Coronary artery disease

File:Depiction of a person suffering from Coronary Artery Disease.png

The most common symptom is chest pain or discomfort that occurs regularly with activity, after eating, or at other predictable times; this phenomenon is termed stable angina and is associated with narrowing of the arteries of the heart. Angina also includes chest tightness, heaviness, pressure, numbness, fullness, or squeezing.{{cite web |title=Coronary Artery Disease Symptoms: Types, Causes, Risks, Treatment |url=https://my.clevelandclinic.org/health/symptoms/16821-coronary-artery-disease-symptoms |website=Cleveland Clinic }} Angina that changes in intensity, character, or frequency is termed unstable. Unstable angina may precede myocardial infarction. In adults who go to the emergency department with an unclear cause of pain, about 30% have pain due to coronary artery disease.{{cite journal | vauthors = Kontos MC, Diercks DB, Kirk JD | title = Emergency department and office-based evaluation of patients with chest pain | journal = Mayo Clinic Proceedings | volume = 85 | issue = 3 | pages = 284–99 | date = March 2010 | pmid = 20194155 | pmc = 2843115 | doi = 10.4065/mcp.2009.0560 }} Angina, shortness of breath, sweating, nausea or vomiting, and lightheadedness are signs of a heart attack or myocardial infarction, and immediate emergency medical services are crucial.

With advanced disease, the narrowing of coronary arteries reduces the supply of oxygen-rich blood flowing to the heart, which becomes more pronounced during strenuous activities during which the heart beats faster and has an increased oxygen demand.{{Cite web|title=Coronary artery disease – Symptoms and causes|url=https://www.mayoclinic.org/diseases-conditions/coronary-artery-disease/symptoms-causes/syc-20350613|access-date=2020-06-27|website=Mayo Clinic|language=en}} For some, this causes severe symptoms, while others experience no symptoms at all.

{{Further|Cardiovascular disease in women}}

Symptoms in females can differ from those in males, and the most common symptom reported by females of all races is shortness of breath.{{cite journal | vauthors = McSweeney JC, O'Sullivan P, Cleves MA, Lefler LL, Cody M, Moser DK, Dunn K, Kovacs M, Crane PB, Ramer L, Messmer PR, Garvin BJ, Zhao W | display-authors = 6 | title = Racial differences in women's prodromal and acute symptoms of myocardial infarction | journal = American Journal of Critical Care | volume = 19 | issue = 1 | pages = 63–73 | date = January 2010 | pmid = 20045850 | pmc = 2860802 | doi = 10.4037/ajcc2010372 }} Other symptoms more commonly reported by females than males are extreme fatigue, sleep disturbances, indigestion, and anxiety.{{cite journal | vauthors = McSweeney JC, Cody M, O'Sullivan P, Elberson K, Moser DK, Garvin BJ | title = Women's early warning symptoms of acute myocardial infarction | journal = Circulation | volume = 108 | issue = 21 | pages = 2619–23 | date = November 2003 | pmid = 14597589 | doi = 10.1161/01.CIR.0000097116.29625.7C | doi-access = free }} However, some females experience irregular heartbeat, dizziness, sweating, and nausea. Burning, pain, or pressure in the chest or upper abdomen that can travel to the arm or jaw can also be experienced in females, but females less commonly report it than males. Generally, females experience symptoms 10 years later than males.{{cite web |title=Women & Cardiovascular Disease |url=https://my.clevelandclinic.org/health/diseases/17645-women--cardiovascular-disease |website=Cleveland Clinic }} Females are less likely to recognize symptoms and seek treatment.

File:Blausen 0257 CoronaryArtery Plaque.png

Coronary artery disease is characterized by heart problems that result from atherosclerosis.Institute of Medicine (US) Committee on Social Security Cardiovascular Disability Criteria. (2010). Cardiovascular Disability: Updating the Social Security Listings. "[https://www.ncbi.nlm.nih.gov/books/NBK209964/ Ischemic Heart Disease]". NCBI, National Academies Press (US). Atherosclerosis is a type of arteriosclerosis which is the "chronic inflammation of the arteries which causes them to harden and accumulate cholesterol plaques (atheromatous plaques) on the artery walls".Tenas, M. S. & Torres, M. F. (2018) "[https://www.clinicbarcelona.org/en/assistance/diseases/ischemic-heart-disease/definition What is Ischaemic Heart Disease?]" Clinic Barcelona. CAD has several well-determined risk factors contributing to atherosclerosis. These risk factors for CAD include "smoking, diabetes, high blood pressure (hypertension), abnormal (high) amounts of cholesterol and other fat in the blood (dyslipidemia), type 2 diabetes and being overweight or obese (having excess body fat)" due to lack of exercise and a poor diet.Nordestgaard, B. G. & Palmer, T. M. & Benn, M. & Zacho, J & Tybjærg-Hansen, A. & Smith, G. D. & Timpson, N. J. (2012). "The Effect of Elevated Body Mass Index on Ischemic Heart Disease Risk: Causal Estimates from a Mendelian Randomisation Approach". PLoS Medicine vol. 9,5 e1001212. {{doi|10.1371/journal.pmed.1001212}}. Some other risk factors include high blood pressure, smoking, diabetes, lack of exercise, obesity, high blood cholesterol, poor diet, depression, family history, psychological stress and excessive alcohol. About half of cases are linked to genetics.{{cite journal | vauthors = Dai X, Wiernek S, Evans JP, Runge MS | title = Genetics of coronary artery disease and myocardial infarction | journal = World Journal of Cardiology | volume = 8 | issue = 1 | pages = 1–23 | date = January 2016 | pmid = 26839654 | pmc = 4728103 | doi = 10.4330/wjc.v8.i1.1 | doi-access = free }} Apart from these classical risk factors, several unconventional risk factors have also been studied including high serum fibrinogen, high c-reactive protein (CRP), chronic inflammatory conditions, hypovitaminosis D, high lipoprotein A levels, serum homocysteine etc.{{Cite journal |last=Ullah |first=Himayat |date=2022-04-29 |title=High Sensitivity C-Reactive Protein Level and Ischemic Heart Disease |url=https://pjmhsonline.com/index.php/pjmhs/article/view/648 |journal=Pakistan Journal of Medical & Health Sciences |language=en |volume=16 |issue=4 |pages=34–35 |doi=10.53350/pjmhs2216434 |issn=2957-899X}}{{Cite journal |last1=Yuan |first1=Deshan |last2=Jiang |first2=Ping |last3=Zhu |first3=Pei |last4=Jia |first4=Sida |last5=Zhang |first5=Ce |last6=Liu |first6=Yue |last7=Liu |first7=Ru |last8=Xu |first8=Jingjing |last9=Tang |first9=Xiaofang |last10=Zhao |first10=Xueyan |last11=Gao |first11=Runlin |last12=Yang |first12=Yuejin |last13=Xu |first13=Bo |last14=Gao |first14=Zhan |last15=Yuan |first15=Jinqing |date=2021-07-16 |title=Prognostic value of fibrinogen in patients with coronary artery disease and prediabetes or diabetes following percutaneous coronary intervention: 5-year findings from a large cohort study |journal=Cardiovascular Diabetology |volume=20 |issue=1 |pages=143 |doi=10.1186/s12933-021-01335-1 |doi-access=free |issn=1475-2840 |pmc=8283976 |pmid=34271936}} Smoking and obesity are associated with about 36% and 20% of cases, respectively. Smoking just one cigarette per day about doubles the risk of CAD.{{cite journal | vauthors = Hackshaw A, Morris JK, Boniface S, Tang JL, Milenković D | title = Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports | journal = BMJ | volume = 360 | pages = j5855 | date = January 2018 | pmid = 29367388 | pmc = 5781309 | doi = 10.1136/bmj.j5855 }} Lack of exercise has been linked to 7–12% of cases.{{cite journal | vauthors = Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT | title = Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy | journal = Lancet | volume = 380 | issue = 9838 | pages = 219–29 | date = July 2012 | pmid = 22818936 | pmc = 3645500 | doi = 10.1016/S0140-6736(12)61031-9 }} Exposure to the herbicide Agent Orange may increase risk.{{cite web |title=Agent Orange presumptive conditions |url=https://www.publichealth.va.gov/exposures/publications/agent-orange/agent-orange-2020/presumptive.asp |website=US Department of Veterans Affairs, Veterans Health Administration }} Rheumatologic diseases such as rheumatoid arthritis, systemic lupus erythematosus, psoriasis, and psoriatic arthritis are independent risk factors as well.{{cite journal | vauthors = Esdaile JM, Abrahamowicz M, Grodzicky T, Li Y, Panaritis C, du Berger R, Côte R, Grover SA, Fortin PR, Clarke AE, Senécal JL | display-authors = 6 | title = Traditional Framingham risk factors fail to fully account for accelerated atherosclerosis in systemic lupus erythematosus | journal = Arthritis and Rheumatism | volume = 44 | issue = 10 | pages = 2331–37 | date = October 2001 | pmid = 11665973 | doi = 10.1002/1529-0131(200110)44:10<2331::aid-art395>3.0.co;2-i }}{{cite journal | vauthors = Kerola AM, Kauppi MJ, Kerola T, Nieminen TV | title = How early in the course of rheumatoid arthritis does the excess cardiovascular risk appear? | journal = Annals of the Rheumatic Diseases | volume = 71 | issue = 10 | pages = 1606–15 | date = October 2012 | pmid = 22736093 | doi = 10.1136/annrheumdis-2012-201334 | s2cid = 8419145 }}{{cite journal | vauthors = Roubille C, Richer V, Starnino T, McCourt C, McFarlane A, Fleming P, Siu S, Kraft J, Lynde C, Pope J, Gulliver W, Keeling S, Dutz J, Bessette L, Bissonnette R, Haraoui B | display-authors = 6 | title = The effects of tumour necrosis factor inhibitors, methotrexate, non-steroidal anti-inflammatory drugs and corticosteroids on cardiovascular events in rheumatoid arthritis, psoriasis and psoriatic arthritis: a systematic review and meta-analysis | journal = Annals of the Rheumatic Diseases | volume = 74 | issue = 3 | pages = 480–89 | date = March 2015 | pmid = 25561362 | pmc = 4345910 | doi = 10.1136/annrheumdis-2014-206624 | type = Systematic Review & Meta-Analysis }}{{cite journal | vauthors = Garshick M, Underberg JA | title = The Use of Primary Prevention Statin Therapy in Those Predisposed to Atherosclerosis | journal = Current Atherosclerosis Reports | volume = 19 | issue = 12 | pages = 48 | date = October 2017 | pmid = 29038899 | doi = 10.1007/s11883-017-0685-7 | type = Review | s2cid = 4630668 }}{{excessive citations inline|date=October 2021}}

