Quick answer: coronary artery disease (CAD) is a buildup of fatty plaque inside the arteries that supply blood to the heart muscle. This process, atherosclerosis, narrows the arteries and restricts blood flow, causing chest pain (angina), shortness of breath, and, in severe cases, a heart attack. It is the leading cause of death in both men and women in the United States. There is no cure, but medication, procedures and lifestyle change can control symptoms and prevent complications.
Warning Signs: Call Emergency Services
- Chest pain, pressure or squeezing lasting more than a few minutes, or that spreads to the shoulders, arms, neck, jaw or back
- Shortness of breath, with or without chest discomfort
- Cold sweat, nausea or light-headedness
- Sudden unusual fatigue, particularly in women
Angina that is new, worsening, or occurring at rest is not something to wait out — call an ambulance rather than driving, since crews can begin treatment on the way.
What Happens to the Arteries
Plaque — made of fat, cholesterol, calcium and other substances in the blood — builds up gradually inside the coronary arteries in a process called atherosclerosis. As it accumulates, it narrows the arteries and reduces blood flow to the heart muscle, which can cause angina, shortness of breath, and, if a plaque ruptures and a clot forms, a heart attack. CAD is also known as ischemic heart disease or coronary heart disease.
Risk Factors
High blood pressure, high LDL cholesterol, diabetes, smoking, obesity and a sedentary lifestyle all raise the risk of developing CAD. Having one or more of these does not guarantee CAD will develop, but it meaningfully increases the odds — and most of these factors are modifiable.
Symptoms
- Chest pain that may come and go
- Shortness of breath
- Reduced tolerance for physical activity
- Fatigue
Early CAD often causes no symptoms at all, which is why known risk factors are managed proactively rather than waiting to feel something.
Diagnosis
Electrocardiogram (ECG or EKG)
A quick, painless test measuring the heart’s electrical activity, showing irregularities from a past or possible future heart attack.
Exercise stress test
If symptoms appear mainly with exertion, this test monitors an ECG while walking on a treadmill or riding a stationary bike. Medication that mimics the effects of exercise can be used if physical activity isn’t possible.
Cardiac CT scan
Reveals calcified deposits or blockages in the coronary arteries directly. Increasingly used as a first-line test for new, stable chest pain.
Nuclear stress test
Similar to an exercise stress test but adds imaging of blood flow through the heart at rest and under exertion, using a radioactive tracer given intravenously.
Treatment
Lifestyle changes
- Quit smoking. Ask a doctor about programs and medications that help.
- Eat a diet low in saturated fat and cholesterol. A registered dietitian can help tailor this.
- Increase physical activity. Aim for at least 150 minutes of moderate exercise weekly, and check with a doctor before starting a new routine.
Medications
- Cholesterol-lowering medication — statins, bile acid sequestrants, niacin, fibrates
- Blood pressure medication — beta blockers, calcium channel blockers, ACE inhibitors
- Angina medication — nitrates, nitroglycerin, ranolazine
- Blood clot prevention — anticoagulants and antiplatelets, including aspirin
Procedures
Coronary artery bypass graft (CABG) surgery creates a new route for blood around a blockage, using a blood vessel taken from the chest, arm or leg.
Enhanced external counterpulsation (EECP) uses inflating cuffs on the lower limbs to improve blood flow and encourage natural pathways around blocked arteries, offering an option for chronic stable angina without surgery or additional medication for some patients.
In stable CAD, large trials have found that opening a narrowed artery with a stent relieves angina but does not on its own reduce the risk of death or heart attack compared with good medical therapy — the calculus is different during an acute heart attack, where opening the artery urgently is life-saving.
Frequently Asked Questions
Family history of heart disease, smoking, high cholesterol, diabetes, high blood pressure, obesity and a sedentary lifestyle are the main risk factors. Most cases involve more than one factor at once, and most of these are modifiable.
Smoking or regular tobacco use combined with physical inactivity are among the most significant modifiable causes, contributing to the atherosclerosis that underlies the disease.
There is no cure, but it is highly treatable. Medication, lifestyle change and, when needed, procedures can control symptoms, slow progression and substantially reduce the risk of a heart attack. Many people live full lives for decades after diagnosis with good management.
Sources
- National Heart, Lung, and Blood Institute — Coronary Heart Disease.
- MedlinePlus — Coronary Artery Disease.
- StatPearls — Bile Acid Sequestrants.
Last updated: August 2026. This article is general information and is not medical advice or a diagnosis. Treatment decisions should be made with your doctor based on your own test results and health history. If you have symptoms suggesting a heart attack, call emergency services rather than reading further.
