There are three main types of coronary heart disease: obstructive coronary artery disease, nonobstructive coronary artery disease, and coronary microvascular disease. Coronary artery disease affects the large arteries on the surface of the heart. Many people have both obstructive and nonobstructive forms of this disease. Coronary microvascular disease affects the tiny arteries in the heart muscle.
The cause depends on the type of coronary heart disease. The condition may also have more than one cause, including plaque buildup or problems that affect how the heart’s blood vessels work. Visit How the Heart Works to learn more.
Plaque buildup in the arteries is called atherosclerosis. When this buildup happens in the heart's arteries over many years, the arteries become narrower and harden, reducing oxygen-rich blood flow to the heart. The result is coronary artery disease.
Obstructive coronary artery disease means the heart’s arteries are more than 50% blocked. The blood flow may eventually be completely blocked in one or more of the three large coronary arteries. In nonobstructive coronary artery disease, the large arteries may be narrowed by plaque, but not as much as they are in obstructive disease.
Small plaques can also develop in the small blood vessels in the heart, causing coronary microvascular disease.
Problems with how the heart’s blood vessels work can cause coronary heart disease. For example, the blood vessels may not respond to signals that the heart needs more oxygen-rich blood. Normally, the blood vessels widen to allow more blood flow when a person is physically active or under stress. But if you have coronary heart disease, the size of these blood vessels may not change, or the blood vessels may even narrow.
The cause of these problems is not fully clear. But it may involve:
In nonobstructive coronary artery disease, damage to the inner walls of the coronary arteries can cause them to spasm (suddenly tighten). This is called vasospasm. The spasm causes the arteries to narrow temporarily and blocks blood flow to the heart.
These problems can also happen in the tiny blood vessels in the heart, causing coronary microvascular disease (sometimes called coronary syndrome X). Coronary microvascular disease can happen with or without obstructive or nonobstructive coronary artery disease.
Learn more about the important role that inflammation, which is the body’s reaction to an injury, plays in the development of coronary heart disease.
Plaque can attract platelets and white blood cells to the area of buildup in the large coronary arteries, causing inflammation. Inflammation can also prevent the small arteries of the heart from responding to the physical, electrical, and chemical signals that tell the arteries when the heart needs more oxygen-rich blood. This can lead to coronary microvascular disease. Research suggests that inflammation may also reduce levels of HDL cholesterol (sometimes called “good” cholesterol).
There are many risk factors for coronary heart disease. Your risk of coronary heart disease goes up with the number of risk factors you have and how serious they are. Some risk factors—such as high blood pressure and high blood cholesterol—can be changed through heart-healthy lifestyle changes. Other risk factors, such as sex, older age, family history and genetics, and race and ethnicity, cannot be changed.
Genetic or lifestyle factors cause plaque to build up in your arteries as you age. In men, the risk for coronary heart disease starts to increase around age 45. Before menopause, women have a lower risk of coronary heart disease than men. After around age 55, women’s risk goes up. This is likely because women make less estrogen (a female hormone) after menopause. Also, changes in the small blood vessels of the heart as you age raise the risk for coronary microvascular disease.
Air pollution in the environment can put you at higher risk of coronary heart disease. The increase in risk may be higher in older adults, women, and people who have diabetes or obesity. Air pollution may cause or worsen other conditions, such as atherosclerosis and high blood pressure, which are known to increase your risk for coronary heart disease.
Your work life can also raise your risk if you:
A family history of early heart disease is a risk factor for coronary heart disease. This is especially true if your father or brother was diagnosed before age 55, or if your mother or sister was diagnosed before age 65. Research shows that some genes are linked with a higher risk for coronary heart disease.
Over time, unhealthy lifestyle habits increase your risk of coronary heart disease because they can lead to plaque buildup in the heart’s blood vessels. Unhealthy lifestyle habits that are risk factors include the following:
Learn about steps you can take to improve your heart health in our Heart-Healthy Living topic.
Other medical conditions that can raise your risk of developing coronary heart disease include:
Coronary heart disease is the leading cause of death for people of most racial and ethnic groups in the United States, including African Americans, Hispanics, and whites.
