Overview By Mayo Clinic Staff Print Coronary artery disease develops when the major blood vessels that supply your heart with blood, oxygen and nutrients (coronary arteries) become damaged or diseased. Cholesterol-containing deposits (plaque) in your arteries and inflammation are usually to blame for coronary artery disease. When plaque builds up, they narrow your coronary arteries, decreasing blood flow to your heart. Eventually, the decreased blood flow may cause chest pain (angina), shortness of breath, or other coronary artery disease signs and symptoms. A complete blockage can cause a heart attack. Because coronary artery disease often develops over decades, you might not notice a problem until you have a significant blockage or a heart attack. But there's plenty you can do to prevent and treat coronary artery disease. A healthy lifestyle can make a big impact Symptoms and causes By Mayo Clinic Staff Print Symptoms If your coronary arteries narrow, they can't supply enough oxygen-rich blood to your heart especially when it's beating hard, such as during exercise. At first, the decreased blood flow may not cause any coronary artery disease symptoms. As plaque continues to build up in your coronary arteries, however, you may develop coronary artery disease signs and symptoms, including: Chest pain (angina). You may feel pressure or tightness in your chest, as if someone were standing on your chest. This pain, referred to as angina, usually occurs on the middle or left side of the chest. Angina is generally triggered by physical or emotional stress. The pain usually goes away within minutes after stopping the stressful activity. In some people, especially women, this pain may be fleeting or sharp and felt in the neck, arm or back. Shortness of breath. If your heart can't pump enough blood to meet your body's needs, you may develop shortness of breath or extreme fatigue with exertion. Heart attack. A completely blocked coronary artery may cause a heart attack. The classic signs and symptoms of a heart attack include crushing pressure in your chest and pain in your shoulder or arm, sometimes with shortness of breath and sweating. Women are somewhat more likely than men are to experience less typical signs and symptoms of a heart attack, such as neck or jaw pain. Sometimes a heart attack occurs without any apparent signs or symptoms. When to see a doctor If you suspect you're having a heart attack, immediately call 911 or your local emergency number. If you don't have access to emergency medical services, have someone drive you to the nearest hospital. Drive yourself only as a last resort. If you have risk factors for coronary artery disease such as high blood pressure, high cholesterol, tobacco use, diabetes, a strong family history of heart disease or obesity talk to your doctor. He or she may want to test you for the condition, especially if you have signs or symptoms of narrowed arteries. Causes Development of atherosclerosis Development of atherosclerosis Coronary artery disease is thought to begin with damage or injury to the inner layer of a coronary artery, sometimes as early as childhood. The damage may be caused by various factors, including: Smoking High blood pressure High cholesterol Diabetes or insulin resistance Sedentary lifestyle Once the inner wall of an artery is damaged, fatty deposits (plaque) made of cholesterol and other cellular waste products tend to accumulate at the site of injury in a process called atherosclerosis. If the surface of the plaque breaks or ruptures, blood cells called platelets will clump at the site to try to repair the artery. This clump can block the artery, leading to a heart attack. Risk factors Risk factors for coronary artery disease include: Age. Simply getting older increases your risk of damaged and narrowed arteries. Sex. Men are generally at greater risk of coronary artery disease. However, the risk for women increases after menopause. Family history. A family history of heart disease is associated with a higher risk of coronary artery disease, especially if a close relative developed heart disease at an early age. Your risk is highest if your father or a brother was diagnosed with heart disease before age 55 or if your mother or a sister developed it before age 65. Smoking. People who smoke have a significantly increased risk of heart disease. Exposing others to your secondhand smoke also increases their risk of coronary artery disease. High blood pressure. Uncontrolled high blood pressure can result in hardening and thickening of your arteries, narrowing the channel through which blood can flow. High blood cholesterol levels. High levels of cholesterol in your blood can increase the risk of formation of