Job stress appears to play a minor role accounting for about 3% of cases.{{cite journal | vauthors = Kivimäki M, Nyberg ST, Batty GD, Fransson EI, Heikkilä K, Alfredsson L, Bjorner JB, Borritz M, Burr H, Casini A, Clays E, De Bacquer D, Dragano N, Ferrie JE, Geuskens GA, Goldberg M, Hamer M, Hooftman WE, Houtman IL, Joensuu M, Jokela M, Kittel F, Knutsson A, Koskenvuo M, Koskinen A, Kouvonen A, Kumari M, Madsen IE, Marmot MG, Nielsen ML, Nordin M, Oksanen T, Pentti J, Rugulies R, Salo P, Siegrist J, Singh-Manoux A, Suominen SB, Väänänen A, Vahtera J, Virtanen M, Westerholm PJ, Westerlund H, Zins M, Steptoe A, Theorell T | display-authors = 6 | title = Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data | journal = Lancet | volume = 380 | issue = 9852 | pages = 1491–97 | date = October 2012 | pmid = 22981903 | pmc = 3486012 | doi = 10.1016/S0140-6736(12)60994-5 }} In one study, females who were free of stress from work life saw an increase in the diameter of their blood vessels, leading to decreased progression of atherosclerosis.{{cite journal | vauthors = Wang HX, Leineweber C, Kirkeeide R, Svane B, Schenck-Gustafsson K, Theorell T, Orth-Gomér K | title = Psychosocial stress and atherosclerosis: family and work stress accelerate progression of coronary disease in women. The Stockholm Female Coronary Angiography Study | journal = Journal of Internal Medicine | volume = 261 | issue = 3 | pages = 245–54 | date = March 2007 | pmid = 17305647 | doi = 10.1111/j.1365-2796.2006.01759.x | s2cid = 38337323 | doi-access = free }} In contrast, females who had high levels of work-related stress experienced a decrease in the diameter of their blood vessels and significantly increased disease progression.

Air pollution, both indoor and outdoor, is responsible for roughly 28% of deaths from CAD. This varies by region: In highly developed areas, this is approximately 10%, whereas in Southern, East and West Africa, and South Asia, approximately 40% of deaths from CAD can be attributed to unhealthy air.{{Cite book |last1=Health Effects Institute |author-link1=Health Effects Institute |url=https://www.stateofglobalair.org/resources/report/state-global-air-report-2024 |title=State of Global Air Report 2024: A Special Report on Global Exposure to Air Pollution and its Health Impacts with a Focus on Children's Health. |last2=Institute for Health Metrics and Evaluation |author-link2=Institute for Health Metrics and Evaluation |last3=UNICEF |author-link3=UNICEF |date=2024 |publisher=Health Effects Institute |pages=27 |issn=2578-6873}} In particular, fine particle pollution (PM_2.5), which comes mostly from the burning of fossil fuels, is a key risk factor for CAD.{{Cite journal |last1=Montone |first1=Rocco A. |last2=Rinaldi |first2=Riccardo |last3=Bonanni |first3=Alice |last4=Severino |first4=Anna |last5=Pedicino |first5=Daniela |last6=Crea |first6=Filippo |last7=Liuzzo |first7=Giovanna |date=2023-02-01 |title=Impact of air pollution on ischemic heart disease: Evidence, mechanisms, clinical perspectives |journal=Atherosclerosis |language=English |volume=366 |pages=22–31 |doi=10.1016/j.atherosclerosis.2023.01.013 |issn=0021-9150 |pmid=36696748|doi-access=free }}

The consumption of different types of fats including trans fat (trans unsaturated), and saturated fat, in a diet "influences the level of cholesterol that is present in the bloodstream".{{Cite web |title=Lipid Health Risks {{!}} BioNinja |url=https://ib.bioninja.com.au/standard-level/topic-2-molecular-biology/23-carbohydrates-and-lipids/lipid-health-risks.html |access-date=2023-12-12 |website=ib.bioninja.com.au |archive-date=19 October 2023 |archive-url=https://web.archive.org/web/20231019125341/https://ib.bioninja.com.au/standard-level/topic-2-molecular-biology/23-carbohydrates-and-lipids/lipid-health-risks.html |url-status=dead }} Unsaturated fats originate from plant sources (such as oils). There are two types of unsaturated fats, cis and trans isomers. Cis unsaturated fats are bent in molecular structure and trans are linear. Saturated fats originate from animal sources (such as animal fats) and are also molecularly linear in structure.{{Cite web |title=Types of Fatty Acids {{!}} BioNinja |url=https://ib.bioninja.com.au/standard-level/topic-2-molecular-biology/23-carbohydrates-and-lipids/types-of-fatty-acids.html |access-date=2023-12-12 |website=ib.bioninja.com.au |archive-date=19 October 2023 |archive-url=https://web.archive.org/web/20231019125734/https://ib.bioninja.com.au/standard-level/topic-2-molecular-biology/23-carbohydrates-and-lipids/types-of-fatty-acids.html |url-status=dead }} The linear configurations of unsaturated trans and saturated fats allow them to easily accumulate and stack at the arterial walls when consumed in high amounts (and other positive measures towards physical health are not met).

• Fats and cholesterol are insoluble in blood and thus are amalgamated with proteins to form lipoproteins for transport. Low-density lipoproteins (LDL) transport cholesterol from the liver to the rest of the body and raise blood cholesterol levels. The consumption of "saturated fats increases LDL levels within the body, thus raising blood cholesterol levels".
• High-density lipoproteins (HDL) are considered 'good' lipoproteins as they search for excess cholesterol in the body and transport it back to the liver for disposal. Trans fats also "increase LDL levels whilst decreasing HDL levels within the body, significantly raising blood cholesterol levels".

High levels of cholesterol in the bloodstream lead to atherosclerosis. With increased levels of LDL in the bloodstream, "LDL particles will form deposits and accumulate within the arterial walls, which will lead to the development of plaques, restricting blood flow". The resultant reduction in the heart's blood supply due to atherosclerosis in coronary arteries "causes shortness of breath, angina pectoris (chest pains that are usually relieved by rest), and potentially fatal heart attacks (myocardial infarctions)".

The heritability of coronary artery disease has been estimated between 40% and 60%.{{cite journal | vauthors = McPherson R, Tybjaerg-Hansen A | title = Genetics of Coronary Artery Disease | journal = Circulation Research | volume = 118 | issue = 4 | pages = 564–78 | date = February 2016 | pmid = 26892958 | doi = 10.1161/circresaha.115.306566 }} Genome-wide association studies have identified over 160 genetic susceptibility loci for coronary artery disease.{{cite journal | vauthors = van der Harst P, Verweij N | title = Identification of 64 Novel Genetic Loci Provides an Expanded View on the Genetic Architecture of Coronary Artery Disease | journal = Circulation Research | volume = 122 | issue = 3 | pages = 433–43 | date = February 2018 | pmid = 29212778 | pmc = 5805277 | doi = 10.1161/circresaha.117.312086 | publisher = Ovid Technologies (Wolters Kluwer Health) }}

Several RNA Transcripts associated with CAD - FoxP1, ICOSLG, IKZF4/Eos, SMYD3, TRIM28, and TCF3/E2A are likely markers of regulatory T cells (Tregs), consistent with known reductions in Tregs in CAD.{{cite journal | vauthors = McCaffrey TA, Toma I, Yang Z, Katz R, Reiner J, Mazhari R, Shah P, Tackett M, Jones D, Jepson T, Falk Z, Wargodsky R, Shtakalo D, Antonets D, Ertle J, Kim JH, Lai Y, Arslan Z, Aledort E, Alfaraidy M, Laurent GS | title = RNA sequencing of blood in coronary artery disease: involvement of regulatory T cell imbalance | journal = BMC Med Genomics | volume = 14 | issue = 216 | date = September 2021 | page = 216 | pmid = 34479557 | pmc = 8414682 | doi = 10.1186/s12920-021-01062-2 | doi-access = free }}

Image:Schematic representation of Treg-related TRACs identified by RNAseq.jpg. The differentially expressed genes identified by RNAseq were curated by automated and manual analysis to identify the molecular pathways involved. The resulting pattern points to changes in the 'immune synapse', which involves both endocytic pathways of T cell receptor-containing vesicles, as well as ciliary protrusions that couple to intracellular signaling pathways.]]

The RNA changes are mostly related to ciliary and endocytic transcripts, which in the circulating immune system would be related to the immune synapse.{{cite journal | vauthors = McCaffrey TA, Toma I, Yang Z, Katz R, Reiner J, Mazhari R, Shah P, Falk Z, Wargowsky R, Goldman J, Jones D, Shtokalo D, Antonets D, Tisha Jepson T, Fetisova A, Jaatinen K, Ree N, Ri M| title = RNAseq profiling of blood from patients with coronary artery disease: Signature of a T cell imbalance | journal = Journal of Molecular and Cellular Cardiology Plus | volume = 4 | date = June 2023 | page = 100033 | doi = 10.1016/j.jmccpl.2023.100033| pmid = 37303712 | pmc = 10256136 | s2cid = 257761467 }} One of the most differentially expressed genes, fibromodulin (FMOD), which is increased 2.8-fold in CAD, is found mainly in connective tissue{{cite journal | pmc=9986681 | date=2023 | title=Fibromodulin, a Multifunctional Matricellular Modulator | journal=Journal of Dental Research | volume=102 | issue=2 | pages=125–34 | doi=10.1177/00220345221138525 | pmid=36515321 | vauthors = Zheng Z, Granado HS, Li C }} and is a modulator of the TGF-beta signaling pathway. However, not all RNA changes may be related to the immune synapse. For example, Nebulette, the most down-regulated transcript (2.4-fold), is found in cardiac muscle; it is a 'cytolinker' that connects actin and desmin to facilitate cytoskeletal function and vesicular movement. The endocytic pathway is further modulated by changes in tubulin, a key microtubule protein, and fidgetin, a tubulin-severing enzyme that is a marker for cardiovascular risk identified by genome-wide association study. Protein recycling would be modulated by changes in the proteasomal regulator SIAH3, and the ubiquitin ligase MARCHF10. On the ciliary aspect of the immune synapse, several of the modulated transcripts are related to ciliary length and function. Stereocilin is a partner to mesothelin, a related super-helical protein, whose transcript is also modulated in CAD. DCDC2, a double-cortin protein, modulates ciliary length. In the signaling pathways of the immune synapse, numerous transcripts are directly related to T-cell function and the control of differentiation. Butyrophilin is a co-regulator for T cell activation. Fibromodulin modulates the TGF-beta signaling pathway, a primary determinant of Tre differentiation. Further impact on the TGF-beta pathway is reflected in concurrent changes in the BMP receptor 1B RNA (BMPR1B), because the bone morphogenic proteins are members of the TGF-beta superfamily, and likewise impact Treg differentiation. Several of the transcripts (TMEM98, NRCAM, SFRP5, SHISA2) are elements of the Wnt signaling pathway, which is a major determinant of Treg differentiation.

