As the most common cause of heart attacks, coronary artery disease is a serious problem. But luckily, there are a few things you can do to prevent it from worsening or, in many cases, developing at all.
When cholesterol, fats and other substances create plaque that builds up in the arteries, the arteries start to narrow. This is called atherosclerosis. Blood and oxygen have a harder time getting to the heart, and over time, usually several years, coronary artery disease, also known as ischemic heart disease, sets in.
“There are modifiable and nonmodifiable risks,” says Melissa Tracy, MD, a cardiologist at Rush. “Our genetics, our age, our sex and, for women, becoming postmenopausal, those are non-modifiable.”
But the good news is that we can usually control our diets, exercise and consumption of alcohol and tobacco.
And we can take steps to lower blood pressure, take medications, manage other conditions that affect the heart and arteries and monitor our heart health to make sure we’re doing everything we can to prevent coronary artery disease.
Best diet tips for coronary artery disease prevention
If you’d like a quick checklist of Tracy’s diet tips for preventing coronary artery disease, she recommends the following:
- Reduce your portions. You don’t need to clear your plate every time.
- Avoid processed foods, especially fast food, whenever possible.
- Reduce your sodium intake. Your food’s sodium content shouldn’t exceed its calories.
- Switch to a salt alternative, like potassium chloride.
- Choose more natural foods, like fruits, vegetables and grains.
- Stick to leaner meats, like chicken.
When it comes to heart-healthy diets, it’s not just about what you eat. How much you eat also matters.
Over time, the size of our dinner plates has increased, and so have our portions. Overeating can contribute to weight gain and obesity, which can lead to coronary artery disease.
"Many of us have a diet consumption that is excessive,” Tracy says. “Forget what your mom said about cleaning your plate. You don't need to clean your plate if you go to a buffet. And if you just don't like something, don't eat it.”
Another way our diets can increase risk for coronary artery disease is through processed foods. These are foods that may have been pre-cooked, frozen, dehydrated, canned, packaged or loaded with preservatives.
Many of us rely on quick and easy options, like processed, fast food, especially when we’re on the road or don’t have time to cook. While these may be convenient, they are not good for heart health.
“There's nothing really good about fast food,” Tracy says. "Staying away from fast foods and fried foods is key.”
One of the reasons processed foods can be bad for your heart is that they often have preservatives and additives, like salt. The increased sodium intake can contribute to coronary artery disease, as well.
Tracy advises reducing sodium intake from salt by switching to a salt substitute.
“A salt substitute is anything that contains at least 25% of something other than sodium chloride,” Tracy says. “That’s typically potassium chloride.”
Avoiding salt can be difficult, but one easy trick is to look at your food’s label.
“If the number per serving of sodium is higher than the number of calories, nix it,” Tracy says. “That’s way too much sodium.”
Instead of salty or processed foods, Tracy recommends choosing foods that have not been highly altered with preservatives and processing.
“We have to get back to more holistic and natural foods,” Tracy says. “So definitely more fruits, vegetables and grains.”
And for proteins, Tracy recommends sticking to leaner meats, like chicken, if you are not a vegetarian. And if you must eat red meat, reduce the amount and opt for leaner cuts.
Best exercises for coronary artery disease prevention
If you’d like a quick list of Tracy’s exercise tips for preventing coronary artery disease, you can use the following:
- Get in at least 150 minutes of movement each week.
- Activity should be moderate to intense. You should be a bit short of breath and break a light sweat.
- If you don’t have 30 minutes a day, break it into shorter, more frequent sessions. Try using your lunch break at work.
- A leisurely walk is still better than no activity.
- Switch things up to keep it fun. Try running, cycling, dancing or other activities you may enjoy.
- Choose appropriate exercises for your body. Swimming is great if you have bad knees or hips.
- Exercise with a partner if you can, so you can keep each other motivated.
You may have heard by now that the general recommendation to keep your heart healthy is 150 minutes of moderate to intense exercise per week. That comes out to about 30 minutes a day, five days a week.
