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Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), or simply heart disease, involves the reduction of blood flow to the
heart muscle Cardiac muscle (also called heart muscle or myocardium) is one of three types of vertebrate Vertebrates () comprise all species of animal Animals (also called Metazoa) are multicellular eukaryotic organisms that form the Kingdom (biolo ...

heart muscle
due to build-up of plaque (
atherosclerosis Atherosclerosis is a disease in which the wall of the artery An artery (plural arteries) () is a blood vessel The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels tr ...

atherosclerosis
) in the
arteries of the heart
arteries of the heart
. It is the most common of the
cardiovascular disease Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels. CVD includes coronary artery disease Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), or simpl ...
s. Types include stable angina,
unstable angina Unstable angina (UA), also called crescendo angina, is a type of angina pectoris Angina, also known as angina pectoris, is chest pain Chest pain is pain or discomfort in the chest, typically the front of the chest. It may be described as sharp ...
,
myocardial infarction A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow Hemodynamics American and British English spelling differences#ae and oe, or haemodynamics are the Fluid dynamics, dynamics of blood flow. The circulatory sy ...

myocardial infarction
, and
sudden cardiac death Cardiac arrest is a sudden loss of blood flow resulting from the failure of the heart The heart is a muscle, muscular Organ (anatomy), organ in most animals, which pumps blood through the blood vessels of the circulatory system. The pump ...
. A common symptom is
chest pain Chest pain is pain or discomfort in the chest, typically the front of the chest. It may be described as sharp, dull, pressure, heaviness or squeezing. Associated symptoms may include pain in the shoulder, arm, upper abdomen, or jaw, along with na ...
or discomfort which may travel into the shoulder, arm, back, neck, or jaw. Occasionally it may feel like
heartburn Heartburn, also known as pyrosis, cardialgia or acid indigestion, is a burning sensation in the central chest or upper central abdomen. The discomfort often rises in the chest and may radiate to the neck, throat, or angle of the arm. Heartbur ...
. Usually symptoms occur with exercise or emotional stress, last less than a few minutes, and improve with rest.
Shortness of breath Shortness of breath (SOB), also known as dyspnea (BrE British English (BrE) is the standard dialect A standard language (also standard variety, standard dialect, and standard) is a language variety that has undergone substantial codificat ...
may also occur and sometimes no symptoms are present. In many cases, the first sign is a
heart attack A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow Hemodynamics American and British English spelling differences#ae and oe, or haemodynamics are the Fluid dynamics, dynamics of blood flow. The circulatory sys ...

heart attack
. Other complications include
heart failure Heart failure (HF), also known as congestive heart failure (CHF) and (congestive) cardiac failure (CCF), is a Syndrome, set of manifestations caused by the failure of the heart's function as a pump supporting the Circulatory system, blood flow t ...
or an abnormal heartbeat. Risk factors include
high blood pressure Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term Long-Term Capital Management L.P. (LTCM) was a hedge fund''A financial History of the United States Volume II: 1970–2001'', Jerry W. Markham, Chapter 5: "Bank ...

high blood pressure
,
smoking Smoking is a practice in which a substance is burned and the resulting smoke Smoke is a collection of airborne and es emitted when a material undergoes or , together with the quantity of air that is or otherwise mixed into the ma ...

smoking
,
diabetes Diabetes mellitus, commonly known as just diabetes, is a group of metabolic disorders characterized by a hyperglycemia, high blood sugar level over a prolonged period of time. Symptoms often include frequent urination, Polydipsia, increased th ...
, lack of exercise,
obesity Obesity is a medical condition A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not due to any immediate external injury. Diseases are often ...

obesity
, high blood cholesterol, poor diet,
depression Depression may refer to: Mental health * Depression (mood), a state of low mood and aversion to activity * Mood disorders characterized by depression are commonly referred to as simply ''depression'', including: ** Dysthymia ** Major depressive ...
, and excessive
alcohol In , alcohol is an that carries at least one (−OH) bound to a atom. The term alcohol originally referred to the primary alcohol (ethyl alcohol), which is and is the main alcohol present in s. An important class of alcohols, of which ...
. A number of tests may help with diagnoses including:
electrocardiogram Electrocardiography is the process of producing an electrocardiogram (ECG or EKG). It is a graph of voltage Voltage, electric potential difference, electromotive force emf, electric pressure or electric tension is the difference in elec ...

electrocardiogram
,
cardiac stress test A cardiac stress test (also referred to as a cardiac diagnostic test, cardiopulmonary exercise test, or abbreviated CPX test) is a cardiological test that measures the heart The heart is a cardiac muscle, muscular Organ (biology), organ in ...
ing,
coronary computed tomographic angiographyCoronary () may, as shorthand in English, be used to mean: * Coronary circulationCoronary () may, as shorthand in English, be used to mean: * Coronary circulation, the system of arteries and veins in mammals ** Coronary artery disease Coronary ...
, and
coronary angiogram A coronary catheterization is a minimally invasive procedure to access the coronary circulation and blood filled chambers of the heart using a catheter. It is performed for both diagnostic and interventional (treatment) purposes. Coronary cathet ...
, among others. Ways to reduce CAD risk include eating a
healthy diet A healthy diet is a diet that maintains or improve overall health. A healthy diet provides the body with essential nutrition: fluid, macronutrients, micronutrientMicronutrients are nutrient, essential elements required by organisms in varying ...
, regularly exercising, maintaining a healthy weight, and not smoking. Medications for diabetes, high cholesterol, or high blood pressure are sometimes used. There is limited evidence for screening people who are at low risk and do not have symptoms. Treatment involves the same measures as prevention. Additional medications such as antiplatelets (including
aspirin Aspirin, also known as acetylsalicylic acid (ASA), is a medication A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug Uncoated tablets, consisting of about 90% acetylsalicy ...

