Coronary Heart Disease

Also known as Coronary Artery Disease, Coronary Microvascular Disease, Coronary Syndrome X, Ischemic Heart Disease, Nonobstructive Coronary Artery Disease, Obstructive Coronary Artery Disease
Heart disease is a catch-all phrase for a variety of conditions that affect the heart’s structure and function. Coronary heart disease is a type of heart disease that develops when the arteries of the heart cannot deliver enough oxygen-rich blood to the heart. It is the leading cause of death in the United States.

Coronary heart disease is often caused by the buildup of plaque, a waxy substance, inside the lining of larger coronary arteries. This buildup can partially or totally block blood flow in the large arteries of the heart. Some types of this condition may be caused by disease or injury affecting how the arteries work in the heart. Coronary microvascular disease is another type of coronary heart disease. It occurs when the heart’s tiny blood vessels do not work normally.

Symptoms of coronary heart disease may be different from person to person even if they have the same type of coronary heart disease. However, because many people have no symptoms, they do not know they have coronary heart disease until they have chest pain, a heart attack, or sudden cardiac arrest.

If you have coronary heart disease, your doctor will recommend heart-healthy lifestyle changes, medicines, surgery, or a combination of these approaches to treat your condition and prevent complications.

Explore this Health Topic to learn more about coronary heart disease, our role in research and clinical trials to improve health, and where to find more information.

Causes - Coronary Heart Disease

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
- Coronary Heart Disease

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.

Normal vs a blocked artery
Normal versus a blocked artery. The image shows a normal coronary artery with normal blood flow and a blocked coronary artery narrowed by plaque. The buildup of plaque limits the flow of oxygen-rich blood through the artery. Medical Illustration Copyright © 2019 Nucleus Medical Media, All rights reserved.

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 affecting the blood vessels
- Coronary Heart 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:

  • Damage or injury to the walls of the arteries or tiny blood vessels from chronic inflammation, high blood pressure, or diabetes.
  • Molecular changes that are part of the normal aging process. Molecular changes affect the way genes and proteins are controlled inside cells.

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.

Spasm and plaque buildup causing arteries to narrow
Spasm and plaque buildup can cause your arteries to narrow. Top left: image of a heart showing the coronary arteries. Top right: This artery does not have plaque buildup but has a vasospasm, causing it to narrow. This is a type of nonobstructive coronary artery disease. Bottom left: This artery is also classified as nonobstructive because it is less than 50% blocked by plaque. However, the vasospasm causes severe narrowing. Bottom right: This artery also has a spasm but is considered to be obstructive coronary artery disease, because it is 80% blocked. Medical Illustration Copyright © 2019 Nucleus Medical Media, All rights reserved.

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.

Coronary microvascular disease in small arteries and obstructive coronary artery disease in large arteries
Coronary microvascular disease in small arteries and obstructive coronary artery disease in large arteries. Figure A shows the small coronary artery network, which includes a normal artery and an artery with coronary microvascular disease. Figure B shows a large coronary artery with plaque buildup.

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.

Risk Factors - Coronary Heart Disease

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.

Age
- Coronary Heart Disease

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.

Environment and occupation
- Coronary Heart 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:

  • Come into contact with toxins, radiation, or other hazards
  • Have a lot of stress at work
  • Sit for long periods
  • Work more than 55 hours a week, or work long, irregular, or night shifts that affect your sleep

Family history and genetics
- Coronary Heart Disease

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.

