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?
CAD is the leading cause of death in the UK. About 2.3 million people live with angina or have survived a heart attack. It kills around 66,000 people per year.
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 999 immediately for sudden severe chest pain, especially with sweating, nausea, or arm pain. See a doctor urgently for chest pain on exertion that is new or worsening.
Diagnosis
ECG, blood troponin levels (cardiac enzyme), echocardiogram, and stress testing. Coronary angiography shows the extent and location of blockages and guides treatment decisions.
Treatments
Medications
Aspirin and dual antiplatelet therapy, statins (reduce cholesterol and plaque inflammation), beta-blockers, ACE inhibitors, and nitrates for angina symptom relief.
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. Preferred for complex multi-vessel disease or in diabetic patients.
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
- Exercise 150 minutes of moderate activity per week
- 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.