“The studies have absolutely shown that if we can get our activity up to that range, we reduce the risk of cardiovascular and cerebrovascular events,” Tracy says.
But most patients who develop coronary artery disease do not get this recommended amount of exercise.
There are many reasons for this. One is that the idea of exercising can be intimidating and, sometimes, confusing. What exactly counts as an exercise?
“Most people don't know how to exercise, so I like to change the word 'exercise’ to ‘movement,’” Tracy says. “It's less intimidating. So instead of saying I need you to get 150 minutes of exercise per week, I say 150 minutes of movement.”
Another reason people may not get enough exercise is that they feel they don’t have enough time.
“Some patients tell me they can’t find 30 minutes, five times per week to be active,” Tracy says. “OK, how about three 10-minute sessions per day? Or two 15-minute sessions? Even walking during your lunch break at work or climbing the stairs helps. You don't have to be a marathon runner.”
Just make sure your activity stays moderate to intense. That means you’ll be feeling a little bit breathless and breaking a sweat. And if you can’t do that, any activity is still better than none.
"Even if you can only get a leisure walk, it’s better than sitting on a chair at the computer,” Tracy says.
Sticking to an exercise routine can also be difficult. For example, many people get bored doing the same exercises every day. To keep things fun and interesting, Tracy recommends switching up your activities.
“It doesn't have to be running. It can be brisk walking. It can be hiking, cycling or using the elliptical” Tracy says. “I love to tell patients, ‘Dance.’ What's more fun than putting on some good music and dancing?”
When choosing an exercise, it’s also important to keep in mind what your body is capable of. Not everyone can safely do the same exercises.
“Take into consideration what your body can do,” Tracy says. “If you have really bad knees or hips, swimming is an excellent option for exercise.”
Another way to stick to your routine is to find an activity buddy. That way, you can rely on each other to stay motivated.
“If you can exercise with someone else, one of you is going to be up if the other is feeling down,” Tracy says. “So you can feed off of each other's energy.”
Coronary artery disease and alcohol
Alcohol consumption is linked to heart and vascular disease. In short, alcohol contributes to coronary artery disease by doing the following:
- It weakens the heart muscle.
- It narrows the blood vessels, increasing blood pressure and heart rate.
- It contributes to anxiety, depression, obesity and diabetes, which increase the risk of coronary artery disease.
- It negatively affects sleep quality, which increases blood pressure, makes weight loss difficult and increases stress.
- It worsens sleep apnea, which is linked to higher risk of heart and artery disease.
“Alcohol is a direct toxin to the heart muscle,” Tracy says. “So excessive alcohol will weaken the heart."
It can also increase your heart rate and blood pressure. Alcohol narrows the blood vessels, making it harder for the heart to pump blood.
Alcohol can contribute to depression and anxiety, obesity, diabetes and other conditions that worsen coronary artery disease.
And alcohol is bad for healthy sleep habits, which impacts heart health. Poor sleep can cause increased blood pressure, difficulty managing weight, increased stress and anxiety and increased risk of coronary artery disease.
“People think that alcohol helps them fall asleep,” Tracy says. “It may help initially to make them feel relaxed and doze off, but alcohol has definitely been found to reduce the quality of sleep and the number of minutes we spend in a nice deep sleep.”
It’s even worse if you have obstructive sleep apnea because alcohol relaxes the upper airway. Sleep apnea has been linked to heart and artery disease.
New studies have shown that there is technically no safe amount of alcohol to drink. This goes against previous studies that suggested that certain amounts of alcohol, especially red wine, can actually be beneficial to your health.
“It’s difficult because people like to have a glass of wine or a cocktail,” Tracy says. “But I think we have to get away from the notion that alcohol is preventive."
To sum up Tracy’s advice, follow the guidelines below:
- There is no “safe” amount of alcohol, but drinking in moderation is safer.
- An average-sized woman should stick to one 6- to 8-ounce beverage, and an average-sized man should have no more than two of those drinks.
- Red wine may be the least harmful drink choice. Hard alcohol is too high in sugars, and beer is too high in calories.