aspirin
),
beta blocker Beta blockers (beta-blockers, β-blockers, etc.) are a class of medications that are predominantly used to manage abnormal heart rhythms, and to protect the heart from a second heart attack (myocardial infarction A myocardial infarction (MI) ...
s, or
nitroglycerin Nitroglycerin (NG), also known as trinitroglycerin (TNG), nitro, glyceryl trinitrate (GTN), or 1,2,3-trinitroxypropane, is a dense, colorless, oily, explosive An explosive (or explosive material) is a reactive substance that contains a grea ...
may be recommended. Procedures such as
percutaneous coronary intervention Percutaneous coronary intervention (PCI) is a non-surgical procedure used to treat narrowing of the coronary arteries The coronary arteries are the arterial blood vessels of coronary circulation, which transport oxygenated blood to the heart m ...
(PCI) or
coronary artery bypass surgery Coronary artery bypass surgery, also known as coronary artery bypass graft (CABG, pronounced "cabbage") surgery, and colloquially heart bypass or bypass surgery, is a surgical procedure to reperfusion therapy, restore normal blood flow to an obs ...
(CABG) may be used in severe disease. In those with stable CAD it is unclear if PCI or CABG in addition to the other treatments improves
life expectancy Life expectancy is a statistical measure of the average time an organism is expected to live, based on the year of its birth, its current age, and other demographic Demography (from prefix ''demo-'' from Ancient Greek Ancien ...

life expectancy
or decreases heart attack risk. In 2015, CAD affected 110 million people and resulted in 8.9 million deaths. It makes up 15.6% of all deaths, making it the most common cause of death globally. The risk of death from CAD for a given age decreased between 1980 and 2010, especially in
developed countries A developed country (or industrialized country, high-income country, more economically developed country (MEDC), advanced country) is a sovereign state A sovereign state is a political entity that is represented by one centralized governmen ...
. The number of cases of CAD for a given age also decreased between 1990 and 2010. In the United States in 2010, about 20% of those over 65 had CAD, while it was present in 7% of those 45 to 64, and 1.3% of those 18 to 45; rates were higher among men than women of a given age.


Signs and symptoms

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. For some, this causes severe symptoms, while others experience no symptoms at all. The most common symptom is
chest pain Chest pain is pain or discomfort in the chest, typically the front of the chest. It may be described as sharp, dull, pressure, heaviness or squeezing. Associated symptoms may include pain in the shoulder, arm, upper abdomen, or jaw, along with na ...
or discomfort that occurs regularly with activity, after eating, or at other predictable times; this phenomenon is termed stable
angina Angina, also known as angina pectoris, is chest pain Chest pain is pain or discomfort in the chest, typically the front of the chest. It may be described as sharp, dull, pressure, heaviness or squeezing. Associated symptoms may include pain in ...

angina
and is associated with narrowing of the
arteries An artery (plural arteries) () is a blood vessel that takes blood away from the heart to one or more parts of the body (tissues, lungs, brain etc.). Most arteries carry oxygenated blood; the two exceptions are the pulmonary arteries, pulmonary ...

arteries
of the
heart The heart is a cardiac muscle, muscular Organ (biology), organ in most animals, which pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste ...

heart
. Angina also includes chest tightness, heaviness, pressure, numbness, fullness, or squeezing. Angina that changes in intensity, character or frequency is termed unstable.
Unstable angina Unstable angina (UA), also called crescendo angina, is a type of angina pectoris Angina, also known as angina pectoris, is chest pain Chest pain is pain or discomfort in the chest, typically the front of the chest. It may be described as sharp ...
may precede
myocardial infarction A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow Hemodynamics American and British English spelling differences#ae and oe, or haemodynamics are the Fluid dynamics, dynamics of blood flow. The circulatory sy ...

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. 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.


Symptoms in women

Symptoms in women can differ from those in men, and the most common symptom reported by women of all races is shortness of breath. Other symptoms more commonly reported by women than men are extreme fatigue, sleep disturbances, indigestion, and anxiety. However, some women do 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 women, but it is less commonly reported by women than men. On average, women experience symptoms 10 years later than men. Women are less likely to recognize symptoms and seek treatment.


Risk factors

Coronary artery disease has a number of well determined risk factors. These include
high blood pressure Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term Long-Term Capital Management L.P. (LTCM) was a hedge fund''A financial History of the United States Volume II: 1970–2001'', Jerry W. Markham, Chapter 5: "Bank ...

high blood pressure
,
smoking Smoking is a practice in which a substance is burned and the resulting smoke Smoke is a collection of airborne and es emitted when a material undergoes or , together with the quantity of air that is or otherwise mixed into the ma ...

smoking
,
diabetes Diabetes mellitus, commonly known as just diabetes, is a group of metabolic disorders characterized by a hyperglycemia, high blood sugar level over a prolonged period of time. Symptoms often include frequent urination, Polydipsia, increased th ...
, lack of exercise,
obesity Obesity is a medical condition A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not due to any immediate external injury. Diseases are often ...

obesity
, high blood cholesterol, poor diet,
depression Depression may refer to: Mental health * Depression (mood), a state of low mood and aversion to activity * Mood disorders characterized by depression are commonly referred to as simply ''depression'', including: ** Dysthymia ** Major depressive ...
,
family history Genealogy (from el, γενεαλογία ' "study of family trees") is the study of families In human society, family (from la, familia) is a Social group, group of people related either by consanguinity (by recognized birth) or Affinity ...
,
psychological stress In psychology Psychology is the scientific Science (from the Latin Latin (, or , ) is a classical language belonging to the Italic languages, Italic branch of the Indo-European languages. Latin was originally spoken in the area ...
and excessive
alcohol In , alcohol is an that carries at least one (−OH) bound to a atom. The term alcohol originally referred to the primary alcohol (ethyl alcohol), which is and is the main alcohol present in s. An important class of alcohols, of which ...

