Medically reviewed by Dr Nabila Laskar, Consultant Cardiologist (GMC 7040901). Coronary artery disease is the build-up of fatty plaque in the arteries supplying the heart muscle. It develops silently over years and is the most common cause of heart attack.
Cholesterol-rich plaque accumulates within the artery wall, gradually narrowing the vessel. Plaque can also rupture suddenly, triggering a clot that blocks the artery — the mechanism of most heart attacks. See /conditions/high-cholesterol.
Many people have no symptoms until the disease is advanced. When symptoms occur they include exertional chest tightness (see /conditions/angina), breathlessness on effort (see /conditions/breathlessness), and reduced exercise tolerance.
High cholesterol, high blood pressure, smoking, diabetes and pre-diabetes, obesity, physical inactivity, family history of premature heart disease, and raised lipoprotein(a). Most of these are measurable and modifiable.
A CT coronary angiogram is now first-line for defining coronary anatomy in stable chest pain (see /conditions/ct-coronary-angiogram). Treatment centres on aggressive risk-factor control and cardiologist-prescribed medication, with stenting or bypass surgery for significant narrowing.
Plaque cannot usually be removed, but intensive treatment of cholesterol, blood pressure and lifestyle can stabilise plaque, reduce inflammation and substantially lower the risk of heart attack. In some cases imaging shows plaque regression.
For most people with stable chest pain, a CT coronary angiogram is the most informative first test because it images the arteries directly and quantifies plaque, rather than only inferring narrowing from symptoms during exercise.
No. A resting ECG is frequently normal in significant coronary disease. That is why symptoms and risk profile, not the ECG alone, determine whether further imaging is needed.
Family history is an important independent risk factor, particularly when a first-degree relative developed heart disease before 55 in men or 65 in women. Inherited high cholesterol and raised Lp(a) are common underlying reasons.