Lifestyle habits
- 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:

  • Being physically inactive, which can worsen other heart disease risk factors, such as high blood cholesterol and triglyceride levels, high blood pressure, diabetes and prediabetes, and overweight and obesity.
  • Not getting enough good quality sleep, including waking up often throughout the night, which may raise your risk of coronary heart disease. While you sleep, your blood pressure and heart rate fall. Your heart does not work as hard as it does when you are awake. As you begin to wake up, your blood pressure and heart rate increase to the usual levels when you are awake and relaxed. Waking up suddenly can cause a sharp increase in blood pressure and heart rate, which has been linked to angina and heart attacks. Learn more in our How Sleep Works topic.
  • Smoking tobacco or long-term exposure to secondhand smoke, which can damage the blood vessels.
  • Stress, which can trigger the tightening of your arteries, which increases your risk of coronary heart disease, especially coronary microvascular disease. Stress may also indirectly raise your risk of coronary heart disease if it makes you more likely to smoke or overeat foods high in fat and added sugars.
  • Unhealthy eating patterns, such as consuming high amounts of saturated fats or trans fats and refined carbohydrates (white bread, pasta, and white rice). This can lead to overweight and obesity, high blood cholesterol, atherosclerosis, and plaque buildup in the heart’s arteries.

 

Learn about steps you can take to improve your heart health in our Heart-Healthy Living topic.

Other medical conditions
- Coronary Heart Disease

Other medical conditions that can raise your risk of developing coronary heart disease include:

Race or ethnicity
- Coronary Heart Disease

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.

Sex
- Coronary Heart Disease

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.

  • Endometriosis, which raises the risk for heart disease in younger women
  • Gestational diabetes, which can raise the risk for diabetes and metabolic syndrome even after pregnancy and the risk of developing coronary heart disease
  • Polycystic ovary syndrome
  • Preeclampsia, a condition that can happen during pregnancy and is linked to an increased lifetime risk for coronary heart disease
  • Early menopause (before age 40)

Screening and Prevention - Coronary Heart Disease

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.

Screening tests and results
- Coronary Heart Disease

To screen for coronary heart disease, your doctor will:

  • Assess risk factors to help evaluate your risk of developing coronary heart disease
  • Check blood pressure readings to see whether you have high blood pressure
  • Calculate your body mass index and waist circumference to see whether you have an unhealthy weight
  • Order blood tests to see whether you have high blood cholesterol, high blood triglycerides, or diabetes

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.

Risk calculators
- Coronary Heart Disease

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.

How to prevent coronary heart disease
- Coronary Heart Disease

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.

Signs, Symptoms, and Complications - Coronary Heart Disease

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.

Signs and symptoms
- Coronary Heart Disease

An acute coronary event, such as a heart attack, may cause the following symptoms:

  • Angina, which can feel like pressure, squeezing, burning, or tightness during physical activity. The pain or discomfort usually starts behind the breastbone, but it can also occur in the arms, shoulders, jaw, throat, or back. The pain may feel like indigestion.
  • Cold sweats
  • Dizziness
  • Light-headedness
  • Nausea or a feeling of indigestion
  • Neck pain
  • Shortness of breath, especially with activity
  • Sleep disturbances
  • Weakness

Women are somewhat less likely than men to experience chest pain. Instead, they are more likely to experience:

  • Dizziness
  • Fatigue
  • Nausea
  • Pressure or tightness in the chest
  • Stomach pain

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:

  • Angina
  • Shortness of breath with physical activity
  • Fatigue
  • Neck pain

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.

Complications
- Coronary Heart Disease

Coronary heart disease can cause serious complications, including the following:

Complications of coronary heart disease can be life-threatening and may lead to disability.

Diagnosis - Coronary Heart Disease

Your doctor will diagnose coronary heart disease based on your symptoms, your medical and family history, your risk factors, and the results from tests and procedures.

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.

Medical history
- 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.

Diagnostic tests and procedures
- Coronary Heart Disease

To diagnose coronary heart disease, your doctor may order some of the following tests.

