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Coronary artery disease
Also known as Ischemic heart disease, Coronary heart disease, and Arteriosclerotic heart diseaseOverview
Coronary artery disease (CAD) is a condition where the arteries that supply blood to the heart become narrowed or blocked due to the buildup of plaque (atherosclerosis). Symptoms include chest pain (angina), shortness of breath, fatigue, and in severe cases, heart attack. However, some people may have no symptoms until the disease significantly worsens.
Men are generally at a higher risk of developing coronary artery disease (CAD) at a younger age. However, women's risk increases after menopause due to the decline in protective estrogen levels. Family history, advancing age, high blood pressure, an abnormal cholesterol profile, diabetes, obesity, and smoking are the major risk factors for CAD.
Management of CAD includes lifestyle changes like consuming a heart-healthy diet, an exercise regime, and cessation of smoking and alcohol. Medications can help to manage risk factors along with treating the symptoms. Surgery might be advised in severe cases.
Key Facts
- Adults after 35 years of age
- Both men and women, but more common in men
- Coronary arteries
- Heart
- World: 315 million (2022)
- One lung problem
- Pulmonary embolism
- Floppy mitral valve syndrome
- Angina pectoris
- Wolff-Parkinson-White syndrome
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Imaging tests: Chest X-ray, Electrocardiogram (ECG, Echocardiography, Treadmill test (Stress test), Computed tomography (CT) scan, MRI (Cardiac), Cardiac positron emission tomography (PET) scan, Coronary calcium scoring, Nuclear ventriculography, Coronary angiography, and Electrophysiology study.
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Blood tests: Cholesterol total, Triglycerides (Tg), Cholesterol LDL, Cholesterol HDL, CRP (C-reactive protein), Lipoprotein (a), Troponin, Homocysteine, and NT-pro (BNP).
- Blood thinners: Clopidogrel, Rivaroxaban, Ticagrelor, Aspirin
- Beta blockers: Atenolol, Bisoprolol, Metoprolol
- Statins: Rosuvastatin, Pravastatin, Atorvastatin
- Calcium channel blockers: Amlodipine, Verapamil, Diltiazem
- Nitrates: Nitroglycerine, Isosorbide mononitrate.
- ACE inhibitors: Ramipril, Lisinopril.
- Surgery: Coronary angioplasty, Coronary artery bypass graft (CABG), and Heart transplant.
- General physician
- Cardiologist
- Cardiac surgeon
- Heart Foundation India
- Swades Foundation
Symptoms Of Coronary Artery Disease
Angina or chest pain is the most common symptom of CAD. Angina develops when too much plaque deposits inside the arteries and narrows them. Angina may cause symptoms like-
- Heaviness or tightness in the chest
- Tiredness
- Indigestion
- Heartburn
- Sweating
For many people, a heart attack is the first clue that they have CAD. A few symptoms of a heart attack include-
- Chest pain or angina
- Weakness
- Nausea
- Cold sweat
- Discomfort in the arms or shoulder
- Shortness of breath or trouble breathing
- Heart palpitations
Over time, CAD can weaken the heart muscle. This may lead to heart failure, a life-threatening condition where the heart cannot pump blood the way it should.
Are you confused between angina, heartburn, and heart attack?
Types Of Coronary Artery Disease
The different forms of coronary artery disease include:
1. Obstructive coronary artery disease
This is the most common type of coronary artery disease. It develops when coronary arteries gradually narrow due to plaque buildup. As the narrowing progresses, it can eventually block blood flow to the heart.
2. Nonobstructive coronary artery disease
This form of CAD is more common in females than males. It is not the result of plaque buildup but occurs due to other coronary artery problems, such as:
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Constriction at inappropriate times
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Malfunctioning in smaller artery branches
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Damage to the artery lining
3. Spontaneous coronary artery dissection (SCAD)
SCAD occurs when a tear in the wall of the coronary artery partially or completely blocks the blood flow. This form can unexpectedly present as a heart attack.
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Causes Of Coronary Artery Disease
Atherosclerosis or the gradual buildup of plaque in coronary arteries (the major blood vessels in the body that supply blood to the heart) causes coronary artery disease.
