Coronary Artery Disease

Coronary Artery Disease (CAD) is a chronic, progressive condition and one of the most common cardiovascular diseases worldwide. It arises when the arteries that supply blood to the heart muscle become narrowed or blocked due to plaque buildup. This restriction in blood flow can lead to symptoms such as chest pain, breathlessness, and, if left unmanaged, heart attacks. With the increasing prevalence of sedentary lifestyles, poor dietary habits, and stress, CAD has become a major health challenge, especially in urban populations. Fortunately, it is both preventable and manageable through early detection, lifestyle changes, medications, and in some cases, surgical interventions.

Coronary Artery Disease (CAD), also referred to as ischemic heart disease or coronary heart disease, is a condition in which plaque—a mixture of cholesterol, fat, calcium, and other substances—builds up inside the coronary arteries. These arteries supply oxygen-rich blood to the heart muscle. The plaque buildup (atherosclerosis) narrows the arteries, reducing blood flow and oxygen delivery to the heart.

Over time, reduced blood flow can cause symptoms like angina (chest pain), and in more advanced stages, it can lead to serious events such as myocardial infarction (heart attack) or sudden cardiac arrest. CAD is a lifelong condition but can be managed with proper care and lifestyle adjustments.

CAD is the leading cause of death globally. According to the World Health Organization, cardiovascular diseases account for nearly 18 million deaths annually, with CAD responsible for over 9 million of these. In India alone, over 30 million people are estimated to be affected, and it remains a growing concern among middle-aged adults due to lifestyle-related risk factors.

• Men are generally more prone to develop CAD at a younger age.
• Women are at increased risk after menopause.
• Urban populations have a higher incidence due to diet, inactivity, and stress.
   

1. Stable Angina
   
   
   • Occurs during physical exertion or stress.
   • Predictable and usually relieved by rest or medication.
      
2. Unstable Angina
   
   • Occurs unpredictably, often at rest.
   • A medical emergency as it may precede a heart attack.
3. Variant (Prinzmetal’s) Angina
   
   • Rare, caused by a spasm in a coronary artery.
   • Often occurs at rest, sometimes at night.
4. Silent Ischemia
   
   • Reduced blood flow without noticeable symptoms.
   • Common in diabetics and older adults.
5. Myocardial Infarction (Heart Attack)
   
   • Complete blockage of a coronary artery.

• Leads to irreversible damage to heart muscle if not treated promptly.
   

CAD is primarily caused by atherosclerosis, the gradual buildup of plaque in the arteries. The underlying triggers include:

• High LDL cholesterol and low HDL cholesterol
• Hypertension (High blood pressure)
• Smoking and tobacco use
• Diabetes and insulin resistance
• Sedentary lifestyle
• Obesity and poor dietary habits
• Chronic stress and mental health disorders
• Genetic predisposition or family history of heart disease
• Excessive alcohol consumption
   

Symptoms of CAD can be gradual or sudden, and may vary from person to person:

• Chest pain or discomfort (Angina): Often described as pressure, squeezing, or tightness.
• Pain radiating to the shoulders, neck, arms, jaw, or back
• Shortness of breath, especially with exertion
• Unusual fatigue
• Lightheadedness or dizziness
• Nausea or indigestion
• Cold sweats

In some cases, CAD may be asymptomatic until a heart attack occurs.

Diagnosing CAD involves a mix of clinical evaluations, lab tests, and imaging:

1. Electrocardiogram (ECG) – Records electrical activity of the heart to detect abnormalities.
2. Stress Test (Treadmill Test or Pharmacologic Stress Test) – Measures heart function under stress or exercise.
3. Echocardiogram – Ultrasound imaging to evaluate heart structure and function.
4. Cardiac CT Scan or CT Angiography – Non-invasive imaging to visualize coronary arteries.
5. Coronary Angiography (Cardiac Catheterization) – Gold standard to detect arterial blockages.
6. Blood Tests – Check for cardiac biomarkers, cholesterol levels, and inflammatory markers like hs-CRP.
    

Managing CAD involves a multifaceted approach combining lifestyle changes, medications, and sometimes surgical interventions.