alcohol
. About half of cases are linked to genetics. 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. Lack of exercise has been linked to 7–12% of cases. Exposure to the
herbicide Herbicides (, ), also commonly known as weedkillers, are substances used to control unwanted plant Plants are predominantly photosynthetic Photosynthesis is a process used by plants and other organisms to Energy transformation, conv ...
Agent Orange Agent Orange is a and chemical, one of the "tactical use" . It is widely known for its use by the as part of its program, , during the from 1961 to 1971. It is a mixture of equal parts of two s, and . In addition to its damaging environm ...

Agent Orange
may increase risk. Rheumatologic diseases such as
rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder An autoimmune disease is a condition arising from an abnormal immune response to a functioning body part. There are at least 80 types of autoimmune diseases. Nearly any body part can ...
,
systemic lupus erythematosus Lupus, technically known as systemic lupus erythematosus (SLE), is an autoimmune disease An autoimmune disease is a condition arising from an abnormal immune response to a functioning body part. There are at least 80 types of autoimmune dise ...
,
psoriasis Psoriasis is a long-lasting, noncontagious autoimmune disease An autoimmune disease is a condition arising from an abnormal immune response to a functioning body part. There are at least 80 types of autoimmune diseases. Nearly any body part c ...

psoriasis
, and
psoriatic arthritis Psoriatic arthritis is a long-term inflammatory arthritisInflammatory arthritis is a group of diseases which includes: rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints. It typi ...
are independent risk factors as well. Job stress appears to play a minor role accounting for about 3% of cases. In one study, women who were free of stress from work life saw an increase in the diameter of their blood vessels, leading to decreased progression of atherosclerosis. In contrast, women who had high levels of work-related stress experienced a decrease in the diameter of their blood vessels and significantly increased disease progression. Having a type A behavior pattern, a group of personality characteristics including time urgency, competitiveness, hostility, and impatience, is linked to an increased risk of coronary disease.


Blood fats

* High blood cholesterol (specifically, serum
LDL Low-density lipoprotein (LDL) is one of the five major groups of lipoprotein 250px, Structure of a chylomicron. ApoA, ApoB, ApoC, ApoE are apolipoproteins; green particles are phospholipids; T is triacylglycerol; C is cholesterol ester. A lipo ...
concentrations). HDL (high density lipoprotein) has a protective effect over development of coronary artery disease. * High blood triglycerides may play a role. * High levels of
lipoprotein(a) Lipoprotein(a) is a low-density lipoprotein variant containing a protein called apolipoprotein(a). Genetic and epidemiological studies have identified lipoprotein(a) as a risk factor for atherosclerosis Atherosclerosis is a disease in which the ...
, a compound formed when LDL cholesterol combines with a protein known as apolipoprotein(a). Dietary cholesterol does not appear to have a significant effect on blood cholesterol and thus recommendations about its consumption may not be needed. Saturated fat is still a concern.


Genetics

The
heritability Heritability is a used in the fields of and that estimates the degree of ''variation'' in a in a that is due to between individuals in that population. It measures how much of the variation of a trait can be attributed to variation of geneti ...

heritability
of coronary artery disease has been estimated between 40% and 60%.
Genome-wide association studies In genetics Genetics is a branch of biology concerned with the study of genes, genetic variation, and heredity in organisms.Hartl D, Jones E (2005) Though heredity had been observed for millennia, Gregor Mendel, Moravia, Moravian scientist a ...
have identified over 160 genetic susceptibility loci for coronary artery disease.


Other

*
Endometriosis Endometriosis is a disease of the female reproductive system in which cells Cell most often refers to: * Cell (biology), the functional basic unit of life Cell may also refer to: Closed spaces * Monastic cell, a small room, hut, or cave in ...

Endometriosis
in women under the age of 40. * Depression and hostility appear to be risks. * 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. * Hemostatic factors: High levels of fibrinogen and coagulation factor VII are associated with an increased risk of CAD. * Low hemoglobin. * In the Asian population, the b fibrinogen gene G-455A polymorphism was associated with the risk of CAD.


Pathophysiology

Limitation of blood flow to the heart causes
ischemia Ischemia or ischaemia is a restriction in blood Blood is a body fluid Body fluids, bodily fluids, or biofluids are liquid A liquid is a nearly incompressible fluid In physics, a fluid is a substance that continually Deformation ( ...
(cell starvation secondary to a lack of oxygen) of the heart's
muscle cells A myocyte is a muscle cell of the heart ( cardiac muscle cell) or of smooth muscle. There are two specialized forms of myocytes with distinct properties: cardiac muscle cells, and smooth muscle cells. A skeletal muscle cell is long and thread ...

muscle cells
. The heart's muscle cells may die from lack of
oxygen Oxygen is the chemical element Image:Simple Periodic Table Chart-blocks.svg, 400px, Periodic table, The periodic table of the chemical elements In chemistry, an element is a pure substance consisting only of atoms that all have the same ...

oxygen
and this is called a
myocardial infarction A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow Hemodynamics American and British English spelling differences#ae and oe, or haemodynamics are the Fluid dynamics, dynamics of blood flow. The circulatory sy ...