Over time, this plaque which is made up of cholesterol, waste products, calcium, and fibrin (which helps in blood clotting) narrows or blocks the coronary arteries. This affects their function to supply enough blood, oxygen, and nutrients to the heart. It leads to chest pain and puts you at risk of a heart attack.
Various factors can elevate the risk of coronary artery disease, which are explored in detail in the next section.
Risk Factors For Coronary Artery Disease
Multiple risk factors can lead to coronary artery disease. They are broadly divided into non-modifiable and modifiable factors:
I. Non-modifiable risk factors
- Hereditary: Genetic factors are a significant risk factor of CAD. People with a family history of CAD are more prone to develop this condition.
- Age: The risk of CAD significantly increases after 35 years of age in both men and women.
- Gender: Men are more likely to have CAD as compared to women. Evidence has shown that lipoprotein (a) which is a cardiovascular risk factor seems to be elevated in men more than in women.
Note: Women are more prone to cardiovascular diseases including CAD after menopause as protective estrogen levels decline.
II. Modifiable risk factors
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Hypertension (High blood pressure): High blood pressure is a major risk factor for coronary artery disease. It is characterized by blood pressure in the arteries and other blood vessels greater than 185/115 mm Hg.
Is your blood pressure under control? Explore our wide range of BP monitors to check your BP at the comfort of your home. -
Abnormal cholesterol profile: Dyslipidemia, i.e. high LDL (bad cholesterol) and triglycerides with low HDL (good cholesterol) raises CAD risk by promoting plaque buildup that blocks arteries and reduces oxygen-rich blood flow to the heart.
Monitor your cholesterol levels regularly for early detection and proactive heart disease prevention. -
Diabetes: The risk of heart disease is higher in men than women with diabetes.
Note: India is the Diabetes capital of the world. Diabetes not only predisposes to heart disease but a plethora of other long-term complications.
Listen to our expert talk about Diabetes, its various complications, and their prevention.
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Obesity: The majority of individuals with CHD are overweight or obese.
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Lack of physical activity: A sedentary lifestyle predisposes to obesity, high blood pressure, high bad cholesterol, and diabetes, which are all major risk factors for CAD.
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A diet rich in unhealthy fats: A diet loaded with saturated fats, trans fat, and packaged food increases the risk of obesity and high bad cholesterol by many folds. This results in excessive plaque formation in coronary arteries, leading to CAD.
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Vitamin D deficiency: Moderate to severe vitamin D deficiency is associated with an increased risk of cardiovascular diseases including high blood pressure, CAD, and heart failure.
Read about various causes of Vitamin D and when to get tested for its optimum levels. -
Excessive alcohol intake: Drinking too much alcohol can raise blood pressure levels and the risk of heart disease.
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Tobacco: Smoking increases plaque deposition in arteries and reduces the capacity of blood to carry oxygen, predisposing to CAD.
Looking to quit smoking? Try our range of smoking cessation products and detach yourself from this deadly habit. -
Periodontitis: It is a severe gum infection that can lead to tooth loss. Research has suggested that periodontitis can expose the body to oral bacteria which can lead to the development of plaque buildup in blood vessels and coronary heart disease.
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Chronic kidney disease (CKD): Individuals with chronic kidney disease (CKD) exhibit an elevated risk of coronary artery disease due to accelerated ageing of the cardiovascular system.
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Air pollution: Breathing polluted air increases heart disease risk by accelerating blood vessel aging and promoting plaque buildup in the arteries.
Exposure to road traffic noise, particularly above 60 dB, is linked to coronary artery disease in adults. Nighttime traffic noise disrupts sleep, raising stress hormones, which can increase blood pressure and elevate cardiovascular risk.
Diagnosis Of Coronary Artery Disease
CAD is usually diagnosed through the following:
1. Physical examination and medical history
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The doctor will check parameters like blood pressure and ask about medical history, lifestyle, and family history.
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The symptoms of chest pain and pain in the jaw, neck, left arm, or back are assessed. Shortness of breath is evaluated during rest and in case of activity.
