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Coronary artery disease

Morbus ischaemicus cordis · Ischemická choroba srdeční

What it is

Cholesterol plaque narrows the heart's own arteries. The world's biggest killer.

Symptoms & signs

  • Chest tightness on exertion
  • breathlessness
  • jaw or arm ache
  • fatigue
  • often silent until the first attack

🚩 Get help if…

  • call 112 / 911 now Chest pain at rest or lasting over 15 minutes
  • call 112 / 911 now Chest pain with sweating, sickness or breathlessness
  • see a doctor soon Chest pain that comes on sooner or more often than before
  • see a doctor soon New chest tightness on exertion that eases with rest

Where it strikes

Medical treatment

  • Statin after a heart attack — about 1 event prevented in 25 over five years trials support
  • Aspirin after a heart attack trials support
  • Beta blocker — clear after a heart attack, unclear years later mixed evidence
  • ACE inhibitor trials support
  • Angioplasty for stable angina — no lives saved in ISCHEMIA; against a sham procedure no gain in exercise time in ORBITA, some angina relief in ORBITA-2 mixed evidence
  • Bypass surgery in left-main or three-vessel disease trials support
  • PCSK9 antibodies (evolocumab, alirocumab) — about 1.5 fewer events per 100 over two years (FOURIER); inclisiran (Leqvio) is approved to lower LDL trials support
  • Low-dose colchicine (Lodoco) — FDA-approved 2023 to cut heart events; the CLEAR SYNERGY trial after a heart attack found no benefit mixed evidence
  • Bempedoic acid — approved; fewer heart events in people who cannot take statins (CLEAR Outcomes)

Natural & lifestyle

  • Mediterranean diet
  • 150 min/week aerobic exercise
  • stop smoking
  • weight loss
  • stress reduction
  • sleep apnoea treatment

Emerging & experimental

  • CRISPR PCSK9 base editing (VERVE-102)

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • Chelation therapy (EDTA infusions) — the TACT trial found fewer cardiac events, mostly in diabetics; TACT2 did not confirm it mixed evidence
  • Coenzyme Q10 with statins — eases muscle aches in some trials, not in others mixed evidence
  • Aged garlic extract and nattokinase — small studies show slower plaque growth or thinner blood; watch bleeding with anticoagulants early / small studies
  • Omega-3 at high dose (icosapent ethyl, REDUCE-IT) — fewer events, though its mineral-oil placebo may have widened the gap, and more atrial fibrillation; ordinary fish-oil capsules did not repeat it mixed evidence
  • Esselstyn and Ornish plant-based programmes — dramatic individual reversals reported; Ornish's small trial showed regression, larger trials lacking anecdotal / traditional

ICD codes