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 Ischemia or ischaemia is a restriction in blood Blood is a body fluid Body fluids, bodily fluids, or biofluids are liquid A liquid is a nearly incompressible fluid In physics, a fluid is a substance that continually Deformation ( ...
which leads to the induction of a
ventricular arrhythmia Arrhythmia, also known as cardiac arrhythmia or heart arrhythmia, is a group of conditions in which the is irregular, too fast, or too slow. The that is too fast – above 100 beats per minute in adults – is called , and a heart rate that i ...
, which may terminate into a dangerous heart rhythm known as
ventricular fibrillation Ventricular fibrillation (V-fib or VF) is an abnormal heart rhythm in which the Ventricle (heart), ventricles of the heart Fibrillation, quiver. It is due to disorganized electrical conduction system of the heart, electrical activity. Ventricular ...

ventricular fibrillation
, which often leads to death. Typically, coronary artery disease occurs when part of the smooth, elastic lining inside a
coronary artery The coronary arteries are the arterial blood vessels of coronary circulationCoronary () may, as shorthand in English, be used to mean: * Coronary circulation, the system of arteries and veins in mammals ** Coronary artery disease Coronary art ...
(the arteries that supply blood to the heart muscle) develops
atherosclerosis Atherosclerosis is a disease in which the wall of the artery An artery (plural arteries) () is a blood vessel The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels tr ...

atherosclerosis
. With atherosclerosis, the artery's lining becomes hardened, stiffened, and accumulates deposits of calcium, fatty lipids, and abnormal inflammatory
cells Cell most often refers to: * Cell (biology), the functional basic unit of life Cell may also refer to: Closed spaces * Monastic cell, a small room, hut, or cave in which a monk or religious recluse lives * Prison cell, a room used to hold peopl ...
– 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 Arteriosclerosis is the thickening, hardening, and loss of elasticity of the walls of arteries. This process gradually restricts the blood flow to one's organs and tissues and can lead to severe health risks brought on by atherosclerosis Athero ...
. This can be seen in a so-called metastatic mechanism of
calciphylaxis Calciphylaxis, also known as calcific uremic arteriolopathy (CUA) or “Grey Scale”, is a rare painful syndrome of calcification of the small blood vessels located within the fatty tissue and dermis, deeper layers of the skin, thrombosis, blood ...

calciphylaxis
as it occurs in
chronic kidney disease Chronic kidney disease (CKD) is a type of kidney disease Kidney disease, or renal disease, technically referred to as nephropathy, is damage to or disease A disease is a particular abnormal condition that negatively affects the str ...
and
hemodialysis Hemodialysis, also spelled haemodialysis, or simply dialysis, is a process of purifying the blood of a person whose kidney The kidneys are two reddish-brown bean-shaped organs An organ is a group of tissues with similar functions. Plant ...

hemodialysis
. Although these people suffer from 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 The coronary arteries are the arterial blood vessels of coronary circulation Coronary circulation is the circulation of blood in the blood vessels that supply the cardiac muscle, heart muscle (myocardium). Coronary arteries supply oxygen saturat ...

coronary arteries
. A more severe form is ''chronic total occlusion'' (CTO) when a coronary artery is completely obstructed for more than 3 months.
Cardiac syndrome X Cardiac syndrome X is a historic term for microvascular angina, angina Angina, also known as angina pectoris, is chest pain Chest pain is pain or discomfort in the chest, typically the front of the chest. It may be described as sharp, dull, pre ...
is chest pain (
angina pectoris Angina, also known as angina pectoris, is chest pain Chest pain is pain or discomfort in the chest, typically the front of the chest. It may be described as sharp, dull, pressure, heaviness or squeezing. Associated symptoms may include pain in ...

angina pectoris
) and chest discomfort in people who do not show signs of blockages in the larger
coronary arteries The coronary arteries are the arterial blood vessels of coronary circulation Coronary circulation is the circulation of blood in the blood vessels that supply the cardiac muscle, heart muscle (myocardium). Coronary arteries supply oxygen saturat ...

coronary arteries
of their hearts when an
angiogram Angiography or arteriography is a medical imaging Medical imaging is the technique and process of imaging the interior of a body for clinical analysis and medical intervention, as well as visual representation of the function of some organs o ...

angiogram
(coronary angiogram) is being performed. The exact cause of cardiac syndrome X is unknown. Explanations include microvascular dysfunction or epicardial atherosclerosis. For reasons that are not well understood, women are more likely than men to have it; however,
hormone A hormone (from the Greek#REDIRECT Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, Ελλάδα, , ), officially the Hellenic Republic, is a country located in Southeast Europe. Its population is appr ...

hormone
s and other risk factors unique to women may play a role.