2. Imaging tests
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Chest X-ray: This test can reveal heart enlargement or signs of fluid buildup, indicating possible heart failure related to the condition.
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Electrocardiogram (ECG): This test helps detect electrical abnormalities in the heart that may indicate coronary artery disease (CAD).
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Echocardiography: It provides real-time images of the heart's structure and function to assess damage or reduced blood flow to the heart due to CAD.
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Treadmill test (Stress test): This test evaluates how the heart responds to physical activity, revealing potential issues related to CAD or heart function.
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Computed tomography (CT) scan: It identifies plaque buildup in the coronary arteries, a key indicator of coronary artery disease.
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MRI (Cardiac): This test detects tissue damage or blood flow issues in the heart and coronary arteries, pointing to CAD.
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Cardiac positron emission tomography (PET) scan: This test is used to see areas of the heart muscle with insufficient blood supply, a sign of CAD.
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Coronary calcium scoring: Measures calcium buildup in the coronary arteries, helping to assess CAD risk.
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Nuclear ventriculography: This is a non-invasive test that uses radioactive material to assess heart function and detect abnormalities in the heart chamber, linked to CAD.
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Coronary angiography: The gold standard for CAD diagnosis, it visualizes blockages and severity in coronary arteries using contrast dye.
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Electrophysiology study: It assesses the electrical system of the heart to detect arrhythmias or electrical abnormalities caused by CAD.
3. Blood tests
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Cholesterol total: It measures overall cholesterol levels to assess the risk of CAD; high levels of cholesterol (>240 mg/dL) increase the risk.
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Triglycerides (Tg): High triglyceride levels (>150 mg/dL) can contribute to CAD risk by promoting plaque buildup in arteries.
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Cholesterol LDL: Elevated LDL(low-density lipoprotein) (>190 mg/dL) leads to plaque formation in arteries, increasing the risk of CAD.
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Cholesterol HDL: Higher HDL (High-density lipoprotein) (>60 mg/dL) reduces the risk of CAD by removing LDL (bad cholesterol) from the bloodstream and promoting better blood flow.
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CRP (C-reactive protein): Elevated CRP levels generally indicate inflammation and an increased risk of heart disease, even before symptoms appear.
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Lipoprotein (a): It is used to assess genetic predisposition. High levels of lipoprotein (a) suggest an increased risk of heart disease, blood clots, and stroke, elevating CAD risk.
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Troponin: Elevated troponin levels indicate damage to the heart muscle, which signals an increased risk of heart disease or a heart attack.
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Homocysteine: High levels of homocysteine are linked to the severity of CAD and increased risk of cardiovascular diseases.
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NT-pro (BNP): Increased BNP levels reflect heart strain and damage, often correlating with worsening coronary artery disease.
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Prevention Of Coronary Artery Disease
The following tips can help in preventing or reducing the risk for coronary artery disease:
1. Consume a healthy diet
Foods to prefer:
- Green leafy vegetables
- Legumes
- Whole fruits
- Whole grains like wheat, brown rice, jowar, ragi and bajra
- Low-fat or fat-free milk or yogurt
- Unsalted nuts and seeds
- Eggs, fish, seafood, lean poultry
- Vegetable and nut oils like olive oil, canola oil
Foods to limit or avoid:
- Refined grains like white flour or white bread
- Table sugar
- Sugar-sweetened beverages
- Packaged foods
- Red and processed meats
- Butter, coconut, palm, cottonseed and palm kernel oils and other oils that congeal at room temperature
- Alcohol consumption
- High salt intake
2. Indulge in physical activity
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Combining a healthy diet with regular exercise is the best way of maintaining a healthy weight.
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Regular exercise strengthens the heart, improves circulation, lowers cholesterol, and helps maintain healthy blood pressure.
Not a gym person? Stay heart-healthy at home. Shop the best exercise equipment for a stronger heart and active lifestyle.
3. Quit smoking
Smoking is never a good idea for your heart's health. It has been researched that giving up on smoking significantly reduces the risk of developing coronary heart disease.
