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    Coronary Artery Disease

    Coronary Artery Disease

    Overview

    The heart

    What is coronary artery disease?

    Coronary artery disease is the most common type of heart disease. It's also the number one killer of both men and women in the United States.

    When you have it, your heart muscle doesn't get enough blood. This can lead to serious problems, including heart attack .

    It can be a shock to find out that you have coronary artery disease. Many people only find out when they have a heart attack. Whether or not you have had a heart attack, there are many things you can do to slow coronary artery disease and reduce your risk of future problems.

    What causes coronary artery disease?

    Coronary artery disease is caused by hardening of the arteries, or atherosclerosis . This means that fatty deposits called plaque (say "plak") build up inside the arteries. Arteries are the blood vessels that carry oxygen-rich blood throughout your body.

    Atherosclerosis can affect any arteries in the body. When it occurs in the ones that supply blood to the heart ( the coronary arteries ), it is called coronary artery disease.

    When plaque builds up in the coronary arteries, the heart doesn't get the blood it needs to work well. Over time, this can weaken or damage the heart. If a plaque tears, the body tries to fix the tear by forming a blood clot around it. The clot can block blood flow to the heart and cause a heart attack .

    What are the symptoms?

    Symptoms can happen when the heart is working harder and needs more oxygen, such as during exercise. Symptoms include:

    • Angina (say "ANN-juh-nuh" or "ann-JY-nuh"), which most often is chest pain or discomfort or a strange feeling in the chest.
    • Shortness of breath.
    • Heart attack. A heart attack is sometimes the first sign of coronary artery disease.

    Less common symptoms include a fast heartbeat, feeling sick to your stomach, and increased sweating. Some people don't have any symptoms. In rare cases, a person can have a "silent" heart attack, without symptoms.

    To find out your risk for a heart attack in the next 10 years, use this Interactive Tool: Are You at Risk for a Heart Attack?

    How is coronary artery disease diagnosed?

    Your doctor will do a physical exam and ask questions about your past health and your risk factors. Risk factors are things that increase the chance that you will have coronary artery disease.

    Some common risk factors are being older than 65; smoking; having high cholesterol, high blood pressure, or diabetes; and having heart disease in your family.

    If your doctor thinks that you have coronary artery disease, you may have tests to check how well your heart is working. These tests include an electrocardiogram (EKG or ECG), a chest X-ray, an exercise electrocardiogram, and blood tests. You may also have a coronary angiogram to check blood flow to the heart.

    How is it treated?

    Treatment focuses on lowering your risk for heart attack and stroke and managing your symptoms. Lifestyle changes, medicine, and procedures are used.

    • Lifestyle changes include quitting smoking (if you smoke), eating heart-healthy foods, getting regular exercise, staying at a healthy weight, lowing your stress level, and limiting how much alcohol you drink. A cardiac rehab program can help you make these changes.
    • Medicines can help you lower high cholesterol and high blood pressure, manage angina, and lower your risk of having a blood clot.
    • Procedures that improve blood flow to the heart include angioplasty and bypass surgery .

    Cause

    Coronary artery disease is caused by hardening of the arteries, or atherosclerosis . This means that fatty deposits called plaque build up inside the arteries. Arteries are the blood vessels that carry oxygen-rich blood throughout your body.

    Atherosclerosis can affect any arteries in the body. When it occurs in the arteries that supply blood to the heart ( the coronary arteries ), it is called coronary artery disease.

    To understand why plaque and atherosclerosis is a problem, compare a healthy artery with an artery with atherosclerosis:

    A healthy artery is like a rubber tube. It is smooth and flexible, and blood flows through it freely. When your heart has to work harder, such as when you exercise, a healthy artery can stretch to let more blood flow to your body's tissues.

    An artery with atherosclerosis is more like a clogged pipe. Plaque narrows the artery and makes it stiff. This limits the flow of blood to the tissues. When the heart has to work harder, the stiff arteries can't flex to let more blood through, and the tissues don't get enough blood and oxygen.