  • Blood tests to check the levels of cholesterol, triglycerides, sugar, lipoproteins, or proteins, such as C-reactive protein, that are a sign of inflammation.
  • Electrocardiogram (EKG or ECG) to determine whether the heart’s rhythm is steady or irregular. An EKG also records the strength and timing of electrical signals as they pass through the heart.
  • Coronary calcium scan to measure the amount of calcium in the walls of your coronary arteries. Buildup of calcium can be a sign of atherosclerosis, coronary artery disease, or coronary microvascular disease. This test is a type of cardiac CT scan. Coronary calcium scans can also help assess coronary heart disease risk for people who smoke or for people who do not have heart symptoms.
  • Stress tests to check how your heart works during physical stress. During stress testing, you walk or run on a treadmill or pedal a stationary bike to make your heart work hard and beat fast. If you have a medical problem that prevents you from exercising, your doctor may give you medicine to make your heart work hard, as it would during exercise. To detect reduced blood flow to your heart muscle, while you exercise you will be monitored by ECG and possibly echocardiogram or a CT scan.
  • Cardiac MRI (magnetic resonance imaging) to detect tissue damage or problems with blood flow in the heart or coronary arteries. It can help your doctor diagnose coronary microvascular disease or nonobstructive or obstructive coronary artery disease. Cardiac MRI can help explain results from other imaging tests such as chest X-rays and CT scans.
  • Cardiac positron emission tomography (PET) scanning to assess blood flow through the small coronary blood vessels and into the heart tissues. This is a type of nuclear heart scan that can diagnose coronary microvascular disease.
  • Coronary angiography to show the insides of your coronary arteries. To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization. This procedure is often used if other tests show that you are likely to have coronary artery disease. To diagnose coronary microvascular disease, your doctor will use coronary angiography with guidewire technology. A guidewire with sensors is inserted into the heart’s arteries. The sensors measure how easily blood flows through the small vessels. Usually, measurements are done before and after giving you medicine to enhance blood flow in your heart.
  • Coronary computed tomographic angiography to show the insides of your coronary arteries rather than an invasive cardiac catheterization. It is a noninvasive imaging test using CT scanning.

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.

Treatment - Coronary Heart Disease

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.

Heart-healthy lifestyle changes
- Coronary Heart Disease

Your doctor may recommend that you adopt lifelong heart-healthy lifestyle changes, including:

  • Aiming for a healthy weight. Losing just 3% to 5% of your current weight can help you manage some coronary heart disease risk factors, such as high blood cholesterol and diabetes. Greater amounts of weight loss can also improve blood pressure readings.
  • Being physically active. Routine physical activity can help manage coronary heart disease risk factors such as high blood cholesterol, high blood pressure, or overweight and obesity. Before starting any exercise program, ask your doctor what level of physical activity is right for you.
  • Heart-healthy eating, such as the DASH (Dietary Approaches to Stop Hypertension) eating plan. A heart-healthy eating plan includes fruits, vegetables, and whole grains and limits saturated fats, trans fats, sodium (salt), added sugars, and alcohol.
  • Managing stress. Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health.
  • Quitting smoking. Visit Smoking and Your Heart and the National Heart, Lung, and Blood Institute's Your Guide to a Healthy Heart. Although these resources focus on heart health, they include basic information about how to quit smoking. For free help and support to quit smoking, you can call the National Cancer Institute's Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848). Talk to your doctor if you vape. There is scientific evidence that nicotine and flavorings found in vaping products may damage your heart and lungs.
  • Get enough good-quality sleep. The recommended amount for adults is 7 to 9 hours of sleep a day.

Learn more about heart-healthy living.

Medicines
- Coronary Heart Disease

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.

  • ACE inhibitors and beta blockers to help lower blood pressure and decrease the heart's workload.
  • Calcium channel blockers to lower blood pressure by allowing blood vessels to relax.
  • Medicines to control blood sugar, such as empagliflozin, canagliflozin, and liraglutide, to help lower your risk for complications if you have coronary heart disease and diabetes.
  • Metformin to control plaque buildup if you have diabetes.
  • Nitrates, such as nitroglycerin, to dilate your coronary arteries and relieve or prevent chest pain from angina.
  • Ranolazine to treat coronary microvascular disease and the chest pain it may cause.
  • Statins and/or non-statin therapies to control high blood cholesterol. Your doctor may recommend statin therapy if you have a higher risk for coronary heart disease or stroke or if you have diabetes and are between ages 40 and 75. Non-statin therapies may be used to reduce cholesterol when statins do not lower cholesterol enough or cause side effects. Your doctor may prescribe non-statin drugs, such as, ezetimibe, bile acid sequestrants, alirocumab, or evolocumab to lower cholesterol or omega-3 fatty acids, gemfibrozil, or fenofibrate to reduce triglycerides.

