Coronary heart disease happens when plaque builds up inside the arteries that supply blood to your heart muscle

Coronary heart disease (also called coronary artery disease or CAD) is the most common type of heart disease. It develops when fatty deposits called plaque accumulate on the inner walls of your coronary arteries — the blood vessels that carry oxygen-rich blood to your heart. As plaque builds up over time, the artery narrows, reducing blood flow to the heart muscle. If blood flow becomes severely restricted or blocked, the heart doesn't get enough oxygen, which can cause chest pain, a heart attack, or heart failure.

The process usually takes years. Plaque doesn't appear overnight. It forms gradually as cholesterol, fat, and other substances from your blood settle in the artery walls. Your age, family history, smoking, high blood pressure, high cholesterol, diabetes, obesity, and physical inactivity all increase your risk. Some people have no symptoms until a heart attack occurs; others experience warning signs like chest discomfort or shortness of breath during exertion.

Key Takeaways

  • Coronary heart disease develops when plaque narrows the arteries supplying blood to your heart, reducing oxygen flow to the heart muscle.
  • Risk factors include age, family history, smoking, high blood pressure, high cholesterol, diabetes, obesity, and lack of physical activity.
  • Many people have no symptoms until a heart attack happens, though some experience chest pain or shortness of breath during activity.
  • Doctors diagnose coronary heart disease using tests like EKGs, stress tests, coronary angiography, and CT scans.
  • Treatment ranges from lifestyle changes and medications to procedures like angioplasty or bypass surgery, depending on severity.

How plaque forms and narrows your arteries

Plaque formation begins with damage to the inner lining of an artery. This damage can result from high blood pressure, high cholesterol, smoking, or inflammation. Once the lining is damaged, cholesterol and other substances from your blood seep into the artery wall. Your body's immune system responds to this buildup, and over time a hard, waxy deposit forms. This plaque can rupture, triggering a blood clot that partially or completely blocks the artery.

The narrowing happens gradually in most cases. You might have significant plaque buildup without feeling anything. But as the artery narrows further, blood flow slows. During times when your heart needs more oxygen — like during exercise or stress — the reduced blood flow can't keep up. This mismatch between oxygen demand and oxygen supply is what causes symptoms like chest pain (angina).

Symptoms and when they appear

Chest pain or discomfort is the most common symptom of coronary heart disease. You might feel pressure, squeezing, heaviness, or tightness in your chest. The pain often starts behind your breastbone and can spread to your arm, shoulder, jaw, or back. It typically happens during physical activity, emotional stress, or after a heavy meal, and usually goes away with rest or medication.

Other symptoms include shortness of breath, fatigue, weakness, and heart palpitations (a feeling that your heart is racing or skipping beats). Women sometimes report different symptoms — unusual fatigue, shortness of breath, or pain in the neck, jaw, or back — which can delay diagnosis. Many people have no symptoms at all until they have a heart attack. This is why screening is important if you have risk factors.

Risk factors you can and cannot change

Some risk factors are fixed: your age (risk increases for men over 45 and women over 55), your sex (men develop coronary heart disease earlier than women), and your family history (if a close relative had heart disease before age 55 or 65, your risk is higher). Race and ethnicity also matter — African Americans, Hispanic Americans, and American Indians have higher rates of coronary heart disease than white Americans.

Other risk factors you can modify. Smoking damages artery walls and increases blood clotting risk. High blood pressure (above 130/80 mmHg) forces your heart to work harder and damages arteries. High LDL cholesterol (the "bad" kind) and low HDL cholesterol (the "good" kind) promote plaque formation. Diabetes damages blood vessels and increases plaque buildup. Obesity, physical inactivity, chronic stress, and poor diet all raise your risk. Even if you cannot change your age or family history, controlling these modifiable factors significantly reduces your chance of developing coronary heart disease or having a heart attack.

How doctors diagnose coronary heart disease

Your doctor starts with your medical history and a physical exam, listening to your heart and checking your blood pressure. Blood tests measure cholesterol levels, blood sugar, and markers of inflammation or heart damage. An electrocardiogram (EKG) records your heart's electrical activity and can show signs of a previous heart attack or current stress on the heart.