• Endometriosis in females under the age of 40.{{cite journal | vauthors = Mu F, Rich-Edwards J, Rimm EB, Spiegelman D, Missmer SA | title = Endometriosis and Risk of Coronary Heart Disease | journal = Circulation: Cardiovascular Quality and Outcomes | volume = 9 | issue = 3 | pages = 257–64 | date = May 2016 | pmid = 27025928 | pmc = 4940126 | doi = 10.1161/CIRCOUTCOMES.115.002224 }}
• Depression and hostility appear to be risks.{{cite journal | vauthors = Albus C | title = Psychological and social factors in coronary heart disease | journal = Annals of Medicine | volume = 42 | issue = 7 | pages = 487–94 | date = October 2010 | pmid = 20839918 | doi = 10.3109/07853890.2010.515605 | s2cid = 25144107 | doi-access = free }}
• The number of categories of adverse childhood experiences (psychological, physical, or sexual abuse; violence against mother; or living with household members who used substances, mentally ill, suicidal, or incarcerated) showed a graded correlation with the presence of adult diseases including coronary artery (ischemic heart) disease.{{cite journal | vauthors = Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS | display-authors = 6 | title = Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study | journal = American Journal of Preventive Medicine | volume = 14 | issue = 4 | pages = 245–58 | date = May 1998 | pmid = 9635069 | doi = 10.1016/S0749-3797(98)00017-8 | s2cid = 26055600 | doi-access = free }}
• Hemostatic factors: High levels of fibrinogen and coagulation factor VII are associated with an increased risk of CAD.{{cite journal | vauthors = Grant PJ | title = The genetics of atherothrombotic disorders: a clinician's view | journal = Journal of Thrombosis and Haemostasis | volume = 1 | issue = 7 | pages = 1381–90 | date = July 2003 | pmid = 12871271 | doi = 10.1046/j.1538-7836.2003.00276.x | df = dmy-all | type = Review | s2cid = 20395787 | doi-access = free }}
• Low hemoglobin.{{cite journal |id={{Gale|A261829143}} | vauthors = Padmanaban P, Toora B |title=Hemoglobin: Emerging marker in stable coronary artery disease |journal=Chronicles of Young Scientists |date=2011 |volume=2 |issue=2 |pages=109 |doi=10.4103/2229-5186.82971 |url=https://ddtjournal.net/?view-pdf=1&embedded=true&article=2acc68c5a97079e54b6b7b584b3de7261Zs4oQ%3D%3D | doi-access = free }}
• In the Asian population, the b fibrinogen gene G-455A polymorphism was associated with the risk of CAD.{{cite journal | vauthors = Fajar JK |title=The β fibrinogen gene G-455A polymorphism in Asian subjects with coronary heart disease: A meta analysis |journal=Egyptian Journal of Medical Human Genetics |date=2017-02-27 |volume=18 |issue=1 |pages=19–28 |doi=10.1016/j.ejmhg.2016.06.002 |url=https://www.ajol.info/index.php/ejhg/article/view/152188 |doi-access=free }}
• Patient-specific vessel ageing or remodelling determines endothelial cell behaviour and thus disease growth and progression. Such 'hemodynamic markers' are patient-specific risk surrogates.{{cite journal | vauthors = Adikari D | title = A new and automated risk prediction of coronary artery disease using clinical endpoints and medical imaging-derived patient-specific insights: protocol for the retrospective GeoCAD cohort study | journal = British Medical Journal | volume = 12 | date = June 2022 | issue = 6 | pages = e054881 | doi = 10.1136/bmjopen-2021-054881 | pmid = 35725256 | pmc = 9214399 | df = dmy-all | type = Prospective study | doi-access = free }}
• HIV is a known risk factor for developing atherosclerosis and coronary artery disease.{{cite journal |last1=Sinha |first1=A |last2=Feinstein |first2=MJ |title=Coronary Artery Disease Manifestations in HIV: What, How, and Why |journal=The Canadian Journal of Cardiology |date=March 2019 |volume=35 |issue=3 |pages=270–79 |doi=10.1016/j.cjca.2018.11.029 |pmid=30825949 |pmc=9532012 }}

File:RCA atherosclerosis.jpg of a coronary artery with the most common form of coronary artery disease (atherosclerosis) and marked luminal narrowing. Masson's trichrome.]]

Limitation of blood flow to the heart causes ischemia (cell starvation secondary to a lack of oxygen) of the heart's muscle cells. The heart's muscle cells may die from lack of oxygen and this is called a myocardial infarction (commonly referred to as a heart attack). It leads to damage, death, and eventual scarring of the heart muscle without regrowth of heart muscle cells. Chronic high-grade narrowing of the coronary arteries can induce transient ischemia which leads to the induction of a ventricular arrhythmia, which may terminate into a dangerous heart rhythm known as ventricular fibrillation, which often leads to death.{{cite journal | vauthors = Ambrose JA, Singh M | title = Pathophysiology of coronary artery disease leading to acute coronary syndromes | journal = F1000Prime Reports | volume = 7 | pages = 08 | year = 2015 | pmid = 25705391 | pmc = 4311268 | doi = 10.12703/P7-08 | doi-access = free }}

Typically, coronary artery disease occurs when part of the smooth, elastic lining inside a coronary artery (the arteries that supply blood to the heart muscle) develops atherosclerosis. With atherosclerosis, the artery's lining becomes hardened, stiffened, and accumulates deposits of calcium, fatty lipids, and abnormal inflammatory cells – to form a plaque. Calcium phosphate (hydroxyapatite) deposits in the muscular layer of the blood vessels appear to play a significant role in stiffening the arteries and inducing the early phase of coronary arteriosclerosis. This can be seen in a so-called metastatic mechanism of calciphylaxis as it occurs in chronic kidney disease and hemodialysis.{{citation needed|date=June 2021}} Although these people have kidney dysfunction, almost fifty percent of them die due to coronary artery disease. Plaques can be thought of as large "pimples" that protrude into the channel of an artery, causing partial obstruction to blood flow. People with coronary artery disease might have just one or two plaques or might have dozens distributed throughout their coronary arteries. {{anchor|CTO}}A more severe form is chronic total occlusion (CTO) when a coronary artery is completely obstructed for more than 3 months.{{cite journal | vauthors = Aziz S, Ramsdale DR | title = Chronic total occlusions – a stiff challenge requiring a major breakthrough: is there light at the end of the tunnel? | journal = Heart | volume = 91 | issue = Suppl 3 | pages = iii42–48 | date = June 2005 | pmid = 15919653 | pmc = 1876352 | doi = 10.1136/hrt.2004.058495 }}

Microvascular angina is a type of angina pectoris in which chest pain and chest discomfort occur without signs of blockages in the larger coronary arteries of their hearts when an angiogram (coronary angiogram) is being performed.{{cite journal | vauthors = Lanza GA | title = Cardiac syndrome X: a critical overview and future perspectives | journal = Heart | volume = 93 | issue = 2 | pages = 159–66 | date = February 2007 | pmid = 16399854 | pmc = 1861371 | doi = 10.1136/hrt.2005.067330 }}{{cite journal |vauthors=Aldiwani H, Mahdai S, Alhatemi G, Bairey Merz CN |title=Microvascular Angina: Diagnosis and Management |journal=Eur Cardiol |volume=16 |issue= |pages=e46 |date=February 2021 |pmid=34950242 |pmc=8674627 |doi=10.15420/ecr.2021.15 |url=}}

The exact cause of microvascular angina is unknown. Explanations include microvascular dysfunction or epicardial atherosclerosis.{{cite journal | vauthors = Jones E, Eteiba W, Merz NB | title = Cardiac syndrome X and microvascular coronary dysfunction | journal = Trends in Cardiovascular Medicine | volume = 22 | issue = 6 | pages = 161–68 | date = August 2012 | pmid = 23026403 | pmc = 3490207 | doi = 10.1016/j.tcm.2012.07.014 }}{{cite journal | vauthors = Petersen JW, Pepine CJ | title = Microvascular coronary dysfunction and ischemic heart disease: where are we in 2014? | journal = Trends in Cardiovascular Medicine | volume = 25 | issue = 2 | pages = 98–103 | date = February 2015 | pmid = 25454903 | pmc = 4336803 | doi = 10.1016/j.tcm.2014.09.013 }} For reasons that are not well understood, females are more likely than males to have it; however, hormones and other risk factors unique to females may play a role.{{cite journal | vauthors = Kaski JC | title = Pathophysiology and management of patients with chest pain and normal coronary arteriograms (cardiac syndrome X) | journal = Circulation | volume = 109 | issue = 5 | pages = 568–72 | date = February 2004 | pmid = 14769677 | doi = 10.1161/01.CIR.0000116601.58103.62 | s2cid = 18216111 | doi-access = free }}

File:Coro Man.jpg

File:Coro Woman.jpg

The diagnosis of CAD depends largely on the nature of the symptoms and imaging. The first investigation when CAD is suspected is an electrocardiogram (ECG/EKG), both for stable angina and acute coronary syndrome. An X-ray of the chest, blood tests and resting echocardiography may be performed.{{Cite web |title=Coronary Artery Disease Diagnosis and Treatment |url=https://www.mayoclinic.org/diseases-conditions/coronary-artery-disease/diagnosis-treatment/drc-20350619 |website=Mayo Clinic}}{{Cite journal |last1=Knuuti |first1=Juhani |last2=Wijns |first2=William |last3=Saraste |first3=Antti |last4=Capodanno |first4=Davide |last5=Barbato |first5=Emanuele |last6=Funck-Brentano |first6=Christian |last7=Prescott |first7=Eva |last8=Storey |first8=Robert F |last9=Deaton |first9=Christi |last10=Cuisset |first10=Thomas |last11=Agewall |first11=Stefan |last12=Dickstein |first12=Kenneth |last13=Edvardsen |first13=Thor |last14=Escaned |first14=Javier |last15=Gersh |first15=Bernard J |date=2019-08-31 |title=2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes |url=|journal=European Heart Journal |volume=41 |issue=3 |pages=407–77 |doi=10.1093/eurheartj/ehz425 |pmid=31504439 |issn=0195-668X|hdl=11379/537215 |hdl-access=free }}

For stable symptomatic patients, several non-invasive tests can diagnose CAD depending on pre-assessment of the risk profile. Noninvasive imaging options include; Computed tomography angiography (CTA) (anatomical imaging, best test in patients with low-risk profile to "rule out" the disease), positron emission tomography (PET), single-photon emission computed tomography (SPECT)/nuclear stress test/myocardial scintigraphy and stress echocardiography (the three latter can be summarized as functional noninvasive methods and are typically better to "rule in"). Exercise ECG or stress test is inferior to non-invasive imaging methods due to the risk of false negative and false positive test results. The use of non-invasive imaging is not recommended on individuals who are exhibiting no symptoms and are otherwise at low risk for developing coronary disease.{{Cite journal |author1=American Society of Echocardiography |author1-link=American Society of Echocardiography |date=20 December 2012 |title=Five Things Physicians and Patients Should Question |url=http://www.choosingwisely.org/doctor-patient-lists/american-society-of-echocardiography |url-status=live |journal=Choosing Wisely: An Initiative of the ABIM Foundation |archive-url=https://web.archive.org/web/20130226052012/http://www.choosingwisely.org/doctor-patient-lists/american-society-of-echocardiography/ |archive-date=26 February 2013 |access-date=27 February 2013}}, citing