Diagnosis

For symptomatic people,
stress echocardiography Stress may refer to: Science and medicine * Stress (biology) Stress, either physiological, biological, or psychological is an organism's response to a stressor such as an environmental condition. Stress is the body's method of reacting to ...
can be used to make a diagnosis for obstructive coronary artery disease., citing * * * The use of
echocardiography An echocardiography, echocardiogram, cardiac echo or simply an echo, is an ultrasound Ultrasound is s with higher than the upper audible limit of human . Ultrasound is not different from "normal" (audible) sound in its physical properties ...
, stress cardiac imaging, and/or advanced non-invasive imaging is not recommended on individuals who are exhibiting no symptoms and are otherwise at low risk for developing coronary disease. The diagnosis of "Cardiac Syndrome X" – the rare coronary artery disease that is more common in women, as mentioned, is a diagnosis of exclusion. Therefore, usually, the same tests are used as in any person with the suspected of having coronary artery disease: * Baseline
electrocardiography Electrocardiography is the process of producing an electrocardiogram (ECG or EKG). It is an electrogram of the heart The heart is a cardiac muscle, muscular Organ (biology), organ in most animals, which pumps blood through the blood ...
(ECG) * Exercise ECG –
Stress testStress test may refer to: *Cardiac stress test, testing of the heart (a.k.a. "treadmill test") *Stress testing of software, hardware, or nuclear plants **Stress test (hardware) **Stress testing (software) *Stress test (financial) *Stress Test (book) ...
* Exercise radioisotope test (nuclear stress test, myocardial
scintigraphy Scintigraphy (from Latin ''scintilla'', "spark"), also known as a gamma scan, is a diagnostic test in nuclear medicine, where radioisotopes attached to drugs that travel to a specific organ or tissue ( radiopharmaceuticals) are taken internally an ...
) *
Echocardiography An echocardiography, echocardiogram, cardiac echo or simply an echo, is an ultrasound Ultrasound is s with higher than the upper audible limit of human . Ultrasound is not different from "normal" (audible) sound in its physical properties ...
(including stress echocardiography) *
Coronary angiography A coronary catheterization is a minimally invasive procedure to access the coronary circulation and blood filled chambers of the heart The heart is a muscle, muscular Organ (anatomy), organ in most animals, which pumps blood through the ...

Coronary angiography
*
Intravascular ultrasound Intravascular ultrasound (IVUS) is a medical imaging methodology using a specially designed catheter with a miniaturized ultrasound Ultrasound is sound waves with frequency, frequencies higher than the upper audible limit of human hearing ...
*
Magnetic resonance imaging Magnetic resonance imaging (MRI) is a medical imaging Medical imaging is the technique and process of imaging Imaging is the representation or reproduction of an object's form; especially a visual representation (i.e., the formation of a ...
(MRI) The diagnosis of coronary disease underlying particular symptoms depends largely on the nature of the symptoms. The first investigation is an
electrocardiogram Electrocardiography is the process of producing an electrocardiogram (ECG or EKG). It is a graph of voltage Voltage, electric potential difference, electromotive force emf, electric pressure or electric tension is the difference in elec ...

electrocardiogram
(ECG/EKG), both for "stable" angina and acute coronary syndrome. An and
blood test A blood test is a laboratory A laboratory (; ; colloquially lab) is a facility that provides controlled conditions in which or technological research, s, and may be performed. Laboratory services are provided in a variety of settings: ...

blood test
s may be performed.


Stable angina

In "stable" angina, chest pain with typical features occurring at predictable levels of exertion, various forms of
cardiac stress test A cardiac stress test (also referred to as a cardiac diagnostic test, cardiopulmonary exercise test, or abbreviated CPX test) is a cardiological test that measures the heart The heart is a cardiac muscle, muscular Organ (biology), organ in ...
s may be used to induce both symptoms and detect changes by way of electrocardiography (using an ECG),
echocardiography An echocardiography, echocardiogram, cardiac echo or simply an echo, is an ultrasound Ultrasound is s with higher than the upper audible limit of human . Ultrasound is not different from "normal" (audible) sound in its physical properties ...
(using
ultrasound Ultrasound is sound wave In physics Physics is the that studies , its , its and behavior through , and the related entities of and . "Physical science is that department of knowledge which relates to the order of nature, or, ...
of the heart) or
scintigraphy Scintigraphy (from Latin ''scintilla'', "spark"), also known as a gamma scan, is a diagnostic test in nuclear medicine, where radioisotopes attached to drugs that travel to a specific organ or tissue ( radiopharmaceuticals) are taken internally an ...
(using uptake of
radionuclide A radionuclide (radioactive nuclide, radioisotope or radioactive isotope) is a nuclide A nuclide (or nucleide, from atomic nucleus, nucleus, also known as nuclear species) is a class of atoms characterized by their number of protons, ''Z'', their ...
by the heart muscle). If part of the heart seems to receive an insufficient blood supply,
coronary angiography A coronary catheterization is a minimally invasive procedure to access the coronary circulation and blood filled chambers of the heart The heart is a muscle, muscular Organ (anatomy), organ in most animals, which pumps blood through the ...
may be used to identify
stenosis A stenosis (from Ancient Greek στενός, "narrow") is an abnormal narrowing in a blood vessel or other tubular Organ (anatomy), organ or structure such as foramina and canals. It is also sometimes called a stricture (as in urethral stricture) ...
of the coronary arteries and suitability for
angioplasty Angioplasty, also known as balloon angioplasty and percutaneous transluminal angioplasty (PTA), is a minimally invasive Minimally invasive procedures (also known as minimally invasive surgeries) encompass surgical Surgery ''cheirourgikē' ...
or
bypass surgery Bypass surgery refers to a class of surgeries involving rerouting a tubular body part. Types include: *Vascular bypass, Vascular bypass surgery such as coronary artery bypass surgery, a heart operation *Cardiopulmonary bypass, a technique used in c ...
. Stable coronary artery disease (SCAD) is also often called stable ischemic heart disease (SIHD). 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.