Procedures
- Coronary Heart Disease

You may need a procedure or heart surgery to treat more advanced coronary heart disease.

  • Percutaneous coronary intervention (PCI) to open coronary arteries that are narrowed or blocked by the buildup of atherosclerotic plaque. A small mesh tube called a stent is usually implanted after PCI to prevent the artery from narrowing again.
  • Coronary artery bypass grafting (CABG) to improve blood flow to the heart by using normal arteries from the chest wall and veins from the legs to bypass the blocked arteries. Surgeons typically use CABG to treat people who have severe obstructive coronary artery disease in multiple coronary arteries.
  • Transmyocardial laser revascularization or coronary endarterectomy to treat severe angina associated with coronary heart disease when other treatments are too risky or did not work.

Living With - Coronary Heart Disease

If you have been diagnosed with coronary heart disease, it is important that you continue your treatment plan. Get regular follow-up care to control your condition and prevent complications.

Receive follow-up care
- 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.

Cardiac rehabilitation
- 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.

Prevent complications over your lifetime
- Coronary Heart Disease

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:

  • You will likely be given a statin to lower your LDL cholesterol, especially after a heart attack.
  • Your doctor may recommend aspirin to prevent a heart attack or stroke. Low-dose aspirin may help prevent blood clots and lower the risk for heart attacks and other complications of coronary heart disease for some people, particularly those with microvascular disease or who have diabetes. Talk to your doctor before taking aspirin, because it raises the risk of serious bleeding.
  • If you have diabetes, you will need to check your blood sugar regularly and keep taking any prescribed medicines.
  • If your coronary heart disease becomes unstable or has led to a heart attack or sudden cardiac arrest, your doctor may recommend a pacemaker or defibrillator to detect and treat certain types of serious arrhythmias.

Take care of your mental health
- Coronary Heart Disease

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:

  • Talking to a professional counselor. If you have depression or anxiety, your doctor also may recommend medicines or other treatments that can improve your quality of life.
  • Joining a patient support group. This may help you adjust to living with heart disease. You can find out how other people manage similar symptoms. Your doctor may be able to recommend local support groups, or you can check with an area medical center.
  • Seeking support from family and friends. Letting your loved ones know how you feel and what they can do to help you can help relieve stress and anxiety.

Learn the warning signs of serious complications and have a plan
- Coronary Heart Disease

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.

Heart attack

The signs and symptoms of a heart attack include:

  • Prolonged or severe chest pain or discomfort not relieved by rest or nitroglycerin. This involves uncomfortable pressure, squeezing, fullness, or pain in the center or left side of the chest that can be mild or strong. This pain or discomfort often lasts more than a few minutes or goes away and comes back.
  • Nausea, vomiting, light-headedness or fainting, or breaking out in a cold sweat. These symptoms of a heart attack are more common in women.
  • Shortness of breath. This may accompany chest discomfort or happen before it.
  • Upper body discomfort. This can be felt in one or both arms, the back, neck, jaw, or upper part of the stomach.

Women and Heart Disease - Coronary Heart Disease

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.

Why does coronary heart disease affect women differently?
- Coronary Heart Disease

Coronary heart disease is different for women than men because of hormonal and anatomical differences.

