Coronary artery disease

The most effective coronary artery disease care for you

• #1 in private cardiovascular care: More patients trust us with their cardiac care than any other provider. Our experience and resources help us deliver better outcomes for every individual, with 99% of people we have treated saying they would recommend us to friends and family. 
• Quick access to coronary artery disease testing: If you have symptoms or worries, we'll confirm an appointment with a specialist within 24 hours. We can offer the full range of tests and state-of-the-art imaging on the same day, with results available within 48 hours for your peace of mind. 
• Full treatment options: If needed, we provide comprehensive coronary artery disease treatments through our private network. Our experts will recommend the most effective options for you, from risk factor management to medication and procedures.  
• Leading consultants and subspecialist teams: You'll be looked after by consultants who are experts in their field. They're supported by subspeciality multi-disciplinary teams (MDTs) who share their knowledge from a range of backgrounds to find the best solutions for you.  
• Highest quality facilities and technology: We invest continuously to offer the best possible environments for your care, including five cardiac hospitals and 15 outpatient centres equipped with the latest diagnostic and treatment technologies.

Types of coronary artery disease

The two main types of coronary artery disease are: 

• Stable ischemic heart disease, where your coronary arteries gradually narrow over time. You may experience some symptoms but can live with your coronary artery disease condition on a daily basis. 
• Acute coronary syndrome, where plaque build-up in your coronary artery suddenly breaks open and forms a blood clot which blocks blood flow completely, leading to a heart attack. This is an emergency and requires immediate medical attention. 

Coronary artery disease risk factors

Risk factors increase your chances of developing a condition. Some you can change or manage, such as physical activity and smoking, while others you can't, such as age and genetics. 

The main risk factors for coronary artery disease that you can influence include:

• Smoking: People who smoke have a significantly higher risk of heart disease. Breathing in second-hand smoke also increases your risk.
• High blood pressure: Uncontrolled high blood pressure can result in hardening and thickening of your arteries over time, narrowing the channel that blood flows through.  
• High blood cholesterol levels: High levels of low-density lipoprotein (‘bad’) cholesterol can also cause the narrowing and blocking of your blood vessels. 
• Diabetes: Type 2 diabetes, in particular, shares similar risk factors with coronary artery disease, such as obesity and high blood pressure, although both types of diabetes can cause inflammation in your blood vessels. 
• Being overweight or obese: Being overweight typically worsens other risk factors associated with coronary artery disease, such as type 2 diabetes and high blood pressure.  
• Eating an unhealthy diet: Your risk is higher if your diet is rich in saturated fats and trans fats (found in some meat and dairy products and baked goods), salt and sugar.
• Physical inactivity: A lack of exercise is also associated with coronary artery disease as fatty deposits can build up in your arteries.  
• High levels of stress: Research shows that unrelieved stress may damage your coronary arteries, as well as worsen other risk factors for the condition such as high blood pressure. It can also lead to unhealthy lifestyle choices, such as overeating or smoking. 

Risk factors that you can’t control include: 

• Age: Getting older increases your risk of damaged and narrowed coronary arteries.
• Family history: A family history of heart disease is associated with a higher risk of coronary artery disease, especially if a close relative developed it 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.
• Sex: Men are generally at greater risk of coronary artery disease, although the risk for women increases after menopause.
• Ethnicity: Some ethnicities are at higher risk than others. 

Risk factors often occur together and one may trigger another. For example, an unhealthy diet and lack of exercise can lead to obesity, which can in turn lead to type 2 diabetes and high blood pressure. 

When grouped, certain risk factors increase your likelihood of developing coronary artery disease. For example, metabolic syndrome – a group of conditions that includes high blood pressure, low HDL (‘good’ cholesterol), high insulin levels and excess body fat around the waist – increases risk. But sometimes coronary artery disease develops without any risk factors. 

If you're concerned about your risk, we offer comprehensive coronary artery disease testing to give you a clearer picture and an effective plan for managing it. 

Coronary artery disease diagnosis

If your consultant feels you may be at risk of coronary artery disease, they'll carry out a full assessment to learn about your medical and family history and your lifestyle. They'll also carry out a physical examination which will include:

• Blood pressure check: High blood pressure is often related to coronary heart disease.
• BMI: This stands for body mass index, and measures whether you are a healthy weight for your height. High BMI (being overweight or obese) is related to coronary artery disease.
• Waist measurement: Men with a waist size over 37in and women with a waist size over 31.5in are at high risk of coronary artery disease. 