Acute coronary syndrome

Diagnosis of
acute coronary syndrome Acute coronary syndrome (ACS) is a syndrome (a set of signs and symptoms) due to decreased blood flow in the coronary arteries such that part of the heart muscle is unable to function properly or dies. The most common symptom is centrally l ...
generally takes place in the
emergency department An emergency department (ED), also known as an accident & emergency department (A&E), emergency room (ER), emergency ward (EW) or casualty department, is a medical treatment facility specializing in emergency medicine #REDIRECT Emergency medici ...
, 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 segmentImage:SinusRhythmLabels.svg, Schematic representation of normal Electrocardiography, ECG In electrocardiography, the ST segment connects the QRS complex and the T wave and has a duration of 0.005 to 0.150 sec (5 to 150 ms). It starts at the J poi ...
", which in the context of severe typical chest pain is strongly indicative of an acute
myocardial infarction A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow Hemodynamics American and British English spelling differences#ae and oe, or haemodynamics are the Fluid dynamics, dynamics of blood flow. The circulatory sy ...

myocardial infarction
(MI); this is termed a STEMI (ST-elevation MI) and is treated as an emergency with either urgent
coronary angiography A coronary catheterization is a minimally invasive procedure to access the coronary circulation and blood filled chambers of the heart The heart is a muscle, muscular Organ (anatomy), organ in most animals, which pumps blood through the ...
and
percutaneous coronary intervention Percutaneous coronary intervention (PCI) is a non-surgical procedure used to treat narrowing of the coronary arteries The coronary arteries are the arterial blood vessels of coronary circulation, which transport oxygenated blood to the heart m ...
(angioplasty with or without
stent In medicine Medicine is the Art (skill), art, science, and Praxis (process) , practice of caring for a patient and managing the diagnosis, prognosis, Preventive medicine, prevention, therapy, treatment or Palliative care , palliation of their ...

stent
insertion) or with
thrombolysis Thrombolysis, also called fibrinolytic therapy, is the breakdown ( lysis) of blood clots formed in blood vessel The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels trans ...
("clot buster" medication), whichever is available. In the absence of ST-segment elevation, heart damage is detected by
cardiac marker Cardiac markers are biomarkers A biomarker, or biological marker is a measurable wikt:indicator, indicator of some biological state or condition. Biomarkers are often measured and evaluated using blood, urine, or soft tissues to examine normal biol ...
s (blood tests that identify heart muscle damage). If there is evidence of damage (
infarction Infarction is tissue death ( necrosis) due to inadequate blood supply to the affected area. It may be caused by artery blockages, rupture, mechanical compression, or vasoconstriction. The resulting lesion A lesion is any damage or abnormal chan ...

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 A coronary care unit (CCU) or cardiac intensive care unit (CICU) is a hospital ward specialized in the care of patient A patient is any recipient of health care services that are performed by Health professional, healthcare professionals. The p ...
for possible complications (such as
cardiac arrhythmia Arrhythmia, also known as cardiac arrhythmia or heart arrhythmia, is a group of conditions in which the heartbeat is irregular, too fast, or too slow. The heart rate that is too fast – above 100 beats per minute in adults – is called tach ...
s – 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.


Risk assessment

There are various risk assessment systems for determining the risk of coronary artery disease, with various emphasis on different variables above. A notable example is Framingham Score, used in the
Framingham Heart Study The Framingham Heart Study is a long-term, ongoing cardiovascular The circulatory system, also called the cardiovascular system or the vascular system, is an organ system An organ system is a group of organs An organ is a group of tissue ...
. It is mainly based on age, gender, diabetes, total cholesterol, HDL cholesterol, tobacco smoking, and systolic blood pressure. When it comes to predicting risk in younger adults (18–39 years old), Framingham Risk Score remains below 10-12% for all deciles of baseline-predicted risk.
Polygenic score In genetics, a polygenic score (PGS), also called a polygenic risk score (PRS), genetic risk score, or genome-wide score, is a number that summarises the estimated effect of many genetic variants on an individual's phenotype, typically calculated ...
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.


Prevention

Up to 90% of cardiovascular disease may be preventable if established risk factors are avoided. Prevention involves adequate physical
exercise Exercise is any bodily activity that enhances or maintains physical fitness Physical fitness is a state of health Health is a state of physical, mental and social well-being Well-being, also known as ''wellness'', ''prudential value ...

exercise
, decreasing
obesity Obesity is a medical condition A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not due to any immediate external injury. Diseases are often ...

obesity
, treating
high blood pressure Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term Long-Term Capital Management L.P. (LTCM) was a hedge fund''A financial History of the United States Volume II: 1970–2001'', Jerry W. Markham, Chapter 5: "Bank ...

high blood pressure
, eating a
healthy diet A healthy diet is a diet that maintains or improve overall health. A healthy diet provides the body with essential nutrition: fluid, macronutrients, micronutrientMicronutrients are nutrient, essential elements required by organisms in varying ...
, decreasing
cholesterol Cholesterol is any of a class of certain organic compound, organic molecules. A cholesterol is a sterol (or chemical modification, modified steroid), a type of lipid. Cholesterol is biosynthesis, biosynthesized by all animal Cell (biology)#Euk ...

cholesterol
levels, and stopping smoking. Medications and exercise are roughly equally effective. High levels of physical activity reduce the risk of coronary artery disease by about 25%. 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. In
diabetes mellitus Diabetes mellitus, commonly known as just diabetes, is a group of metabolic disorders characterized by a hyperglycemia, high blood sugar level over a prolonged period of time. Symptoms often include frequent urination, Polydipsia, increased th ...
, there is little evidence that very tight
blood sugar The blood sugar level, blood sugar concentration, or blood glucose level is the concentration of glucose Glucose is a simple with the . Glucose is the most abundant , a subcategory of s. Glucose is mainly made by and most during from water ...
control improves cardiac risk although improved sugar control appears to decrease other problems such as
kidney failure Kidney failure, also known as end-stage kidney disease, is a medical condition in which the kidneys are functioning at less than 15% of normal levels. Kidney failure is classified as either acute kidney failure, which develops rapidly and may res ...
and
blindness Visual impairment, also known as vision impairment or vision loss, is a decreased ability to see to a degree that causes problems not fixable by usual means, such as glasses Glasses, also known as eyeglasses or spectacles, are vision eyew ...
. The
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations United Nations Specialized Agencies are autonomous organizations working with the United Nations and each other through the co-ordinating machinery of the Unit ...
(WHO) recommends "low to moderate alcohol intake" to reduce risk of coronary artery disease while high intake increases the risk.


