Some people learn they have coronary artery disease when their heart stops

Coronary artery disease is **the most common type of heart disease in the
United States** and a leading cause of death for both men and women. It
affects the coronary arteries, the vessels carrying blood and oxygen to
the heart muscle itself. Damaged or diseased, they stop delivering what the
heart needs.

It develops slowly, as plaque — a waxy sticky substance of fat,
cholesterol, calcium and other blood materials — builds up inside the
arteries. That buildup is atherosclerosis. As the plaque grows the
arteries narrow, and over time the flow can be partly or fully blocked.

Three forms, and the third one is often missed

The third is worth knowing about, because a test that looks at the large
arteries can come back reassuring while the small ones are the problem.

Symptoms, and their absence

Symptoms vary. **Some people have none at all. Others do not know they have
CAD until they have a heart attack, or their heart suddenly stops beating.**

When symptoms do occur:

• Chest pain, pressure, tightness or discomfort that may spread to the
  neck, jaw, shoulder or arm
• Shortness of breath
• Unusual fatigue

These typically start or worsen with activity or stress and ease with rest,
and get worse over time as plaque accumulates.

Get emergency help right away if chest pain or discomfort does not go
away, or happens while you are resting. That may be a heart attack. Call
911.

The "at rest" clause is the distinguishing one: pain that arrives with
exertion and leaves with rest is angina; pain that arrives at rest is not.

What it leads to

Angina — chest pain from reduced flow. Heart attack — a clot suddenly
blocking flow to part of the heart, causing permanent muscle damage. **Heart
failure** — the heart unable to pump enough blood for the body. Arrhythmia
— a problem with the rate or rhythm of the heartbeat.

Risk

A diet high in saturated fat · smoking or tobacco use · physical inactivity ·
being overweight or having obesity · high blood pressure, high cholesterol, or
high blood glucose · **a family history, especially a parent or sibling
diagnosed before 50** · getting older, **especially men, who tend to develop
CAD earlier than women**.

Your provider may use a risk calculator to estimate your chance of a heart
attack or stroke in the next 10 years.

Diagnosis and treatment

Diagnosis: symptoms, personal and family history, risk factors and lifestyle,
a physical exam including blood pressure, blood tests for cholesterol and
glucose, and heart health tests.

Treatment depends on which arteries are affected, how much flow is blocked,
and what else is going on:

• Heart-healthy lifestyle changes — diet, activity, quitting smoking
• Medicines — to lower blood pressure, reduce cholesterol, control blood
  glucose, or prevent clots
• Procedures or surgery — angioplasty, or **coronary artery bypass
  grafting**, to open or bypass blocked arteries
• Cardiac rehabilitation, to improve quality of life and prevent future
  heart problems

Prevention

Heart-healthy foods · regular physical activity · reaching or maintaining a
healthy weight · not smoking and avoiding secondhand smoke · limiting alcohol
· managing stress · getting enough good-quality sleep.

Source: National Heart, Lung, and Blood Institute, via MedlinePlus.