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Coronary heart disease


Expert reviewer, Dr Tim Cripps, Consultant Cardiologist
Next review due March 2019

Coronary heart disease is a condition in which fatty substances build up in the walls of the arteries that run to your heart. This causes them to narrow, which can reduce the supply of oxygen to your heart. This may lead to angina (pain in your chest), and there’s a risk you could have a heart attack. It’s estimated that about two million people in the UK are living with coronary heart disease.

About coronary heart disease

Your heart is a muscle and it pumps blood to your lungs and the rest of your body to supply it with oxygen and nutrients. But your heart also needs a supply of blood, and it gets this from your coronary arteries. 

Coronary heart disease happens when fat and cholesterol in your blood build up in your artery walls and form a plaque – also called an atheroma. This process of fat building up is called atherosclerosis. It narrows your artery and reduces the blood flow so the result is your heart muscle doesn’t get all the oxygen it needs.

This can damage your heart muscle and lead to a range of symptoms, which can be serious. In the UK, more people die from coronary heart disease than any other cause.

Image showing a coronary artery affected by atherosclerosis

Symptoms of coronary heart disease

Coronary heart disease develops slowly over many years. Sometimes the only symptom you’ll get is feeling short of breath sometimes, particularly when you exercise. You might not even know anything is wrong until you start getting chest pain (angina), or have a heart attack (myocardial infarction). 

Coronary heart disease may weaken your heart and lead to heart failure too. If your heart muscle is damaged or dies, this may make your heart beat abnormally, which is called arrhythmia.

For information about these conditions and the symptoms of each, see Related information.

Diagnosis of coronary heart disease

Your GP will ask about your symptoms and examine you. They’ll ask about your medical history too.

For information about how your GP assesses you, see ‘How will my GP work out my risk of coronary heart disease?’ below. Your GP may refer you to see a cardiologist – a doctor who specialises in conditions that affect the heart and blood vessels.

You might need to have one or more of the following tests.

  • Blood tests. These can check the levels of certain fats, cholesterol, sugar and proteins in your blood.
  • An electrocardiogram (ECG). This measures the electrical activity of your heart and can show any damage to your heart muscle or signs of coronary heart disease. However, an ECG can be normal even if you have coronary heart disease.
  • An echocardiogram. This uses ultrasound to check the structure of your heart and to see how well it’s working.
  • A radionuclide test. Your doctor will give you a small, harmless injection of radioactive material, which passes through your heart muscle. They’ll direct a large camera at your heart, which will pick up rays sent out by the radioactive material. This will show the flow of blood through your heart.
  • A coronary angiogram. Your doctor will inject a dye into your coronary arteries to make them show up clearly on X-rays.
  • A computerised tomography (CT) scan. This can produce images of your coronary arteries and give a measure of the amount of calcium in your arteries. This can show if you might have coronary heart disease.
  • A magnetic resonance imaging (MRI) scan. This uses magnets and radio waves to produce images of the inside of your body to examine your heart for signs of coronary heart disease.

Treatment options for coronary heart disease

There are lots of treatments for the symptoms of coronary heart disease, which we describe below. Your doctor will discuss what your options are and the best treatments for you. 

Self-help

If you make some changes to your lifestyle, it might help your symptoms or prevent a heart attack. But you’ll probably need to take medicines too, or have further treatment. The kind of changes to make include:

  • eating a healthy, balanced diet
  • stopping smoking
  • doing some regular exercise
  • keeping to maintaining a healthy weight 

If you need help making these changes to your lifestyle, see our Quick links for information and advice. Or your GP may direct you to local information and support too.

Medicines

There are lots of different medicines used to treat coronary heart disease, which work in different ways. The medicines you need to take will depend on what’s causing your condition. If it’s high blood pressure, then you might need to take medicines to lower this, for example.

You may be offered one, or a combination, of medicines. Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist or doctor for advice. 

Here are some examples of medicines you might need to take if you have coronary heart disease.

  • Antiplatelet medicines, such as aspirin or clopidogrel, and anticoagulant medicines make your blood less likely to form clots. They also reduce your risk of having a heart attack.
  • Cholesterol-lowering medicines, such as statins, slow down the process of the fatty substances building up in your arteries (atherosclerosis). They also help to prevent these fatty substances breaking off from your arteries.
  • Beta-blockers slow your heart rate and reduce the amount of work your heart has to do. They can also help to control your heart rhythm.
  • ACE inhibitors lower your blood pressure and are used if you have heart failure or have had a heart attack.
  • Angiotensin II receptor blockers are an alternative treatment to ACE inhibitors if you get side-effects from them.
  • Calcium-channel blockers relax and widen your arteries.
  • Nitrates relax your coronary arteries and allow more blood to reach your heart.
  • Nicorandil works like a nitrate – you might need to take it to treat or prevent angina. 