  • Hormonal changes affect a woman’s risk for coronary heart disease. Before menopause, the hormone estrogen provides women with some protection against coronary artery disease. Estrogen raises levels of HDL cholesterol (sometimes called “good” cholesterol) and helps keep the arteries flexible so they can widen to deliver more oxygen to the tissues of the heart in response to chemical and electrical signals. After menopause, estrogen levels drop, increasing a woman’s risk for coronary heart disease.
  • The size and structure of the heart is different for women and men. A woman’s heart and blood vessels are smaller, and the muscular walls of women’s hearts are thinner.
  • Women are more likely to have nonobstructive coronary heart disease or coronary microvascular disease. These types are harder to diagnose than obstructive coronary artery disease, which can be harder to diagnose. This can cause delays in getting diagnosed and treated.

What factors affect risk for women differently?
- Coronary Heart Disease

Women are more likely than men to have medical conditions or life issues that raise their risk for coronary heart disease.

  • Anemia, especially during pregnancy
  • Early menopause (before age 40)
  • Endometriosis
  • High blood pressure after age 65
  • History of problems during pregnancy, including gestational diabetes, preeclampsia, eclampsia (high blood pressure during pregnancy), and giving birth to a baby who is premature or smaller than average.
  • Hormonal birth control
  • Inflammatory and autoimmune diseases
  • Lack of physical activity
  • Mental health issues, such as stress, marital stress, anxiety, depression, or low social support
  • Metabolic syndrome, a group of risk factors that raises your risk of heart disease and other health problems
  • Overweight and obesity

Some factors raise women’s risk for coronary heart disease more than they increase risk in men.

  • Diabetes
  • Low levels of HDL cholesterol
  • Mild to moderate high blood pressure
  • Smoking

Visit The Heart Truth® to learn more about coronary heart disease risk factors for women and how to lower them.

Can symptoms differ for women?
- Coronary Heart Disease

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.

  • Activity that brings on chest pain. In men, angina tends to worsen with physical activity and go away with rest. Women are more likely than men to have angina while they are resting. In women who have coronary microvascular disease, angina often happens during routine daily activities, such as shopping or cooking, rather than during exercise. Microvascular angina events may last longer and be more painful than other types of angina.
  • Location and type of pain. Pain symptoms are different for each person. Women having angina or a heart attack often describe their chest pain as crushing, or they say it feels like pressure, squeezing, or tightness. Women may have pain in the chest or the neck and throat.
  • Mental stress. Mental stress is more likely to trigger angina pain in women than in men.
  • Other symptoms. Common signs and symptoms for women include nausea, vomiting, shortness of breath, abdominal pain, sleep problems, fatigue, and lack of energy.

What do women need to know about diagnosis and treatment?
- Coronary Heart Disease

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.

  • Ask about important diagnostic tests. Doctors are less likely to refer women for diagnostic tests for coronary heart disease. When women go to the hospital for heart symptoms, they are more likely than men to experience delays receiving an initial EKG, are less likely to receive care from a heart specialist during hospitalization, and are less likely to receive certain types of therapy and medicines. Younger women are more likely than men to be misdiagnosed and sent home from the emergency department after cardiac events that occur from undiagnosed and untreated vascular heart disease.
  • Ask about treatment options that are effective for men and women. Women may be less likely than men to receive aspirin, statins, and beta blockers for treating their heart disease. Although women may be as likely as men to benefit from a pacemaker or a defibrillator, women are less likely to receive these treatments for complications of coronary heart disease. Women are often less likely to receive percutaneous coronary intervention or coronary artery bypass grafting than men are, even though research shows that both men and women can benefit from these procedures.
  • Know and share your risk factors. Doctors may not recognize women’s risk for coronary heart disease. Commonly used risk-scoring systems may not accurately predict risk in women. Also, in one survey, fewer than one in four women reported that their doctors had ever discussed their risk for heart disease.
  • Learn the symptoms and seek medical care right away. Being familiar with the symptoms of coronary heart disease and how they may differ in women may help you recognize when to talk to your doctor or when to seek medical care. Immediate care may help prevent complications such as heart attack or sudden cardiac arrest.

