Coronary Artery Disease
Narrowing of the heart's arteries by atherosclerosis, causing angina or heart attack.
Overview
Coronary artery disease (CAD) develops when cholesterol plaques narrow the arteries that supply the heart. It causes angina on exertion and, if a plaque ruptures, an acute heart attack. Management combines lifestyle change, medication, and sometimes stenting or bypass.
Symptoms
- • Central chest tightness on exertion
- • Pain radiating to arm or jaw
- • Breathlessness
- • Fatigue
- • Nausea or sweating with episodes
Risk factors
- • Smoking
- • High LDL cholesterol
- • Hypertension
- • Diabetes
- • Family history of early heart disease
- • Obesity
- • Sedentary lifestyle
Causes
- • Atherosclerosis
- • Coronary spasm
- • Coronary microvascular dysfunction
🚨 Red flags — seek urgent care
- • Chest pain at rest or lasting >10 minutes
- • Pain with sweating, nausea or breathlessness
- • Pain radiating to jaw or left arm
When to seek care
- • New chest tightness with exertion
- • Worsening angina pattern
- • Any rest chest pain — emergency
Diagnosis
- • History of typical / atypical angina; risk-stratify with QRISK3
- • First-line investigation: CT coronary angiography for new chest pain of suspected cardiac origin
- • Functional imaging (stress echo, perfusion MRI, MPI) for known CAD or inconclusive CT
- • Invasive coronary angiography for high-risk presentations and revascularisation planning
Treatment
- • Lifestyle: smoking cessation, Mediterranean diet, 150 min/week activity, cardiac rehab
- • Secondary prevention quartet: antiplatelet (aspirin/clopidogrel), high-intensity statin, ACEi/ARB if LVSD/HTN/DM, beta-blocker post-MI
- • Anti-anginal: beta-blocker or CCB first-line; add long-acting nitrate, ivabradine, ranolazine
- • Revascularisation: PCI or CABG based on anatomy (SYNTAX) and clinical profile
- • GLP-1 / SGLT2 inhibitors where comorbid diabetes
Prevention
- • Don't smoke; second-hand smoke matters too
- • Maintain LDL-C low (per QRISK and clinical context)
- • Manage BP, diabetes and weight
- • Aerobic activity + resistance training
- • Mediterranean / DASH dietary pattern
Complications
- • Acute coronary syndromes (unstable angina, NSTEMI, STEMI)
- • Heart failure
- • Arrhythmias including sudden cardiac death
- • Mechanical complications post-MI (rupture, mitral regurgitation)
- • Ischaemic cardiomyopathy
Education & self-care
This guidance is reviewed by Dr. Handel Emery, MD, FRCP (UK) and last updated 2026-06-08. It is educational and not a substitute for professional medical advice.
Frequently asked questions
Can lifestyle reverse CAD?
Aggressive lifestyle and statin therapy can stabilise and modestly regress plaque, and dramatically reduce event risk.
Will I need a stent or bypass?
Most stable coronary disease is managed with medication and risk-factor control. Revascularisation (stent or bypass) is reserved for ongoing symptoms despite treatment, or specific high-risk patterns of disease.
Is it safe to exercise after a heart attack?
Yes — cardiac rehabilitation, started within weeks of the event, improves survival, fitness and mood. Most people return to normal activity, including sex, within 4–6 weeks.
How long do I take aspirin and a statin?
Both are typically lifelong after a diagnosis of coronary disease. A second antiplatelet (clopidogrel or ticagrelor) is added for 6–12 months after a stent or heart attack.