    When plaque builds up in the coronary arteries, the heart doesn't get the blood it needs to work well. This is called ischemia (say "is-KEE-mee-uh"). Ischemia can cause symptoms such as chest pain or pressure. Over time, ischemia can weaken or damage the heart.

    If a plaque tears, the body tries to fix the tear by forming a blood clot around it. The clot can block blood flow to the heart and cause a heart attack .

    Symptoms

    The most common symptoms of coronary artery disease are angina (say "ANN-juh-nuh" or "ann-JY-nuh") and shortness of breath when exercising or doing other vigorous activity. Women are somewhat more likely than men to have other symptoms like nausea and back or jaw pain.

    Angina

    Angina symptoms include chest pain or pressure or a strange feeling in the chest. This feeling can be in areas other than the chest , such as in the neck or jaw. Angina can be stable or unstable.

    • Stable angina has a typical pattern. You can likely predict when it will happen. It happens when your heart is working harder and needs more oxygen, such as during exercise. Symptoms go away when you rest or take nitroglycerin.
    • Unstable angina is a change in your usual pattern of stable angina. It is a warning sign that a heart attack may soon occur. It is an emergency.

    Silent ischemia

    Some people don't have any symptoms. This is called "silent ischemia." In rare cases, you can even have a "silent heart attack," a heart attack without symptoms.

    What Increases Your Risk

    Things that can increase your risk for coronary artery disease are called risk factors. Some risk factors, such as your gender, your age, and your family history , can't be changed. Other risk factors for heart disease are tied to your lifestyle and habits. These are often things you can change, like quitting smoking, eating heart-healthy foods, and getting more exercise.

    Women have unique risk factors for heart disease. These include using birth control pills, using hormone therapy, and having pregnancy-related problems.

    Your chance of getting coronary artery disease rises with the number of risk factors you have.

    To learn how to lower your risk, see Prevention.

    What's your risk?

    Your doctor can help you find out your risk of getting coronary artery disease. And you can use the Interactive Tool: Are You at Risk for a Heart Attack? if you know your blood pressure and cholesterol numbers.

    When to Call a Doctor

    Do not wait if you think you are having a heart attack. Some people aren't sure whether they're having one, or they don't want to bother others, so they wait. But getting help fast can save your life.

    Call 911 or other emergency services immediately if you have symptoms of a heart attack or are with someone who has symptoms. Symptoms may include:

    • Chest pain or pressure, or a strange feeling in the chest.
    • Sweating.
    • Shortness of breath.
    • Nausea or vomiting.
    • Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly or in one or both shoulders or arms.
    • Lightheadedness or sudden weakness.
    • A fast or irregular heartbeat.

    After you call 911, the operator may tell you to chew 1 adult-strength or 2 to 4 low-dose aspirin. Wait for an ambulance. Do not try to drive yourself. By taking an ambulance, you may be able to start treatment before you arrive at the hospital.

    Nitroglycerin. If you typically use nitroglycerin to relieve angina and if one dose of nitroglycerin has not relieved your symptoms within 5 minutes, call 911. Do not wait to call for help.

    Call your doctor if:

    • Your angina symptoms are different, more frequent, or severe.

    Who to see

    To see if you are at risk for heart disease, have symptoms of heart disease, or need long-term care for existing heart disease, see your family doctor or internist . For diagnosis of coronary artery disease, you may see a cardiologist . For ongoing care of stable angina, you will likely see your family doctor or an internist. For angioplasty or surgery, you will be referred to an interventional cardiologist or cardiovascular surgeon .

    Exams and Tests

    Your doctor will do a physical exam and a number of tests to find out your risk for coronary artery disease and to diagnose it.

    To find out your risk for coronary artery disease

    Your doctor will check your blood pressure and cholesterol levels and ask about other risk factors, such as your age and whether you smoke, to help find out your risk for getting heart disease.

    If you know your blood pressure and cholesterol levels, you can use this tool:

    Interactive Tool: Are You at Risk for a Heart Attack?