plaques and atherosclerosis. High cholesterol can be caused by a high level of low-density lipoprotein (LDL), known as the "bad" cholesterol. A low level of high-density lipoprotein (HDL), known as the "good" cholesterol, can be a sign of atherosclerosis. Diabetes. Diabetes is associated with an increased risk of coronary artery disease. Type 2 diabetes and coronary artery disease share similar risk factors, such as obesity and high blood pressure. Overweight or obesity. Excess weight typically worsens other risk factors. Physical inactivity. Lack of exercise also is associated with coronary artery disease and some of its risk factors, as well. High stress. Unrelieved stress in your life may damage your arteries as well as worsen other risk factors for coronary artery disease. Risk factors often occur in clusters and may build on one another, such as obesity leading to type 2 diabetes and high blood pressure. When grouped together, certain risk factors put you at an even greater risk of coronary artery disease. For example, metabolic syndrome a cluster of conditions that includes elevated blood pressure, high triglycerides, elevated insulin levels and excess body fat around the waist increases the risk of coronary artery disease. Sometimes coronary artery disease develops without any classic risk factors. Researchers are studying other possible factors, including: Sleep apnea. This disorder causes you to repeatedly stop and start breathing while you're sleeping. Sudden drops in blood oxygen levels that occur during sleep apnea increase blood pressure and strain the cardiovascular system, possibly leading to coronary artery disease. High sensitivity C-reactive protein. High sensitivity C-reactive protein (hs-CRP) is a normal protein that appears in higher amounts when there's inflammation somewhere in your body. High hs-CRP levels may be a risk factor for heart disease. It's thought that as coronary arteries narrow, you'll have more hs-CRP in your blood. High triglycerides. This is a type of fat (lipid) in your blood. High levels may raise the risk of coronary artery disease, especially for women. Homocysteine. Homocysteine is an amino acid your body uses to make protein and to build and maintain tissue. But high levels of homocysteine may increase your risk of coronary artery disease. Complications Coronary artery disease can lead to: Chest pain (angina). When your coronary arteries narrow, your heart may not receive enough blood when demand is greatest particularly during physical activity. This can cause chest pain (angina) or shortness of breath. Heart attack. If a cholesterol plaque ruptures and a blood clot forms, complete blockage of your heart artery may trigger a heart attack. The lack of blood flow to your heart may damage your heart muscle. The amount of damage depends in part on how quickly you receive treatment. Heart failure. If some areas of your heart are chronically deprived of oxygen and nutrients because of reduced blood flow, or if your heart has been damaged by a heart attack, your heart may become too weak to pump enough blood to meet your body's needs. This condition is known as heart failure. Abnormal heart rhythm (arrhythmia). Inadequate blood supply to the heart or damage to heart tissue can interfere with your heart's electrical impulses, causing abnormal heart rhythms. Diagnosis By Mayo Clinic Staff Print The doctor will ask questions about your medical history, do a physical exam and order routine blood tests. He or she may suggest one or more diagnostic tests as well, including: Electrocardiogram (ECG). An electrocardiogram records electrical signals as they travel through your heart. An ECG can often reveal evidence of a previous heart attack or one that's in progress. In other cases, Holter monitoring may be recommended. With this type of ECG, you wear a portable monitor for 24 hours as you go about your normal activities. Certain abnormalities may indicate inadequate blood flow to your heart. Echocardiogram. An echocardiogram uses sound waves to produce images of your heart. During an echocardiogram, your doctor can determine whether all parts of the heart wall are contributing normally to your heart's pumping activity. Parts that move weakly may have been damaged during a heart attack or be receiving too little oxygen. This may indicate coronary artery disease or various other conditions. Stress test. If your signs and symptoms occur most often during exercise, your doctor may ask you to walk on a treadmill or ride a stationary bike during an ECG. This is known as an exercise stress test. In some cases, medication to stimulate your heart may be used instead of exercise. Some stress tests are done using an echocardiogram. For