Diagnosing coronary artery disease
How to find out if you have this common type of heart disease.
- Reviewed by Howard E. LeWine, MD, Chief Medical Editor, 天博体育 Publishing; Editorial Advisory Board Member, 天博体育 Publishing
Even if you follow a healthy lifestyle, there's a good chance you have at least an early stage of coronary artery disease (CAD), the most common type of heart disease.
CAD typically begins with a buildup of fatty plaque in the coronary arteries, the blood vessels that supply blood and oxygen to the heart. This substance is known as "soft plaque," meaning it has not yet become hardened by calcium deposits ("hard plaque").
Soft plaque is potentially more dangerous than hard plaque as it's more likely to rupture, restrict blood flow, and trigger a heart attack. "CAD usually begins well before chest pain or other symptoms appear," says Dr. Howard LeWine, editor in chief of Harvard Men's Health Watch. "But there are ways to determine if you have CAD or are at high risk for it, so you can often stop the disease from progressing."
CAD self-assessment
How can you find out if you have early CAD? It begins with some self-reflection. When exercising, do you break out in a cold sweat or get dizzy with too much exertion? Do you feel discomfort during workouts, like in your arms or chest? Does walking up several flights of stairs leave you out of breath?
"If you answer yes to any of these, you need to see your doctor for diagnostic evaluation. While there are other potential reasons for your symptoms, determining if the cause is advanced CAD takes priority," says Dr. LeWine.
Otherwise, with no apparent symptoms, your next step might be a self-assessment of your CAD risk by using a 10-year heart risk calculator. These online calculators incorporate many factors, like age, cholesterol levels, blood pressure, smoking history, and diabetes status, to estimate your chance of being diagnosed with CAD over the next decade. (See "Calculating CAD risk.")
"If your results suggest an intermediate or high risk, schedule an appointment with your doctor to discuss risk reduction strategies. If it's low risk, this is also useful information to share with your doctor at your yearly wellness visit," says Dr. LeWine.
Calculating CAD riskThere are many risk calculators available. Ones with a high reputation include the Framingham Risk Score, the ASCVD Risk Estimator developed by the American College of Cardiology and the American Heart Association, and the Multi-Ethnic Study of Atherosclerosis Risk Score. |
Risk consultation
Your doctor will begin by reviewing your exercise habits, diet, weight, and basic health metrics like cholesterol, blood pressure, and blood sugar levels. You'll also be asked about your smoking history and any family history of CAD, especially in relatives who were diagnosed under age 65.
If your risk is intermediate, your doctor may recommend a coronary artery calcium (CAC) scan. Plaque in coronary arteries can attract calcium circulating in your bloodstream and lead to hard deposits.
The CAC scan measures the amount of calcium in your coronary arteries, reflecting how much hardened plaque has accumulated there. The CAC score ranges from zero to several thousand. A score of one to 10 indicates a small amount of plaque and suggests a low risk of heart attack, but any number above zero indicates the presence of hard plaque. Hard plaque can restrict blood flow, causing chest pain and shortness of breath, especially during exercise or periods of emotional stress. A high CAC score also indicates a greater risk of heart attack.
Additional testing
Anyone with symptoms that suggest significant CAD requires further evaluation. The goal is to determine whether CAD is the problem and, if so, how severe it is. Evaluation usually begins with a resting electrocardiogram (ECG). Your doctor may next order a walking stress test, echocardiogram, or more sophisticated heart imaging.
If you have no symptoms, your doctor will make recommendations based on your personal heart risk assessment. "Based on your test results and CAC score, your doctor will have a clearer idea what treatment path to take, whether it's lowering blood pressure, cholesterol, or blood sugar," says Dr. LeWine.
The additional diagnostic tests also serve other purposes. For instance, if your heart risk assessment score is intermediate or high, and you don't regularly exercise, a walking stress test can determine your fitness level and safe exertion effort. A resting ECG provides a baseline if you later have CAD symptoms.
Keep in mind that everyone's CAD risk is different, and many factors can influence whether or not that risk rises. "Even if you don't have symptoms, you probably have some early stage of CAD and should find out your risk level so you can take steps to keep it from worsening," says Dr. LeWine.
Image: © andreswd/Getty Images
About the Author
Matthew Solan, Executive Editor, Harvard Men's Health Watch
About the Reviewer
Howard E. LeWine, MD, Chief Medical Editor, 天博体育 Publishing; Editorial Advisory Board Member, 天博体育 Publishing
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