    Your doctor may do other tests, such as a C-reactive protein (CRP) test and a coronary calcium scan.

    Click here to view a Decision Point. Heart Disease Risk: Should I Have a Coronary Calcium Scan?

    Sometimes doctors schedule heart tests because they think that's what patients expect. But some heart tests may not be needed. If your doctor recommends a test, ask what it is for and why you need it. See the topic Heart Tests: When Do You Need Them?

    To diagnose coronary artery disease

    If your doctor thinks you may have heart disease, you will need some tests to make sure. Most often, the first tests include:

    Other tests may include:

    Treatment Overview

    Treatment focuses on lowering your risk for heart attack and stroke and managing your symptoms. Lifestyle changes, medicine, and procedures are used.

    Lifestyle changes

    Lifestyle changes are the first step for anyone with coronary artery disease. Healthy habits can slow or even stop the disease and improve the quality and length of your life. These habits include:

    A cardiac rehabilitation program can help you make these changes.

    It's also important to manage any health problems you have. If you have high blood pressure, high cholesterol, or diabetes, be sure you're doing everything you can to keep these conditions under control.

    To learn what you can do, see Living With Heart Disease.

    One Man's Story:

    Photo of older man

    Alan, 73

    "I've had to work at keeping my weight under control, and that has really helped my cholesterol. When you have heart disease, you learn to eat better for the rest of your life. And if you don't, you're asking for trouble."? Alan

    Read more about Alan and the lessons he's learned about diet and exercise.

    Medicines

    You will probably have to take several medicines. These include:

    Procedures

    If your angina symptoms get worse even though you are taking medicines, you may think about having a procedure to improve blood flow to your heart. These include angioplasty with or without stenting and bypass surgery. They are done when the coronary arteries are severely blocked.

    Click here to view a Decision Point. Heart Disease: Should I Have Angioplasty for Stable Angina?
    Click here to view a Decision Point. Heart Disease: Should I Have Bypass Surgery?

    Palliative care

    If your coronary artery disease gets worse, you may want to think about palliative care. Palliative care focuses on improving your quality of life?not just in your body, but also in your mind and spirit. It may help you manage symptoms or side effects from treatment.

    If you are interested in palliative care, talk to your doctor. He or she may be able to manage your care or refer you to a doctor who specializes in this type of care.

    For more information, see the topic Palliative Care.

    Prevention

    You can help prevent coronary artery disease by taking steps toward a heart-healthy lifestyle. A heart-healthy lifestyle can also help you reduce risk factors such as high cholesterol and high blood pressure.

    Lifestyle changes

    • Quit smoking . Avoid secondhand smoke too. Quitting smoking may be the best thing you can do to prevent heart disease.
    • Exercise . There are lots of ways that exercise boosts your heart health. It can improve cholesterol and blood pressure. It can also help you reach a healthy weight. Talk to your doctor before starting an exercise program to make sure that it's safe for you.
    • Eat a heart-healthy diet . The way you eat can help you control your cholesterol and blood pressure.
    • Stay at a healthy weight . Being active and eating healthy foods can help you stay at a healthy weight or lose weight if you need to.

    Medicines

    Control your cholesterol and blood pressure

    To reduce your risk of heart disease, you'll need to control your cholesterol and manage your blood pressure. Quitting smoking, changing the way you eat, and getting more exercise can help. But if these things don't work well enough, you may need to take medicines too.

    Click here to view a Decision Point. High Cholesterol: Should I Take Statins?
    Click here to view a Decision Point. High Blood Pressure: Should I Take Medicine?
    Use aspirin to prevent heart attack and stroke

    If you're already at risk for heart disease, taking daily aspirin may reduce your chances of having a stroke or a heart attack. That's because a daily aspirin lowers your risk of getting blood clots. Blood clots can lead to a heart attack in people with heart disease. Clots can also cause heart attacks in people who have other problems that can lead to heart disease, such as diabetes, high blood pressure, and high cholesterol.

    Taking aspirin has some risks. Talk with your doctor before starting aspirin treatment.