- Drinking at high altitudes, like on an airplane, increases blood pressure and heart rate, so it is best to avoid it.
While no amount of alcohol is entirely safe to drink, you can at least be safer by drinking responsibly. That means drinking in moderation.
“Typically that's one six- to eight-ounce beverage for an average-sized woman, and no more than two of those standard-sized drinks for a man,” Tracy says.
Your choice of alcohol also matters. Tracy advises that red wine may be less harmful than other options.
“Hard liquor is less beneficial,” she says. “There are a lot of sugars in hard liquor, and there really isn’t any benefit to beer because it's just so loaded with calories.”
And the choice of where you drink can also impact your health. For example, many people like to drink on airplanes because they have long trips where they aren’t driving. But drinking on an airplane is actually more harmful to your health.
“Because the concentration of oxygen in your blood falls in an airplane, alcohol absolutely affects it,” Tracy says. “It will further decline your oxygen saturation. It will raise your heart rate. It will raise your blood pressure. How you metabolize alcohol on an airplane is really important.”
Coronary artery disease and smoking
If there is no safe amount of drinking when it comes to coronary artery disease, it may come as no surprise that there is no safe amount of smoking either.
The following are some of Tracy’s warnings and tips when it comes to smoking:
- Smoking stiffens blood vessels and affects cholesterol.
- It increases heart rate and blood pressure.
- Cigarettes, cigars, vapes and nicotine gums can all contribute to coronary artery disease.
- It’s best to never smoke at all, but quitting will be beneficial to your heart and vascular health.
- Weight gain from quitting smoking is not as harmful as continuing to smoke. It can be managed with diet and exercise.
“Smoking affects the blood vessels, whether they’re the arteries of the heart or the vessels in the brain,” Tracy says. “The vessels become stiffer, less pliable. It affects our cholesterol levels. And the nicotine increases heart rate and blood pressure. So not even one cigarette is a safe amount.”
Any form of smoking, whether it’s cigarettes, cigars or vapes can worsen coronary artery disease and heart disease.
“Cigars are worse because there are no filters in cigars,” Tracy says. “And people think, 'I only smoke a cigar a week or month.’ But a cigar is worse than a cigarette.”
Many people, especially teens and young people, have come to think of vapes as a safer alternative to cigars and cigarettes. But they have problems too.
“There can be various levels of nicotine. Some can be very, very high,” Tracy says. “But it's also the heat and the content of the oils that are driving the nicotine into your circulation. So you're still getting the negative effect of the nicotine on the vessels, blood pressure and pulse."
Another option that may at first seem less dangerous is nicotine gums, like Nicorette. But one of the problems Tracy sees with patients who transition to gum and cut back on smoking is that they often make up for having less cigarettes by chewing way too much nicotine gum. Then they end up getting a double hit of nicotine from both smoking and gum.
All of this may be discouraging if you’re a smoker, and some patients feel that there is no point to quitting because their health is already poor.
While it is best for your health to never start smoking at all, you can still improve your heart and vascular health by quitting.
“Depending on how long you've smoked, within about five to 10 years, your body is recirculating and rejuvenating,” Tracy says. “So it does take a while for the body to repair itself because it's taken a while for you to have all that damage to your lungs and arteries."
Some people worry that quitting smoking will lead to weight gain, which can also be harmful to heart and vascular health. But weight gain is manageable, and it’s not as harmful as smoking.
"Is smoking worse than you gaining that 10 to 15 pounds? Yes,” Tracy says. “Nobody wants to gain those pounds. But it's healthier to stop smoking, and then we can work on weight loss. We can incorporate a healthier diet and exercise to get rid of the weight.”
Lowering your blood pressure to prevent coronary artery disease
High blood pressure, or hypertension, can lead to coronary artery disease because it can damage blood vessels, including the arteries that supply the heart with blood. Lowering blood pressure can reduce the risk of coronary artery disease.
But it’s also important to choose safe methods of lowering blood pressure, and there are several ways to do so. You should discuss these with your cardiologist.