Depending on the results, you may be referred for further tests including:

• Blood tests: To provide a range of information about your heart muscle by measuring the enzymes, cholesterol and proteins in your blood. You may have speciality cardiac blood tests as well as other blood tests that measure the health of your entire body and its potential impact on your heart. 
• Electrocardiogram (ECG): Attaching sensors to your chest to measure the rate, rhythm and electrical activity of your heart. It's a painless test which usually only takes a few minutes to complete.
• Echocardiogram: Using sound waves to create moving pictures of your beating heart to check for weaknesses that may be caused by coronary artery disease or other conditions. It takes between 15 and 30 minutes. 
• Exercise ECG (also known as a cardiac stress test): To see how your heart responds to moderate exercise, for example, while walking on a treadmill. This test usually takes around half an hour with a consultant monitoring you. It also records your blood pressure.
• Coronary angiogram (also known as cardiac catheterisation): A small, flexible tube is inserted into your artery, at the top of your leg or in your arm, and a fine wire is guided along the arteries of your heart. A dye is injected and a series of X-rays are taken so that your consultant can see whether your coronary arteries are narrowed or blocked.

If they are, your consultant may carry out a coronary angioplasty (see treatment section below). 

• Imaging tests: These include MRI, CT scans and PET scans, which provide high-definition images of your heart and surrounding arteries to check for narrowing and blockages.

Your doctor will decide which tests are most appropriate for you. We carry out more tests every year than any other UK private provider, including over 25,000 ECGs, over 20,000 echocardiograms and thousands of imaging tests, ensuring you get accurate results without delay. 

Coronary artery disease treatment and prevention

If you receive a diagnosis, your consultant will recommend the best treatment for your coronary artery disease. Treatment can significantly relieve your symptoms as well as decrease your risk of a heart attack or a stroke. 

Your recommended treatment may include a combination of lifestyle changes, medications and, in some cases, a procedure or surgery. 

Lifestyle changes

Your doctor will recommend making some heart-healthy lifestyle changes to manage your condition or prevent you from developing it. These will include:

• Eating a healthy diet and maintaining a healthy weight (losing weight if necessary)
• Cutting down on alcohol
• Giving up smoking
• Trying to avoid or reduce stress
• Taking regular exercise, starting slowly and gradually building your activity level 

Our coronary artery specialists can give you advice on the most impactful ways to manage your risk. 

Coronary artery disease medications

• Nitrates: Most people with stable coronary artery disease are prescribed a medicine called glyceryl trinitrate (GTN), which comes in spray form or as tablets that dissolve under your tongue. GTN works by dilating your arteries, reducing pressure on the heart muscle.
• Beta blockers: These are sometimes prescribed to prevent angina attacks caused by coronary artery disease. Beta blockers slow down the heart by reducing the amount of adrenaline your body produces. 
• ACE (angiotensin-converting enzyme) inhibitors: These drugs reduce blood pressure by helping to relax your veins and arteries making it easier for your heart to pump blood around the body. 

Some people experience unpleasant side effects from ACE inhibitors, so they are prescribed Angiotensin II receptor blockers (ARBs) instead for the same purpose.

• Statins, like atorvastatin: These are used to lower blood cholesterol, which helps prevent blockages in the blood vessels. 
• Calcium channel blockers: These prevent calcium from entering your arteries and heart, helping the blood vessels to relax and reducing blood pressure.
• Blood-thinning medications: These medicines, including low-dose aspirin, help to thin the blood and prevent heart attacks and strokes in people with coronary artery heart disease. 
• Diuretics: These are medicines that make you pass more urine and help relieve the symptoms of coronary heart disease by flushing excess water and salts from your body.

Coronary artery disease procedures

If your condition is serious or if medication doesn't relieve symptoms, your doctor may recommend coronary artery disease surgery. 

There are two main types of medical procedure for coronary artery disease:

• Coronary angioplasty and stenting: Following an angiogram, a tiny balloon is used to inflate a narrow artery which is then held open by a stent (a small wire tube). This procedure can be used to treat the symptoms of coronary heart disease as well as heart attacks in emergencies. 
• Coronary artery bypass graft (CABG): In this surgical treatment for coronary artery disease, an artery from another part of your body (usually the chest, leg or arm) is attached above and below the blocked section of the coronary artery to divert the blood flow (this is known as a graft). 

The operation is carried out under general anaesthetic and takes between three and six hours. You may need more than one graft, depending on how severe your coronary artery disease is.

Coronary artery disease complications

The complications of coronary artery disease can be prevented with accurate diagnosis and appropriate treatment. Without them, the condition can lead to:

• Chest pain (angina) and shortness of breath when your heart doesn't receive enough blood when it needs it most, for example, while exercising. 
• Heart attack, when fatty build-up in your coronary arteries breaks open and causes a blood clot that blocks blood flow to your heart.
• Heart failure, when narrowed coronary arteries restrict your heart's ability to pump blood.
• Cardiac arrhythmia, when reduced blood flow to your heart alters its signalling and causes an irregular rhythm.