Angina (Chest Pain) Causes and Risk Factors
What causes angina?
Angina pain happens when your heart muscle does not get as much oxygen-rich blood as it needs.
The cells in your heart need to work: The harder your heart muscle works, the more oxygen it needs. When cells need more oxygen than they can get, they may stop working as they should. That is why angina usually occurs when your heart is working harder than usual (for example, during physical activity) or when the blood flow to your heart muscle is lower than usual (for example, if your arteries are partially blocked).
An angina event does not cause permanent damage to the heart. However, your angina may turn into a heart attack if the cells in your heart do not get enough oxygen for too long and they start to die. Damage from a heart attack is permanent and can even cause your heart to suddenly stop working, also known as a cardiac arrest.
To understand the causes of angina, it helps to learn about how the heart works.
Angina is not itself a disease, but a symptom of an underlying heart problem. Medical conditions, such as coronary heart disease, can cause angina. The type of angina you have may depend on the condition causing it.
- 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 pieces of plaque break off and cause , which can also partially or totally block the coronary arteries.
- Coronary microvascular disease occurs when the tiny arteries that branch off the larger coronary arteries are damaged or unable to expand as usual when the heart muscle needs more oxygen-rich blood. Lowered blood flow in these arteries can cause microvascular angina.
- Spasms of the coronary arteries happen when the muscles within your heart’s arteries suddenly tighten. The spasm causes the arteries to narrow temporarily and can block blood flow to the heart. A spasm that tightens your coronary arteries can cause vasospastic angina. Damage to your heart’s arteries may cause them to spasm. Spasms can occur whether or not you have coronary heart disease and can affect large or small coronary arteries.
What raises the risk of angina?
You may have a higher risk of angina because of your age, sex, race, medical conditions, family history and genetics, environment or occupation, or lifestyle. When speaking with your healthcare provider about potential symptoms, be sure to talk about risk factors. This will help your provider diagnose the condition and prepare a treatment plan specific to your needs.
Genetic or lifestyle factors can cause to build up in your arteries as you age. This means that your risk of coronary heart disease and angina increases as you get older.
People who have vasospastic angina are often younger than those who have more common 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 available time 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 affect a person’s risk of developing angina.
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 vasospastic 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 raise your risk of 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. Sometimes, noncardiac surgery can also trigger unstable angina or vasospastic angina.
Race or ethnicity
Some groups of people are at higher risk of developing coronary heart disease and one of its main symptoms, angina. Black or African American people who have already had a heart attack have a higher chance of developing angina than White people.
Vasospastic angina is more common among people living in Japan, especially men, than among people living in Western countries.
Angina affects men and women. In men, the chance of having heart disease starts to rise at age 45. Before age 55, women have a lower risk of heart disease than men. After age 55, the risk rises in both women and men. Women who have already had a heart attack have a higher chance of developing 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 healthcare provider may talk to you about 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 not misusing drugs, managing stress, and getting enough good-quality sleep.