For Asian Americans or Pacific Islanders and American Indians or Alaska Natives, heart disease is second only to cancer. People of South Asian ancestry are at higher risk of developing coronary heart disease and serious complications than other Asian Americans.
Coronary heart disease affects men and women. Obstructive coronary artery disease is more common in men. However, nonobstructive coronary artery disease is more common in women. Since the nonobstructive type is harder to diagnose, women may not be diagnosed and treated as quickly as men.
If you are a woman having chest discomfort or shortness of breath during physical activity, ask your doctor about tests to check for nonobstructive coronary artery disease or coronary microvascular disease.
Women may have a higher than normal risk for developing coronary heart disease if they have one of the following conditions.
You should start getting screening tests and risk assessments for coronary heart disease around age 20 if you do not have any risk factors for coronary heart disease. Children may need screening if they have risk factors, such as obesity, low levels of physical activity, or a family history of heart problems.
Afterward, your doctor may recommend preventive treatments such as heart-healthy lifestyle changes to help you lower your risk of coronary heart disease.
To screen for coronary heart disease, your doctor will:
Screening usually occurs in a doctor's office, but sometimes screenings are done at health fairs, drugstores, or other places. Blood samples might be collected at your doctor's office, a hospital, or a laboratory.
Ask your doctor or nurse whether you need to fast (not eat or drink anything besides water) before the blood tests.
Your doctor may use a risk calculator to estimate your risk of having a heart attack, having a stroke, or dying from a heart or blood vessel disease in the next 10 years or throughout your lifetime.
For example, the Atherosclerotic Cardiovascular Disease (ASCVD) Estimator considers your cholesterol levels, age, sex, race, and blood pressure. It also factors in whether you smoke or take medicines to manage your high blood pressure or cholesterol.
Ask about your risk during your annual check-up. Knowing your risk will help you and your doctor decide on healthy lifestyle changes and possibly medicines to lower your risk.
Risk assessments should be repeated every 4 to 6 years in adults 20 to 79 years of age who do not have heart or blood vessel disease.
No single risk calculator is appropriate for all people. Calculators can give you and your doctor a good idea about your risk, but your doctor might have to consider other factors to estimate your risk more accurately.
Commonly used risk calculators might not accurately estimate risk in certain situations, such as if you:
In these cases, your doctor may suggest other tests for coronary heart disease even if the ASCVD Risk Estimator says you are not at high risk.
Studies show that heart-healthy living—never smoking, eating healthy, and being physically active—throughout life can prevent coronary heart disease and its complications.
Work with your doctor to set up a plan that works for you based on your lifestyle, your home and neighborhood environments, and your culture. Working with a team of healthcare providers may help with making changes in your diet, being physically active, managing other medical conditions, and helping you quit smoking.
Some people have severe symptoms of coronary heart disease. Others have no symptoms at all. If you have “silent” coronary heart disease, you may not have any symptoms until you have a heart attack or other complication.
An acute coronary event, such as a heart attack, may cause the following symptoms:
Women are somewhat less likely than men to experience chest pain. Instead, they are more likely to experience:
Women are also more likely than men to have no symptoms of coronary heart disease.
Chronic (long-term) coronary heart disease can cause symptoms such as the following:
The symptoms may get worse as the buildup of plaque continues to narrow the coronary arteries. Chest pain or discomfort that does not go away or happens more often or while you are resting might be a sign of a heart attack. If you do not know whether your chest pain is angina or a heart attack, call 9-1-1 right away. All chest pain should be checked by a doctor.
Because women and their doctors may not recognize coronary heart disease symptoms that are different from men’s, women may not be diagnosed and treated as quickly as men. It is important to seek care right away if you have symptoms of coronary heart disease.
Your doctor will ask about your eating and physical activity habits, your medical history, your family history, and risk factors for coronary heart disease. Your doctor may ask whether you have any other signs or symptoms. This information can help your doctor determine whether you have complications or other conditions that may cause coronary heart disease.
To diagnose coronary heart disease, your doctor may order some of the following tests.
If you have coronary heart disease risk factors, your doctor may recommend diagnostic tests even if you do not have symptoms.