• {{cite journal |author13=Society for Cardiovascular Angiography Interventions |author14=Society of Critical Care Medicine |author15=American Society of Echocardiography |display-authors=6 |vauthors=Douglas PS, Garcia MJ, Haines DE, Lai WW, Manning WJ, Patel AR, Picard MH, Polk DM, Ragosta M, Ward RP, Weiner RB |date=March 2011 |title=ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance Endorsed by the American College of Chest Physicians |journal=Journal of the American College of Cardiology |volume=57 |issue=9 |pages=1126–66 |doi=10.1016/j.jacc.2010.11.002 |pmid=21349406 |doi-access=free |author20=American Heart Association |author18=Society for Cardiovascular Magnetic Resonance |author16=American Society of Nuclear Cardiology |author17=Heart Failure Society of America |author19=Society of Cardiovascular Computed Tomography |author21=Heart Rhythm Society}}
• {{cite journal |author15=American Heart Association Task Force on practice guidelines (Committee on the Management of Patients With Chronic Stable Angina) |display-authors=6 |vauthors=Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, Ferguson TB, Fihn SD, Fraker TD, Gardin JM, O'Rourke RA, Pasternak RC, Williams SV |date=January 2003 |title=ACC/AHA 2002 guideline update for the management of patients with chronic stable angina – summary article: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on the Management of Patients With Chronic Stable Angina) |journal=Journal of the American College of Cardiology |volume=41 |issue=1 |pages=159–68 |doi=10.1016/S0735-1097(02)02848-6 |pmid=12570960 |doi-access=free}}
• {{cite journal |display-authors=6 |vauthors=Greenland P, Alpert JS, Beller GA, Benjamin EJ, Budoff MJ, Fayad ZA, Foster E, Hlatky MA, Hodgson JM, Kushner FG, Lauer MS, Shaw LJ, Smith SC, Taylor AJ, Weintraub WS, Wenger NK, Jacobs AK, Smith SC, Anderson JL, Albert N, Buller CE, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hochman JS, Kushner FG, Nishimura R, Ohman EM, Page RL, Stevenson WG, Tarkington LG, Yancy CW |date=December 2010 |title=2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines |journal=Journal of the American College of Cardiology |volume=56 |issue=25 |pages=e50–103 |doi=10.1016/j.jacc.2010.09.001 |pmid=21144964 |doi-access=free}}{{Citation|author1=American College of Cardiology|author1-link=American College of Cardiology|date=September 2013|title=Five Things Physicians and Patients Should Question|publisher=American College of Cardiology|work=Choosing Wisely: an initiative of the ABIM Foundation|url=http://www.choosingwisely.org/doctor-patient-lists/american-college-of-cardiology|access-date=10 February 2014|url-status=live|archive-url=https://web.archive.org/web/20131217231756/http://www.choosingwisely.org/doctor-patient-lists/american-college-of-cardiology/|archive-date=17 December 2013}} Invasive testing with coronary angiography (ICA) can be used when non-invasive testing is inconclusive or show a high event risk.

The diagnosis of microvascular angina (previously known as cardiac syndrome X – the rare coronary artery disease that is more common in females, as mentioned, is a diagnosis of exclusion. Therefore, usually, the same tests are used as in any person suspected of having coronary artery disease:{{cite journal | vauthors = Agrawal S, Mehta PK, Bairey Merz CN | title = Cardiac Syndrome X: update 2014 | journal = Cardiology Clinics | volume = 32 | issue = 3 | pages = 463–78 | date = August 2014 | pmid = 25091971 | pmc = 4122947 | doi = 10.1016/j.ccl.2014.04.006 }}

• Intravascular ultrasound
• Magnetic resonance imaging (MRI)

{{main|Angina#Stable angina}}

Stable angina is the most common manifestation of ischemic heart disease, and is associated with reduced quality of life and increased mortality. It is caused by epicardial coronary stenosis which results in reduced blood flow and oxygen supply to the myocardium.{{cite web |title=Angina – Symptoms and causes |url=https://www.mayoclinic.org/diseases-conditions/angina/symptoms-causes/syc-20369373 |website=Mayo Clinic |language=en}}

Stable angina is short-term chest pain during physical exertion caused by an imbalance between myocardial oxygen supply and metabolic oxygen demand. Various forms of cardiac stress tests may be used to induce both symptoms and detect changes by way of electrocardiography (using an ECG), echocardiography (using ultrasound of the heart) or scintigraphy (using uptake of radionuclide by the heart muscle). If part of the heart seems to receive an insufficient blood supply, coronary angiography may be used to identify stenosis of the coronary arteries and suitability for angioplasty or bypass surgery.{{cite web|title=Coronary Angiography|url=https://www.nhlbi.nih.gov/health/health-topics/topics/ca|website=National Heart, Blood, and Lung Institute|access-date=10 December 2017}}

In minor to moderate cases, nitroglycerine may be used to alleviate acute symptoms of stable angina or may be used immediately before exertion to prevent the onset of angina. Sublingual nitroglycerine is most commonly used to provide rapid relief for acute angina attacks and as a complement to anti-anginal treatments in patients with refractory and recurrent angina.{{cite journal |last1=Tarkin |first1=Jason M |last2=Kaski |first2=Juan Carlos |title=Pharmacological treatment of chronic stable angina pectoris |journal=Clinical Medicine |pages=63–70 |doi=10.7861/clinmedicine.13-1-63 |date=February 2013|volume=13 |issue=1 |pmid=23472498 |pmc=5873712 }} When nitroglycerine enters the bloodstream, it forms free radical nitric oxide, or NO, which activates guanylate cyclase and in turn stimulates the release of cyclic GMP. This molecular signaling stimulates smooth muscle relaxation, resulting in vasodilation and consequently improved blood flow to heart regions affected by atherosclerotic plaque.{{cite web |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/021134s004lbl.pdf |archive-url=https://web.archive.org/web/20140419045424/http://www.accessdata.fda.gov/drugsatfda_docs/label/2010/021134s004lbl.pdf |archive-date=2014-04-19 |url-status=live |title=Nitrostat® (Nitroglycerin Sublingual Tablets, USP) |publisher=United States Food and Drug Administration}}

Stable coronary artery disease (SCAD) is also often called stable ischemic heart disease (SIHD).{{cite book | vauthors = Li YR |chapter=Overview of ischemic heart disease, stable angina, and drug therapy |pages=245–53 |chapter-url=https://books.google.com/books?id=rXy0BgAAQBAJ&pg=PA245 |title=Cardiovascular Diseases: From Molecular Pharmacology to Evidence-Based Therapeutics |date=2015 |publisher=John Wiley & Sons |isbn=978-0-470-91537-0 }} A 2015 monograph explains that "Regardless of the nomenclature, stable angina is the chief manifestation of SIHD or SCAD." There are U.S. and European clinical practice guidelines for SIHD/SCAD.{{cite journal | vauthors = Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, Fonarow GC, Lange RA, Levine GN, Maddox TM, Naidu SS, Ohman EM, Smith PK | display-authors = 6 | title = 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons | journal = Circulation | volume = 130 | issue = 19 | pages = 1749–67 | date = November 2014 | pmid = 25070666 | doi = 10.1161/CIR.0000000000000095 | doi-access = free }}{{cite web |title=ESC Guidelines on Chronic Coronary Syndromes (Previously titled Stable Coronary Artery Disease) |url=https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Chronic-Coronary-Syndromes |website=European Society of Cardiology }} In patients with non-severe asymptomatic aortic valve stenosis and no overt coronary artery disease, the increased troponin T (above 14 pg/mL) was found associated with an increased 5-year event rate of ischemic cardiac events (myocardial infarction, percutaneous coronary intervention, or coronary artery bypass surgery).{{Cite journal |last1=Hadziselimovic |first1=Edina |last2=Greve |first2=Anders M. |last3=Sajadieh |first3=Ahmad |last4=Olsen |first4=Michael H. |last5=Kesäniemi |first5=Y. Antero |last6=Nienaber |first6=Christoph A. |last7=Ray |first7=Simon G. |last8=Rossebø |first8=Anne B. |last9=Wachtell |first9=Kristian |last10=Nielsen |first10=Olav W. |date=April 2023 |title=Association of high-sensitivity troponin T with outcomes in asymptomatic non-severe aortic stenosis: a post-hoc substudy of the SEAS trial |url=|journal=eClinicalMedicine |volume=58 |pages=101875 |doi=10.1016/j.eclinm.2023.101875 |issn=2589-5370 |pmc=10006443 |pmid=36915288}}

{{main|Acute coronary syndrome}}

Diagnosis of acute coronary syndrome generally takes place in the emergency department, where ECGs may be performed sequentially to identify "evolving changes" (indicating ongoing damage to the heart muscle). Diagnosis is clear-cut if ECGs show elevation of the "ST segment", which in the context of severe typical chest pain is strongly indicative of an acute myocardial infarction (MI); this is termed a STEMI (ST-elevation MI) and is treated as an emergency with either urgent coronary angiography and percutaneous coronary intervention (angioplasty with or without stent insertion) or with thrombolysis ("clot buster" medication), whichever is available. In the absence of ST-segment elevation, heart damage is detected by cardiac markers (blood tests that identify heart muscle damage). If there is evidence of damage (infarction), the chest pain is attributed to a "non-ST elevation MI" (NSTEMI). If there is no evidence of damage, the term "unstable angina" is used. This process usually necessitates hospital admission and close observation on a coronary care unit for possible complications (such as cardiac arrhythmias – irregularities in the heart rate). Depending on the risk assessment, stress testing or angiography may be used to identify and treat coronary artery disease in patients who have had an NSTEMI or unstable angina.{{Citation needed|date=January 2021}}

There are various risk assessment systems for determining the risk of coronary artery disease, with various emphasis on the different variables above. A notable example is Framingham Score, used in the Framingham Heart Study. It is mainly based on age, gender, diabetes, total cholesterol, HDL cholesterol, tobacco smoking, and systolic blood pressure. When predicting risk in younger adults (18–39 years old), the Framingham Risk Score remains below 10–12% for all deciles of baseline-predicted risk.{{cite journal | vauthors = Berry JD, Lloyd-Jones DM, Garside DB, Greenland P | title = Framingham risk score and prediction of coronary heart disease death in young men | journal = American Heart Journal | volume = 154 | issue = 1 | pages = 80–86 | date = July 2007 | pmid = 17584558 | pmc = 2279177 | doi = 10.1016/j.ahj.2007.03.042 }}

