Angina (Chest Pain) Causes and Risk Factors
What causes angina?
Angina happens when your heart muscle does not get enough oxygen-rich blood. Medical conditions, particularly heart disease, or lifestyle habits can cause angina. To understand the causes of angina, it helps to understand how the heart works.
Coronary heart disease
Two types of coronary heart disease can cause angina.
- Coronary artery disease happens when builds up inside the large arteries that supply blood to the heart. This is called atherosclerosis. Plaque narrows or blocks the arteries, reducing blood flow to the heart muscle. Sometimes plaque breaks open and causes to form. Blood clots can partially or totally block the coronary arteries.
- Coronary microvascular disease affects the tiny arteries that branch off the larger coronary arteries. Reduced blood flow in these arteries causes microvascular angina. The arteries may be damaged and unable to expand as usual when the heart needs more oxygen-rich blood.
Spasm of the coronary arteries
A spasm that tightens your coronary arteries can cause angina. Spasms can occur whether or not you have coronary heart disease and can affect large or small coronary arteries. Damage to your heart’s arteries may cause them to narrow instead of widen when the heart needs more oxygen-rich blood.
What raises the risk of angina?
You may have an increased risk for angina because of your age, environment or occupation, family history and genetics, lifestyle, other medical conditions, race, or sex. When speaking with your doctor about potential symptoms, be sure to talk about risk factors. This will help your healthcare provider diagnose the condition and prepare a treatment plan specific to your needs.
Genetic or lifestyle factors can cause plaque to build up in your arteries as you age. This means that your risk for coronary heart disease and angina increases as you get older.
Variant angina is rare, but people who have variant angina often are younger than those who have other types of angina.
Environment or occupation
Angina may be linked to a type of air pollution called particle pollution. Particle pollution can include dust from roads, farms, dry riverbeds, construction sites, and mines.
Your work life can increase your risk of angina. Examples include work that limits your time available for sleep, involves high stress, requires long periods of sitting or standing, is noisy, or exposes you to potential hazards such as radiation.
Family history and genetics
Coronary heart disease often runs in families. Also, people who have no lifestyle-related risk factors can develop heart disease. These factors suggest that genes are involved in coronary heart disease and can influence a person’s risk of developing angina.
Variant angina has also been linked to specific changes.
The more heart disease risk factors you have, the greater your risk of developing angina. The main lifestyle risk factors for angina include:
- Alcohol use, for variant angina
- Illegal drug use, which can cause your heart to race or damage your blood vessels
- Lack of physical activity
- Smoking tobacco or long-term exposure to secondhand smoke
- Unhealthy eating patterns
Other medical conditions
Medical conditions in which your heart needs more oxygen-rich blood than your body can supply increase your risk for angina. They include:
- Cardiomyopathy, or disease of the heart muscle
- Heart problems, such as heart failure, heart valve diseases, or high blood pressure
- Metabolic syndrome
Heart procedures such as stent placement, percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG) can trigger coronary spasms and angina. Although rare, noncardiac surgery can also trigger unstable angina or variant angina.
Race or ethnicity
Some groups of people are at higher risk for developing coronary heart disease and one of its main symptoms, angina. African Americans who have already had a heart attack are more likely than whites to develop angina.
Variant angina is more common among people living in Japan, especially men, than among people living in Western countries.
Angina affects both men and women, but at different ages based on men and women’s risk of developing coronary heart disease. In men, heart disease risk starts to increase at age 45. Before age 55, women have a lower risk for heart disease than men. After age 55, the risk rises in both women and men. Women who have already had a heart attack are more likely to develop angina compared with men.
Microvascular angina most often begins in women around the time of menopause.
How can you prevent angina?
To prevent angina, your doctor may recommend that you adopt heart-healthy lifestyle changes to lower your risk of heart disease, the most common cause of angina. Heart-healthy lifestyle changes include choosing a heart-healthy eating pattern such as the DASH eating plan, being physically active, aiming for a healthy weight, quitting smoking, and managing stress. You should also avoid using illegal drugs.