example, your doctor may do an ultrasound before and after you exercise on a treadmill or bike. Or your doctor may use medication to stimulate your heart during an echocardiogram. Another stress test known as a nuclear stress test helps measure blood flow to your heart muscle at rest and during stress. It's similar to a routine exercise stress test but with images in addition to an ECG. A tracer is injected into your bloodstream, and special cameras can detect areas in your heart that receive less blood flow. Cardiac catheterization or angiogram. To view blood flow through your heart, your doctor may inject a special dye into your coronary arteries. This is known as an angiogram. The dye is injected into the arteries of the heart through a long, thin, flexible tube (catheter) that is threaded through an artery, usually in the leg, to the arteries in the heart. This procedure is called cardiac catheterization. The dye outlines narrow spots and blockages on the X-ray images. If you have a blockage that requires treatment, a balloon can be pushed through the catheter and inflated to improve the blood flow in your coronary arteries. A mesh tube (stent) may then be used to keep the dilated artery open. Heart scan. Computerized tomography (CT) technologies can help your doctor see calcium deposits in your arteries that can narrow the arteries. If a substantial amount of calcium is discovered, coronary artery disease may be likely. A CT coronary angiogram, in which you receive a contrast dye injected intravenously during a CT scan, also can generate images of your heart arteries. Treatment By Mayo Clinic Staff Print Treatment for coronary artery disease usually involves lifestyle changes and, if necessary, drugs and certain medical procedures. Lifestyle changes Making a commitment to the following healthy lifestyle changes can go a long way toward promoting healthier arteries: Quit smoking. Eat healthy foods. Exercise regularly. Lose excess weight. Reduce stress. Drugs Various drugs can be used to treat coronary artery disease, including: Cholesterol-modifying medications. By decreasing the amount of cholesterol in the blood, especially low-density lipoprotein (LDL, or the "bad") cholesterol, these drugs decrease the primary material that deposits on the coronary arteries. Your doctor can choose from a range of medications, including statins, niacin, fibrates and bile acid sequestrants. Aspirin. Your doctor may recommend taking a daily aspirin or other blood thinner. This can reduce the tendency of your blood to clot, which may help prevent obstruction of your coronary arteries. If you've had a heart attack, aspirin can help prevent future attacks. There are some cases where aspirin isn't appropriate, such as if you have a bleeding disorder or you're already taking another blood thinner, so ask your doctor before starting to take aspirin. Beta blockers. These drugs slow your heart rate and decrease your blood pressure, which decreases your heart's demand for oxygen. If you've had a heart attack, beta blockers reduce the risk of future attacks. Nitroglycerin. Nitroglycerin tablets, sprays and patches can control chest pain by temporarily dilating your coronary arteries and reducing your heart's demand for blood. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). These similar drugs decrease blood pressure and may help prevent progression of coronary artery disease. Procedures to restore and improve blood flow Illustration showing balloon to widen a coronary artery Coronary artery stent Sometimes more aggressive treatment is needed. Here are some options: Angioplasty and stent placement (percutaneous coronary revascularization). Your doctor inserts a long, thin tube (catheter) into the narrowed part of your artery. A wire with a deflated balloon is passed through the catheter to the narrowed area. The balloon is then inflated, compressing the deposits against your artery walls. A stent is often left in the artery to help keep the artery open. Some stents slowly release medication to help keep the artery open. Coronary artery bypass surgery. A surgeon creates a graft to bypass blocked coronary arteries using a vessel from another part of your body. This allows blood to flow around the blocked or narrowed coronary artery. Because this requires open-heart surgery, it's most often reserved for cases of multiple narrowed coronary arteries. Alternative medicine Omega-3 fatty acids are a type of unsaturated fatty acid that's thought to reduce inflammation throughout the body, a contributing factor to coronary artery disease. However, recent studies have not shown them to be beneficial. More research is needed. Fish and fish oil. Fish and fish oil are the most effective