What is coronary artery disease (CAD)?

Coronary artery disease (CAD) is the most common type of heart disease.1 The disease itself forms via atherosclerosis, a condition defined by a build-up of plaque (or fatty deposits) within the arteries. This plaque build-up causes the arteries to narrow and harden, which may limit the supply of blood and oxygen to the heart and brain. This can lead to serious events such as heart attack and stroke.2

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Risk factors for CAD

In order to understand the risk factors for CAD, it is important to know the risk factors for atherosclerosis (plaque build-up).3,4

Family history

Older age (65+)

Males

High cholesterol

High blood pressure

Diabetes

In addition, lifestyle factors that can put people at higher risk of atherosclerosis include:

Lack of exercise

Smoking

Being overweight or obese

Unhealthy diet

Stress

What can you do to reduce your risk?

Although some people inherit a higher risk of vascular disease, making it difficult to prevent, there are still ways to reduce your risk:3

– Talk to your healthcare professional about resources
available to help you quit smoking3

– Have a healthy diet and weight3,5

– Have a regular exercise regimen3,5

– Get enough sleep – 7-9 hours is the standard recommendation6,7

– Avoid excess stress8

– Moderate your alcohol consumption3

What to do if you think you may be at risk

If you think you may already suffer from a vascular disease, you should see a doctor as soon as possible. Help may be necessary and treatments may be prescribed to ensure you remain as healthy as possible.

It is advised that you visit your doctor for a vascular health check if you fall into any of the risk categories (i.e. high cholesterol, high blood pressure, diabetes, older age) or have any symptoms related to vascular disease (i.e. chest pain, shortness of breath, leg pain).3

If you are over the age of 40, and feel you may be at increased risk of vascular disease, ask your doctor if you are doing all you can to protect your vascular health. You can find some helpful questions on this page!

Symptoms and complications of CAD

CAD often has no symptoms. However, as plaque build-up in the arteries worsens, symptoms begin to develop and the build-up may result in chronic CAD with stable angina.4 In 2019, the European Society of Cardiology released new guidelines on the management of chronic coronary syndromes (CCS). These guidelines redefine chronic CAD with stable angina as CCS to emphasise that the disease can have stable periods but can also become unstable at any time due to a cardiovascular event caused by changes to plaque build-up.9

Chronic CAD with stable angina (now called chronic coronary syndromes due to guideline change)9,10

What is it?

When the heart muscle needs more blood and oxygen than it is getting i.e. during physical activity or times of stress.

What are the symptoms?

Uncomfortable pressure, fullness or squeezing pain in the centre of the chest, which may also be felt in the neck, shoulders, back and arm.

It is important to understand that although you may not be experiencing any further symptoms, the risk of complications such as heart attack and stroke may still remain even after preventative treatment. Understanding your diagnosis of CCS is key to managing your ongoing, remaining risk and helps ensure you are doing all you can to protect your vascular health.

Some patients with CCS are at higher risk than others, for example those with diabetes, high blood pressure or high cholesterol, those who have a history of stroke, and the elderly.9, 11

If the plaque build-up is severe, it may result in unstable angina or heart attack.

Chronic CAD with unstable angina12

What is it?

Unstable angina is caused by reduced blood flow to the heart muscle due to arteries being narrowed by plaque build-up or blood clots.12

What are the symptoms?

Chest pain or discomfort which may occur while you are resting or sleeping and possibly get worse over time. If plaque build-up worsens and completely blocks blood flow to the heart, it may result in a heart attack, which could be fatal. If you experience this type of new, worsening or persistent chest pain, you must see a doctor as soon as possible.12

CAD can also be associated with an increased risk of stroke, should plaque build-up block blood flow to the brain,1 and an increased risk of PAD, should plaque build-up block blood flow to the limbs.13

Diagnosis of CAD

There are a variety of ways in which CAD can be diagnosed.

Your doctor will usually collect information about your medical history, do a physical exam and conduct a blood test. They may also carry out one of the following tests:14

Electrocardiogram (ECG): records electrical signals travelling through the heart. Certain abnormalities may indicate inadequate blood flow to your heart.

Echocardiogram: creates images of the heart using soundwaves to determine how well it’s working. An area of the heart that shows weak movement can signal damage caused by a lack of oxygen.

Stress test: measures the impact of physical activity on the heart by conducting an electrocardiogram whilst walking on a treadmill or doing a similar exercise.

Nuclear stress test: similar to a stress test, but also collects images of the heart via a tracer injected into the bloodstream. The images can show areas of the heart that receive less blood flow.

Coronary angiogram: a special dye is injected into your coronary arteries. The dye outlines plaque build-up and blockages on x-ray images.

Heart scan: computerised tomography (CT) scans are used to find calcium deposits in arteries, to determine how narrowed the arteries are. You can also have a cardiac magnetic resonance imaging (MRI) scan. This is a type of scan that uses strong magnetic fields and radio waves to produce detailed images of the heart.

Treatment of CAD

Current treatments include lifestyle changes, prescription medication and, sometimes, surgery.

Medications for CAD11,13,14

For cholesterol control
Statins14

For blood clot prevention
Antiplatelets15
Antithrombotics14

For high blood pressure
Antihypertensives14

For diabetes control
Insulin/ antiglycaemic drugs

Main surgeries for CAD11

Angioplasty14
Percutaneous coronary intervention, or PCI14

Coronary artery bypass surgery14

The remaining risk of CAD

Patients with CAD are at increased risk of experiencing complications such as:

Heart attack

Should plaque build-up block blood flow to the heart.1

Stroke

Should plaque build-up block blood flow to the brain.1

Peripheral artery disease (PAD)

Should plaque build up and block blood flow to the limbs.2

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