CAD stands for coronary artery disease, a condition where the arteries supplying blood to your heart become narrowed by a buildup of fatty plaque. It’s the most common type of heart disease in the United States, affecting about 1 in 20 adults age 20 and older, and it killed more than 371,000 Americans in 2022 alone. The narrowing happens gradually over years or decades, which means many people don’t realize they have it until symptoms appear or a heart attack occurs.
How Plaque Builds Up in Your Arteries
CAD starts with damage to the inner lining of a coronary artery. High blood pressure, smoking, high cholesterol, and chronic inflammation can all cause this initial injury. Once the lining is damaged, cholesterol particles (specifically a form called LDL) slip beneath the artery wall. White blood cells follow, attempting to clean up the cholesterol, but in the process they become engorged with fat and turn into what researchers call “foam cells.” These foam cells cluster together and form a fatty streak, the earliest visible sign of the disease.
Over time, smooth muscle cells migrate into the area and deposit collagen, creating a fibrous cap over the fatty core. This is plaque. As plaque grows, it narrows the artery’s interior and restricts the flow of oxygen-rich blood to the heart muscle. If the fibrous cap ruptures, a blood clot can form on the spot and suddenly block the artery entirely. That’s a heart attack.
Symptoms in Men vs. Women
The classic warning sign of CAD is chest pain or pressure during physical activity, often described as dull, heavy, tight, or crushing. This pain can radiate into the arm, jaw, or neck. Men tend to experience chest pain more prominently and may also notice a burning or pricking sensation along with heavy sweating.
Women often present differently. While chest pain is still the most common symptom in both sexes, women are more likely to experience nausea, vomiting, dizziness, shortness of breath, and pain in the jaw, neck, upper back, or abdomen. Women also tend to have more symptoms at once during a heart attack than men do. Perhaps more importantly, women are more likely to experience prodromal symptoms, warning signs in the days leading up to a heart attack. The most common are unusual fatigue, sleep disturbance, anxiety, and shortness of breath.
These differences matter in a practical way. Because women’s symptoms less often match what people expect a heart attack to look like, women tend to arrive at the hospital later than men after symptoms start. Jaw or tooth discomfort, unusual fatigue, and arm pain or aching have all been found to be significantly predictive of a heart attack within 90 days.
How CAD Is Diagnosed
Diagnosis depends on whether you’re having symptoms right now or whether your doctor suspects CAD based on your risk profile. For people experiencing acute chest pain, doctors classify patients into low, intermediate, or high risk using structured assessments. High-risk patients, including those showing signs of a heart attack or whose blood pressure is unstable, typically go straight to coronary angiography, a procedure where dye is injected into the arteries so they can be seen on imaging. Intermediate-risk patients often get a stress test or a CT scan of the coronary arteries instead.
For people with stable, ongoing symptoms, the workup looks different. If your risk is low, a coronary artery calcium score (a quick, noninvasive CT scan) can help rule out significant plaque buildup. For intermediate-to-high risk patients, a CT scan of the coronary arteries or stress imaging is recommended. If those tests come back inconclusive but symptoms persist, angiography may follow.
Lifestyle Changes That Help
Medical experts recommend that people with CAD get at least two hours of moderate endurance exercise per week. Brisk walking, cycling, and swimming all count. You can split this up however works for you: 30 minutes four times a week, 15 minutes eight times a week, or any combination, as long as each session lasts at least ten minutes.
A Mediterranean-style eating pattern is commonly recommended, emphasizing fruits, vegetables, nuts, whole grains, fish, and poultry. While much of the specific dietary advice lacks rigorous clinical proof, the evidence is clearer on what to limit: foods high in saturated and trans fats, sugary foods and drinks, highly processed foods, excess salt, and alcohol. These changes won’t reverse CAD overnight, but they can slow its progression and reduce the chance of a heart attack.
Medical Treatment
Most people diagnosed with CAD take medications to manage it. Cholesterol-lowering drugs are a cornerstone of treatment. Current guidelines aim for a meaningful reduction in LDL cholesterol, particularly for anyone whose levels are above 70 mg/dL. Blood pressure management matters too, with a target of keeping systolic pressure (the top number) below 130.
After a heart attack, medications that slow the heart rate and reduce its workload are typically prescribed for at least three years in people with normal heart function. For those whose heart’s pumping ability has been weakened, these drugs may be continued indefinitely because they’ve been shown to significantly reduce the risk of death and future heart attacks. Blood-thinning medications to prevent clots are another standard part of the treatment plan.
Stents vs. Bypass Surgery
When medications and lifestyle changes aren’t enough, two procedural options exist. The less invasive approach involves threading a small balloon into the blocked artery, inflating it to compress the plaque, and placing a tiny mesh tube (a stent) to keep the artery open. This is done through a small puncture in the wrist or groin and typically involves a short hospital stay.
Bypass surgery is a more involved operation. A surgeon takes a healthy blood vessel from another part of your body and grafts it onto the coronary artery, creating a detour around the blockage. Bypass surgery tends to be preferred for patients with more severe or widespread disease: blockages in the left main artery, severe disease in three or more vessels, significantly weakened heart muscle, or diabetes. In the landmark BARI trial, patients with diabetes who received a bypass using an artery from the chest wall had a seven-year survival rate of 83%, compared to roughly 55% for those who had a stent procedure.
Both options provide good relief from symptoms like chest pain. However, patients who receive stents are more likely to need repeat procedures down the line, while bypass surgery offers a more durable result for people with extensive disease.
Long-Term Outlook
CAD is a chronic condition, but with treatment it’s very manageable. After a heart attack, one-year survival rates are around 88%, and five-year survival sits at about 78%. Seven-year survival is roughly 74%. These numbers reflect averages across all patients. Your individual outlook depends heavily on how much heart muscle was damaged, how quickly you received treatment, and how well risk factors like cholesterol, blood pressure, and blood sugar are managed going forward. People who stick with their medications, stay active, and address their risk factors can live for decades after a CAD diagnosis.