sources of omega-3 fatty acids. Fatty fish such as salmon, herring and light canned tuna contain the most omega-3 fatty acids and, therefore, the most benefit. Fish oil supplements may offer benefit, but the evidence is strongest for eating fish. Flax and flaxseed oil. Flax and flaxseed oil also contain beneficial omega-3 fatty acids, though studies have not found these sources to be as effective as fish. The shell on raw flaxseeds also contains soluble fiber, which can help lower blood cholesterol. Other dietary sources of omega-3 fatty acids. Other dietary sources of omega-3 fatty acids include canola oil, soybeans and soybean oil. These foods contain smaller amounts of omega-3 fatty acids than do fish and fish oil, and evidence for their benefit to heart health isn't as strong. Other supplements may help reduce your blood pressure or cholesterol level, two contributing factors to coronary artery disease. These include: Alpha-linolenic acid (ALA) Artichoke Barley Beta-sitosterol (found in oral supplements and some margarines, such as Promise Activ) Blond psyllium Cocoa Coenzyme Q10 Garlic Oat bran (found in oatmeal and whole oats) Sitostanol (found in oral supplements and some margarines, such as Benecol) he Mayo Clinic experience and patient stories Our patients tell us that the quality of their interactions, our attention to detail and the efficiency of their visits mean health care like they've never experienced. See the stories of satisfied Mayo Clinic patients. Cardiac Rehabilitation Helps Ardis Kyker Improve Her Health, Lose Weight and Avoid Surgery Departments and specialties Mayo Clinic has one of the largest and most experienced practices in the United States, with campuses in Arizona, Florida and Minnesota. Staff skilled in dozens of specialties work together to ensure quality care and successful recovery. Departments that treat this condition Cardiac Surgery Cardiovascular Diseases Pediatric Cardiology Mayo Clinic's coronary artery disease experts provide comprehensive care for more than 44,000 adults each year. Teamwork. Mayo Clinic doctors in many areas including heart disease specialists (cardiologists) and heart surgeons (cardiovascular surgeons) work together as a multidisciplinary team to provide coordinated, comprehensive care. Treatment expertise. Mayo Clinic also offers a number of clinics to treat people with coronary artery disease, and those at risk of developing coronary artery disease. Staff in the Coronary Artery Disease Clinic at Mayo Clinic's campus in Minnesota offers access to cardiac catheterization, and offers evaluation and treatment for people with high-risk and complex forms of coronary artery disease, chest pain (intractable angina), and valvular heart disease. Mayo Clinic doctors in the Chest Pain and Coronary Physiology Clinic at Mayo Clinic's campus in Minnesota treat people with challenging chest pain syndromes. A team of doctors with training in heart disease (cardiologists), fitness specialists (exercise physiologists), nutrition specialists (dietitians) and other specialists staff the Cardiovascular Health Clinic at Mayo Clinic's campuses in Florida and Minnesota. The staff in the clinic helps people with coronary artery disease or other heart conditions to understand their current heart health and how to reduce their heart disease risk. Mayo Clinic campuses are nationally recognized for expertise in cardiology and cardiovascular surgery: Mayo Clinic in Rochester, Minnesota, is ranked among the Best Hospitals for heart and heart surgery by U.S. News & World Report. Mayo Clinic Children's Center in Rochester, Minnesota, is ranked among the Best Children's Hospitals for heart and heart surgery by U.S. News & World Report. Mayo Clinic in Phoenix/Scottsdale, Arizona, is ranked among the Best Hospitals for heart and heart surgery by U.S. News & World Report. With Mayo Clinic's emphasis on collaborative care, specialists at each of the campuses Minnesota, Arizona and Florida interact very closely with colleagues at the other campuses and the Mayo Clinic Health System. Learn more about Mayo Clinic's cardiovascular diseases and cardiac surgery departments' expertise and rankings. Below are current clinical trials. 