Coronary Heart Disease

What is Coronary Heart Disease?

Coronary heart disease (CHD) is a condition where the coronary arteries become narrowed or blocked, reducing blood flow to the heart muscle and leading to chest pain, heart attacks, or other heart complications.

Overview

Coronary heart disease, also known as coronary artery disease, is caused by the buildup of plaque—a combination of fat, cholesterol, and other substances—in the coronary arteries. These arteries supply oxygen-rich blood to the heart muscle. Over time, this plaque can harden or rupture, leading to serious heart conditions, including heart attacks.

As arteries narrow due to plaque buildup, less blood can flow through them. This condition can result in angina, which is chest pain or discomfort that occurs when the heart muscle doesn’t get enough blood. If a plaque ruptures and a blood clot forms, it can block blood flow entirely, leading to a heart attack.

HD affects the body by reducing the efficiency of the heart, potentially leading to heart failure—a condition where the heart cannot pump blood effectively. It can also cause arrhythmias, irregular heartbeats that can be life-threatening.

How common is Coronary Heart Disease?

Coronary heart disease is a significant health issue in the United States and worldwide. In the U.S., about 18.2 million adults aged 20 and older have CHD. Globally, it is the leading cause of death, responsible for 17.9 million deaths annually, according to the World Health Organization (WHO).

Symptoms

Plaque build-up that leads to coronary artery disease can occur for a very long time with no symptoms. As the plaque builds up in the arteries that supply blood to your heart, you may begin to notice mild symptoms as your heart works harder to pump blood.

Symptoms may include:

• Shortness of breath during light physical activity. This is known as dyspnea.
• Stable angina, a temporary chest pain or discomfort that comes and goes in a predictable pattern. Usually noticeable during physical activity or emotional distress, this discomfort tends to go away when at rest.
• Heart attack. For some people, the first discernable symptom of CAD is a heart attack. This is why CAD is known as a “silent killer;” you could have the condition for years with no symptoms until a heart attack strikes.

Women are less likely than men to experience chest pain with a heart attack. Instead, they are more likely to experience symptoms such as:

• Dizziness
• Extreme tiredness
• Nausea
• Pressure or tightness in the chest
• Stomach pain

Causes and Risk Factors

Coronary heart disease is primarily caused by atherosclerosis, a condition where plaque builds up inside the coronary arteries. This process is usually slow and develops over many years. The causes and risk factors of CHD include:

Atherosclerosis, the gradual buildup of plaque, is the primary cause of coronary artery disease. Plaque consists of cholesterol, waste products, calcium, and a blood-clotting substance known as fibrin. As plaque collects along your artery walls, they become narrow, stiff, and clogged.

When plaque builds up in your coronary arteries, your heart muscle can’t receive enough blood, and your heart can’t get the oxygen and nutrients it needs to work properly.

Risk factors include:

• Age: being over the age of 45 for males or 55 for females
• Diet: eating a lot of saturated fats or refined carbohydrates
• Exercise: not getting enough exercise or being sedentary
• Sleep: lack of sleep and sleep disorders such as sleep apnea
• Substance use: tobacco use, smoking, and vaping
• Weight: a body mass index (BMI) over 25
• Other health conditions: high blood pressure, high cholesterol, atherosclerosis, diabetes/ gestational diabetes, metabolic syndrome, autoimmune disease, chronic kidney disease, HIV/ AIDS, early menopause, and endometriosis, can all increase your CAD risk.

Genetics

Family history may affect your susceptibility to coronary heart disease, but your lifestyle and risk factors can have the biggest impact on your risk of developing CAD.

The Four Stages Of Coronary Heart Disease

Stage 1: Early Atherosclerosis — Plaque begins to build up in the coronary arteries but may not yet cause symptoms.

Stage 2: Stable Angina — Plaque continues to accumulate, reducing blood flow and causing chest pain during physical activity or stress.

Stage 3: Unstable Angina — Plaque may rupture, and blood clots can form, causing more persistent chest pain and increasing the risk of a heart attack.

Stage 4: Myocardial Infarction (Heart Attack) — Blood flow is severely restricted or completely blocked, leading to damage to the heart muscle.

Coronary Heart Disease Diagnosis

Healthcare professionals use several methods to diagnose coronary heart disease, including:

• Physical Examination: Assessing physical symptoms and medical history.
• Electrocardiogram (ECG): Measuring the electrical activity of the heart.
• Blood Tests: Checking for markers of heart damage or risk factors like cholesterol and blood sugar levels.
• Echocardiogram: Using ultrasound to visualize the heart’s structure and function.
• Stress Tests: Evaluating heart function during physical exertion.

