Key Points

• About 13 million people in the United States have coronary artery disease (CAD). It is the leading cause of death in both men and women. Each year, more than half a million Americans die from CAD.
• CAD occurs when the arteries that supply blood to the heart muscle (the coronary arteries) become hardened and narrowed. The arteries harden and narrow due to buildup of a material called plaque on their inner walls. The buildup of plaque is known as atherosclerosis. As the plaque increases in size, the insides of the coronary arteries get narrower and less blood can flow through them. Eventually, blood flow to the heart muscle is reduced, and, because blood carries much-needed oxygen, the heart muscle is not able receive the amount of oxygen it needs. Reduced flow of blood and oxygen can lead to problems such as angina (chest pain) and heart attack.
• Plaque in the coronary arteries can be hard and stable or soft and unstable. Hard plaque causes the artery walls to thicken and harden. This condition is associated more with angina than with a heart attack. Soft plaque is more likely to break open or break off from the artery walls and cause blood clots. This can lead to a heart attack.
• Some of the risk factors for CAD can't be modified but others can. For example, you can't modify your age and family history. But you can control high blood cholesterol, high blood pressure, cigarette smoking, high blood sugar, overweight or obesity, and lack of physical activity.
• Angina is the most common symptom of CAD.
• There is no single test to diagnose CAD. Your doctor will ask about your medical history and your family's medical history, assess your risk factors, and do a physical exam and several tests. These procedures are used to decide if you have CAD, to determine the extent and severity of the disease, and to rule out other possible causes of your symptoms.
• The goals of treatment are to:
  • Relieve symptoms
  • Slow or stop atherosclerosis by controlling or reducing the risk factors
  • Lower the risk of having blood clots form, which can cause a heart attack
  • Widen or bypass clogged arteries
• Prevention begins with knowing which risk factors you have and taking action. Your chance of developing CAD increases with the number of risk factors you have.