8 studies in Coronary artery disease (open studies only). Filter this list of studies by location, status and more. Exercise and Low-Dose Rapamycin in Older Adults with CAD:Cardiac Rehabilitation And Rapamycin in Elderly (CARE) Trial Albert Lea, Minn., Austin, Minn., Rochester, Minn. Overview The investigators will do the study in two phases. The first phase will be a pilot study on up to 18 participants [patients 60 years or older with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) or patients who are eligible to undergo and participate in cardiac rehabilitation (CR)]; up to 6 participants each will be given oral daily rapamycin (0.5, 1, and 2mg) dose for the duration of CR. Baseline and follow-up data will be collected for age-associated impairment (AAI): frailty (primary endpoint) and quality of life (QOL),senescent-associated secretory phenotype (SASP)and abdominal/thigh subcutaneous adipose biopsy for measurement of adipocyte mitochondrial DNA copy number and to quantitate the number of senescent preadipocytes. Safety of rapamycin will be assessed by periodic clinical follow-up, blood draws, and serum rapamycin levels. Following completion of the pilot phase, the data will be analyzed. If favorable changes are noted in the SASP or AAI, the investigators will start a phase 2 randomized trial. Second phase: In a prospective, randomized, clinical trial design, patients 60 years or older will be randomized at the time of CR to a standardized exercise protocol, or exercise protocol with the addition of low-dose rapamycin to test the hypothesis whether low-dose rapamycin (demonstrated in the pilot trial to improve SASP/AAI) will improve measures of AAI, SASP, or findings on the fat biopsy as compared to exercise alone. The null hypotheses are that there is no improvement with rapamycin in measures of AAI or SASP. Study details Is Our Microbiome a Predictor of Cardiac Risk Rochester, Minn. Overview The purpose of this study is to determine a relationship between a person's flora/bacteria in their gut (the intestinal microbiome) and their risk of cardiovascular disease. Investigators will look at inflammatory markers in the blood and also look at the genome of the bacteria in the gut. This research is being done because Investigators believe that there is a connection between the way food is digested by a person's gut bacteria and the development of atherosclerosis (hardening of the arteries) and cardiovascular disease. The ultimate goal of this research is to eventually determine if changes to the gut bacteria can prevent cardiovascular disease or disease progression. Study details New Technologies to Determine Carotid Plaque Vulnerability Rochester, Minn. Overview Hypothesis: Identification of vulnerable atherosclerotic plaques (with or without neovascularization) using carotid CEUS is an independent predictor of MACE (over clinical risk factors, stress echo wall motion results, and carotid ultrasound two-dimensional speckle tracking strain indices). Primary Aims: Evaluate the diagnostic role of carotid CEUS and two-dimensional speckle tracking strain imaging for detection of carotid plaque: To determine the feasibility and safety of Carotid CEUS and Two-dimensional speckle tracking strain imaging SE . To determine if carotid CEUS and two-dimensional speckle tracking strain imaging findings are associated with coronary angiographic results in those patients undergoing clinically indicated cardiac catheterization. To determine the diagnostic accuracy of CEUS in identifying a vulnerable atherosclerotic plaque and neovascularization compared to carotid MRI, in a subset of patients. Evaluate the prognostic role of carotid CEUS and two-dimensional speckle tracking strain imaging for prediction of MACE: To determine if plaque identification (with or without neovascularization) on Carotid CEUS SE can improve the overall prediction of MACE over stress echo results alone To determine if Carotid ultrasound two-dimensional speckle tracking strain indices can improve the overall prediction of MACE over stress echo results alone. To determine if the detection of plaque neovascularization by Carotid CEUS is an independent predictor of MACE (over clinical risk factors, stress echo wall motion results, and carotid ultrasound two-dimensional speckle tracking strain indices). Study details International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA) Rochester, Minn. Overview The purpose of the ISCHEMIA trial is to determine the best management strategy for higher-risk patients with stable ischemic heart disease. This is a multicenter randomized controlled trial with a target enrollment of ~8000 patients with at least moderate ischemia on stress imaging. Patients will be assigned at random to a routine invasive strategy (INV) with cardiac catheterization (cath) followed by revascularization plus optimal medical therapy (OMT) or to a conservative strategy (CON) of OMT, with cath and revascularization reserved for those who fail OMT. SPECIFIC AIMS A. Primary Aim The primary aim of the ISCHEMIA trial is to determine whether an initial invasive strategy of cardiac catheterization followed by optimal revascularization, if feasible, in addition to OMT, will reduce the primary