Coronary Artery Disease

Coronary artery disease (CAD) — also called ischaemic heart disease — is the build-up of fatty plaque inside the arteries that feed the heart muscle. When the artery narrows enough, the heart doesn't get enough blood, causing angina. If a plaque suddenly ruptures and blocks the artery, it causes a heart attack.

Why Indians should take CAD very seriously

Heart attacks in Indians happen on average about a decade earlier than in Western populations. The South-Asian risk pattern — higher "bad" LDL and triglycerides, lower "good" HDL, a larger waist even at normal weight, earlier diabetes — means people in their 40s (and sometimes 30s) develop severe CAD. Family history further raises risk.

Risk factors

• Smoking (cigarettes, bidis, hookah).
• High blood pressure.
• Diabetes and pre-diabetes.
• High LDL cholesterol and triglycerides; low HDL.
• Obesity, especially belly fat.
• Inactive lifestyle.
• Family history of early heart disease (before 55 in men, before 65 in women).
• Chronic stress and poor sleep.

Symptoms

• Chest discomfort with exertion (angina) — see the Angina page.
• Breathlessness on climbing stairs or quick walking.
• Tiredness on mild effort.
• Some people have no symptoms until a heart attack — silent disease is common in diabetes.

Red flags — dial 112

• Crushing chest pain lasting more than 15 minutes.
• Pain spreading to arm, jaw, back, or tummy.
• Cold sweat, nausea, severe breathlessness.
• Sudden collapse.
• Any of these — call 112 and chew a regular aspirin tablet unless allergic (standard first-aid guidance).

Diagnosis

Lipid profile, blood sugar, BP, ECG, ECHO, stress test, coronary CT or coronary angiography — selected based on risk and symptoms.

Treatment and prevention

• Lifestyle is the foundation: no tobacco; daily walk; weight control; diet low in trans fats and refined sugar; manage stress; sleep.
• Control the numbers: BP, blood sugar, LDL.
• Medicines — antiplatelets, cholesterol-lowering tablets, BP medicines where indicated.
• Angioplasty with stent for significant blockages.
• Bypass surgery (CABG) for complex or multi-vessel disease.
• Cardiac rehabilitation after any heart event — substantially lowers the chance of a second.