Research for Your Health

The NHLBI is part of the U.S. Department of Health and Human Services’ National Institutes of Health (NIH)—the Nation’s biomedical research agency that makes important scientific discovery to improve health and save lives. We are committed to advancing science and translating discoveries into clinical practice to promote the prevention and treatment of heart, lung, blood, and sleep disorders, including coronary heart disease. Learn about current and future NHLBI efforts to improve health through research and scientific discovery.

Improving health with current research
- Coronary Heart Disease

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.

  • Long-standing Leadership in Cardiovascular Diseases. For more than 70 years, the NHLBI has been at the forefront of improving the Nation’s health and reducing the burden of heart disease. Although coronary heart disease remains the leading cause of death in the United States, the rate of heart disease deaths has declined by 70% over the past 50 years, thanks in part to NHLBI-funded research. Visit Heart and Vascular Diseases to learn more.
  • NHLBI Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents. We support the development of guidelines based on up-to-date research to evaluate and manage risk of coronary heart disease in children and adolescents. Visit Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents for more information.
  • Following Coronary Heart Disease in Generations of Families. NHLBI’s landmark Framingham Heart Study (FHS), launched in 1948, has contributed transformative discoveries related to the risk factors and treatment of heart disease. Through the FHS, scientists learned that many of those risks can be changed. Such findings are paving the way for new interventions to preempt, prevent, or treat these conditions more effectively. FHS discoveries have changed the way Americans look at—and get treated for—heart disease. To learn more, visit “Our Gift to the World”: Three generations of Framingham Heart Study help fight heart disease and view the video Unraveling the Mysteries of Cardiovascular Disease: Lessons from NHLBI’s Framingham Heart Study.
  • Advancing Research in HIV/AIDS-related Heart and Vascular Diseases. The NHLBI is the primary steward of the new Multicenter AIDS Cohort Study (MACS)/Women’s Interagency HIV Study (WIHS) Combined Cohort Study (MACS/WIHS-CCS). This trans-NIH collaborative research effort aims to understand and reduce the impact of chronic health conditions that affect people living with HIV. The MACS/WIHS-CCS will build on decades of research in thousands of men and women to further our understanding of chronic heart, lung, blood, sleep, and other disorders associated with HIV. The Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) tests the effectiveness of statins to reduce the risk of heart and vascular diseases in adults living with HIV.
  • Global Leadership in Cardiovascular Health. We are proud to serve as a global leader and respond to legislative calls to increase U.S. global health efforts. The Health Inequities and Global Health Branch seeks to stimulate global health research, education, and training for many conditions, including coronary heart disease.
  • Recommendation Against Hormone Replacement Therapy in Postmenopausal Women. The NHLBI-sponsored Women’s Health Initiative, one of the country's largest clinical trials of women ever undertaken, recruited more than 161,000 postmenopausal women to allow researchers to study strategies to prevent coronary heart disease, among other conditions. The initiative provided evidence that hormone replacement therapy does not protect older postmenopausal women from coronary heart disease and its complications. As a result, doctors no longer routinely prescribe long-term hormone therapy for postmenopausal women.
  • National Education Program to Raise Awareness of Heart Disease. NHLBI’s The Heart Truth® is an initiative to get the message out about the dangers of heart disease. Working with national and community organizations, we provide educational materials for the public and health professionals, train leaders to educate women and men in their community, support National Wear Red Day®, and more.
  • NHLBI's Women's Ischemia Syndrome Evaluation (WISE) Study. The WISE study, which started in 1996, is advancing the understanding of heart disease in women, leading to improved diagnosis and treatment. Most of what is known about coronary microvascular disease comes from the study. The WISE study revealed that 8% of women who had chest pain but no sign of obstructive coronary artery disease actually had scars in their heart muscle, indicating that they had had an undetected heart attack at some point, which could increase their risk of serious heart complications. WISE researchers are now studying women who have coronary microvascular disease or nonobstructive coronary artery disease to find ways to prevent heart failure.
  • South Asian Origin as a Key Risk Factor for Coronary Heart Disease. We supported the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study, the first long-term study to look at the factors leading to coronary heart disease in South Asians in the United States and guide prevention and treatment. Importantly, MASALA study researachers found that in South Asians, body fat tends to be stored around organs. This raises the risk of diabetes and coronary heart disease, even in people who have a low body weight. The American Heart Association used MASALA data in its cholesterol guidelines, which recommend that South Asians be considered a high-risk group and therefore carefully considered for statin treatment.
  • Studying Innovations to Improve Heart and Vascular Disease Outcomes. The Cardiothoracic Surgical Trials Network (CTSN) is an international network that studies heart valve disease, arrhythmias, heart failure, coronary heart disease, and the complications of surgery. CTSN researchers have studied the success of treatments for people who have atrial fibrillation and need heart valve surgery. For example, they compared rate control and rhythm control as a first treatment after surgery. The strategies were equally effective at treating atrial fibrillation and preventing complications.