    Click here to view a Decision Point. Aspirin: Should I Take Daily Aspirin to Prevent a Heart Attack or Stroke?

    Stress

    Stress can hurt your heart. Keep stress low by talking about your problems and feelings, rather than keeping your feelings hidden. Try different ways to reduce stress, such as exercise, deep breathing, meditation, or yoga.

    What Happens

    Coronary artery disease most often begins when the inside walls of the coronary arteries are damaged because of another health problem, such as high cholesterol, high blood pressure, diabetes, or smoking. This damage can lead to atherosclerosis, or hardening of the arteries.

    If your heart disease gets worse, your arteries will narrow, and less blood will flow to your heart. You may start to have angina symptoms, such as chest pain or discomfort when you exercise or feel stressed. This is called stable angina .

    In some cases, sudden and serious problems can happen. New blockages that form in the arteries of the heart can become unstable. They can suddenly tear and cause blood clots to form. These clots block blood flow to your heart, causing a heart attack or unstable angina .

    Complications of heart disease

    Over time, you may have other health problems caused by coronary artery disease. Low blood flow can make it harder for your heart to pump. This can lead to heart failure or atrial fibrillation . Atrial fibrillation increases the risk of stroke.

    Living With Heart Disease

    A diagnosis of coronary artery disease can be hard to accept and understand. If you don't have symptoms, it may be especially hard to recognize that heart disease is serious and can lead to other health problems.

    It's important to talk with your doctor to learn about the disease and what you can do to help manage it and keep it from getting worse.

    Lifestyle changes

    • Quit smoking, and avoid secondhand smoke. Quitting smoking is the best thing you can do to reduce your risk of future problems. When you quit, you quickly lower your risk of a heart attack. 1
    • Exercise. Start an exercise program (if your doctor says it's safe). Try walking, swimming, biking, or jogging for at least 30 minutes on most, if not all, days of the week. Any activity you enjoy will work, as long as it gets your heart rate up.
      Click here to view an Actionset. Heart Disease: Exercising for a Healthy Heart
    • Eat a heart-healthy diet. This can help you keep your disease from getting worse. A chart (What is a PDF document?) that compares heart-healthy diets can help you see what foods are suggested in each plan. Heart-healthy foods include fruits, vegetables, high-fiber foods, fish, and foods low in sodium, saturated fat, trans fat, and cholesterol.
      Heart-Healthy Eating
    • Stay at a healthy weight. Being active and eating healthy foods can help you stay at a healthy weight or lose weight if you need to.
      Weight Management

    Your doctor may suggest that you attend a cardiac rehabilitation (rehab) program. In cardiac rehab, you will get education and support that help you build new, healthy habits, such as eating right and getting more exercise.

    Medicines

    Medicines are an important part of your treatment.

    • Take your medicines exactly as directed. Do not stop taking your medicine unless your doctor tells you to.
    • Get a flu vaccine every year.

    Get help for depression

    Depression and heart disease are linked. People with heart disease are more likely to get depressed. And if a person has both depression and heart disease, he or she may not stay as healthy as possible. This can make depression and heart disease worse.

    If you think you may have depression, talk to your doctor. Take this short quiz to check your symptoms: Interactive Tool: Are You Depressed? For more information, see the topic Depression.

    Manage other health problems

    To reduce your risk of heart attack or stroke, you will need to control other health problems you may have. These problems include high cholesterol and high blood pressure. Quitting smoking, changing the way you eat, and getting more exercise can help. But if these things don't work well enough, you may also need to take medicines.

    Click here to view a Decision Point. High Cholesterol: Should I Take Statins?
    Click here to view a Decision Point. High Blood Pressure: Should I Take Medicine?

