Coronary Artery Disease and Acute Coronary Syndromes
Coronary artery disease (CAD) is the narrowing or obstruction of the coronary arteries, most often by atherosclerosis, that limits blood supply to the heart muscle. It spans a continuum from silent plaque accumulation through stable, effort-related angina to the acute coronary syndromes that follow sudden plaque disruption and thrombosis, and it remains one of the leading causes of death worldwide.
Definition
Coronary artery disease is the impairment of myocardial blood flow caused by atherosclerotic (and occasionally non-atherosclerotic) disease of the coronary arteries, presenting clinically as chronic (stable) or acute coronary syndromes depending on whether flow limitation is fixed and demand-related or abrupt and thrombotic.
Scope
This area orients the reader to the spectrum of ischemic heart disease: the formation and progression of atherosclerotic plaque, the chronic stable presentation, the acute coronary syndromes (ST-elevation and non-ST-elevation myocardial infarction and unstable angina), and the cardiovascular risk factors that drive the disease and frame its prevention. It is a reference overview that connects these topics rather than a detailed treatment of any single one.
Sub-topics
Key concepts
- Atherosclerosis as the dominant cause of CAD
- Supply-demand mismatch and myocardial ischemia
- Stable (chronic) versus acute coronary syndromes
- Plaque rupture or erosion and coronary thrombosis
- ST-elevation and non-ST-elevation myocardial infarction
- Modifiable and non-modifiable risk factors
- Primary and secondary prevention
Mechanisms
CAD develops when lipid retention, endothelial dysfunction, and chronic arterial inflammation produce atherosclerotic plaques that narrow the coronary lumen. A stable, flow-limiting plaque causes ischemia mainly when oxygen demand rises, producing exertional angina. The acute coronary syndromes arise when a plaque ruptures or erodes and exposes thrombogenic material, triggering thrombus formation that abruptly reduces or interrupts flow; the resulting ischemia, if sustained, causes myocardial necrosis (infarction). The pathophysiology thus links a chronic inflammatory process to discrete acute events.
Clinical relevance
CAD is a central topic in internal medicine and cardiology because it underlies angina, myocardial infarction, heart failure, and sudden cardiac death. This overview describes how the disease is conceptualised and classified and how its acute and chronic forms relate; it is educational and does not provide diagnostic thresholds or individualised treatment guidance.
Epidemiology
Ischemic heart disease is among the most common causes of death globally, with burden shaped by population ageing and the prevalence of modifiable risk factors such as smoking, hypertension, dyslipidaemia, and diabetes. Large international studies have shown that a small set of modifiable factors accounts for the majority of population-attributable risk for myocardial infarction.
Evidence & guidelines
Contemporary classification rests on the Fourth Universal Definition of Myocardial Infarction and on professional-society guidelines that separate chronic coronary syndromes from acute coronary syndromes. These documents define the disease entities and diagnostic frameworks referenced throughout this area; they are cited here for orientation rather than as actionable recommendations.
History
Understanding of CAD shifted over the twentieth century from a view of progressive mechanical narrowing to a model centred on atherosclerosis as an inflammatory, lipid-driven process punctuated by acute thrombotic events. The recognition that most myocardial infarctions follow plaque disruption rather than simple critical stenosis reframed both research and clinical classification, leading to the modern distinction between chronic and acute coronary syndromes.
Key figures
- Peter Libby
- Goran K. Hansson
- Russell Ross
- Kristian Thygesen
Related topics
Seminal works
- libby-2005
- hansson-2005
- thygesen-2018
Frequently asked questions
- What is the difference between coronary artery disease and an acute coronary syndrome?
- Coronary artery disease is the underlying chronic atherosclerotic disease of the coronary arteries, whereas an acute coronary syndrome is an acute event — unstable angina or myocardial infarction — that usually occurs when a plaque disrupts and a thrombus suddenly limits coronary flow.
- Is coronary artery disease the same as atherosclerosis?
- Atherosclerosis is the dominant cause of coronary artery disease but is a broader process that can affect arteries throughout the body; coronary artery disease specifically refers to atherosclerotic (or other) disease affecting the coronary arteries that supply the heart.