Coronary Artery Disease

Coronary artery disease (CAD) — also called coronary vascular, arteriosclerotic and ischemic heart disease — remains the leading cause of death in North America. The disease is caused by arteriosclerosis or “hardening of the arteries,” which interferes with the normal flow of blood to the heart. It affects the arteries that surround and supply blood to the heart, causing more than a half million deaths a year.

When the heart doesn’t receive enough blood, symptoms may include pain or pressure in the chest, arm or jaw. This is a warning sign that your heart is having difficulty. If left untreated, it can result in a heart attack.

Risk factors for coronary artery disease include:

  • Hypercholesterolemia (specifically, serum LDL concentrations)
  • Smoking
  • Hypertension (high systolic pressure seems to be most significant in this regard)
  • Hyperglycemia (due to diabetes mellitus or otherwise)
  • Type A Behavioural Patterns, TABP
  • Hemostatic Factors
  • Hereditary differences in such diverse aspects as lipoprotein structure and that of their associated receptors, homocysteine processing/metabolism, etc.
  • High levels of Lipoprotein(a), a compound formed when LDL cholesterol combines with a substance known as Apoliprotein (a)
  • Lack of exercise
  • Consumption of alcohol
  • Stress
  • Diet rich in saturated fats
  • Diet low in antioxidants
  • Obesity
  • Men over 60; Women over 65

Treatment options for coronary artery disease are based on three principles:

  1. Medical treatment – drugs (e.g. cholesterol lowering medications, beta-blockers, nitroglycerin, calcium antagonists, etc.);
  2. Coronary interventions as angioplasty and coronary stent-implantation;
  3. Coronary artery bypass grafting (CABG – coronary artery bypass surgery).


The most common disease of the coronary arteries is arteriosclerosis, commonly called “hardening of the arteries.” Plaque — a combination of cholesterol and other fats, calcium and other elements carried in the blood — builds up in the small blood vessels that feed the heart. When this condition exists in other parts of the body, it is called atherosclerosis.

Angina (symptoms of insufficient blood flow) can develop when plaque buildup narrows the arteries so severely that blood flow to the heart is inadequate. Angina is a term meaning strangling or oppressive heaviness and pain, but it has become synonymous with angina pectoris or chest pain caused by lack of oxygen to the heart due to poor blood supply.

In addition to angina or chest pain, arteriosclerosis can produce:

  • Fatigue
  • Shortness of breath
  • Abnormal heart beat (arrhythmia)

Plaque also can tear the artery walls and form blood clots that can lead to a heart attack. Often, there are no symptoms of arteriosclerosis until a heart attack occurs.