Polygenic score is another way of risk assessment. In one study the relative risk of incident coronary events was 91% higher among participants at high genetic risk than among those at low genetic risk.{{cite journal | vauthors = Khera AV, Emdin CA, Drake I, Natarajan P, Bick AG, Cook NR, Chasman DI, Baber U, Mehran R, Rader DJ, Fuster V, Boerwinkle E, Melander O, Orho-Melander M, Ridker PM, Kathiresan S | display-authors = 6 | title = Genetic Risk, Adherence to a Healthy Lifestyle, and Coronary Disease | journal = The New England Journal of Medicine | volume = 375 | issue = 24 | pages = 2349–58 | date = December 2016 | pmid = 27959714 | pmc = 5338864 | doi = 10.1056/NEJMoa1605086 }}

Up to 90% of cardiovascular disease may be preventable if established risk factors are avoided.{{cite journal | vauthors = McGill HC, McMahan CA, Gidding SS | title = Preventing heart disease in the 21st century: implications of the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study | journal = Circulation | volume = 117 | issue = 9 | pages = 1216–27 | date = March 2008 | pmid = 18316498 | doi = 10.1161/CIRCULATIONAHA.107.717033 | doi-access = free }}{{cite journal | vauthors = McNeal CJ, Dajani T, Wilson D, Cassidy-Bushrow AE, Dickerson JB, Ory M | title = Hypercholesterolemia in youth: opportunities and obstacles to prevent premature atherosclerotic cardiovascular disease | journal = Current Atherosclerosis Reports | volume = 12 | issue = 1 | pages = 20–28 | date = January 2010 | pmid = 20425267 | doi = 10.1007/s11883-009-0072-0 | s2cid = 37833889 }} Prevention involves adequate physical exercise, decreasing obesity, treating high blood pressure, eating a healthy diet, decreasing cholesterol levels, and stopping smoking. Medications and exercise are roughly equally effective.{{cite journal | vauthors = Naci H, Ioannidis JP | title = Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study | journal = BMJ | volume = 347 | issue = oct01 1 | pages = f5577 | date = October 2013 | pmid = 24473061 | pmc = 3788175 | doi = 10.1136/bmj.f5577 }} High levels of physical activity reduce the risk of coronary artery disease by about 25%.{{cite journal | vauthors = Kyu HH, Bachman VF, Alexander LT, Mumford JE, Afshin A, Estep K, Veerman JL, Delwiche K, Iannarone ML, Moyer ML, Cercy K, Vos T, Murray CJ, Forouzanfar MH | display-authors = 6 | title = Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013 | journal = BMJ | volume = 354 | pages = i3857 | date = August 2016 | pmid = 27510511 | pmc = 4979358 | doi = 10.1136/bmj.i3857 }} Life's Essential 8 are the key measures for improving and maintaining cardiovascular health, as defined by the American Heart Association. AHA added sleep as a factor influencing heart health in 2022.{{Cite web |title=Life's Essential 8 |url=https://www.heart.org/en/healthy-living/healthy-lifestyle/lifes-essential-8 |access-date=2022-07-03 |website=www.heart.org |language=en}}

Most guidelines recommend combining these preventive strategies. A 2015 Cochrane Review found some evidence that counseling and education to bring about behavioral change might help in high-risk groups. However, there was insufficient evidence to show an effect on mortality or actual cardiovascular events.{{cite journal | vauthors = Ebrahim S, Taylor F, Ward K, Beswick A, Burke M, Davey Smith G | title = Multiple risk factor interventions for primary prevention of coronary heart disease | journal = The Cochrane Database of Systematic Reviews | issue = 1 | pages = CD001561 | date = January 2011 | volume = 2013 | pmid = 21249647 | pmc = 4160097 | doi = 10.1002/14651858.cd001561.pub3 }}

In diabetes mellitus, there is little evidence that very tight blood sugar control improves cardiac risk although improved sugar control appears to decrease other problems such as kidney failure and blindness.{{Cite web |last=Norman |first=James |date=2019-10-07 |title=Managing Diabetes with Blood Glucose Control |url=https://www.endocrineweb.com/conditions/diabetes/assessing-how-well-diabetes-controlled |website=Endocrineweb}}

A 2024 study published in The Lancet Diabetes & Endocrinology found that the oral glucose tolerance test (OGTT) is more effective than hemoglobin A1c (HbA1c) for detecting dysglycemia in patients with coronary artery disease.{{Cite journal |last1=Ferrannini |first1=Giulia |last2=Tuomilehto |first2=Jaakko |last3=De Backer |first3=Guy |last4=Kotseva |first4=Kornelia |last5=Mellbin |first5=Linda |last6=Schnell |first6=Oliver |last7=Wood |first7=David |last8=De Bacquer |first8=Dirk |last9=Rydén |first9=Lars |date=2024 |title=Dysglycaemia screening and its prognostic impact in patients with coronary artery disease: experiences from the EUROASPIRE IV and V cohort studies |url=https://linkinghub.elsevier.com/retrieve/pii/S2213858724002018 |journal=The Lancet Diabetes & Endocrinology |volume=12 |issue=11 |pages=790–98 |language=en |doi=10.1016/S2213-8587(24)00201-8|pmid=39326426 |url-access=subscription }} The study highlighted that 2-hour post-load glucose levels of at least 9 mmol/L were strong predictors of cardiovascular outcomes, while HbA1c levels of at least 5.9% were also significant but not independently associated when combined with OGTT results.{{Cite web |date=2024-10-16 |title=Oral Glucose Tolerance Test Superior to HbA1c in Coronary Artery Disease |url=https://www.endocrinologyadvisor.com/news/oral-glucose-tolerance-test-superior-to-hba1c/ |access-date=2024-10-19 |website=Endocrinology Advisor |language=en-US}}

{{Main|Diet and heart disease}}

A diet high in fruits and vegetables decreases the risk of cardiovascular disease and death.{{cite journal | vauthors = Wang X, Ouyang Y, Liu J, Zhu M, Zhao G, Bao W, Hu FB | title = Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies | journal = BMJ | volume = 349 | pages = g4490 | date = July 2014 | pmid = 25073782 | pmc = 4115152 | doi = 10.1136/bmj.g4490 }} Vegetarians have a lower risk of heart disease,{{cite journal | vauthors = Li D | title = Effect of the vegetarian diet on non-communicable diseases | journal = Journal of the Science of Food and Agriculture | volume = 94 | issue = 2 | pages = 169–73 | date = January 2014 | pmid = 23965907 | doi = 10.1002/jsfa.6362 | bibcode = 2014JSFA...94..169L }}{{cite journal | vauthors = Huang T, Yang B, Zheng J, Li G, Wahlqvist ML, Li D | title = Cardiovascular disease mortality and cancer incidence in vegetarians: a meta-analysis and systematic review | journal = Annals of Nutrition & Metabolism | volume = 60 | issue = 4 | pages = 233–40 | date = 2012 | pmid = 22677895 | doi = 10.1159/000337301 | doi-access = free }} possibly due to their greater consumption of fruits and vegetables.{{cite journal | vauthors = Ginter E | title = Vegetarian diets, chronic diseases and longevity | journal = Bratislavske Lekarske Listy | volume = 109 | issue = 10 | pages = 463–66 | date = 2008 | pmid = 19166134 }} Evidence also suggests that the Mediterranean diet{{cite journal | vauthors = Walker C, Reamy BV | title = Diets for cardiovascular disease prevention: what is the evidence? | journal = American Family Physician | volume = 79 | issue = 7 | pages = 571–78 | date = April 2009 | pmid = 19378874 }} and a high fiber diet lower the risk.{{cite journal | vauthors = Threapleton DE, Greenwood DC, Evans CE, Cleghorn CL, Nykjaer C, Woodhead C, Cade JE, Gale CP, Burley VJ | display-authors = 6 | title = Dietary fibre intake and risk of cardiovascular disease: systematic review and meta-analysis | journal = BMJ | volume = 347 | pages = f6879 | date = December 2013 | pmid = 24355537 | pmc = 3898422 | doi = 10.1136/bmj.f6879 }}{{cite journal | vauthors = Reynolds A, Mann J, Cummings J, Winter N, Mete E, Te Morenga L | title = Carbohydrate quality and human health: a series of systematic reviews and meta-analyses | journal = Lancet | volume = 393 | issue = 10170 | pages = 434–45 | date = February 2019 | pmid = 30638909 | doi = 10.1016/S0140-6736(18)31809-9 | s2cid = 58632705 | doi-access = free }}

The consumption of trans fat (commonly found in hydrogenated products such as margarine) has been shown to cause a precursor to atherosclerosis{{cite journal | vauthors = Lopez-Garcia E, Schulze MB, Meigs JB, Manson JE, Rifai N, Stampfer MJ, Willett WC, Hu FB | display-authors = 6 | title = Consumption of trans fatty acids is related to plasma biomarkers of inflammation and endothelial dysfunction | journal = The Journal of Nutrition | volume = 135 | issue = 3 | pages = 562–66 | date = March 2005 | pmid = 15735094 | doi = 10.1093/jn/135.3.562 | doi-access = free }} and increase the risk of coronary artery disease.{{cite journal | vauthors = Mozaffarian D, Katan MB, Ascherio A, Stampfer MJ, Willett WC | title = Trans fatty acids and cardiovascular disease | journal = The New England Journal of Medicine | volume = 354 | issue = 15 | pages = 1601–13 | date = April 2006 | pmid = 16611951 | doi = 10.1056/NEJMra054035 }}

Evidence does not support a beneficial role for omega-3 fatty acid supplementation in preventing cardiovascular disease (including myocardial infarction and sudden cardiac death).{{cite journal | vauthors = Rizos EC, Ntzani EE, Bika E, Kostapanos MS, Elisaf MS | title = Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and meta-analysis | journal = JAMA | volume = 308 | issue = 10 | pages = 1024–33 | date = September 2012 | pmid = 22968891 | doi = 10.1001/2012.jama.11374 }}{{cite journal | vauthors = Kwak SM, Myung SK, Lee YJ, Seo HG | title = Efficacy of omega-3 fatty acid supplements (eicosapentaenoic acid and docosahexaenoic acid) in the secondary prevention of cardiovascular disease: a meta-analysis of randomized, double-blind, placebo-controlled trials | journal = Archives of Internal Medicine | volume = 172 | issue = 9 | pages = 686–94 | date = May 2012 | pmid = 22493407 | doi = 10.1001/archinternmed.2012.262 | doi-access = free }}

Secondary prevention is preventing further sequelae of already established disease. Effective lifestyle changes include:

• Weight control
• Smoking cessation
• Avoiding the consumption of trans fats (in partially hydrogenated oils)
• Decreasing psychosocial stress{{cite journal | vauthors = Linden W, Stossel C, Maurice J | title = Psychosocial interventions for patients with coronary artery disease: a meta-analysis | journal = Archives of Internal Medicine | volume = 156 | issue = 7 | pages = 745–52 | date = April 1996 | pmid = 8615707 | doi = 10.1001/archinte.1996.00440070065008 }}
• Exercise

