. Eating foods with a lot of saturated fat, trans fat, salt and sugar can increase the risk of coronary artery disease.
  • Alcohol use. Heavy alcohol use can lead to heart muscle damage. It can also worsen other risk factors of coronary artery disease.
  • Amount of sleep. Too little and too much sleep have both been linked to an increased risk of heart disease.

Risk factors often occur together. One risk factor may trigger another.

When grouped together, certain risk factors make you even more likely to develop coronary artery disease. For example, metabolic syndrome — a cluster of conditions that includes high blood pressure, high blood sugar, excess body fat around the waist and high triglyceride levels — increases the risk of coronary artery disease.

Sometimes coronary artery disease develops without any classic risk factors. Other possible risk factors for coronary artery disease may include:

  • Breathing pauses during sleep (obstructive sleep apnea). This condition causes breathing to stop and start during sleep. It can cause sudden drops in blood oxygen levels. The heart must work harder. Blood pressure goes up.
  • High-sensitivity C-reactive protein (hs-CRP). This protein appears in higher-than-usual amounts when there's inflammation somewhere in the body. High hs-CRP levels may be a risk factor for heart disease. It's thought that as coronary arteries narrow, the level of hs-CRP in the blood goes up.
  • High triglycerides. This is a type of fat (lipid) in the blood. High levels may raise the risk of coronary artery disease, especially for women.
  • Homocysteine. Homocysteine is an amino acid the body uses to make protein and to build and maintain tissue. But high levels of homocysteine may increase the risk of coronary artery disease.
  • Preeclampsia. This pregnancy complication causes high blood pressure and increased protein in the urine. It can lead to a higher risk of heart disease later in life.
  • Other pregnancy complications. Diabetes or high blood pressure during pregnancy are also known risk factors for coronary artery disease.
  • Certain autoimmune diseases. People who have conditions such as rheumatoid arthritis and lupus (and other inflammatory conditions) have an increased risk of atherosclerosis.

Complications

Coronary artery disease can lead to:

  • Chest pain (angina). When the coronary arteries narrow, the heart may not get enough blood when it needs it most — like when exercising. This can cause chest pain (angina) or shortness of breath.
  • Heart attack. A heart attack can happen if a cholesterol plaque breaks open and causes a blood clot to form. A clot can block blood flow. The lack of blood can damage the heart muscle. The amount of damage depends in part on how quickly you are treated.
  • Heart failure. Narrowed arteries in the heart or high blood pressure can slowly make the heart weak or stiff so it's harder to pump blood. Heart failure is when the heart doesn't pump blood as it should.
  • Irregular heart rhythms (arrhythmias). Not enough blood to the heart can alter normal heart signaling, causing irregular heartbeats.

Prevention

The same lifestyle habits used to help treat coronary artery disease can also help prevent it. A healthy lifestyle can help keep the arteries strong and clear of plaque. To improve heart health, follow these tips:

  • Quit smoking.
  • Control high blood pressure, high cholesterol and diabetes.
  • Exercise often.
  • Maintain a healthy weight.
  • Eat a low-fat, low-salt diet that's rich in fruits, vegetables and whole grains.
  • Reduce and manage stress.

Coronary artery disease care at Mayo Clinic

May 25, 2022
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