Lifestyle Modifications:

• Healthy diet: Emphasize fruits, vegetables, whole grains, lean proteins, and healthy fats.
• Quit smoking: Smoking cessation significantly lowers risk.
• Exercise: At least 150 minutes/week of moderate-intensity aerobic activity.
• Weight management: Maintain a healthy BMI.
• Stress management: Yoga, meditation, and counseling.

Medications:

• Antiplatelet drugs (Aspirin, Clopidogrel) – Prevent clot formation (Brand: Disprin Tablet)
• Statins (Atorvastatin, Rosuvastatin) – Lower cholesterol levels.
• Beta-blockers – Reduce heart rate and blood pressure.
• ACE inhibitors/ARBs – Control blood pressure and reduce heart strain.
• Nitrates – Relieve angina.
• Calcium channel blockers – Improve blood flow and relieve chest pain.

Interventional Procedures:

• Angioplasty and Stenting – Opens narrowed arteries using a balloon and inserts a stent.
• Coronary Artery Bypass Grafting (CABG) – A surgical bypass using a graft from another artery or vein to reroute blood flow.
  
   

Complementary therapies may support conventional treatments:

• Meditation and Mindfulness-Based Stress Reduction (MBSR)
• Heart-healthy supplements: Omega-3 fatty acids, CoQ10, garlic extract (with medical supervision)
• Ayurveda: Arjuna bark and other heart-supportive herbs
• Acupuncture: May help manage angina and stress
• Tai Chi and Yoga: Low-impact exercises to improve heart health

Note: Always consult your doctor before beginning any alternative therapy.

CAD risk factors can be modifiable or non-modifiable:

Modifiable:

• High blood pressure
• High cholesterol
• Diabetes
• Smoking
• Physical inactivity
• Poor diet
• Obesity
• Stress

Non-modifiable:

• Age (Men ≥45, Women ≥55)
• Family history of CAD

Ethnic background (South Asians at higher risk)
 

Untreated or poorly managed CAD can lead to:

• Heart attack (Myocardial infarction)
• Heart failure
• Arrhythmias (irregular heartbeat)
• Sudden cardiac death
• Stroke
• Chronic angina
  
   

• Take prescribed medications regularly and follow up with your doctor.
• Monitor blood pressure, blood sugar, and cholesterol at home.
• Learn to identify warning signs of worsening symptoms.
• Join a cardiac rehabilitation program if recommended.
• Maintain a support system—family, friends, or support groups.
• Keep emergency numbers accessible at all times.
   

• “CAD only affects old people.”
  ➝ False. It can affect younger individuals, especially with poor lifestyle habits.
  
   
• “I have no symptoms, so I must be fine.”
  ➝ False. Many CAD cases are silent until a major event like a heart attack.
  
   
• “Heart disease is a man’s issue.”
  ➝ False. Women are equally susceptible and often experience different symptoms.
  
   
• “Once treated, CAD is cured.”
  ➝ False. CAD is manageable but not curable. Ongoing care is essential.
  
   
• “Exercise is unsafe for heart patients.”
  ➝ False. Regular, supervised activity is vital for heart health.
  
   

Seek medical attention if you experience:

• Persistent or recurring chest pain
• Shortness of breath
• Unusual fatigue
• Irregular heartbeat or palpitations
• Light-headedness or fainting spells

Call emergency services immediately if you suspect a heart attack—especially if chest pain is accompanied by sweating, nausea, or radiating pain.

• How serious is my condition?
• What lifestyle changes should I prioritize?
• Which medications do I need and why?
• Are there any side effects I should watch for?
• What are my treatment options—medical, interventional, or surgical?
• Can I continue my current exercise or work routine?
• How do I reduce my risk of heart attack or stroke?
  
   

• Encourage a heart-healthy lifestyle and attend appointments with them.
• Help them manage stress with calm, supportive communication.
• Educate yourself about their condition to better assist them.
• Be alert to signs of a cardiac emergency and know how to respond.
• Help them maintain a medication routine and dietary goals.
   

Coronary Artery Disease is a lifelong condition but is no longer the inevitable road to severe disability or premature death it once was. With early detection, disciplined lifestyle changes, and medical management, people with CAD can lead active, fulfilling lives. Prevention, awareness, and regular monitoring are the cornerstones of long-term heart health.