Testing

• Electrocardiogram (ECG or EKG) records the strength and timing of electrical signals as they pass through the heart and determines whether the heart’s rhythm is steady or irregular.
• Coronary calcium scan measures the amount of calcium in the walls of your coronary arteries. This test is a type of cardiac computed tomography (CT) scan. Coronary calcium scans can also help assess coronary heart disease risk for people who smoke or who do not have heart disease symptoms.
• Stress tests check how your heart works during physical activity or in response to a medication. During stress testing, you walk or run on a treadmill or pedal a stationary bike to make your heart work hard and beat quickly. If you have a medical problem that prevents you from exercising, your provider may give you medicine to make your heart work harder, as it would during exercise. To check for low blood flow to your heart muscle, your provider will use an ECG, echocardiogram, or another imaging test to monitor you while you exercise.
• Cardiac magnetic resonance imaging (MRI) detects tissue damage or problems with blood flow in the heart or coronary arteries. It can help your provider diagnose coronary microvascular disease, as well as nonobstructive or obstructive coronary artery disease. A cardiac MRI can also help explain results from other imaging tests.
• Cardiac positron emission tomography (PET) scan assesses blood flow through the coronary blood vessels and into the heart muscle. This type of nuclear imaging test can help diagnose coronary microvascular disease.
• Invasive coronary angiography uses contrast dye to detect blockages in the coronary arteries. Your provider will insert the dye into your coronary arteries in a procedure called cardiac catheterization. This procedure is often used if other tests show that you are likely to have coronary artery disease.
• Coronary CT angiography is a less invasive imaging test that looks at blood flow through the coronary arteries using a specialized X-ray machine that takes multiple pictures of the heart.

Treatment for Coronary Heart Disease

Depending on the severity of your condition, your healthcare provider may prescribe a combination of heart-healthy lifestyle changes and medications to treat your coronary heart disease.

Heart-Healthy Lifestyle Changes:

Lifestyle changes may help prevent CAD, prevent it from worsening, and be part of your treatment plan.

Heart-healthy diet. A heart-healthy eating plan includes fruits, vegetables, and whole grains and limits saturated fats, sodium (salt), added sugars, and alcohol, like the DASH (Dietary Approaches to Stop Hypertension) eating plan or the Mediterranean diet.

Physical activity. Regular physical activity can help manage coronary heart disease risk factors such as high blood cholesterol, high blood pressure, and weight-related risks. Before starting any exercise program, ask your provider what level of physical activity is right for you.

Quit smoking. Smoking can damage and tighten your blood vessels. Talk to your provider if you smoke, vape, or use tobacco products. There is scientific evidence that nicotine and flavorings found in vaping products may damage your heart and lungs.

Get enough good-quality sleep. During sleep, your body can work to repair your heart and blood vessels. Not getting enough hours of sleep or good-quality sleep can raise your risk for heart disease and other health problems. The recommended amount for adults is 7 to 9 hours of sleep a day.

Control your blood sugar. High levels of glucose (sugar in your blood) can damage your blood vessels. You can work with your provider to limit the number of calories you get each day from added sugars to help lower your risk of heart disease.

Manage stress. Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health.

Medications

Some medicines can reduce or prevent chest pain and manage other medical conditions that may contribute to your coronary heart disease, including:

• Statins to lower cholesterol
• Anticoagulants to prevent blood clots
• Blood pressure medications
• Nitrates to relieve chest pain

Living With Coronary Heart Disease

Living with coronary heart disease requires ongoing management and lifestyle adjustments. Patients are encouraged to:

• Follow prescribed treatment plans and take medications as directed.
• Regularly monitor and manage risk factors such as blood pressure, cholesterol, and blood sugar levels.
• Engage in regular physical activity suitable for their condition.
• Attend regular check-ups with healthcare providers to monitor heart health and adjust treatments if necessary.

Preventing Coronary Heart Disease

You may be able to lower your risk of coronary artery disease and help prevent it from getting worse. The same lifestyle changes that can be used to treat coronary artery disease may also help you prevent coronary heart disease:

• Eat heart-healthy foods.
• Get enough sleep.
• Commit to quitting smoking and all tobacco use.
• Stay at a weight that’s healthy for you.
• Learn your risk for heart disease.
• Limit alcohol use.
• Move around more.
• Keep taking your medications.

FAQs

What is the main cause of coronary heart disease?

The main cause is the buildup of plaque in the coronary arteries, known as atherosclerosis.

Can coronary heart disease be reversed?

While the damage cannot always be reversed, progression can be slowed or stopped with lifestyle changes and treatment.

What lifestyle changes can help manage CHD?

Eating a healthy diet, exercising regularly, quitting smoking, and reducing stress are essential.

Is CHD more common in men or women?

Men are generally at higher risk at a younger age, but women's risk increases and equals men's after menopause.