Tracy recommends having a blood pressure cuff at home so you can monitor yourself.
“I have patients monitor their blood pressure at home and send me those readings because I only see them for a few minutes in an office every few months," she says. “What's happening at home? What's happening at their office?”
Once they have more data on your blood pressure, your cardiologist can form a care plan that works for you.
Women who’ve had post gestational hypertension — preeclampsia or eclampsia — during pregnancy or postpartum have an increased risk for the development of cardiovascular disease as they get older, including coronary artery disease. If you've had this condition, it’s important to discuss it with your health care provider, especially if you intend to be pregnant again.
Care plans for patients with high blood pressure can include lifestyle modifications like diet and exercise, or they can pair healthy lifestyle with medications.
Many of these medications are called antihypertensives, which means they lower blood pressure. And if one doesn’t work for you, there are many different types available.
When discussing these options with your cardiologist, you should also tell them about your needs and ask about the potential side effects of the medication.
“For instance, if you're a ride share driver, truck driver or schoolteacher, being on a diuretic, which is a great first line drug for treating high blood pressure, may not be conducive for your employment because you need to run to the bathroom,” Tracy says.
If a medication’s effects won’t work for you, ask your cardiologist about other options. But no matter which option you and your cardiologist choose, you will need to couple it with diet and exercise.
Some other medication options used to treat high blood pressure include the following:
Other medications for coronary artery disease prevention
When looking for medications to prevent coronary artery disease, it’s often important to treat the health issues that cause or contribute to the condition. These can include the following:
- High cholesterol
- Diabetes
- Obesity
- Sleep apnea
- Anxiety
- Depression
There are several medications and therapies available that can help treat each of these issues. You should discuss these with your cardiologist.
For high cholesterol, statins are the most common medications, and most people tolerate them well. Not only do they help lower cholesterol, but they also have an anti-inflammatory effect. That’s especially beneficial for patients who’ve already had a heart attack.
There are also antiplatelet agents, which make platelets less “sticky” and prevent clots.
Aspirin is one of the most common. But while aspirin has often been recommended in the past as a blood thinner, new studies show that it’s best to weigh the risks and benefits first. It has a risk of causing bleeding and gastrointestinal problems.
“We limit aspirin now to patients who have high risk factor profiles or, more likely, those who have documented cardiovascular or cerebrovascular disease or who have had heart attacks or strokes,” Tracy says. “So aspirin is beneficial, but only in this select group.”
Before you buy over-the-counter aspirin to prevent coronary artery disease, make sure you talk to your cardiologist about the risks.
For patients who’ve already had more extensive issues and needed a stent placed, there are other types of antiplatelet agents, called P2Y12 inhibitors. They work a bit differently than aspirin. They help keep the stent open and prevent platelet stickiness in the coronaries.
Diabetes affects all arteries in the body, so it’s important to keep your blood sugar under control. If you’re in the prediabetic range, you may control blood sugar through diet, exercise and weight loss. But if you have diabetes, you may need insulin injections or medications that help your body produce more insulin.
Another possible option for diabetes treatment is a glucagon-like peptide-1 (GLP-1) receptor agonist. These include medications like semaglutide, known by the brand name Ozempic.
“These drugs were first brought to the surface for diabetes, but now we're seeing an improvement in major adverse cardiovascular events with them and chronic kidney disease,” Tracy says. “They’re not for everybody, and insurance companies don't always cover the cost, but they're showing huge promise for reducing the risk of major adverse cardiovascular events, even in patients who don't have diabetes.”
Obesity contributes to coronary artery disease. These medications may help with weight loss and management, further reducing the risks.
Anxiety and depression can cause high blood pressure and worsen coronary artery disease. That’s one reason it’s so important to take care of your mental health.
Meditation, mindfulness, yoga, diet and exercise can all improve mental health, as can therapy. But some patients with these conditions can also benefit from an antidepressant or antianxiety medication.
“Mental health is something that we have to address, and we have to get rid of that taboo of being on an antidepressant or an antianxiety medication or seeing a therapist or instilling more of that mindfulness through yoga or meditation,” Tracy says. “Stress management is huge.”
