Coronary artery disease (CAD) is the most common form of heart disease in America and Europe and is a serious health problem worldwide. The incidence of CAD is lower in Asian countries, particularly Japan, where diets are low in saturated fat and cholesterol.

CAD occurs from atherosclerosis, when arteries become narrow and hardened due to cholesterol plaque build-up. Further narrowing may occur from thrombi (blood clots) that form on the surfaces of plaques. Angina (chest pain) or dyspnea (shortness of breath) may be present.

X-section of a Normal healthy coronary artery

Diseased coronary showing severe stenosis

Statistics show CAD to be the leading cause of death among both men and women in the United States and in Europe. For example, approximately 12,400,000 Americans suffer from CAD and nearly 500,000 Americans die annually from heart attacks caused by CAD. Over 12 million Americans have a history of myocardial infarction or angina or both (Source : American Heart Association).

Risk factors for CAD include to major categories:

  • Controllable factors
  • Uncontrollable factors

Controllable risk factors for CAD include high blood cholesterol, hypertension, smoking, diabetes, obesity, lack of physical activity, and stress. Uncontrollable risk factors for CAD include gender, family history, race, and genetics.

Tests used to detect/diagnose CAD include physical exam, blood cholesterol tests, blood pressure measurements, electrocardiogram, exercise testing, chest X-ray, coronary angiography, echo cardiogram, cardiac magnetic resonance imaging, sub-second/multi-slice CT, and nuclear medicine imaging.

Treatment of CAD depends on severity. Invasive treatment options for severe CAD include coronary angioplasty and coronary artery bypass graft.



Lifetime risk of CAD after age 40 is 49% for males, 32% for women. Efforts to reduce controllable risk factors, including diet and physical activity, should be taken to decrease CAD risk.

Controllable risk factors:

  • High blood cholesterol:
    • Low-density lipoproteins (LDL cholesterol)
    • High-density lipoproteins (HDL cholesterol)
  • Hypertension: Hypertension (high blood pressure) results from arterial narrowing, which causes blood to be pumped with greater force against the artery walls.
  • Smoking: significantly increases heart disease and stroke risk. Specifically, smoking causes atherosclerosis, thrombosis (blood clots), coronary artery spasm (abnormal constriction of the muscle fibers of the coronary artery) cardiac arrhythmia (abnormal heartbeat) and other disorders which increase the risk of myocardial infarction.
  • Diabetes: increases the risk of heart disease, stroke, blindness, hypertension, kidney disease and amputations.
  • Obesity: increases CAD and stroke risk. Obesity increases strain on the heart, raises blood pressure and cholesterol, and increases diabetes risk.
  • Lack of physical activity: Regular exercise reduces CAD risk by controlling blood cholesterol levels, decreasing the risk of obesity or diabetes, and lowering blood pressure levels in some patients.
  • Stress: Research indicates a possible relationship between stress and CAD.

Uncontrollable risk factors:

  • Gender: Males are at higher risk of CAD than females, and males are also more likely to suffer myocardial infarction earlier in life.
  • Family History: A family history of heart disease increases the risk for CAD and other heart problems.
  • Race: In the United States, African Americans tend to have more severe high blood pressure than Caucasians, increasing CAD risk.
  • Genetics: Patients may have congenital heart defects or other diseases that increase CAD risk.


Approximately 50% of men and 63% of women who die suddenly from CAD show no previous signs of the disease.
Typically, CAD detection occurs during routine office visits, even if the patient has no symptoms of CAD. In some cases, angina (chest pain) and dyspnea (shortness of breath) may accompany CAD.

Other symptoms may include:

  • Tightness, heaviness, burning sensation, pressure, squeezing, or pain behind the breastbone or less commonly also in the arms, neck or jaws
  • Nausea and vomiting
  • Fatigue
  • Sweating
  • Weakness

Tests to detect CAD:

  • Blood cholesterol
    Total cholesterol
    LDL cholesterol
    HDL cholesterol
    Ideal: Less than 200 Ideal: less than 130 Ideal: 35 or higher
    High risk: 240 and over High risk: 160 or higher


  • Blood pressure
    (mm Hg) Ideal Normal High Normal Hypertension
    (top number)
    Less than 120 Less than 130 130-139 140 or higher
    (bottom number)
    Less than 80 Less than 85 85-89 90 or higher
  • Chest X-ray
  • Electrocardiogram (ECG)
  • Exercise Testing
  • Ambulatory Monitoring (Holter Monitoring)


Treatment of coronary artery disease (CAD) will depend on its severity.

Lifestyle changes:

  • Change to a diet low in saturated fat and cholesterol
  • Exercise regularly
  • Lose weight if overweight or obese
  • Quit smoking
  • Minimize stress
  • Lowering cholesterol
  • Lowering blood pressure
  • Coronary angioplasty
  • Coronary artery bypass graft
Belgian Society Of Cardiology
Cyprus Society of Cardiology
Czech Society Of Cardiology
European Society of Cardiology
German Cardiac Society
German Society of Vascular Surgery
Hellenic Society of Cardiology
Iranian Society Of Interventional Cardiology
Japanese Educational Clinical Cardiology Society
Jordan Society of Cardiology
Lebanese Society of Cardiology and Cardiac Surgery
Pakistan Society of Cardiology
Brazilian Society Of Cardiology
Brazilian Society Of Interventional Cardiology
Society for Cardiovascular Angiography & Interventions
Singapore Society of Cardiology
Spanish Association of Nursing in Cardiology