composite endpoint of cardiovascular death or nonfatal myocardial infarction in participants with SIHD and at least moderate ischemia over an average follow-up of approximately 4 years compared with an initial conservative strategy of OMT alone with catheterization reserved for failure of OMT. The primary endpoint is time to centrally adjudicated cardiovascular death or nonfatal myocardial infarction. B. Secondary Aims Major To compare angina-related quality of life between groups. Other secondary aims include: a) comparing the incidence of all-cause death; the components of the primary endpoint; the composite endpoint of cardiovascular death, myocardial infarction, or hospitalization for unstable angina, resuscitated cardiac arrest, or heart failure; stroke; and stroke combined with cardiovascular death, myocardial infarction, or hospitalization for unstable angina, resuscitated cardiac arrest, or heart failure between randomized groups; and b) comparing health resource utilization, costs, and cost-effectiveness between groups. Condition: Coronary Disease Procedure: Coronary CT Angiogram Procedure: Cardiac catheterization Phase: Phase III Condition: Cardiovascular Diseases Procedure: Angioplasty, Transluminal, Percutaneous Coronary, other catheter-based interventions Phase: Phase III Condition: Heart Diseases Procedure: Coronary Artery Bypass Surgery Phase: Phase III Study details The "Virtual" Multicenter Spontaneous Coronary Artery Dissection (SCAD) Registry Rochester, Minn. Overview Study details A Study Relating Voice Characteristics and Coronary Artery Disease Rochester, Minn. Overview The primary goal of this project is to describe the clinical and physiologic characteristics of Spontaneous Coronary Artery Dissections (SCAD) in order to increase awareness, understanding, treatment and prevention of a potentially fatal cardiovascular event. This study will be a retrospective and prospective review of medical course and current health of men and women with SCAD. Study details An Evaluation of Rigid Sternal Fixation in Supporting Bone Healing and Improving Postoperative Recovery Jacksonville, Fla. Overview he purpose of this study is to see if a new voice signal recording software program, called Beyond Clinical, can find a connection between abnormal voice signals and the presence and severity of coronary artery disease. Study details Tailored Antiplatelet Therapy Following PCI La Crosse, Wis., Eau Claire, Wis., Scottsdale/Phoenix, Ariz., Jacksonville, Fla., Rochester, Minn. Overview The primary objective of this study is to evaluate sternal bone healing following a full median sternotomy versus standard of care for sternal closure with wire cerclage. Additional outcomes on post-operative pain and analgesic usage, patient function and quality of life, and complications will also be collected. A health economics study will also be conducted, in which cost and billing data will be collected from sites participating in this clinical study. Study details Departments and specialties lopidogrel is an anti-platelet medication approved by the U.S. Federal Drug Administration (FDA) for use in patients who undergo Percutaneous Coronary Intervention (PCI) with coronary stent implantation. Anti-platelet medications work to prevent blood clots from forming. Some studies have suggested that patients who have a certain genetic liver enzyme abnormality (known as cytochrome P450 2C19 [CYP2C19] *2 or *3 allele) may have a reduced ability to activate clopidogrel, and therefore may have a lowered response to clopidogrel. It is thought that perhaps people who have a coronary stent procedure may have this genetic liver enzyme abnormality. There is a research genetic test available to determine whether or not someone has this genetic liver enzyme abnormality. Ticagrelor, is a newer anti-platelet drug that is not dependent on the CYP2C19 liver enzyme for its activation and hence in poor clopidogrel metabolizers, alternative drugs like Ticagrelor have been recommended for use as an anti-platelet agent after PCI. The purpose of this study is to determine if genetic testing can identify the best anti-platelet therapy, for patients who undergo a coronary stent placement and do not activate clopidogrel very well. Mayo Clinic has one of the largest and most experienced practices in the United States, with campuses in Arizona, Florida and Minnesota. Staff skilled in dozens of specialties work together to ensure quality care and successful recovery. Departments that treat this condition Cardiac Surgery Cardiovascular Diseases Pediatric Cardiology Back in 2014, Ardis Kyker was at home going about her daily routine when she experienced tightening in her chest. The pain went away as