If your doctor suspects coronary heart disease, you may have a stress test (also called an exercise test), where you walk on a treadmill or ride a stationary bike while your heart rhythm and blood pressure are monitored. A coronary angiography is more definitive — a thin tube called a catheter is threaded through an artery to your heart, and dye is injected so the arteries show up on X-ray. This reveals exactly where plaque is narrowing arteries. A CT coronary angiography uses imaging instead of a catheter and is less invasive. Your doctor chooses the test based on your symptoms, risk factors, and what they suspect.

Treatment options depend on how severe the narrowing is

If your coronary arteries are only mildly narrowed, treatment focuses on slowing plaque growth and preventing a heart attack. This means managing risk factors: quitting smoking, controlling blood pressure and cholesterol through diet and exercise, managing diabetes, and reducing stress. Your doctor may prescribe medications like statins (to lower cholesterol), ACE inhibitors or beta-blockers (to lower blood pressure and reduce heart workload), aspirin (to prevent blood clots), or nitrates (to relieve chest pain).

If an artery is severely narrowed or blocked, your doctor may recommend a procedure. Percutaneous coronary intervention (PCI), also called angioplasty, uses a balloon to push plaque against the artery wall and often places a stent (a small metal tube) to keep the artery open. Coronary artery bypass grafting (CABG) is surgery that creates a new route for blood to flow around the blocked artery using a vessel from your leg, arm, or chest. Your doctor weighs the severity of blockage, your symptoms, and your overall health when deciding between medication, angioplasty, or surgery.

Living with coronary heart disease

If you have been diagnosed with coronary heart disease, your goal is to prevent a heart attack and slow the disease's progression. This means taking medications as prescribed, even if you feel fine. Attend all follow-up appointments and cardiac rehabilitation programs if recommended — these teach you how to exercise safely, manage stress, and make heart-healthy dietary changes. Keep a record of your symptoms and report any new chest pain, shortness of breath, or unusual fatigue to your doctor immediately.

Lifestyle changes are as important as medication. Eat a heart-healthy diet low in saturated fat and sodium. Exercise regularly — your doctor will tell you what level is safe for you. Manage stress through relaxation techniques, counseling, or support groups. If you smoke, quitting is the single most important thing you can do. Monitor your blood pressure and cholesterol at home if your doctor recommends it. Many people with coronary heart disease live long, active lives when they follow their treatment plan and make these changes.

Frequently Asked Questions

Is coronary heart disease the same as a heart attack?

No. Coronary heart disease is the underlying condition — narrowed arteries. A heart attack happens when blood flow is suddenly blocked, usually by a blood clot, starving the heart muscle of oxygen. You can have coronary heart disease for years without having a heart attack, but coronary heart disease is the most common cause of heart attacks.

Can coronary heart disease be reversed?

Plaque cannot be completely removed by lifestyle changes or medication alone. However, aggressive treatment of risk factors can slow plaque growth, stabilize existing plaque, and prevent new plaque from forming. Some research suggests that very strict diet and exercise regimens may slightly reduce plaque, but this is not may provide and requires medical supervision.

What should I do if I have chest pain?

If you experience chest pain or pressure, especially if it spreads to your arm or jaw, call 911 or go to an emergency room immediately. Do not drive yourself. If you have been diagnosed with coronary heart disease and have prescribed nitroglycerin, take it as directed. Chest pain can signal a heart attack, which is a medical emergency.

How often do I need to see a doctor if I have coronary heart disease?

Your doctor will set a schedule based on your condition's severity and how well your symptoms are controlled. Most people see their cardiologist or primary care doctor every three to six months. You will also need regular blood tests to monitor cholesterol and other markers, and periodic imaging tests to check your arteries.

Can I exercise if I have coronary heart disease?

Yes, but only under your doctor's guidance. Exercise strengthens your heart and improves circulation, but doing too much too fast can trigger chest pain or a heart attack. Your doctor may recommend a stress test first to see what level of activity is safe, and may refer you to cardiac rehabilitation, where trained staff supervise exercise and teach you how to exercise safely.