Looking to quit smoking, but finding it very difficult? Read about some practical ways that will help you get rid of this unhealthy habit.
4. Manage your stress effectively
Stress, anxiety, and negative mental health are associated with an increased risk of heart disease and stroke. It is important to find ways to manage stress in ways that suit you the best.
You can also try our extensive range of natural mind care products after consulting with your doctor.
5. Get sound and sufficient sleep
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Poor sleep quality is associated with high blood pressure, and elevated cholesterol, which are major risk factors of CAD.
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A healthy diet, regular exercise, sleep hygiene, and low stress promote deep and restorative sleep essential for good cardiovascular health.
Struggling to fall asleep? Read about some amazing tips that will help you sleep like a baby.
6. Keep your blood pressure under control
Always keep your blood pressure under control. Eat a healthy diet, exercise regularly, and, if needed, take prescribed medications to lower your blood pressure.
Keep your heart in check. Monitor your blood pressure regularly to prevent CAD and stay on top of your heart health.
This is some good news for all coffee lovers. Research has shown that having two to three cups of black coffee a day has been associated with lowering the risk of developing coronary heart disease. Not just this, coffee has some other amazing health benefits too.
Doctor To Visit
The doctors that can be consulted for the diagnosis and management of CAD include:
- General physician
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Cardiologist
- Cardiac surgeon
A general physician helps in the early detection and management of CAD risk factors like high blood pressure, cholesterol, and diabetes.
A cardiologist specializes in diagnosing and treating coronary artery disease with medications, lifestyle changes, and non-invasive procedures.
A cardiac surgeon performs surgical interventions like bypass surgery to restore blood flow in severe cases of CAD.
Consult our team of trusted doctors for the right diagnosis and timely treatment.
Treatment Of Coronary Artery Disease
Treatment for coronary artery disease (CAD) involves managing the symptoms and reducing the risk of further problems. CAD can be managed effectively with a combination of lifestyle changes, medications, and, in a few cases, surgery.
A. Medications
1. Blood thinners: Blood thinners are a class of medicine that helps reduce the risk of a heart attack by thinning the blood and preventing it from clotting. Common blood thinners are:
2. Beta-blockers: These medicines are used to treat angina and high blood pressure. Common beta blockers are:
3. Statins: This class of drugs works by blocking the formation of bad cholesterol (low-density lipoprotein, LDL). Common statins are:
4. Calcium channel blockers
This class of drug works by decreasing blood pressure by relaxing the muscles, which causes the arteries to become wider and reduces blood pressure. Common calcium blockers are:
Note: Popping calcium supplements without consulting your doctor could increase the risk of plaque buildup in arteries. Learn more about this.
5. Nitrates: Nitrates are referred to as vasodilators that are used to widen your blood vessels. Common Nitrates are:
- Glyceryl trinitrate
- Isosorbide mononitrate
6. Angiotensin-converting enzyme (ACE) inhibitors: These medicines block the activity of a hormone called angiotensin-2, which causes the blood vessels to narrow. Common ACE inhibitors are:
Note: Heart medications should never be stopped suddenly without consulting your doctor as there is a risk of making symptoms worse.
B. Surgery
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Coronary angioplasty: Also called percutaneous coronary intervention (PCI) or balloon angioplasty, this procedure uses a small balloon to widen narrowed arteries, improving blood flow.
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Coronary artery bypass graft (CABG): CABG is also known as bypass surgery or a heart bypass. It is a procedure to restore blood flow to areas of your heart that are blocked, causing heart attacks and CAD.
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Heart transplant: When the heart is severely damaged and is unable to adequately pump blood around the body, a heart transplant may be needed.
Complications Of Coronary Artery Disease
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Chest pain (angina): In the case of narrowed coronary arteries, the blood supply to the heart is not enough. This can lead to chest pain (angina) or shortness of breath.
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Irregular heart rhythms (arrhythmias): When the heart does not receive sufficient blood and oxygen due to CAD, the normal heart signaling can get altered leading to irregular heartbeats.