Diet

A diet high in fruits and vegetables decreases the risk of cardiovascular disease and death.
Vegetarians Vegetarianism is the practice of abstaining from the consumption of meat Meat is animal flesh that is eaten as food. Humans have hunted and killed animals for meat since prehistoric times. The advent of civilization allowed the domestica ...
have a lower risk of heart disease, possibly due to their greater consumption of fruits and vegetables. Evidence also suggests that the
Mediterranean diet The Mediterranean diet is a diet inspired by the eating habits of people who live near the Mediterranean Sea The Mediterranean Sea is a sea connected to the Atlantic Ocean, surrounded by the Mediterranean Basin and almost completely enclosed ...
and a
high fiber diet Dietary fiber (British spelling fibre) or roughage is the portion of plant-derived food that cannot be completely broken down by human digestive enzymes. Dietary fibers are diverse in chemical composition, and can be grouped generally by their ...
lower the risk. The consumption of
trans fat Trans fat, also called trans-unsaturated fatty acids or trans fatty acids, is a type of that naturally occurs in small amounts in meat and milk fat. It became widely produced as an unintentional byproduct in the industrial processing of vegetable ...
(commonly found in
hydrogenated Hydrogenation is a chemical reaction between molecular hydrogen (H2) and another compound or element, usually in the presence of a Catalysis, catalyst such as nickel, palladium or platinum. The process is commonly employed to redox, reduce or S ...

hydrogenated
products such as
margarine Margarine (, also , ) is a spread used for flavoring, baking and cooking. It is most often used as a substitute for butter. Although originally made from animal fats, most margarine consumed today is made from vegetable oil. The foodstuff was or ...

margarine
) has been shown to cause a precursor to
atherosclerosis Atherosclerosis is a disease in which the wall of the artery An artery (plural arteries) () is a blood vessel The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels tr ...

atherosclerosis
and increase the risk of coronary artery disease. Evidence does not support a beneficial role for
omega-3 fatty acid Omega−3 fatty acids, also called Omega-3 oils, ω−3 fatty acids or ''n''−3 fatty acids, are polyunsaturated fatty acid Polyunsaturated fatty acids (PUFAs) are fatty acids that contain more than one double bond in their backbone. This ...
supplementation in preventing
cardiovascular disease Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels. CVD includes coronary artery disease Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), or simpl ...
(including
myocardial infarction A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow Hemodynamics American and British English spelling differences#ae and oe, or haemodynamics are the Fluid dynamics, dynamics of blood flow. The circulatory sy ...

myocardial infarction
and
sudden cardiac death Cardiac arrest is a sudden loss of blood flow resulting from the failure of the heart The heart is a muscle, muscular Organ (anatomy), organ in most animals, which pumps blood through the blood vessels of the circulatory system. The pump ...
). There is tentative evidence that intake of menaquinone ( Vitamin K2), but not phylloquinone (), may reduce the risk of CAD
mortality Mortality is the state of being mortal, or susceptible to death (1906) Death is the permanent, Irreversible process, irreversible cessation of all biological process, biological functions that sustain a living organism. Brain death is some ...

mortality
.


Secondary prevention

Secondary prevention is preventing further sequelae of already established disease. Effective lifestyle changes include: *
Weight control Obesity is a medical condition A disease is a particular abnormal condition that negatively affects the structure A structure is an arrangement and organization of interrelated elements in a material object or system A syst ...
*
Smoking cessation Smoking cessation, usually called quitting smoking or stopping smoking, is the process of discontinuing tobacco smoking Tobacco smoking is the practice of burning tobacco village in Xanthi, Greece Tobacco is the common name of sever ...
* Avoiding the consumption of
trans fat Trans fat, also called trans-unsaturated fatty acids or trans fatty acids, is a type of that naturally occurs in small amounts in meat and milk fat. It became widely produced as an unintentional byproduct in the industrial processing of vegetable ...
s (in partially hydrogenated oils) * Decreasing psychosocial stress *
Exercise Exercise is any bodily activity that enhances or maintains physical fitness Physical fitness is a state of health Health is a state of physical, mental and social well-being Well-being, also known as ''wellness'', ''prudential value ...

Exercise
Aerobic exercise Aerobic exercise (also known as endurance activities, cardio or cardio-respiratory exercise) is physical exercise Exercise is any bodily activity that enhances or maintains physical fitness Physical fitness is a state of health Health ...

Aerobic exercise
, like walking, jogging, or swimming, can reduce the risk of mortality from coronary artery disease. Aerobic exercise can help decrease blood pressure and the amount of blood cholesterol (LDL) over time. It also increases HDL cholesterol which is considered "good cholesterol". 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. The
American Heart Association The American Heart Association (AHA) is a nonprofit organization A nonprofit organization (NPO), also known as a non-business entity, not-for-profit organization, or nonprofit institution, is a legal entity organized and operated for a collectiv ...
, based on a non-systematic review, recommends that doctors counsel patients on exercise. Psychological symptoms are common in people with CHD, and while 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. Antibiotics for secondary prevention of coronary heart disease Antibiotics may help patients with coronary disease to reduce the risk of heart attacks and strokes. However, the latest evidence suggests that antibiotics for secondary prevention of coronary heart disease are harmful with increased mortality and occurrence of stroke. So, the use of antibiotics is not currently supported for preventing secondary coronary heart disease.