Sleep apnea is another condition that can cause stress, elevate blood pressure and increase heart rate. Most patients with obstructive sleep apnea are prescribed machines or devices, like CPAP or BiPAP, that help them breathe during sleep.
“Lack of sleep drives up heart rate, blood pressure and stress,” Tracy says. “Your blood pressure is going to be more difficult to control."
Tests for your heart and vascular health
If you’re concerned about coronary artery disease, especially if you have a family history of the condition, you may be wondering how you can get tested for it.
Some of tests your cardiologist might use to diagnose coronary artery disease include the following:
- Electrocardiogram (EKG)
- Blood pressure test
- Blood test for cholesterol
- Echocardiogram
- Stress test
- Coronary calcium test
- Coronary CT
- PET scan
- Heart catheterization
There are several noninvasive tests your cardiologist can perform that will give them a good indication of your cardiovascular health.
An electrocardiogram, or EKG, is one of the most common. It measures the electrical activity of your heart and can show evidence of whether you’ve had a heart attack.
The EKG doesn’t rely on any needles. You’ll just have a few stickers on your chest, and the test is done right in your physician’s office.
Your cardiologist can also easily check your blood pressure and do a blood test to measure your cholesterol.
"If I have a patient who has no symptoms and exercises regularly, I do an annual EKG and see them in the office," Tracy says. “I check their cholesterol and blood pressure.”
An echocardiogram is a test that uses ultrasound to check the size and function of the heart chambers and valves. It can tell your cardiologist if there are any problems with the structure of your heart.
Your cardiologist may also perform a stress test. This measures how your heart and blood vessels function while you’re exercising. It lets them know about your endurance, how your heart rate and blood pressure increase with activity and how quickly you recover.
Another test you can take is the coronary calcium test. This isn’t an annual test, but it can let you know whether plaque has built up in your arteries.
During the test, you’ll lie down in a scanner for a bit and then get a coronary calcium score. Ideally, you’ll have no plaque in your arteries, and your score will be zero. But the lower your score, the better.
A higher number means a higher risk of a cardiovascular event, like a heart attack or stroke. If your number is high, your cardiologist can form a preventative care plan with the information they gather.
Coronary CT and PET scans are other tests that can create 3D reconstructions of your coronaries and measure blood flow.
And if any of your tests come back abnormal, your cardiologist can call for a slightly more invasive test called a heart catheterization. This involves placing an IV in the artery of the groin, then running a catheter up to the heart to find any problems.
All of these tests will help check if your heart and arteries are healthy, diagnose any issues and allow your cardiologist to form a care plan to address your needs.
Can coronary artery disease be reversed?
Coronary artery disease can’t be reversed, but it can be slowed or stopped, and your overall health and quality of life can improve.
“Once plaque has already calcified in the coronaries, it's there,” Tracy says. “It can't go away, but it can be stabilized, so it's not all said and done.”
It’s very important to not get discouraged or avoid seeking care because you can’t reverse coronary artery disease.
Even if you've had a heart attack or need a stent, there are care options, called secondary prevention, that can improve your health and have you functioning better than when you begin treatment.
“One of the things we really urge patients to do is cardiac rehabilitation,” Tracy says. “It's an outpatient program with in-person, virtual and hybrid options that helps patients start exercising, eat better and understand what their medications are. We can absolutely get them back to where they were if not better.”
It’s also important to seek treatment even if you haven’t been taking care of yourself as well as you could have. Even marathon runners can have coronary artery disease and heart problems.
“I've had patients who are soccer players, tennis players, powerlifters or marathon runners who have had a cardiovascular event and feel like their life is over,” Tracy says. “Nope. We just have to instill secondary prevention and cardiac rehabilitation.”
You can learn more about the signs and symptoms of coronary artery disease on our Coronary Artery Disease page. If you’d like to make an appointment with a cardiologist, you can also learn more on our Cardiology Services page or call Rush at (888) 352-7874.
