CHD stands for coronary heart disease, a condition where the arteries supplying blood to your heart become narrowed or blocked by a buildup of fatty deposits. It is the most common type of heart disease in the United States, affecting about 1 in 20 adults age 20 and older and killing 371,506 people in 2022 alone.
How CHD Develops
Your coronary arteries are the blood vessels that deliver oxygen-rich blood to your heart muscle. CHD starts when the inner lining of these arteries becomes damaged, often from high blood pressure, high cholesterol, or smoking. Once that lining is irritated, fats and cholesterol begin collecting inside the artery wall. Over time, fibrous tissue and calcium deposits build up around these fatty pockets, forming what’s called plaque.
This process, known as atherosclerosis, narrows the artery and reduces blood flow to the heart. It unfolds over years or even decades, often without any symptoms at first. As the plaque grows, your heart muscle gets less oxygen than it needs, especially during physical activity or stress. If a plaque ruptures suddenly, it can trigger a blood clot that blocks the artery entirely, causing a heart attack.
Symptoms to Recognize
The hallmark symptom of CHD is chest pain or discomfort called angina. It can feel like pressure, tightness, squeezing, heaviness, or burning in the chest. The pain often spreads to the shoulders, arms, neck, back, or jaw. Other symptoms include shortness of breath, unusual fatigue, lightheadedness, nausea, and sweating.
Not all angina is the same. Stable angina follows a predictable pattern: it shows up during physical activity or stress, eases within about five minutes of resting, and hasn’t changed in character over the past couple of months. Unstable angina is more dangerous. The pain lasts longer than 20 minutes, may come on during rest or sleep, doesn’t respond to rest, and feels more intense than usual. Unstable angina signals that a heart attack may be imminent.
Some people have no symptoms at all. Studies of patients undergoing surgery found that only about 6% of those who experienced a heart attack during the procedure reported typical chest pain. This “silent” form of CHD is particularly common in people with diabetes.
Major Risk Factors
High blood pressure is the single largest contributor. Roughly one in three adults has it, and a 2009 review found that hypertension and smoking together accounted for the greatest number of CHD deaths among all modifiable risk factors. High blood pressure damages artery walls through both mechanical force and oxidative stress, creating the conditions for plaque to form.
High cholesterol is the second most common risk factor. The World Health Organization has estimated that elevated cholesterol causes about 2.6 million deaths globally. Triglycerides also play a role, though their contribution becomes harder to separate from related issues like insulin resistance and abdominal fat.
Smoking roughly doubles the risk of cardiovascular disease for current smokers. Even former smokers carry a 37% higher risk compared to people who never smoked, and nonsmokers regularly exposed to secondhand smoke face a 25% to 30% increase. Diet matters too. Every 2% of daily calories that come from trans fats is linked to a 23% higher risk of CHD. Sugary drinks and soft drinks are associated with a 22% higher risk of heart attack. Diabetes, obesity, a sedentary lifestyle, and chronic stress round out the major modifiable risk factors.
How CHD Is Diagnosed
Doctors use a combination of tools to evaluate CHD. An electrocardiogram (ECG) records the heart’s electrical activity and can reveal irregular rhythms or signs of a current or past heart attack. Blood tests check cholesterol, blood sugar, and markers of inflammation. An echocardiogram uses sound waves to show how blood moves through the heart and whether any areas of the heart muscle are working weakly due to poor blood supply.
If those initial tests suggest a problem, the next step is often a stress test, which monitors your heart while it’s working hard, typically during exercise on a treadmill. For a more detailed picture, coronary CT angiography uses a special X-ray machine to visualize blood flow through the coronary arteries. The most definitive test is invasive coronary angiography, where a thin tube is guided into the coronary arteries and contrast dye is injected so blockages show up clearly on imaging.
For people with no symptoms, routine screening for CHD is generally not recommended unless you fall into a high-risk category, such as having diabetes or a strong family history. European cardiology guidelines only weakly support imaging-based screening even in those groups.
Treatment Options
Treatment depends on how many arteries are affected and how severe the blockages are. When only one artery is narrowed, opening it with a small balloon and placing a stent (a tiny mesh tube that holds the artery open) tends to produce the best results. When two arteries are blocked, stenting and bypass surgery generally perform equally well.
Bypass surgery becomes the stronger option when three or more arteries are involved, or when a critical section of the main artery on the front of the heart is severely narrowed. In bypass surgery, a healthy blood vessel from another part of the body is used to reroute blood around the blocked section. For patients with less complex blockages, stenting carries a lower short-term risk and produces similar survival rates over the intermediate term.
Medications form the foundation of CHD management regardless of whether a procedure is needed. Cholesterol-lowering drugs reduce plaque buildup. Blood pressure medications ease the strain on artery walls. Blood thinners help prevent clots from forming at the site of existing plaque. These medications are typically taken long-term.
Reducing Your Risk
Because CHD develops over decades, prevention has an outsized impact. The American Heart Association recommends keeping saturated fat below 7% of total daily calories, or below 6% if you’re already at cardiovascular risk. For someone eating 2,000 calories a day, that means no more than about 13 to 16 grams of saturated fat. Sodium intake should stay under 2,300 milligrams per day, which is roughly one teaspoon of table salt.
Beyond diet, the most effective steps are straightforward: stop smoking, stay physically active, maintain a healthy weight, and manage blood pressure and cholesterol. Because so many of CHD’s risk factors overlap and reinforce each other, improving even one or two of these areas lowers overall risk meaningfully. The disease is slow-moving, which means the window for changing its course is wide, but only if you use it.