Coronary artery disease (also called coronary heart disease) is the number-one killer of both men and women in the United States, and it’s the most common type of heart disease. This often preventable disease causes the dangerous thickening and narrowing of the coronary arteries—the vessels that bring blood to the heart—which disrupts the flow of oxygen and nutrients to the heart, causing serious problems.

Without enough blood, coronary artery disease can lead to angina (chest pain). Over time, the heart has to work harder, possibly causing heart failure (when the heart cannot pump efficiently) or arrhythmia (when the heart beats irregularly or too quickly). The damaged arteries may become completely blocked, or become prone to clotting, causing a heart attack.

“Coronary artery disease develops slowly, usually over decades, so the good news is that we have a huge window of opportunity for prevention, through a good lifestyle and healthy habits,” says Seth Martin, M.D., M.H.S., of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease. 

Prevention

Preventing coronary artery disease is largely about controlling the risk factors. “Ideally, prevention habits start early, but they remain important all through life,” Bill McEvoy, MBBCh, of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease says. It’s never too late to effect change, though the earlier in life you do so, the greater the advantage. Smart steps to take:

• Quit smoking—or better yet, never start. Smoking is considered one of the key risk factors for heart attack. Also steer clear of secondhand smoke. If a household member is a smoker, help him or her find ways to quit, such as calling your state’s free 800-QUIT-NOW line, suggests Martin.
• Eat less of the foods that add to heart problems, and more of the foods that protect the heart. Aim for an eating plan that’s low in saturated fats and trans fats, higher in monounsaturated and polyunsaturated the fats found in olive oil and fish, high in fiber (found in plant foods), and low in salt and sugar. Get practical ideas to eat for heart health in Eat Smart.
• Become more active, and stay active, all through life. A good goal is at least 150 minutes (2.5 hours) of moderate exercise each week, or 75 minutes (1.25 hours) of vigorous aerobic exercise each week. Or aim to be active for 30 minutes a day, most days of the week. Check with your doctor before you launch a new workout program if you’ve never worked out before. Learn how implementing an exercise routine helps your heart in Move More.
• Keep your weight within the normal range on a Body Mass Index (BMI) chart. If you’re overweight, losing just 5 percent to 10 percent of your current weight will lower your risk of developing coronary artery disease.
• Find healthy outlets for your stress. Some stress is unavoidable in life. But it tends to push us toward not-so-great habits (overeating, drinking, sitting too much). You’ll be more heart-healthy if you can offload stress in ways you enjoy and that are good for you, such as exercise, meditation and relaxing with friends, says McEvoy. A stress-management program can help.

Diagnosis & Treatment

Diagnosis

Because coronary artery disease develops over time, the symptoms depend on the stage of illness. Damage may be present without outward signs. It’s common to first notice shortness of breath or chest pains when you exert yourself physically. Some people have mild episodes of these symptoms. For others, the first experience is more severe chest pain, even heart attack.

To diagnose coronary artery disease, your doctor will look at markers such as blood pressure, cholesterol profile and blood glucose (from a blood test) as well as your health history and family history, says McEvoy. This information can help estimate your 10-year cardiovascular risk—your odds of a heart attack or stroke.

Depending on the symptoms you have, tests that may be given to provide additional information include:      

• Coronary calcium testing: A simple CT scan provides images of the heart between beats, showing calcium and plaque buildup. “You can actually see the damage that’s known as hardening of the arteries,” says Martin. This test may be considered in persons without known coronary heart disease in whom the decision to treat with a statin and aspirin is unclear.
• High Sensitivity C-reactive protein blood test: This indicates whether you have higher than average levels of inflammation.
• Electrocardiogram (EKG or ECG): Measurement of the electrical activity of your heartbeat during rest.
• Exercise stress test (“treadmill test”): A test done on a treadmill to measure your heart rate when the heart has to pump harder.
• Echocardiogram: An ultrasound image of your heart.
• Chest X-ray: An image of your heart, lungs and other chest organs.
• Cardiac catheterization: A test in which a thin tube is inserted into an artery to check for blockages in heart arteries.
• Coronary angioplasty: a procedure in which a expandable balloon is used to open up a narrowed artery. Nearly 90% of the time, a stent (metal scaffold) is placed at the site of the narrowing in the artery.

Treatment

“Treatments work better early on,” says Martin, which is why early identification and intervention are so important. Depending on your health status and goals, there are three key approaches to treating heart disease: 

Lifestyle changes. The same steps for preventing coronary artery disease are part of a treatment approach to forestalling further problems—that is, modify the many factors that are in your control, like diet, exercise, de-stressing and not smoking. 

Medication. You may be prescribed medications to manage the risk factors for coronary artery disease, such as high blood pressure, high cholesterol, prediabetes and diabetes. 

Procedures to help open blood vessels. Several different types of surgeries (usually outpatient) may be done to repair damage to arteries. These include: 

• Coronary angioplasty. A “balloon” is inserted into the artery through a catheter (a long, narrow, flexible tube) and then inflated to enlarge the passage through the artery. Typically a stent—a wire mesh tube—is also inserted, which forms a scaffolding around the balloon to keep the artery open. 
• Atherectomy. A rotating shaver is used to remove plaque from the artery. 
• Coronary artery bypass surgery (or coronary artery bypass graft). In this more serious surgery, an artery or vein from another part of the body, such as the leg, is grafted onto the coronary artery to create a new route around a blocked section. More than one graft may be done at a time. 

Living With...

Living in the shadow of a potential heart attack or other heart problems can be unnerving—but it can also be motivating. Here’s what to focus on after a diagnosis.

• Know your numbers. Heart health is in large part a numbers game. The key numbers to know include your HDL and LDL cholesterol, total cholesterol and triglycerides, your blood pressure, your glucose, your BMI and your waist circumference measurement, says McEvoy. Get your measurements and readings as often as recommended, make the recommended lifestyle changes and be sure to take medications as directed. This knowledge can be a powerful incentive. 

• Be optimistic. Fear of future cardiac events is common and natural. You may feel anxious, or even depressed. But with good medical care and personal effort, you can still lead a long life of high quality. Small changes really do add up. 

Research

Johns Hopkins experts are on the leading edge of research to prevent and treat heart disease. Examples of recent findings include:

Higher levels of physical fitness lower the risk of heart attack. It also cut the risk of death during the time of the study by 75 percent in those who have been diagnosed with coronary artery disease. A Johns Hopkins study found this true whether or not the subjects had a procedure to open blocked arteries (like stenting or bypass surgery).

The traditional formula for assessing LDL cholesterol sometimes  underestimates risk. (LDL signals the buildup of plaque in arteries.) Johns Hopkins researchers discovered this risk discrepancy and have devised a more accurate calculation that uses the same basic blood test