Coronary Heart Disease

CHD can be a “silent disease,” with many people experiencing no symptoms until they have a heart attack or other severe cardiac event. Common symptoms include:

• Angina: Chest pain or discomfort that may feel like pressure, squeezing or burning. It can spread to the shoulders, arms, neck, jaw, back or abdomen.
• Shortness of breath: Especially during physical activity.
• Other symptoms: Nausea, cold sweats, dizziness, weakness and fatigue. Women may experience symptoms differently, such as nausea, shortness of breath or fatigue rather than chest pain. Sudden or worsening symptoms, particularly at rest, can indicate unstable angina or a heart attack, both of which require immediate medical attention. 

Your risk of coronary heart disease goes up based on the risk factors you have and how serious they are. Many risk factors — such as smoking, stress, obesity, high blood pressure, high cholesterol, and diabetes — can be adjusted through heart-healthy lifestyle changes with or without medications. Other risk factors, such as your age, sex, family history, and race and ethnicity, cannot be changed.

Age, sex and family history

• Age: Genetic or lifestyle factors can cause plaque to build up in your arteries as you age. In men, the risk for coronary heart disease starts to increase substantially around age 45. Before menopause, women have a lower risk of coronary heart disease than men. After around age 55, the risk for women goes up. Age-related changes in the small blood vessels of the heart also raise the risk for coronary microvascular disease.
• Gender: Coronary heart disease affects both men and women. Obstructive coronary artery disease is more common in men. However, nonobstructive coronary artery disease is more common in women. Since the nonobstructive type is harder to diagnose, women may not be diagnosed and treated as quickly as men are.
  • If you are a woman who has chest discomfort or shortness of breath during physical activity, ask your healthcare provider about tests to check for nonobstructive coronary artery disease or coronary microvascular disease. Learn about more conditions that increase risk for women in the section “Women and Heart Disease” later in this section.
• Race or ethnicity: Heart disease is the leading cause of death for people of most racial and ethnic groups in the United States, including African Americans and white people. For people who are Hispanic, Asian American or Pacific Islander, American Indian or Alaska Native, heart disease is second only to cancer in causing death. People of South Asian ancestry have a higher risk of developing coronary heart disease and serious complications than others who are Asian American.

Lifestyle habits

Over time, unhealthy lifestyle habits can lead to plaque buildup in the heart’s blood vessels. 

• Being physically inactive can worsen other heart disease risk factors, such as high blood cholesterol, high blood pressure, diabetes and prediabetes, and overweight and obesity.
• Unhealthy eating patterns, including consuming high amounts of saturated fats and refined carbohydrates (such as white bread, pasta, and white rice), can lead to overweight and obesity, high blood cholesterol, atherosclerosis and plaque buildup in the heart’s arteries.
• Smoking or long-term exposure to secondhand smoke can damage your blood vessels.  
• Stress can cause your arteries to tighten. Stress may also indirectly raise your risk of coronary heart disease if it makes you more likely to smoke or overeat foods that are high in fat and added sugars.
• Not getting enough good-quality sleep, including waking up often throughout the night, may raise your risk of coronary heart disease. While you sleep, your heart does not work as hard as it does when you are awake. Waking up suddenly can cause a sharp increase in blood pressure and heart rate, which has been linked to angina (chest pain related to the heart) and heart attacks.

Medical conditions

Other medical conditions can raise your risk of developing coronary heart disease, including:

• Obesity and Metabolic Syndrome
• Prediabetes and Diabetes
• Smoking and COPD (chronic obstructive lung disease)
• High blood pressure
• High blood LDL cholesterol (sometimes called “bad cholesterol”) and markedly elevated triglycerides.
• Peripheral vascular disease due to atherosclerosis
• Congenital coronary artery defects (heart problems you are born with)  
• History of heart transplant. These patients are at very high risk of developing CAD in part because of treatment side effects and typically undergo regular heart catheterizations or other testing to monitor progress
• Mental health conditions, including anxiety, depression and post-traumatic stress disorder (PTSD)
• Chronic kidney disease
• Sleep disorders, such as sleep apnea or sleep deprivation and deficiency  
• Autoimmune and inflammatory diseases, such as Crohn’s disease, ulcerative colitis, psoriasis, lichen planus, pemphigus, histiocytosis, lupus erythematosus and rheumatoid arthritis
• HIV/AIDS, especially among older adults, in part because of side effects of HIV treatments

Through a careful evaluation, your provider can calculate your 10-year risk of developing significant CAD and work with you to determine how best to reduce your risk going forward. 

CHD is diagnosed through a combination of medical history, physical exams and various tests, including EKGs, stress tests, coronary calcium scans and cardiac imaging like CT angiography or MRI.

Preventing CHD involves adopting a heart-healthy lifestyle early in life and managing risk factors like high blood pressure, high cholesterol and diabetes. For those living with CHD, regular follow-up care, adherence to medications, cardiac rehabilitation and lifestyle modifications are crucial to prevent serious complications like heart attacks or heart failure. Mental health support, such as counseling or support groups, can also be beneficial in managing the emotional impact of living with heart disease. Women, in particular, should be vigilant as they may experience different symptoms and face delays in diagnosis and treatment compared to men.