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Heart failure: The narrowed arteries due to CAD makes the heart weak and difficult for the heart to perform its functions eventually leading to heart failure.
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Heart attack: The rupture of plaque in one of the coronary arteries can result in the formation of blood clots. This blood clot can stop the supply of blood and oxygen to the heart leading to a heart attack.
People with COVID-19 are at an increased risk of a broad range of heart disorders. In a vicious loop, cardiac risk factors such as obesity, hypertension, and diabetes increase the risk of acquiring COVID-19 infection in the first place and lead to worse cardiovascular outcomes after COVID-19.
Home Care For Coronary Artery Disease
Certain spices are rich in antioxidants that may help manage heart disease and inflammation. But, they should be used as an adjunct to conventional treatment, not a replacement. These include:
Turmeric (Haldi): Cumurin in turmeric can reduce inflammation helping to prevent plaque buildup in arteries.
Boost your heart health naturally with the power of turmeric.
Ginger (Adrak): It improves blood circulation and may help lower blood pressure and cholesterol levels.
Garlic (Lehsun): It can support heart health by reducing cholesterol, blood pressure, and stiffness in the arteries.
Coriander (Dhaniya): Helps lower cholesterol and blood sugar levels, reducing the risk of heart disease.
Black pepper (Kalimirch): Rich in antioxidants, black pepper helps reduce inflammation and supports healthy blood circulation.
Cinnamon (Dalchini): Helps lower blood sugar and cholesterol levels, reducing the risk of heart disease.
Omega-3 fatty acids: They reduce inflammation and triglyceride levels that can support heart health. Found in flaxseeds, chia seeds, walnuts, fatty fish, and plant oils.
Explore our wide range of omega fatty acid supplements.
Vitamin D: It can reduce heart disease risk. Get sunlight exposure and consume milk, eggs, tuna, and fortified foods.
Fill any gaps in your Vitamin D levels by dietary supplements. Check out our wide range of supplements.
Note: Taking supplements can be considered under the guidance of a healthcare provider.
Apart from these consume a heart-friendly diet that includes:
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Eat fruits, vegetables, lean proteins, and healthy fats.
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Limit saturated fats, trans fats, and cholesterol.
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Reduce salt to prevent fluid retention & high BP.
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Cut down on sugar to manage blood sugar levels.
Alternative Therapies For Coronary Artery Disease
1. Yoga
Yoga helps in maintaining and elevating the positive health of people with coronary artery disease. Practicing yoga can help with obesity, and keeping lipid profile, blood pressure, and diabetes in control.
Practicing yoga can keep your heart healthy.
2. Acupuncture
Research has shown that acupuncture can be a viable complementary therapy for CAD as it can improve blood circulation throughout the body and within the heart.
Living With Coronary Artery Disease
It's possible to lead a normal life after having heart surgery or problems like a heart attack. Here are a few tips that will help you in your journey of recovery from CAD:
Get into a cardiac rehabilitation program
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It is a major step for anyone recovering from a heart attack, heart failure, or other heart problem that requires surgery or medical care.
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A rehab program aims to improve the quality of life and prevent another cardiac event.
Coordinate with your doctor
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Schedule routine check-ups to monitor heart health.
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Get tests like cholesterol, blood pressure, and ECG as advised.
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Report symptoms like chest pain, breathlessness, or dizziness immediately.
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Stay updated on flu and pneumonia shots to prevent complications.
Stay protected without stepping out! Book vaccinations at home for a safe, hassle-free, and expert-administered experience.
Follow a proper medication regimen
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Take the medications prescribed by your doctor regularly without fail.
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It is also a good idea to consult your doctor when starting any medication for other medical conditions, to avoid interactions between different drugs.
Exercise regularly for heart health
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Consult your doctor for suitable exercises.
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Try brisk walking, stretching, swimming, or light jogging for 15-20 mins, 3-4 times a week.
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Rest if tired; don’t overexert.
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Wear comfortable clothing for ease of movement.
Join support groups
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If you have a heart condition you might find it useful to meet other people who are facing a similar situation.
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This gives a sense of motivation to live with your condition.
Frequently Asked Questions
References
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