What is coronary artery disease?
Coronary artery disease remains the leading cause of death in the U.S. Atherosclerotic (buildup of plaque) coronary artery disease (CAD) is the underlying cause of most ischemic cardiac events and can result in myocardial infarction, congestive heart failure, cardiac arrhythmias, and sudden cardiac death. In coronary artery disease, the coronary arteries become narrowed or blocked by a gradual buildup of fat (cholesterol) within the artery wall, which reduces the blood flow to the heart muscle. Plaque may partially or totally block the blood's flow through an artery. Two things that can happen where plaque occurs are: 1) bleeding (hemorrhage) into the plaque and 2)the plaque ruptures and a blood clot (thrombus) forms on the plaque's surface. If either of these occurs and blocks the entire artery, a heart attack or stroke may result. Atherosclerosis affects large and medium-sized arteries. The type of artery and where the plaque develops varies with each person. A person’s risk of coronary artery disease increases with advancing age and in the presence of risk factors such as smoking, hypertension, diabetes, high cholesterol, and family history of heart disease.

What are the risk factors for coronary artery disease?

• Controllable
  • High blood pressure
  • High blood cholesterol
  • Smoking
  • Obesity
  • Physical inactivity
  • Diabetes
  • Stress
• Uncontrollable
  • Gender
  • Heredity (family history)
  • Age

How can coronary artery disease be diagnosed?
A doctor usually can tell whether someone has heart disease on the basis of the medical history and the physical examination. Diagnostic tests are used to confirm the diagnosis, determine the extent and consequence of the disease, and help in planning treatment.

How can coronary artery disease be treated?

1. Reducing your risk factors
   Risk factors are traits related to the development and progression of heart disease. They can be divided into risk factors you cannot change (non-modifiable) and those you can change (modifiable).

   Non-modifiable risk factors include:

   • family history of early heart disease (before age 60)
   • being a male
   • being a female after menopause
   • age (over 45 years old)

   These help define your basic likelihood for developing heart disease. If you have any non-modifiable risk factors, it is even more important to work on the risk factors you can change.

   Modifiable risk factors include:

   • Smoking. Smoking is directly related to an increased risk of heart attack and its complications.
   • High blood cholesterol. A high-fat diet can contribute to increased fat in your blood. Follow a low-fat, low-cholesterol eating plan. When proper eating does not control cholesterol levels, medication is prescribed.
   • High blood pressure. High blood pressure can damage the lining of your coronary arteries and lead to coronary artery disease. A healthy diet, exercise, medications and controlling sodium in your diet can help control high blood pressure.
   • Diabetes. High blood sugars are linked to the progression of coronary artery disease. If you have diabetes, it is important to control high blood sugar through diet, exercise and medications.
   • Lack of exercise. A regular exercise program helps to regain or maintain your energy level, lower cholesterol, manage weight, control diabetes and relieve stress. Check with your doctor first before beginning an exercise program.
   • Weight. Obesity is defined as being very overweight (greater than 25 percent body fat for men or 30 percent body fat for women). When you are very overweight, your heart has to do more work, and you are at increased risk of high blood pressure, high cholesterol levels and diabetes. A healthy diet and exercise program aimed at weight loss can help improve your health.
   • Stress and anger. Uncontrolled stress or anger are linked to increased coronary artery disease risk. You may need to learn skills such as time management, relaxation or yoga to help lower your stress levels.
      
2. Taking your medications
   Medications may be needed to help your heart work more efficiently and receive more oxygen-rich blood. The medications you are on depend on you and your specific heart problem.

   It is important to know the names of your medications, what they are for and how often and at what times to take them. Your doctor or nurse should review your medications with you. Keep a list of your medications and bring them to each of your doctor visits. If you have questions about your medications, ask your doctor or pharmacist.
    

3. Having surgery or an invasive procedure
   The diagnostic tests your cardiologist orders help to identify the location, type and extent of your blockage. The results of these tests will help you and your cardiologist decide what type of procedure will be best for you.

   Procedures to treat coronary artery disease include balloon angioplasty (PTCA), stent, rotoblation, atherectomy, heart surgery and coronary artery bypass surgery.

   All of these procedures increase blood supply to your heart, but they do not cure coronary artery disease. You will still need to decrease your risk factors to prevent future disease.