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Coronary artery disease is the build-up of cholesterol-rich plaque in the walls of the arteries that supply the heart muscle. Over years the plaque narrows the channel, and if a plaque cracks open, a clot can block the artery suddenly and cause a heart attack.

It is the commonest cause of death worldwide, yet much of it is preventable and its progression can be slowed. Treatment has two separate aims: preventing heart attack and death, mainly through medicines and lifestyle, and relieving symptoms, through medicines, stents or bypass surgery.

Symptoms

• Angina: chest tightness or pressure on exertion that eases with rest
• Breathlessness on effort
• Discomfort in the arm, jaw, neck, back or upper abdomen
• Unusual fatigue, more often described by women
• No symptoms until a heart attack, particularly in people with diabetes
• Heart attack: prolonged chest pain, sweating, nausea, breathlessness, collapse
• Palpitations or heart failure symptoms in long-standing disease

Causes and risk factors

Atherosclerosis starts when LDL cholesterol particles enter the artery wall and trigger inflammation. The strongest modifiable risk factors are smoking, raised LDL cholesterol, high blood pressure, diabetes, abdominal obesity, physical inactivity, an unhealthy diet, chronic kidney disease and chronic stress. Age, male sex, early menopause, a family history of premature heart disease, raised lipoprotein(a) and South Asian ancestry add risk that you cannot change. Inflammatory diseases such as rheumatoid arthritis and previous chest radiotherapy also contribute.

How it is diagnosed

• Risk assessment: History, blood pressure, lipids, glucose and a validated risk calculator.
• ECG and echocardiography: Signs of previous heart attack, and pumping function.
• CT coronary angiography and calcium score: Shows plaque directly, including non-obstructive plaque that still warrants preventive therapy.
• Stress imaging: Stress echo, nuclear perfusion or stress MRI to detect ischaemia.
• Invasive coronary angiography: Defines anatomy for stenting or surgery; pressure wire testing assesses borderline lesions.

Treatment options

• Lifestyle: Stopping smoking roughly halves risk within a few years. Regular exercise, a Mediterranean-style diet and weight loss all help.
• Lipid lowering: High-intensity statin, with ezetimibe, bempedoic acid, or PCSK9 inhibitors or inclisiran when LDL targets are not reached.
• Antiplatelet therapy: Aspirin or clopidogrel long term; two agents for a period after a stent or heart attack.
• Blood pressure and diabetes control: ACE inhibitors or ARBs, beta blockers after heart attack, and SGLT2 inhibitors or GLP-1 agonists in diabetes.
• Angioplasty and stents: For heart attack as an emergency, and for stable angina not controlled by medicines.
• Bypass surgery: For left main or multi-vessel disease, particularly with diabetes or a weakened ventricle.
• Cardiac rehabilitation: After a heart attack, stent or surgery.

When it is urgent

Chest pain or pressure lasting more than 10 to 15 minutes, pain spreading to the arm or jaw, or pain with sweating, nausea, breathlessness or collapse may be a heart attack. Call your local emergency number at once and chew aspirin if you are not allergic and have been advised that this is safe. Do not drive yourself and do not wait to see if it passes.

Travelling to Türkiye for treatment

A visit can offer a thorough assessment, CT or invasive angiography, a heart team opinion, and planned stenting or bypass surgery for stable disease. It cannot offer the most important part, which is decades of risk factor control; that needs a regular doctor at home. After a recent heart attack, wait until your cardiologist confirms you are stable before flying.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

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