Learn about some of the pioneering research contributions we have made over the years that have improved clinical care.

Advancing research for improved health
- Coronary Heart Disease

In support of our mission, we are committed to advancing coronary heart disease research in part through the following ways.

  • We perform research. Our Division of Intramural Research, which includes investigators from our Cardiovascular Branch and Population Sciences Branch, is engaged in research on diseases that affect the heart and blood vessels, including coronary heart disease.
  • We fund research. The research we fund today will help improve our future health. Our Division of Cardiovascular Sciences oversees much of the research on coronary heart disease we fund, helping us to understand, prevent, and manage coronary heart disease and other cardiovascular conditions. Through the Center for Translation Research and Implementation Science, we plan, foster, and support research to identify the best strategies for ensuring successful integration of evidence-based interventions within clinical and public health settings, such as health centers, worksites, communities, and schools in the United States and abroad. Search the NIH RePORTER to learn about research that we are funding on coronary heart disease.
  • We stimulate high-impact research. Our Trans-Omics for Precision Medicine (TOPMed) program includes participants with coronary heart disease, which may help us understand how genes contribute to differences in disease severity and how patients respond to treatment. The NHLBI Strategic Vision highlights ways in which we may support research over the next decade.

Learn about exciting research areas the NHLBI is exploring about coronary heart disease.

Participate in NHLBI Clinical Trials

We lead or sponsor many studies on coronary heart disease. See if you or someone you know is eligible to participate in our clinical trials and observational studies.

Trials at the NIH Clinical Center

Sample collection for studies of blood vessel diseases

This study is collecting blood samples to study the role of inflammation in diseases of the blood vessels, including coronary heart disease and sickle cell disease. To participate, you or your child must be at least 2 years old and either be healthy or have a disease affecting the blood vessels.

Statin use to decrease cholesterol plaque buildup

This study aims to determine whether medicines called statins, which are prescribed to lower blood cholesterol levels, can reduce plaque in the heart’s arteries. Participants who are taking statins to reduce their risk for heart and blood vessel disease will have blood and imaging tests to measure any changes in plaque in their arteries. To participate in this study, men must be age 45-75 and women must be age 50-75. This study is located in Bethesda, Maryland.

Evaluating heart conditions

This study aims to help train staff on a range of heart conditions by evaluating patients of all ages at the NIH Clinical Center who have heart disease or are at risk of heart disease. Participants in the study must be at risk for or have symptoms of cardiovascular diseases. Some examples of cardiovascular diseases include coronary heart disease, heart valve disease, cardiomyopathies, peripheral artery disease, congenital heart disease, and vascular disease of the kidneys. This study is located in Bethesda, Maryland.

Link between psoriasis and heart diseases

This study is exploring possible links among several diseases associated with chronic inflammation. Participants with an inflammatory disease called psoriasis will be monitored to learn more about whether this condition affects their risk for developing high blood cholesterol, atherosclerosis, and cardiovascular disease, including coronary heart disease. To participate in this study, you must be at least 18 years old and have psoriasis. This study is located in Bethesda, Maryland.

