Elderly woman clasping her heart to symbolize coronary heart disease

What causes coronary heart disease?

Written on February 27, 2023 by Sendra Yang, PharmD, MBA. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

Table of contents

What is coronary heart disease?

Coronary heart disease (CHD), also called coronary artery disease or ischemic heart disease, is the most common type of heart disease [1]. In 2020, it was estimated that about 20.1 million adults have CHD, leading to more than 380,000 deaths that same year in the United States [2]. About 2 in 10 deaths from CHD occur in adults less than 65 years old in the US.

Causes of coronary heart disease

CHD is caused by plaque buildup in the walls of the coronary arteries or the blood vessels that supply the heart with oxygen-rich blood [1,3]. Plaque is made of cholesterol and other substances that deposit in the walls of blood vessels. Over time, the gradual buildup of plaque can narrow or block the blood vessels; this process is called atherosclerosis. The narrowing or blocking of the coronary arteries limits the amount of blood reaching the heart to supply it with oxygen. The lack of oxygen to the heart leads to many of the symptoms experienced by patients with CHD [3].

Coronary heart disease symptoms

You may not experience any symptoms of CHD for a long time because the gradual plaque buildup may take years [3]. The most common symptom of CHD is angina, or chest pain and discomfort [1]. Angina usually occurs when you have increased physical activity or experience emotional distress but will go away when you rest [3]. Other symptoms of CHD are shortness of breath and fatigue [1-4].

Sometimes CHD symptoms may go unrecognized in the beginning until a heart attack occurs [3,4]. A heart attack can be the first symptom of CHD following a complete blockage of blood flow to the heart [4]. Typical signs and symptoms of a heart attack include chest pain or pressure, shortness of breath, shoulder or arm pain, and sweating. Women experience less common heart attack symptoms like jaw pain, nausea, and fatigue. Heart attacks in women can also sometimes happen with no apparent signs or symptoms.

Factors contributing to coronary heart disease

Several risk factors are traditionally known to contribute to developing coronary heart disease. Risk factors are divided into modifiable and nonmodifiable risks. Modifiable risks are those that can be altered with management strategies, whereas nonmodifiable factors are those that cannot be changed.

Nonmodifiable factors are [5,6]:

  • Age and gender: After age 35, the CHD prevalence increases regardless of gender. Men, in general, have an increased risk compared to women.
  • Ethnicity: Ethnic groups that are at an increased risk of death due to CHD are Blacks, Hispanics/Latinos, and Southeast Asians.
  • Family history: A family history of CHD is a significant risk factor.

Modifiable risks include [5,6]:

  • High blood pressure, high cholesterol, and type 2 diabetes: These three chronic diseases have long been considered risk factors for CHD. Triglycerides, a type of cholesterol, have been associated with CHD. Heart disease occurs at 2.5 times the rate in adult diabetics compared to those without the condition.
  • Obesity: Being obese is a risk factor for CHD and increases the risk of high blood pressure, elevated cholesterol, and diabetes.
  • Smoking: Smoking causes an elevated risk for CHD of around 50% in people with diabetes and up to 30% in people regularly exposed to second-hand smoke.
  • Poor diet and lack of physical activity: A diet with high fructose corn syrup, sucrose, and added sugars has an increased impact on the risk of CHD. Increased physical activity or exercise is a preventative measure for the development of CHD.
  • Additional modifiable risk factors not classically associated with CHD include other chronic diseases such as non-alcoholic fatty liver disease, chronic kidney disease, systemic lupus erythematosus, inflammatory bowel disease, thyroid disease, and vitamin D deficiency.

Preventing coronary heart disease

A significant part of managing and reducing the risk of CHD is prevention [6]. Lifestyle changes, including a healthy diet, increased exercise, and no smoking are all critical in decreasing heart disease risks. Control of chronic conditions known to increase CHD risks, such as high blood pressure, elevated cholesterol, and diabetes, is essential to risk reduction. If you want to know more about the risks of CHD and ways you can reduce your risk, it’s essential to speak with your healthcare provider. There are lifestyle modifications and additional treatment and prevention strategies your healthcare provider can recommend for you based on your circumstance.

Telehealth and at-home lab test via Everlywell

Everlywell offers access to a telehealth option via Virtual Care Visits. You can schedule a visit from the comfort of your home with a certified healthcare provider to discuss your overall health or your heart disease risks and questions you may have about the condition. You can also consider an at-home Heart Health lab test for a more comprehensive look at your heart health. The test measures several markers that can help indicate a higher or lower risk of heart disease.

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  1. Coronary artery disease. Centers for Disease Control and Prevention. URL. Published July 19, 2021. Accessed February 24, 2023.
  2. Heart disease facts. Centers for Disease Control and Prevention. URL. Published October 14, 2022. Accessed February 24, 2023.
  3. Coronary artery disease: Symptoms, causes & treatment. Cleveland Clinic. URL. Accessed February 24, 2023.
  4. Coronary artery disease. Mayo Clinic. URL. Published May 25, 2022. Accessed February 24, 2023.
  5. Risk factors for coronary artery disease. National Library of Medicine. URL. Updated June 5, 2022. Accessed February 24, 2023.
  6. Coronary artery disease prevention. National Library of Medicine. URL. Updated August 8, 2022. Accessed February 24, 2023.
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