Neuropsychological Assessment

A thorough systematic review found that indeed there is a link between a CHD condition and brain dysfunction in females/women. 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.


Treatment

There are a number of treatment options for coronary artery disease: * Lifestyle changes * Medical treatment – commonly prescribed drugs (e.g., Antihyperlipidemic, cholesterol lowering medications, beta-blockers, nitroglycerin, calcium channel blockers, etc.); * Coronary interventions as
angioplasty Angioplasty, also known as balloon angioplasty and percutaneous transluminal angioplasty (PTA), is a minimally invasive Minimally invasive procedures (also known as minimally invasive surgeries) encompass surgical Surgery ''cheirourgikē' ...
and coronary stent; * Coronary artery bypass grafting (CABG)


Medications

* Statins, which reduce cholesterol, reduce the risk of coronary artery disease * Medical use of nitroglycerin, Nitroglycerin * Calcium channel blockers and/or beta-blockers * Antiplatelet drugs such as
aspirin Aspirin, also known as acetylsalicylic acid (ASA), is a medication A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug Uncoated tablets, consisting of about 90% acetylsalicy ...

aspirin
It is recommended that blood pressure typically be reduced to less than 140/90 mmHg. The diastolic blood pressure however should not be lower than 60 mmHg. Beta blockers are recommended first line for this use.


Aspirin

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. It is thus recommended only in adults who are at increased risk for coronary artery disease where increased risk is defined as "men older than 90 years of age, postmenopausal women, and younger persons with risk factors for coronary artery disease (for example, hypertension, diabetes, or smoking) who are at increased risk for heart disease and may wish to consider aspirin therapy". More specifically, high-risk persons are "those with a 5-year risk ≥ 3%".


Anti-platelet therapy

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. Specifically, its use does not change the risk of death in this group. In those who have had a stent, more than 12 months of clopidogrel plus aspirin does not affect the risk of death.


Surgery

Revascularization for
acute coronary syndrome Acute coronary syndrome (ACS) is a syndrome (a set of signs and symptoms) due to decreased blood flow in the coronary arteries such that part of the heart muscle is unable to function properly or dies. The most common symptom is centrally l ...
has a mortality benefit. Percutaneous revascularization for ''stable'' ischaemic heart disease does not appear to have benefits over medical therapy alone. In those with disease in more than one artery, coronary artery bypass grafts appear better than
percutaneous coronary intervention Percutaneous coronary intervention (PCI) is a non-surgical procedure used to treat narrowing of the coronary arteries The coronary arteries are the arterial blood vessels of coronary circulation, which transport oxygenated blood to the heart m ...
s. Newer "anaortic" or no-touch off-pump coronary artery revascularization techniques have shown reduced postoperative stroke rates comparable to percutaneous coronary intervention. 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.


Epidemiology

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. 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. Males are affected more often than females. 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.Indian Heart Association Why South Asians Facts
, 29 April 2015; accessed 26 October 2015.
Coronary artery disease is the leading cause of death for both men and women and accounts for approximately 600,000 deaths in the United States every year. According to present trends in the United States, half of healthy 40-year-old men will develop CAD in the future, and one in three healthy 40-year-old women. It is the most common reason for death of men and women over 20 years of age in the United States.American Heart Associatio
Heart Disease and Stroke Statistics
2007 Update. AHA, Dallas, Texas, 2007


Society and culture


Names

Other terms sometimes used for this condition are "hardening of the arteries" and "narrowing of the arteries". In Latin it is known as ''morbus ischaemicus cordis'' (''MIC'').


Support groups

The Infarct Combat Project (ICP) is an international nonprofit organization founded in 1998 which tries to decrease ischemic heart diseases through education and research.


Industry influence on research

In 2016 research into the archives of the Sugar Association, 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
"How the Sugar Industry Shifted Blame to Fat"
, ''The New York Times'', 12 September 2016. Retrieved 12 September 2016.


Research

Research efforts are focused on new angiogenesis, angiogenic treatment modalities and various (adult) stem-cell therapy, stem-cell therapies. A region on Chromosome 17 (human), chromosome 17 was confined to families with multiple cases of myocardial infarction. Other genome-wide studies have identified a firm risk variant on chromosome 9 (9p21.3). However, these and other locus (genetics), loci are found in intergenic segments and need further research in understanding how the phenotype is affected. A more controversial link is that between ''Chlamydophila pneumoniae'' infection and atherosclerosis. While this intracellular organism has been demonstrated in atherosclerotic plaques, evidence is inconclusive as to whether it can be considered a causative factor. Treatment with antibiotics in patients with proven atherosclerosis has not demonstrated a decreased risk of heart attacks or other coronary vascular diseases. Since the 1990s the search for new treatment options for coronary artery disease patients, particularly for so called "no-option" coronary patients, focused on usage of angiogenesis and (adult) stem cell therapies. Numerous clinical trials were performed, either applying protein (angiogenic growth factor) therapies, such as FGF-1 or Vascular endothelial growth factor, VEGF, or cell therapies using different kinds of adult stem cell populations. Research is still going on – with first promising results particularly for FGF-1 and utilization of endothelial progenitor cells. Myeloperoxidase has been proposed as a biomarker. Plant-based nutrition has been suggested as a way to reverse coronary artery disease, but strong evidence is still lacking for claims of potential benefits.


References


External links


Risk Assessment of having a heart attack or dying of coronary artery disease
from the American Heart Association. * {{DEFAULTSORT:Coronary Artery Disease Aging-associated diseases Heart diseases Ischemic heart diseases Wikipedia medicine articles ready to translate Wikipedia emergency medicine articles ready to translate