Nonobstructive coronary artery disease and coronary microvascular disease can be missed because patients or doctors may not recognize the warning signs. Diagnosing these types often requires more invasive tests or specialized tests, such as cardiac PET scans, that are not widely available.
Your treatment plan depends on how severe your disease is, the severity of your symptoms, and any other health conditions you may have. Possible treatments for coronary heart disease include heart-healthy lifestyle changes, medicines, or procedures such as coronary artery bypass grafting or percutaneous coronary intervention.
Your doctor will consider your 10-year risk calculation when deciding how best to treat your coronary heart disease.
Your doctor may recommend that you adopt lifelong heart-healthy lifestyle changes, including:
Learn more about heart-healthy living.
Your doctor may recommend medicines to manage your risk factors or treat underlying causes of coronary heart disease. Some medicines can reduce or prevent chest pain and manage other medical conditions that may be contributing to your coronary heart disease.
You may need a procedure or heart surgery to treat more advanced coronary heart disease.
It is important to get routine medical care and to take all medicines regularly, as your doctor prescribes. Do not change the amount of your medicine or skip a dose unless your doctor tells you to. Talk with your doctor about how often you should schedule office visits and blood tests.
Between visits, call your doctor if you have any new symptoms, if your symptoms worsen, or if you have problems with your blood pressure or blood sugar.
Return to Treatment to review possible treatment options for coronary heart disease.
You may be referred for exercise-based cardiac rehabilitation, also called cardiac rehab, to manage symptoms and reduce the chances of future problems such as heart attack. Studies have shown that cardiac rehabilitation lowers the risk of hospitalization and death. It can also improve your quality of life.
Your doctor will work with you to manage medical conditions that can raise your risk of heart problems and complications.
Your doctor will likely suggest heart-healthy lifestyle changes, such as eating heart-healthy foods, being physically active, and quitting smoking. Your doctor may refer you to other professionals, such as a registered dietitian or exercise physiologist. Your healthcare team can help you set up a personal plan to meet your health goals.
There are benefits to quitting smoking no matter how long or how much you have smoked. Coronary heart disease risk associated with smoking begins to decrease soon after you quit, and it generally continues to decrease over time. In addition:
Living with heart disease may cause fear, anxiety, depression, and stress. You may worry about having heart problems or making lifestyle changes that are necessary for your health. Talk with your healthcare team about how you feel. Your doctor may talk to you about:
Coronary heart disease can lead to heart attack or stroke. If you think that you are or someone else is having the following symptoms, call 9-1-1 right away. Every minute matters.
The signs and symptoms of a heart attack include:
Coronary heart disease is the leading cause of death for women. About 80% of women ages 40 to 60 have one or more risk factors for coronary heart disease. Having multiple risk factors significantly increases a woman’s chance of developing coronary heart disease.
Learn more about how the causes, risk factors, symptoms, diagnosis, and treatment of coronary heart disease may be different for women than for men. Read Advancing Women's Heart Health to learn more.
Coronary heart disease is different for women than men because of hormonal and anatomical differences.
Women are more likely than men to have medical conditions or life issues that raise their risk for coronary heart disease.
Some factors raise women’s risk for coronary heart disease more than they increase risk in men.
Visit The Heart Truth® to learn more about coronary heart disease risk factors for women and how to lower them.
Although men and women can experience the same symptoms of coronary heart disease, women often experience no symptoms or have different symptoms than men do.
Tests and procedures for diagnosing coronary heart disease are very similar for women and men. But women may experience delays in diagnosis or treatment. Learn about important diagnostic tests and treatment options.
Learn about the following ways the NHLBI continues to translate current research into improved health for people with heart disease. Research on this topic is part of the NHLBI's broader commitment to advancing heart and vascular disease, population and epidemiology studies, and women’s health scientific discovery.
Learn about some of the pioneering research contributions we have made over the years that have improved clinical care.
In support of our mission, we are committed to advancing coronary heart disease research in part through the following ways.
Learn about exciting research areas the NHLBI is exploring about coronary heart disease.
To learn more about clinical trials at the NIH Clinical Center or to talk to someone about a study that might fit your needs, call the Office of Patient Recruitment 800-411-1222.
After reading our Coronary Heart Disease Health Topic, you may be interested in additional information found in the following resources.