Aerobic exercise, like walking, jogging, or swimming, can reduce the risk of mortality from coronary artery disease.{{cite journal | vauthors = Swardfager W, Herrmann N, Cornish S, Mazereeuw G, Marzolini S, Sham L, Lanctôt KL | title = Exercise intervention and inflammatory markers in coronary artery disease: a meta-analysis | journal = American Heart Journal | volume = 163 | issue = 4 | pages = 666–76.e1–3 | date = April 2012 | pmid = 22520533 | doi = 10.1016/j.ahj.2011.12.017 }} Aerobic exercise can help decrease blood pressure and the amount of blood cholesterol (LDL) over time. It also increases HDL cholesterol.{{cite web|title=Coronary Heart Disease (CHD)|url=http://www.credoreference.com/entry/penguinbio/coronary_heart_disease_chd|location=Penguin Dictionary of Biology|year=2004}}

Although exercise is beneficial, it is unclear whether doctors should spend time counseling patients to exercise. The U.S. Preventive Services Task Force found "insufficient evidence" to recommend that doctors counsel patients on exercise but "it did not review the evidence for the effectiveness of physical activity to reduce chronic disease, morbidity, and mortality", only the effectiveness of counseling itself.{{cite journal | title = Behavioral counseling in primary care to promote physical activity: recommendation and rationale | journal = Annals of Internal Medicine | volume = 137 | issue = 3 | pages = 205–07 | date = August 2002 | pmid = 12160370 | doi = 10.7326/0003-4819-137-3-200208060-00014 | s2cid = 38338385 | author1 = U.S. Preventive Services Task Force }} The American Heart Association, based on a non-systematic review, recommends that doctors counsel patients on exercise.{{cite journal |author6-link=Bess Marcus | vauthors = Thompson PD, Buchner D, Pina IL, Balady GJ, Williams MA, Marcus BH, Berra K, Blair SN, Costa F, Franklin B, Fletcher GF, Gordon NF, Pate RR, Rodriguez BL, Yancey AK, Wenger NK | display-authors = 6 | title = Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity) | journal = Circulation | volume = 107 | issue = 24 | pages = 3109–16 | date = June 2003 | pmid = 12821592 | doi = 10.1161/01.CIR.0000075572.40158.77 | doi-access = free }}

Psychological symptoms are common in people with CHD. Many psychological treatments may be offered following cardiac events. There is no evidence that they change mortality, the risk of revascularization procedures, or the rate of non-fatal myocardial infarction.{{cite journal | vauthors = Richards SH, Anderson L, Jenkinson CE, Whalley B, Rees K, Davies P, Bennett P, Liu Z, West R, Thompson DR, Taylor RS | display-authors = 6 | title = Psychological interventions for coronary heart disease | journal = The Cochrane Database of Systematic Reviews | volume = 4 | issue = 2 | pages = CD002902 | date = April 2017 | pmid = 28452408 | pmc = 6478177 | doi = 10.1002/14651858.CD002902.pub4 | collaboration = Cochrane Heart Group }}

Antibiotics for secondary prevention of coronary heart disease

Early studies suggested that antibiotics might help patients with coronary disease to reduce the risk of heart attacks and strokes.{{cite journal | vauthors = Sethi NJ, Safi S, Korang SK, Hróbjartsson A, Skoog M, Gluud C, Jakobsen JC | title = Antibiotics for secondary prevention of coronary heart disease | journal = The Cochrane Database of Systematic Reviews | volume = 2 | issue = 5 | pages = CD003610 | date = February 2021 | pmid = 33704780 | pmc = 8094925 | doi = 10.1002/14651858.CD003610.pub4 | collaboration = Cochrane Heart Group }} However, a 2021 Cochrane meta-analysis found that antibiotics given for secondary prevention of coronary heart disease are harmful to people with increased mortality and occurrence of stroke. So, antibiotic use is not currently supported for preventing secondary coronary heart disease.

A thorough systematic review found that indeed there is a link between a CHD condition and brain dysfunction in females.{{cite journal | vauthors = Narvaez Linares NF, Poitras M, Burkauskas J, Nagaratnam K, Burr Z, Labelle PR, Plamondon H | title = Neuropsychological Sequelae of Coronary Heart Disease in Women: A Systematic Review | journal = Neuroscience and Biobehavioral Reviews | volume = 127 | pages = 837–51 | date = August 2021 | pmid = 34062209 | doi = 10.1016/j.neubiorev.2021.05.026 | s2cid = 235245540 }} Consequently, since research is showing that cardiovascular diseases, like CHD, can play a role as a precursor for dementia, like Alzheimer's disease, individuals with CHD should have a neuropsychological assessment.{{Cite journal |last1=Deckers |first1=Kay |last2=Schievink |first2=Syenna H. J. |last3=Rodriquez |first3=Maria M. F. |last4=Oostenbrugge |first4=Robert J. van |last5=Boxtel |first5=Martin P. J. van |last6=Verhey |first6=Frans R. J. |last7=Köhler |first7=Sebastian |date=2017-09-08 |title=Coronary heart disease and risk for cognitive impairment or dementia: Systematic review and meta-analysis |journal=PLOS ONE |language=en |volume=12 |issue=9 |pages=e0184244 |doi=10.1371/journal.pone.0184244 |issn=1932-6203 |pmc=5590905 |pmid=28886155|bibcode=2017PLoSO..1284244D |doi-access=free }}

There are a number of treatment options for coronary artery disease:{{cite book|vauthors=Jameson JN, Kasper DL, Harrison TR, Braunwald E, Fauci AS, Hauser SL, Longo DL|title=Harrison's principles of internal medicine|publisher=McGraw-Hill Medical Publishing Division|location=New York|year=2005|edition=16th|isbn=978-0-07-140235-4|url=http://highered.mcgraw-hill.com/sites/0071402357/information_center_view0|oclc=54501403|access-date=26 October 2015|url-status=dead|archive-url=https://web.archive.org/web/20140219090440/http://highered.mcgraw-hill.com/sites/0071402357/information_center_view0/|archive-date=19 February 2014}}

• Lifestyle changes
• Medical treatment – commonly prescribed drugs (e.g., cholesterol lowering medications, beta-blockers, nitroglycerin, calcium channel blockers, etc.);
• Coronary interventions as angioplasty and coronary stent;
• Coronary artery bypass grafting (CABG)

• Statins, which reduce cholesterol, reduce the risk of coronary artery disease{{cite journal | vauthors = Gutierrez J, Ramirez G, Rundek T, Sacco RL | title = Statin therapy in the prevention of recurrent cardiovascular events: a sex-based meta-analysis | journal = Archives of Internal Medicine | volume = 172 | issue = 12 | pages = 909–19 | date = June 2012 | pmid = 22732744 | doi = 10.1001/archinternmed.2012.2145 | doi-access = free }}
• Nitroglycerin{{MedlinePlusEncyclopedia|a601086|Nitroglycerin Sublingual}}
• Calcium channel blockers and/or beta-blockers{{cite journal | vauthors = Ohman EM | title = Clinical Practice: Chronic Stable Angina | journal = The New England Journal of Medicine | volume = 374 | issue = 12 | pages = 1167–76 | date = March 2016 | pmid = 27007960 | doi = 10.1056/NEJMcp1502240 }}
• Antiplatelet drugs such as aspirin{{cite journal | vauthors = Grove EL, Würtz M, Thomas MR, Kristensen SD | title = Antiplatelet therapy in acute coronary syndromes | journal = Expert Opinion on Pharmacotherapy | volume = 16 | issue = 14 | pages = 2133–47 | date = 2015 | pmid = 26293612 | doi = 10.1517/14656566.2015.1079619 | type = Review | s2cid = 9841653 }}

It is recommended that blood pressure typically be reduced to less than 140/90 mmHg. The diastolic blood pressure should not be below 60 mmHg. Beta-blockers are recommended first line for this use.{{cite journal | vauthors = Rosendorff C, Lackland DT, Allison M, Aronow WS, Black HR, Blumenthal RS, Cannon CP, de Lemos JA, Elliott WJ, Findeiss L, Gersh BJ, Gore JM, Levy D, Long JB, O'Connor CM, O'Gara PT, Ogedegbe G, Oparil S, White WB | display-authors = 6 | title = Treatment of hypertension in patients with coronary artery disease: a scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension | journal = Circulation | volume = 131 | issue = 19 | pages = e435–70 | date = May 2015 | pmid = 25829340 | doi = 10.1161/cir.0000000000000207 | pmc = 8365343 | doi-access = free }}

In those with no previous history of heart disease, aspirin decreases the risk of a myocardial infarction but does not change the overall risk of death.{{cite journal | vauthors = Guirguis-Blake JM, Evans CV, Senger CA, O'Connor EA, Whitlock EP | title = Aspirin for the Primary Prevention of Cardiovascular Events: A Systematic Evidence Review for the U.S. Preventive Services Task Force | journal = Annals of Internal Medicine | volume = 164 | issue = 12 | pages = 804–13 | date = June 2016 | pmid = 27064410 | doi = 10.7326/M15-2113 | type = Systematic Review and Meta-Analysis | doi-access = free }} Aspirin therapy to prevent heart disease is thus recommended only in adults who are at increased risk for cardiovascular events, which may include postmenopausal females, males above 40, and younger people with risk factors for coronary heart disease, including high blood pressure, a family history of heart disease, or diabetes. The benefits outweigh the harms most favorably in people at high risk for a cardiovascular event, where high risk is defined as at least a 3% chance over five years, but others with lower risk may still find the potential benefits worth the associated risks.{{cite journal | author = U.S. Preventive Services Task Force | title = Aspirin for the primary prevention of cardiovascular events: recommendation and rationale | journal = Annals of Internal Medicine | volume = 136 | issue = 2 | pages = 157–60 | date = January 2002 | pmid = 11790071 | doi = 10.7326/0003-4819-136-2-200201150-00015 | doi-access = free }}

Clopidogrel plus aspirin (dual anti-platelet therapy) reduces cardiovascular events more than aspirin alone in those with a STEMI. In others at high risk but not having an acute event, the evidence is weak.{{cite journal | vauthors = Squizzato A, Bellesini M, Takeda A, Middeldorp S, Donadini MP | title = Clopidogrel plus aspirin versus aspirin alone for preventing cardiovascular events | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | pages = CD005158 | date = December 2017 | issue = 12 | pmid = 29240976 | pmc = 6486024 | doi = 10.1002/14651858.CD005158.pub4 }} Specifically, its use does not change the risk of death in this group.{{cite web|title=FDA Drug Safety Communication: FDA review finds long-term treatment with blood-thinning medicine Plavix (clopidogrel) does not change risk of death|url=https://www.fda.gov/Drugs/DrugSafety/ucm471286.htm|website=FDA|access-date=25 January 2016|date=6 November 2015|url-status=dead|archive-url=https://web.archive.org/web/20160204011823/https://www.fda.gov/Drugs/DrugSafety/ucm471286.htm|archive-date=4 February 2016}} In those who have had a stent, more than 12 months of clopidogrel plus aspirin does not affect the risk of death.{{cite journal | vauthors = Elmariah S, Mauri L, Doros G, Galper BZ, O'Neill KE, Steg PG, Kereiakes DJ, Yeh RW | display-authors = 6 | title = Extended duration dual antiplatelet therapy and mortality: a systematic review and meta-analysis | journal = Lancet | volume = 385 | issue = 9970 | pages = 792–98 | date = February 2015 | pmid = 25467565 | pmc = 4386690 | doi = 10.1016/S0140-6736(14)62052-3 }}