    Other steps to stay healthy

    • Find emotional support. Think about joining a heart disease support group. Ask your doctor about the types of support that are available where you live. Meeting other people with the same problems can help you know you're not alone. Your family and friends can also give you support.
    • Drink alcohol in moderation, if you drink. This means having 1 drink a day for women or 2 drinks a day for men.
    • Manage stress and anger. Stress and anger can also hurt your heart. They might make your symptoms worse. Try different ways to reduce stress, such as exercise, deep breathing, meditation, or yoga.
    • Seek help for sleep problems. Sleep apnea is a common problem in people who have heart disease.
    • Have sex when you're ready. You can resume sexual activity after a heart attack when you are healthy and feel ready for it. Your doctor can help you know if your heart is healthy enough for sex.

    Medications

    Medicines are an important part of your treatment. Using them correctly can lower your risk of having a heart attack or dying from coronary artery disease.

    Medicine to lower blood pressure and the heart's workload

    Medicine to prevent blood clots from forming and causing a heart attack

    Aspirin, ibuprofen, and naproxen are all nonsteroidal anti-inflammatory drugs (NSAIDs) and can relieve pain and inflammation. But only aspirin will reduce your risk for heart attack or stroke. Don't substitute ibuprofen or naproxen for low-dose aspirin therapy. If you need to take an NSAID for a long time, talk with your doctor to see if it is safe for you.

    Click here to view a Decision Point. Aspirin: Should I Take Daily Aspirin to Prevent a Heart Attack or Stroke?
    Click here to view an Actionset. Blood Thinners Other Than Warfarin: Taking Them Safely

    Medicine to lower cholesterol

    Medicine to manage angina symptoms

    Stable angina can often be controlled with medicine such as:

    If you take nitrates

    Do not use erection-enhancing medicines such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra) if you take nitroglycerin or other nitrates for angina. Combined, these two drugs can cause a serious drop in blood pressure. Talk to your doctor. There are other medicines that may work instead to ease your angina.

    For more help with controlling angina, see:

    Quick Tips: Taking Charge of Your Angina.
    Using Nitroglycerin for Angina.

    Help taking your medicines

    Medicine is a powerful tool to help you manage your heart disease. To get the most of your medicines, take them as prescribed. This may be hard because of how many you have to take and their cost. You may also worry about side effects.

    Taking Medicines as Prescribed
    Dealing With Medicine Side Effects and Interactions
    Reducing Medicine Costs

    You may have regular blood tests to monitor how the medicine is working in your body. Your doctor will likely let you know when you need to have the tests.

    Surgery

    Sometimes coronary artery bypass graft surgery is needed to improve blood flow to the heart. During this surgery, a doctor connects (grafts) a healthy artery or vein from another part of your body to the blocked coronary artery . The grafted artery goes around (bypasses) the blocked part of the artery. The bypass provides a new pathway for blood to your heart.

    If you have surgery, you'll still need to make changes in the way you eat and how much you exercise. These changes, along with not smoking, will give you the best chance of living a longer, healthier life. A cardiac rehabilitation program can help you make these healthy changes.

    Click here to view a Decision Point. Heart Disease: Should I Have Bypass Surgery?

    Angioplasty

    Angioplasty is a procedure that widens the coronary artery to improve blood flow to the heart. It is done using a thin, soft tube called a catheter, which is inserted in your artery.

    Angioplasty is not surgery. It doesn't use large cuts (incisions) or require anesthesia to make you sleep.

    Most of the time, stents are placed during angioplasty. The stent keeps the artery open . When stents are used, there is a smaller chance that the artery will become narrow again.

    Atherectomy might be done during angioplasty. Atherectomy is done to shave away and maybe remove plaque in a narrowed artery. It is only done in certain cases.

    If you decide to have angioplasty, you'll still need to make changes in the way you eat and how much you exercise. These changes, along with not smoking, will give you the best chance of living a longer, healthier life. A cardiac rehabilitation program can help you make these healthy changes.

    Click here to view a Decision Point. Heart Disease: Should I Have Angioplasty for Stable Angina?

    End-of-Life Decisions

    If your heart disease is advanced and your life will most likely be shortened by the illness, talk to your doctor about whether you want to be revived (resuscitated) when your illness progresses and your breathing stops. You may want to learn more about aggressive life-sustaining medical treatment and whether it is right for you.