soon as she sat down to rest, so she proceeded with her day. Later, while pushing a cart at a grocery store, the pain returned with more intensity. So Ardis checked [...] Mayo Clinic researchers develop and research potential diagnostic tools and treatments for people who have coronary artery disease, including: Cell- and gene-based trials to improve cardiac function Evaluation of potential drugs to improve blood vessel function Devices to treat blockages Doctors will consider you for enrollment in research studies, if appropriate. Learn more about research in cardiovascular diseases at Mayo Clinic's Cardiovascular Disease Research Center. Publications See a list of publications by Mayo Clinic doctors on coronary artery disease on PubMed, a service of the National Library of Medicine. Costs and insurance By Mayo Clinic Staff Print Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people. In most cases, Mayo Clinic doesn't require a physician referral. Some insurers require referrals, or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need. Learn more about appointments at Mayo Clinic. Please contact your insurance company to verify medical coverage and to obtain any needed authorization prior to your visit. Often, your insurer's customer service number is printed on the back of your insurance card. Additional information about billing and insurance at each Mayo Clinic campus also is available: Preparing for your appointment By Mayo Clinic Staff Print Early-stage coronary artery disease often produces no symptoms, so you may not discover you're at risk of the condition until a routine checkup reveals you have high cholesterol or high blood pressure. So it's important to have regular checkups. If you know you have symptoms of or risk factors for coronary artery disease, you're likely to see your primary care doctor or a general practitioner. Eventually, however, you may be referred to a heart specialist (cardiologist). Here's some information to help you get ready for your appointment and to know what to expect from your doctor. What you can do Be aware of any pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet. For some tests, for example, you may need to fast for a time beforehand. Write down any symptoms you're experiencing, including any that may seem unrelated to coronary artery disease. Write down your key medical information, including other conditions with which you've been diagnosed, all medications and supplements you're taking, and family history of heart disease. Find a family member or friend who can come with you to the appointment, if possible. Someone who accompanies you can help remember what the doctor says. Write down questions to ask your doctor. Questions to ask your doctor at your initial appointment include: What are the possible causes for my signs and symptoms? What tests do I need? Should I see a specialist? Should I follow any restrictions while I wait for my next appointment? What emergency signs and symptoms should prompt a call to 911 or emergency medical help? Questions to ask if you are referred to a cardiologist include: What is my diagnosis? What is my risk of long-term complications from this condition? What treatment do you recommend? If you're recommending medications, what are the possible side effects? Am I a candidate for surgery? Why or why not? What diet and lifestyle changes should I make? What restrictions do I need to follow, if any? How frequently will you see me for follow-up visits? I have these other health problems. How can I best manage these conditions together? Don't hesitate to ask additional questions about your condition. What to expect from your doctor A doctor or cardiologist who sees you for heart-related signs and symptoms may ask: What are your symptoms? When did you begin experiencing symptoms? Have your symptoms gotten worse over time? Do you have chest pain or difficulty breathing? Does exercise or physical exertion make your symptoms worse? Are you aware of heart problems in your family? Have you been diagnosed with other health conditions? What medications are you taking? Have you ever been treated with radiation therapy? How much do you exercise in a typical week? What's your typical daily diet? Do you or did you smoke? How much? If you quit, when? Do you drink alcohol? How much? What you can do in the meantime It's never too early to make healthy lifestyle changes, such as quitting smoking, eating healthy foods and becoming more physically active. These are primary lines of defense against coronary artery disease and its complications, including heart attack and stroke Self-management By Mayo Clinic Staff Print Lifestyle and home remedies Lifestyle changes can help you prevent or slow