Revascularization for acute coronary syndrome has a mortality benefit.{{cite journal | vauthors = Braunwald E, Antman EM, Beasley JW, Califf RM, Cheitlin MD, Hochman JS, Jones RH, Kereiakes D, Kupersmith J, Levin TN, Pepine CJ, Schaeffer JW, Smith EE, Steward DE, Theroux P, Gibbons RJ, Alpert JS, Faxon DP, Fuster V, Gregoratos G, Hiratzka LF, Jacobs AK, Smith SC | display-authors = 6 | title = ACC/AHA guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction—2002: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina) | journal = Circulation | volume = 106 | issue = 14 | pages = 1893–900 | date = October 2002 | pmid = 12356647 | doi = 10.1161/01.CIR.0000037106.76139.53 | doi-access = free }} Percutaneous revascularization for stable ischaemic heart disease does not appear to have benefits over medical therapy alone.{{cite journal | vauthors = Stergiopoulos K, Boden WE, Hartigan P, Möbius-Winkler S, Hambrecht R, Hueb W, Hardison RM, Abbott JD, Brown DL | display-authors = 6 | title = Percutaneous coronary intervention outcomes in patients with stable obstructive coronary artery disease and myocardial ischemia: a collaborative meta-analysis of contemporary randomized clinical trials | journal = JAMA Internal Medicine | volume = 174 | issue = 2 | pages = 232–40 | date = February 2014 | pmid = 24296791 | doi = 10.1001/jamainternmed.2013.12855 | doi-access = free }} In those with disease in more than one artery, coronary artery bypass grafts appear better than percutaneous coronary interventions.{{cite journal | vauthors = Sipahi I, Akay MH, Dagdelen S, Blitz A, Alhan C | title = Coronary artery bypass grafting vs percutaneous coronary intervention and long-term mortality and morbidity in multivessel disease: meta-analysis of randomized clinical trials of the arterial grafting and stenting era | journal = JAMA Internal Medicine | volume = 174 | issue = 2 | pages = 223–30 | date = February 2014 | pmid = 24296767 | doi = 10.1001/jamainternmed.2013.12844 | doi-access = free }} Newer "anaortic" or no-touch off-pump coronary artery revascularization techniques have shown reduced postoperative stroke rates comparable to percutaneous coronary intervention.{{cite journal | vauthors = Zhao DF, Edelman JJ, Seco M, Bannon PG, Wilson MK, Byrom MJ, Thourani V, Lamy A, Taggart DP, Puskas JD, Vallely MP | display-authors = 6 | title = Coronary Artery Bypass Grafting With and Without Manipulation of the Ascending Aorta: A Network Meta-Analysis | journal = Journal of the American College of Cardiology | volume = 69 | issue = 8 | pages = 924–36 | date = February 2017 | pmid = 28231944 | doi = 10.1016/j.jacc.2016.11.071 | doi-access = free }} Hybrid coronary revascularization has also been shown to be a safe and feasible procedure that may offer some advantages over conventional CABG though it is more expensive.{{cite journal | vauthors = Reynolds AC, King N | title = Hybrid coronary revascularization versus conventional coronary artery bypass grafting: Systematic review and meta-analysis | journal = Medicine | volume = 97 | issue = 33 | pages = e11941 | date = August 2018 | pmid = 30113498 | pmc = 6112891 | doi = 10.1097/MD.0000000000011941 }}

File:Ischaemic heart disease world map-Deaths per million persons-WHO2012.svg

File:Ischaemic heart disease world map - DALY - WHO2004.svg for ischaemic heart disease per 100,000 inhabitants in 2004.{{cite web|url=https://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html|title=WHO Disease and injury country estimates|year=2009|website=World Health Organization|access-date=11 November 2009|url-status=live|archive-url=https://web.archive.org/web/20091111101009/http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html|archive-date=11 November 2009}}{{Div col|small=yes|colwidth=10em}}

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As of 2010, CAD was the leading cause of death globally resulting in over 7 million deaths. This increased from 5.2 million deaths from CAD worldwide in 1990.{{cite journal | vauthors = Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Barker-Collo S, Bartels DH, Bell ML, Benjamin EJ, Bennett D, Bhalla K, Bikbov B, Bin Abdulhak A, Birbeck G, Blyth F, Bolliger I, Boufous S, Bucello C, Burch M, Burney P, Carapetis J, Chen H, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahodwala N, De Leo D, Degenhardt L, Delossantos A, Denenberg J, Des Jarlais DC, Dharmaratne SD, Dorsey ER, Driscoll T, Duber H, Ebel B, Erwin PJ, Espindola P, Ezzati M, Feigin V, Flaxman AD, Forouzanfar MH, Fowkes FG, Franklin R, Fransen M, Freeman MK, Gabriel SE, Gakidou E, Gaspari F, Gillum RF, Gonzalez-Medina D, Halasa YA, Haring D, Harrison JE, Havmoeller R, Hay RJ, Hoen B, Hotez PJ, Hoy D, Jacobsen KH, James SL, Jasrasaria R, Jayaraman S, Johns N, Karthikeyan G, Kassebaum N, Keren A, Khoo JP, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lipnick M, Lipshultz SE, Ohno SL, Mabweijano J, MacIntyre MF, Mallinger L, March L, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGrath J, Mensah GA, Merriman TR, Michaud C, Miller M, Miller TR, Mock C, Mocumbi AO, Mokdad AA, Moran A, Mulholland K, Nair MN, Naldi L, Narayan KM, Nasseri K, Norman P, O'Donnell M, Omer SB, Ortblad K, Osborne R, Ozgediz D, Pahari B, Pandian JD, Rivero AP, Padilla RP, Perez-Ruiz F, Perico N, Phillips D, Pierce K, Pope CA, Porrini E, Pourmalek F, Raju M, Ranganathan D, Rehm JT, Rein DB, Remuzzi G, Rivara FP, Roberts T, De León FR, Rosenfeld LC, Rushton L, Sacco RL, Salomon JA, Sampson U, Sanman E, Schwebel DC, Segui-Gomez M, Shepard DS, Singh D, Singleton J, Sliwa K, Smith E, Steer A, Taylor JA, Thomas B, Tleyjeh IM, Towbin JA, Truelsen T, Undurraga EA, Venketasubramanian N, Vijayakumar L, Vos T, Wagner GR, Wang M, Wang W, Watt K, Weinstock MA, Weintraub R, Wilkinson JD, Woolf AD, Wulf S, Yeh PH, Yip P, Zabetian A, Zheng ZJ, Lopez AD, Murray CJ, AlMazroa MA, Memish ZA | display-authors = 6 | title = Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 | journal = Lancet | volume = 380 | issue = 9859 | pages = 2095–128 | date = December 2012 | pmid = 23245604 | doi = 10.1016/S0140-6736(12)61728-0 | pmc = 10790329 | hdl-access = free | s2cid = 1541253 | hdl = 10536/DRO/DU:30050819 | url = https://repozitorij.upr.si/Dokument.php?id=7123&dn= }} It may affect individuals at any age but becomes dramatically more common at progressively older ages, with approximately a tripling with each decade of life.{{cite journal | vauthors = Finegold JA, Asaria P, Francis DP | title = Mortality from ischaemic heart disease by country, region, and age: statistics from World Health Organisation and United Nations | journal = International Journal of Cardiology | volume = 168 | issue = 2 | pages = 934–45 | date = September 2013 | pmid = 23218570 | pmc = 3819990 | doi = 10.1016/j.ijcard.2012.10.046 }} Males are affected more often than females.

The World Health Organization reported that: "The world's biggest killer is ischemic heart disease, responsible for 13% of the world's total deaths. Since 2000, the largest increase in deaths has been for this disease, rising by 2.7 million to 9.1 million deaths in 2021."{{Cite web |title=The top 10 causes of death |url=https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death |access-date=2024-08-12 |website=www.who.int |language=en}}

It is estimated that 60% of the world's cardiovascular disease burden will occur in the South Asian subcontinent despite only accounting for 20% of the world's population. This may be secondary to a combination of genetic predisposition and environmental factors. Organizations such as the Indian Heart Association are working with the World Heart Federation to raise awareness about this issue.[http://indianheartassociation.org/why-indians-why-south-asians/overview Indian Heart Association Why South Asians Facts] {{webarchive|url=https://web.archive.org/web/20150518111218/http://indianheartassociation.org/why-indians-why-south-asians/overview/ |date=18 May 2015 }}, 29 April 2015; accessed 26 October 2015.

Coronary artery disease is the leading cause of death for both males and females and accounts for approximately 600,000 deaths in the United States every year.{{cite journal | vauthors = Kochanek KD, Xu J, Murphy SL, Miniño AM, Kung HC | title = Deaths: final data for 2009 | journal = National Vital Statistics Reports | volume = 60 | issue = 3 | pages = 1–116 | date = December 2011 | pmid = 24974587 | url = https://www.cdc.gov/nchs/https://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_03.pdf }} According to present trends in the United States, half of healthy 40-year-old males will develop CAD in the future, and one in three healthy 40-year-old females.{{cite journal | vauthors = Rosamond W, Flegal K, Friday G, Furie K, Go A, Greenlund K, Haase N, Ho M, Howard V, Kissela B, Kissela B, Kittner S, Lloyd-Jones D, McDermott M, Meigs J, Moy C, Nichol G, O'Donnell CJ, Roger V, Rumsfeld J, Sorlie P, Steinberger J, Thom T, Wasserthiel-Smoller S, Hong Y | display-authors = 6 | title = Heart disease and stroke statistics—2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee | journal = Circulation | volume = 115 | issue = 5 | pages = e69–171 | date = February 2007 | pmid = 17194875 | doi = 10.1161/CIRCULATIONAHA.106.179918 | doi-access = free }} It is the most common reason for death of males and females over 20 years of age in the United States.{{Cite web |title=Heart Disease and Stroke Statistics {{!}} American Heart Association (AHA)|url=http://www.americanheart.org/presenter.jhtml?identifier=3000090 |year=2007 |access-date=2023-12-12 |archive-url=https://web.archive.org/web/20081220112752/http://www.americanheart.org:80/presenter.jhtml?identifier=3000090 |archive-date=2008-12-20}}

After analysing data from 2 111 882 patients, the recent meta-analysis revealed that the incidence of coronary artery diseases in breast cancer survivors was 4.29 (95% CI 3.09–5.94) per 1000 person-years.{{Cite journal |last1=Galimzhanov |first1=Akhmetzhan |last2=Istanbuly |first2=Sedralmontaha |last3=Tun |first3=Han Naung |last4=Ozbay |first4=Benay |last5=Alasnag |first5=Mirvat |last6=Ky |first6=Bonnie |last7=Lyon |first7=Alexander R |last8=Kayikcioglu |first8=Meral |last9=Tenekecioglu |first9=Erhan |last10=Panagioti |first10=Maria |last11=Kontopantelis |first11=Evangelos |last12=Abdel-Qadir |first12=Husam |last13=Mamas |first13=Mamas A |date=2023-07-27 |title=Cardiovascular outcomes in breast cancer survivors: a systematic review and meta-analysis |url=https://academic.oup.com/eurjpc/advance-article/doi/10.1093/eurjpc/zwad243/7232455 |journal=European Journal of Preventive Cardiology |volume=30 |issue=18 |pages=2018–31 |language=en |doi=10.1093/eurjpc/zwad243 |pmid=37499186 |issn=2047-4873|doi-access=free }}

Other terms sometimes used for this condition are "hardening of the arteries" and "narrowing of the arteries".{{cite web|title=Other Names for Coronary Heart Disease|url=http://www.nhlbi.nih.gov/health/health-topics/topics/cad/names|access-date=23 February 2015|date=29 September 2014|url-status=live|archive-url=https://web.archive.org/web/20150213015725/http://www.nhlbi.nih.gov/health/health-topics/topics/cad/names|archive-date=13 February 2015}} In Latin it is known as morbus ischaemicus cordis (MIC).