    Click here to view a Decision Point. Advance Care Planning: Should I Stop Treatment That Prolongs My Life?

    For more information, see:

    Other Places To Get Help

    Organizations

    Society for Interventional Radiology
    3975 Fair Ridge Drive
    Suite 400 North
    Fairfax, VA 22033
    Phone: 1-800-488-7284
    Web Address: www.sirweb.org

    The Society of Interventional Radiology is a national organization of physicians, scientists, and health professionals dedicated to improving public health through disease management and minimally invasive, image-guided therapies. Intervention radiology includes using X-rays, MRI, and other imaging to move a thin tube in the body, usually in an artery, to treat a disease. An example is angioplasty for heart disease. The Web site includes a section on patient information. This section gives information on therapies for various diseases and conditions. The Web site can also help you find a doctor.


    Society of Thoracic Surgeons
    633 North Saint Claire Street
    Floor 23
    Chicago, IL 60611
    Phone: (312) 202-5800
    Fax: (312) 202-5801
    Web Address: www.sts.org

    The Society of Thoracic Surgeons provides patient information on surgeries of the chest and throat that are done by cardiothoracic surgeons. These surgeries include heart, lung, and throat surgery. The patient information section of the website describes diseases, surgeries, patient options, and what to expect after surgery. And using the website, you can search for surgeons in your area.


    American Heart Association (AHA)
    7272 Greenville Avenue
    Dallas, TX75231
    Phone: 1-800-AHA-USA1 (1-800-242-8721)
    Web Address: www.heart.org

    Visit the American Heart Association (AHA) website for information on physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your nearest local or state AHA group. The AHA provides brochures and information about support groups and community programs, including Mended Hearts, a nationwide organization whose members visit people with heart problems and provide information and support.


    CardioSmart
    Web Address: www.cardiosmart.org

    CardioSmart is an online education and support program that can be your partner in heart health. This website engages, informs, and empowers people to take part in their own care and to work well with their health care teams. It has tools and resources to help you prevent, treat, and/or manage heart diseases.

    You can set health and wellness goals and track your progress with online tools. You can track your weight, waist measurement, blood pressure, and activity. You can use calculators to help you find your body mass index (BMI) and check your risk for heart problems. You can search for a cardiologist. And you can find medicine information and prepare for your next appointment. Also, you can join online communities to connect with peers and take heart-healthy challenges.

    CardioSmart was designed by cardiovascular professionals at the American College of Cardiology, a nonprofit medical society. Members include doctors, nurses, and surgeons.


    National Heart, Lung, and Blood Institute (NHLBI)
    P.O. Box 30105
    Bethesda, MD20824-0105
    Phone: (301) 592-8573
    Fax: (240) 629-3246
    TDD: (240) 629-3255
    Email: nhlbiinfo@nhlbi.nih.gov
    Web Address: www.nhlbi.nih.gov

    The U.S. National Heart, Lung, and Blood Institute (NHLBI) information center offers information and publications about preventing and treating:

    • Diseases affecting the heart and circulation, such as heart attacks, high cholesterol, high blood pressure, peripheral artery disease, and heart problems present at birth (congenital heart diseases).
    • Diseases that affect the lungs, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema, sleep apnea, and pneumonia.
    • Diseases that affect the blood, such as anemia, hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.

    WomenHeart: The National Coalition for Women With Heart Disease
    818 18th Street NW
    Suite 1000
    Washington, DC20006
    Phone: 1-877-771-0030 toll-free
    Fax: (202) 728-7238
    Web Address: www.womenheart.org

    WomenHeart: The National Coalition for Women with Heart Disease is a nonprofit organization dedicated to reducing heart disease, death, and disability among women. The coalition also sponsors a network of support groups, a bulletin board, a newsletter, and other services.


    References

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    Credits

    By Healthwise Staff
    Primary Medical Reviewer Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
    Specialist Medical Reviewer Robert A. Kloner, MD, PhD - Cardiology
    Last Revised May 8, 2013

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