the progression of coronary artery disease. Stop smoking. Smoking is a major risk factor for coronary artery disease. Nicotine constricts blood vessels and forces your heart to work harder, and carbon monoxide reduces oxygen in your blood and damages the lining of your blood vessels. If you smoke, quitting is one of the best ways to reduce your risk of a heart attack. Control your blood pressure. Ask your doctor for a blood pressure measurement at least every two years starting at age 18. If you're age 40 or older, or you're age 18-39 with a high risk of high blood pressure, ask your doctor for a blood pressure reading every year. He or she may recommend more frequent measurements if your blood pressure is higher than normal or you have a history of heart disease. The ideal blood pressure is generally below 120 systolic and 80 diastolic, as measured in millimeters of mercury (mm Hg). Check your cholesterol. Ask your doctor for a baseline cholesterol test when you're in your 20s and at least every five years after. If your test results aren't within desirable ranges, your doctor may recommend more-frequent measurements. Most people should aim for an LDL level below 130 milligrams per deciliter (mg/dL), or 3.4 millimoles per liter (mmol/L). If you have other risk factors for heart disease, your target LDL may be below 100 mg/dL (2.6 mmol/L). Keep diabetes under control. If you have diabetes, tight blood sugar management can help reduce the risk of heart disease. Get moving. Exercise helps you achieve and maintain a healthy weight and control diabetes, elevated cholesterol and high blood pressure all risk factors for coronary artery disease. With your doctor's OK, aim for about 30 to 60 minutes of moderate to physical activity most or all days of the week. Eat healthy foods. A heart-healthy diet, such as the Mediterranean diet, that emphasizes plant-based foods, such as fruits, vegetables, whole grains, legumes and nuts and is low in saturated fat, cholesterol and sodium can help you control your weight, blood pressure and cholesterol. Eating one or two servings of fish a week also is beneficial. Maintain a healthy weight. Being overweight increases your risk of coronary artery disease. Losing even just a few pounds can help lower your blood pressure and reduce your risk of coronary artery disease. Manage stress. Reduce stress as much as possible. Practice healthy techniques for managing stress, such as muscle relaxation and deep breathing. In addition to healthy lifestyle changes, remember the importance of regular medical checkups. Some of the main risk factors for coronary artery disease high cholesterol, high blood pressure and diabetes have no symptoms in the early stages. Early detection and treatment can set the stage for a lifetime of better heart health. Prevention The same lifestyle habits that can help treat coronary artery disease can also help prevent it from developing in the first place. Leading a healthy lifestyle can help keep your arteries strong and clear of plaques. To improve your heart health, you can: Quit smoking Control conditions such as high blood pressure, high cholesterol and diabetes Stay physically active Eat a low-fat, low-salt diet that's rich in fruits, vegetables and whole grains Maintain a healthy weight Reduce and manage stress In-depth Symptoms Symptom Checker Foot pain? Headache? Sore throat? Skin rash? Use the Symptom Checker to find out what's causing your symptom. Treatments and drugs Angina treatment: Stents, drugs, lifestyle changes What's best? Angina treatment can involve using stents to widen blocked heart arteries, taking medications or making lifestyle changes. Find out what might be best. Drug-eluting stents Niacin can boost 'good' cholesterol Resources Mayo Clinic products and services Book: The Mayo Clinic A to Z Health Guide Mayo Clinic Store Book: Mayo Clinic Healthy Heart for Life! Book: Mayo Clinic on Healthy Aging DVD: Mayo Clinic Wellness Solutions for Heart Health Web sites American Heart Association National Heart, Lung, and Blood Institute News from Mayo Clinic 2015 Mayo Clinic Q and A: Chest pain despite normal stress test Dec. 19, 2015, 01:17 p.m. CDT Mayo Clinic Q and A: Cardiac assessment may show if heart issues need to be addressed Dec. 12, 2015, 02:00 p.m. CDT In Case You Missed the Show: #MayoClinicRadio PODCAST 7/11/2015 July 13, 2015, 11:37 a.m. CST Mayo Clinic News Network Headline 6/19/2015 June 19, 2015, 01:39 p.m. CST Mayo Clinic Q & A: Regardless of risk, take steps to protect heart health Feb. 28, 2015, 02:00 p.m. CDT 2014 Mayo Clinic Radio: Coronary Artery Disease Sept. 23, 2014, 04:17 p.m. CST 2013 Carotid artery disease: Mayo Clinic Radio Health Minute Dec. 31, 2013, 10:13 a.m. CDT