Hospital treatment

If medicines don’t help you, the main procedures for coronary heart disease are described below.


Causes of coronary heart disease

Coronary heart disease is usually caused by a build-up of fatty substances on your artery walls.

It’s more common in older people – particularly men over 45 and women over 55. Coronary heart disease is very common in developed countries such as the UK because of the lifestyle we lead. It’s also more common in people from South Asia who live in the UK. 

Other things that increase your risk of developing coronary heart disease include:

  • smoking
  • being overweight – especially if you have excess fat around your waist
  • an inactive lifestyle
  • diabetes
  • high blood pressure
  • high cholesterol
  • drinking too much alcohol
  • a family history of heart disease
  • eating an unhealthy diet, such as foods that are high in saturated fat, cholesterol, salt and sugar
  • mental health problems, such as stress and depression

Prevention of coronary heart disease

You can help to prevent coronary heart disease by living a healthy lifestyle. This includes:

  • not smoking
  • losing weight (if you’re overweight or obese)
  • exercising regularly
  • eating a healthy, balanced diet, without too much saturated fat, cholesterol, salt and sugar
  • not drinking too much alcohol 

Frequently asked questions

  • Yes, most people can continue to have a healthy sex life after being diagnosed with coronary heart disease.

    Some people worry they won't be able to have sex if they have coronary heart disease, but this isn't usually the case. Sex is like any other form of exercise. 

    After a heart attack you can start to have sex again as soon as you feel ready to do so. If you haven’t had any problems with your recovery, this will probably be after about a month, but see how you feel. If you have any chest pain or breathlessness when you have sex, or any other form of exercise, tell your GP.

    You might have a lower sex drive after a heart attack or surgery for coronary heart disease, but it will usually come back. Some people feel depressed after having a heart attack, and this can also affect your sex drive. But this should improve with time. If you’re feeling low, contact your GP for support and advice. Some of the medicines for coronary heart disease, such as beta-blockers, can affect your sex drive too. If you have any problems, talk to your GP.

  • Your GP will use information about your health, family medical history and lifestyle to work out your risk of coronary heart disease.

    After many years of research, doctors now know a lot about what affects your risk of coronary heart disease. The more risk factors you have, the more likely you are to develop coronary heart disease.

    If you’re over 40, your GP may offer you a health check called a cardiovascular risk assessment. They’ll ask you about your medical history, family medical history and lifestyle. Your GP may listen to your heart and lungs and measure your blood pressure. They might offer you a blood test to measure your cholesterol and sometimes your blood glucose (sugar) – this is to check for diabetes.

    Your GP will put all this information together and use specially designed charts or an online risk calculator. This can give an indication of how likely you are to develop coronary heart disease. Many doctors use the QRISK® calculator to work this out – you may find it useful to look at this.

    Depending on your risk, your GP may recommend you have some more tests or offer you medicines.

    You and your GP can also discuss how making lifestyle changes may help reduce your risk of coronary heart disease. These may include stopping smoking or being more active.

  • It depends on your symptoms and the kind of vehicle you drive.

    If you have coronary heart disease, it can be dangerous for you to drive. Angina or a heart attack might cause you to lose control of your car. 

    The Driver and Vehicle Licensing Agency (DVLA) rules state if you have angina, you must stop driving until your symptoms are under control. If you’ve had a heart attack, you must stop driving for at least four weeks. The rules are usually different depending on whether you drive a car, or a heavy goods vehicle or passenger carrying vehicle, such as a bus. You may also need to tell the DVLA about your condition.

    You can contact the DVLA for advice or see the guidelines on its website. If you’re in any doubt about driving, contact your motor insurers so that you're aware of their recommendations, and always follow your doctor’s advice.


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Related information

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    • Coronary heart disease: epidemiology and prevention. Oxford textbook of medicine (online). Oxford Medicine Online. www.oxfordmedicine.com, published 29 October 2015
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    • Overview of coronary artery disease. The Merck Manuals. www.merckmanuals.com, published May 2013
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 16 February 2016
    • Percutaneous coronary intervention. PatientPlus. www.patient.info/patientplus, reviewed 21 February 2013
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    • Cardiovascular disease prevention. National Institute for Health and Care Excellence (NICE), 22 June 2010. www.nice.org.uk
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  • Reviewed by Rachael Mayfield-Blake, Bupa Health Content Team, March 2016
    Expert reviewer, Dr Tim Cripps, Consultant Cardiologist
    Next review due March 2019



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