Overview
Coronary artery disease (CAD) is the narrowing or blockage of the arteries that supply blood and oxygen to the heart muscle, caused by a build-up of fatty plaques (atherosclerosis). It is the most common form of heart disease and can lead to angina, heart attack, and heart failure.
How common is it?
Coronary artery disease is a major cause of death and disability. Risk generally rises with age and is higher with smoking, high blood pressure, high cholesterol or diabetes.
Causes and risk factors
Atherosclerosis begins when damage to artery walls allows cholesterol and inflammatory cells to accumulate, forming plaques. Over time these plaques narrow the artery and may rupture, triggering a blood clot that blocks the artery completely.
Common risk factors
- High cholesterol and high LDL
- High blood pressure
- Smoking
- Diabetes
- Family history of heart disease under 60
- Obesity
- Physical inactivity
- Male sex and increasing age
Symptoms
- Chest pain or tightness on exertion (angina), typically in the centre of the chest
- Pain spreading to the arm, jaw, neck, or back
- Shortness of breath on exertion
- Symptoms that settle with rest (stable angina)
- Sudden severe crushing chest pain at rest (suggests heart attack)
When to see a doctor
Call your local emergency number for suspected heart attack: new chest pressure, tightness or discomfort that persists, especially with pain spreading to an arm, jaw or back, sweating, nausea or breathlessness. Pain need not be severe, and a heart attack can occur without chest pain. Do not drive yourself. New or worsening exertional symptoms need urgent medical assessment.
Diagnosis
Tests depend on whether symptoms are stable or suggest a heart attack. Suspected heart attack needs urgent ECG and blood tests for troponin, a protein released with heart muscle injury. Stable symptoms may be investigated with CT coronary angiography or other tests; invasive angiography helps guide treatment when needed.
Treatments
Medications
Medicines may include an antiplatelet, a statin, blood pressure treatment and anti-angina treatment. Two antiplatelets are used for selected patients, often after a heart attack or stent, not for everyone with CAD. Do not start aspirin or change prescribed heart medicines on your own. Nitrates must not be combined with erectile dysfunction medicines such as sildenafil or tadalafil.
Coronary angioplasty and stenting (PCI)
A balloon is inflated in the narrowed artery and a stent (metal mesh tube) is left to keep it open. The standard treatment for heart attacks and suitable angina.
Coronary artery bypass grafting (CABG)
A vein or artery graft bypasses blocked coronary arteries. CABG may be preferred for complex multivessel disease, including in people who have both diabetes and multivessel disease. The heart team considers the anatomy, symptoms, overall health and individual preferences.
Self-care and lifestyle
- Stop smoking: risk of heart attack halves within a year of stopping
- Follow a Mediterranean-style diet rich in olive oil, fish, vegetables, and wholegrains
- Build up regular activity with advice from your care team; cardiac rehabilitation can help after a heart event. Do not exercise through chest pain or new breathlessness.
- Control blood pressure, cholesterol, and blood sugar through medication and lifestyle
Prevention
Statins, blood pressure treatment, not smoking, regular exercise, and a heart-healthy diet prevent the majority of preventable coronary artery disease. Know your cholesterol and blood pressure numbers.
Sources for targeted updates
Updated: 24 October 2026. Targeted corrections to frequency, treatment, diagnosis, urgent-care guidance, key facts, self-care. This update covers the named sections; a full review of the remaining guide is pending.