Coronary Artery Disease Risk Factors

Coronary artery disease (CAD) is a common condition that affects about 20 million Americans, including 1 in 5 older Americans. Marc Sabatine, MD, MPH answers patients’ most commonly searched questions about coronary artery disease prevention and treatment. Dr. Sabatine is a Mass General Brigham cardiologist. He is the Chair of the TIMI Study Group at Brigham and Women’s Hospital.

“This is a preventable disease,” says Dr. Sabatine. “It's incumbent on all of us to take action early to help prevent this disease from developing.”

Coronary artery disease is the buildup of atherosclerotic plaque, made of cholesterol and other substances, in the walls of the coronary arteries. Each person has three major coronary arteries that deliver blood, oxygen, and nutrients to the heart muscle. If too much plaque builds up in the coronary arteries, it can affect blood flow to the heart and cause serious issues like heart attacks. 

Research has found that the four main risk factors for coronary artery disease are:

    1.    High cholesterol
    2.    High blood pressure
    3.    Smoking
    4.    Diabetes

“When we talk about prevention, there are two fundamental approaches,” says Dr. Sabatine. “One is with lifestyle modification, including diet and exercise, and the other one is through medications.”

To help reduce your risk of coronary artery disease:

• Eat healthy foods.
• Stop smoking.
• Stay active with regular exercise.
• Reduce the amount of fat, salt, and sugar you eat. This can help lower your risk of having high cholesterol, high blood pressure, and diabetes.

Research suggests that controlling the four most common risk factors at an early age can lower the odds of developing coronary disease by close to 80 percent. “If those risk factors aren't under good control, then you should work with your doctor in terms of specific medicines to control the high cholesterol, the high blood pressure, or the diabetes,” says Dr. Sabatine.

A stress test is a common test for coronary artery disease. During a stress test, a patient exercises and health care providers monitor the patient’s electrocardiogram (ECG). The ECG can show abnormalities if there’s insufficient blood flow to the heart muscle.

Sometimes your doctor will couple these tests with special imaging of the heart that measures the amount of blood flow. A computerized tomography scan, or CT scan, is another test your doctor may use to diagnose CAD. A CT scan uses computer technology to combine X-rays taken from different angles to show more details than traditional X-rays. This test can show potential narrowings of the coronary arteries.

If those initial tests show significant coronary disease, then patients typically go to the cardiac catheterization lab for an invasive coronary angiography. In that case, your cardiologist inserts thin catheters into the coronary arteries, and then injects a special dye into them. They next take X-rays of the dye’s movement through the arteries to show the full extent and severity of the blockages. Your cardiologist uses this information to develop a treatment plan tailored to your condition.