Using MRI to better understand cardiovascular and brain function

This study aims to identify better MRI methods and new ways of imaging cardiovascular disease to understand cardiovascular and brain function. Researchers are also interested in seeing whether gadolinium, the commonly used MRI contrast agent, stays in the body long after an MRI is performed. To participate in this study, you or your child should be healthy or have a cardiovascular condition and be at least 7 years old.

Developing new cardiovascular MRI imaging techniques

This study is comparing the ability of two types of magnetic resonance imaging (MRI) scanners to detect coronary heart disease, heart failure, congenital heart disease, and valve disease. The new type of MRI scanner in this study uses less energy than a traditional scanner and may be suitable for people who have metal devices in their bodies. To participate in this study, you should be healthy or have stable coronary heart disease and be at least 18 years old. This study is located in Bethesda, Maryland.

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.

Are you living with HIV and high blood cholesterol or high blood pressure?

This study is evaluating a nurse-led reminder system to help people who have HIV stay on track with their heart medicines. Participants will have four visits with a nurse, and the nurse will help them manage their medicine schedule with telephone reminders. To participate in this study, you must be at least 18 years old; have HIV, high blood cholesterol, or high blood pressure or be taking medicines to manage these conditions; and have access to a telephone. This study is located in Cleveland, Ohio, and Durham, North Carolina.

Do you have depression symptoms and have been diagnosed with coronary heart disease?

This study aims to find out whether an online tool can help improve symptoms of depression in people who have coronary heart disease and encourage them to start treatment for depression. To participate in this study, you must be at least 21 years old and have symptoms of depression and a history of coronary heart disease. This study is located in New York, New York.

Did you have a heart attack in the past eight months?

This study is looking at the link between mental stress and heart disease in men and women. Taking part in this study involves one clinic visit, one week of at-home monitoring, and follow-up phone calls every six months for three years. To participate in this study, you must be no more than 60 years old and have a history of a heart attack in the past eight months. This study is located in Atlanta, Georgia.

Do you have coronary artery disease or arteriovenous malformation?

This study aims to learn about the genes that may lead to coronary artery disease, a type of coronary heart disease, or arteriovenous malformations, which are abnormal connections between arteries and veins. To participate in this study, you must be at least 45 years old and have a history of coronary artery disease or arteriovenous malformation, and you must have a living brother or sister who has the same heart condition. This study is located in Cleveland, Ohio.

Are you interested in getting text messages to remind you to take your medicines for heart health or diabetes?

This study is assessing whether text messages can help people remember to take statins for high blood cholesterol, blood pressure medicine, or medicines for atrial fibrillation or diabetes. To participate in this study, you must be taking one of these types of medicines, have either a landline or cell phone, speak English or Spanish, be between 18 and 89 years old, and not be pregnant. This study is located in Aurora and Denver, Colorado.

Do you have diabetes and a history of heart attack?

This is a follow-on study of the Trial to Assess Chelation Therapy (TACT), which showed that medicine to help remove metals in the blood reduced the risk of ischemic heart disease complications, including stroke and unstable angina, in people who have diabetes who had a prior heart attack. To participate in this study, you must be at least 50 years old and have a history of diabetes and heart attack. This study is located in Miami, Florida.

Do you want to help improve heart imaging techniques?

This study aims to improve magnetic resonance imaging (MRI) methods to detect coronary heart disease. Healthy people and people who have coronary heart disease will have MRI scans while resting and after taking a medicine that temporarily makes your heart work harder. To participate in this study, you must be at least 18 years old and either healthy or diagnosed with coronary heart disease. The study is taking place in Los Angeles, California.

More Information

After reading our Coronary Heart Disease Health Topic, you may be interested in additional information found in the following resources.

Non-NHLBI resources
- Coronary Heart Disease

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