Coronary heart disease (CHD) remains a major cause of death in the UK, developing when fatty deposits build up in the arteries that supply blood to the heart. While CHD cannot always be prevented, people can reduce their risk, and for those who already have the condition, treatment can help control symptoms and reduce the risk of a heart attack.
Understanding Coronary Heart Disease
The heart needs a continuous supply of oxygen-rich blood, which reaches it through blood vessels called the coronary arteries. Over time, fatty deposits build up within the walls of these arteries, narrowing them in a process called atherosclerosis.
If the heart muscle does not receive enough blood, particularly during physical activity, this can cause chest pain or discomfort known as angina. A heart attack can occur if a fatty deposit ruptures and a blood clot forms, suddenly reducing or blocking blood flow. Without urgent treatment, the affected heart muscle may be permanently damaged.
Recognising Symptoms and Diagnosis
Angina often feels like tightness, pressure or heaviness in the chest, and the discomfort may spread to your arms, shoulders, neck or jaw. You may also feel short of breath. Symptoms are often triggered by physical activity or stress and usually improve with rest or angina medication. However, some people have discomfort resembling indigestion, while others may have no warning symptoms before a heart attack.
Contact NHS 111 for urgent advice if you have new chest discomfort that comes and goes, or if your usual angina becomes more frequent, lasts longer or occurs at rest. Call 999 if you think you may be having a heart attack. Warning signs include chest pain that feels tight or squeezing, or pain spreading to your arms, neck or jaw, along with breathlessness, sweating, nausea or lightheadedness. Do not wait for symptoms to become severe, and do not drive yourself to hospital.
If you have symptoms suggesting CHD, your doctor will ask about these, your medical history and your family history. They may examine you, check your blood pressure and arrange blood tests. An electrocardiogram (ECG) records the heart's electrical activity, but a normal ECG does not rule out angina. Depending on your symptoms, you may be referred for further investigations, such as CT coronary angiography, a scan that uses X-rays and an injected dye to show narrowing in the coronary arteries.
Treatment and Risk Reduction
Treatment aims to relieve symptoms and reduce the risk of heart attacks and other complications, usually involving a combination of medicines and lifestyle changes. Statins lower cholesterol and are recommended for people with established CHD, even if their cholesterol is not high. Other medicines may help prevent blood clots, lower blood pressure or relieve angina. Do not start taking daily aspirin to prevent heart disease unless a healthcare professional advises you to do so.
Some people also need angioplasty, which uses a small balloon to widen a narrowed artery and usually leaves a small mesh tube called a stent to keep it open, or bypass surgery, which creates another route for blood to reach the heart muscle. These treatments do not remove the need for ongoing preventive care.
Smoking, high blood pressure, high cholesterol and diabetes increase your risk of CHD, as do being physically inactive and being overweight. Your risk increases as you get older and may be higher if a close relative developed heart disease at a young age. Here are three steps that could help reduce your risk:
- Quit smoking: If you smoke, stopping is one of the most effective steps you can take. Ask about stop-smoking support and treatments.
- Eat well and exercise: A balanced diet with vegetables, fruit, whole grains and beans can help protect your heart. Reduce salt and replace some saturated fats with unsaturated fats, and engage in regular physical activity.
- Attend health checks: Have your blood pressure and cholesterol checked and attend reviews for diabetes or other long-term conditions. In England, eligible adults aged 40–74 are offered an NHS Health Check every five years.
After a heart attack, cardiac rehabilitation supports recovery through exercise, education and practical advice. If you have had a heart attack and have not been offered cardiac rehabilitation, ask your healthcare team about a referral. Anxiety and low mood can also affect recovery, so discuss these with your healthcare team.