The Infarct Combat Project (ICP) is an international nonprofit organization founded in 1998 which tries to decrease ischemic heart diseases through education and research.{{cite web |title=Our Mission |url=http://www.infarctcombat.org/OurMission.html |website=Infarct Combat Project }}

In 2016 research into the internal documents of the Sugar Research Foundation, the trade association for the sugar industry in the US, had sponsored an influential literature review published in 1965 in the New England Journal of Medicine that downplayed early findings about the role of a diet heavy in sugar in the development of CAD and emphasized the role of fat; that review influenced decades of research funding and guidance on healthy eating.O'Connor, Anahad, [https://www.nytimes.com/2016/09/13/well/eat/how-the-sugar-industry-shifted-blame-to-fat.html "How the Sugar Industry Shifted Blame to Fat"] {{webarchive|url=https://web.archive.org/web/20170228172339/https://www.nytimes.com/2016/09/13/well/eat/how-the-sugar-industry-shifted-blame-to-fat.html |date=28 February 2017 }}, The New York Times, 12 September 2016. Retrieved 12 September 2016.{{cite journal | vauthors = Nestle M | title = Food Industry Funding of Nutrition Research: The Relevance of History for Current Debates | journal = JAMA Internal Medicine | volume = 176 | issue = 11 | pages = 1685–86 | date = November 2016 | pmid = 27618496 | doi = 10.1001/jamainternmed.2016.5400 }}{{cite journal | vauthors = Kearns CE, Schmidt LA, Glantz SA | title = Sugar Industry and Coronary Heart Disease Research: A Historical Analysis of Internal Industry Documents | journal = JAMA Internal Medicine | volume = 176 | issue = 11 | pages = 1680–85 | date = November 2016 | pmid = 27617709 | pmc = 5099084 | doi = 10.1001/jamainternmed.2016.5394 }}{{cite news| vauthors = Ifill G |title=How the sugar industry paid experts to downplay health risks|url=https://www.pbs.org/newshour/bb/sugar-industry-paid-experts-downplay-health-risks/|work=PBS NewsHour|date=13 September 2016|url-status=live|archive-url=https://web.archive.org/web/20170820202628/http://www.pbs.org/newshour/bb/sugar-industry-paid-experts-downplay-health-risks/|archive-date=20 August 2017}}

{{further|Atheroma|Atherosclerosis}}

Research efforts are focused on new angiogenic treatment modalities and various (adult) stem-cell therapies. A region on chromosome 17 was confined to families with multiple cases of myocardial infarction.{{cite journal | vauthors = Farrall M, Green FR, Peden JF, Olsson PG, Clarke R, Hellenius ML, Rust S, Lagercrantz J, Franzosi MG, Schulte H, Carey A, Olsson G, Assmann G, Tognoni G, Collins R, Hamsten A, Watkins H | display-authors = 6 | title = Genome-wide mapping of susceptibility to coronary artery disease identifies a novel replicated locus on chromosome 17 | journal = PLOS Genetics | volume = 2 | issue = 5 | pages = e72 | date = May 2006 | pmid = 16710446 | pmc = 1463045 | doi = 10.1371/journal.pgen.0020072 | doi-access = free }} Other genome-wide studies have identified a firm risk variant on chromosome 9 (9p21.3).{{cite journal | vauthors = Roberts R, Stewart AF | title = 9p21 and the genetic revolution for coronary artery disease | journal = Clinical Chemistry | volume = 58 | issue = 1 | pages = 104–12 | date = January 2012 | pmid = 22015375 | doi = 10.1373/clinchem.2011.172759 | doi-access = free }} However, these and other loci are found in intergenic segments and need further research in understanding how the phenotype is affected.{{cite journal | vauthors = Dandona S, Stewart AF, Roberts R | title = Genomics in coronary artery disease: past, present and future | journal = The Canadian Journal of Cardiology | volume = 26 | issue = Suppl A | pages = 56A–59A | date = March 2010 | pmid = 20386763 | doi = 10.1016/s0828-282x(10)71064-3 }}

A more controversial link is that between Chlamydophila pneumoniae infection and atherosclerosis.{{cite journal | vauthors = Saikku P, Leinonen M, Tenkanen L, Linnanmäki E, Ekman MR, Manninen V, Mänttäri M, Frick MH, Huttunen JK | display-authors = 6 | title = Chronic Chlamydia pneumoniae infection as a risk factor for coronary heart disease in the Helsinki Heart Study | journal = Annals of Internal Medicine | volume = 116 | issue = 4 | pages = 273–78 | date = February 1992 | pmid = 1733381 | doi = 10.7326/0003-4819-116-4-273 | s2cid = 21496102 }} While this intracellular organism has been demonstrated in atherosclerotic plaques, evidence is inconclusive regarding whether it can be considered a causative factor.{{cite journal | vauthors = Grayston JT, Belland RJ, Byrne GI, Kuo CC, Schachter J, Stamm WE, Zhong G | title = Infection with Chlamydia pneumoniae as a cause of coronary heart disease: the hypothesis is still untested | journal = Pathogens and Disease | volume = 73 | issue = 1 | pages = 1–9 | date = February 2015 | pmid = 25854002 | pmc = 4492408 | doi = 10.1093/femspd/ftu015 }} Treatment with antibiotics in patients with proven atherosclerosis has not demonstrated a decreased risk of heart attacks or other coronary vascular diseases.{{cite journal | vauthors = Andraws R, Berger JS, Brown DL | title = Effects of antibiotic therapy on outcomes of patients with coronary artery disease: a meta-analysis of randomized controlled trials | journal = JAMA | volume = 293 | issue = 21 | pages = 2641–47 | date = June 2005 | pmid = 15928286 | doi = 10.1001/jama.293.21.2641 }}

Myeloperoxidase has been proposed as a biomarker.{{cite journal | vauthors = Loria V, Dato I, Graziani F, Biasucci LM | title = Myeloperoxidase: a new biomarker of inflammation in ischemic heart disease and acute coronary syndromes | journal = Mediators of Inflammation | volume = 2008 | pages = 135625 | year = 2008 | pmid = 18382609 | pmc = 2276594 | doi = 10.1155/2008/135625 | doi-access = free }}

Plant-based nutrition has been suggested as a way to reverse coronary artery disease,{{cite journal | vauthors = Esselstyn CB, Gendy G, Doyle J, Golubic M, Roizen MF | title = A way to reverse CAD? | journal = The Journal of Family Practice | volume = 63 | issue = 7 | pages = 356–64b | date = July 2014 | pmid = 25198208 | url = https://cdn.mdedge.com/files/s3fs-public/Document/September-2017/JFP_06307_Article1.pdf }} but strong evidence is still lacking for claims of potential benefits.{{cite journal | vauthors = Freeman AM, Morris PB, Barnard N, Esselstyn CB, Ros E, Agatston A, Devries S, O'Keefe J, Miller M, Ornish D, Williams K, Kris-Etherton P | display-authors = 6 | title = Trending Cardiovascular Nutrition Controversies | journal = Journal of the American College of Cardiology | volume = 69 | issue = 9 | pages = 1172–87 | date = March 2017 | pmid = 28254181 | doi = 10.1016/j.jacc.2016.10.086 | doi-access = free }}

Several immunosuppressive drugs targeting the chronic inflammation in coronary artery disease have been tested.{{cite journal | vauthors = Mikkelsen RR, Hundahl MP, Torp CK, Rodríguez-Carrio J, Kjolby M, Bruun JM, Kragstrup TW | title = Immunomodulatory and immunosuppressive therapies in cardiovascular disease and type 2 diabetes mellitus: A bedside-to-bench approach | journal = Eur J Pharmacol | year = 2022 | volume = 925 | page = 174998 | pmid = 35533739 | doi = 10.1016/j.ejphar.2022.174998 | s2cid = 248589827 | doi-access = free }}

• Mental stress-induced myocardial ischemia

{{Reflist}}

• [https://web.archive.org/web/20151231195936/http://www.heart.org/HEARTORG/Conditions/HeartAttack/HeartAttackToolsResources/Heart-Attack-Risk-Assessment_UCM_303944_Article.jsp Risk Assessment of having a heart attack or dying of coronary artery disease], from the American Heart Association.
• {{cite web | url = https://medlineplus.gov/coronaryarterydisease.html | publisher = U.S. National Library of Medicine | work = MedlinePlus | title = Coronary Artery Disease }}
• {{Cite web |last=Norman |first=James |date=2019-10-07 |title=Managing Diabetes with Blood Glucose Control |url=https://www.endocrineweb.com/conditions/diabetes/assessing-how-well-diabetes-controlled |website=Endocrineweb}}

{{Medical condition classification and resources

| DiseasesDB =

| ICD11 = {{ICD11|BA40}}–{{ICD11|BA60}}, {{ICD11|BA81}}–{{ICD11|BA86}}, {{ICD11|BE1A}}

| ICD10 = {{ICD10|I20-I25}}

| ICD9 = {{ICD9|410}}-{{ICD9|414}}, {{ICD9|429.2}}

| ICDO =

| OMIM =

| MedlinePlus = 007115

| eMedicineSubj = radio

| eMedicineTopic = 192

| MeshID = D003324

}}

{{Circulatory system pathology}}

{{Vascular diseases}}

{{Cigarettes}}

{{Authority control}}

{{DEFAULTSORT:Coronary Artery Disease}}

Category:Aging-associated diseases

Category:Heart diseases

Category:Ischemic heart diseases

Category:Wikipedia medicine articles ready to translate

Category:Wikipedia emergency medicine articles ready to translate