Coronary artery disease (CAD) is the most common form of heart disease. In coronary artery disease, fatty deposits known as plaques collect on the inner wall of the blood vessels. Over time, the plaques thicken and arteries narrow (atherosclerosis) making it harder for the heart to pump blood throughout your body. Left untreated, atherosclerosis can lead to a heart attack. Diet, stress, activity level, and family history all play a role in developing CAD.

Coronary artery disease begins quietly during childhood, starting as early as age 3. Although a number of factors contribute to the development of coronary artery disease, lifestyle choices top the list. "All human beings start with normal, pristine arteries, like pipes in a newly built house,” explains Jonathan Halperin, MD PhD, Professor of Cardiology and Director of Clinical Cardiology Services. “But gradually, over time, we pollute them."

Risk Factors for Coronary Artery Disease

Common risk factors for coronary artery disease include:

• Smoking
• Physical inactivity
• Obesity
• High blood pressure (hypertension)
• High blood cholesterol
• Diabetes

Age, gender, and ethnicity can contribute to your risk for developing coronary artery disease. The vast majority of people who develop coronary artery disease are seniors. Men are at greater risk for developing coronary artery disease, and develop it earlier than women.

Ethnicity weighs heavily in your likelihood of developing coronary artery disease. African Americans are at higher risk for early death and have higher mortality rates from cardiovascular problems in general. African-American women with coronary artery disease are more likely to have a heart attack than Caucasian women.

Heart disease also runs in families. If a family member develops coronary artery disease before age 50, relatives should enroll in a heart disease screening program to receive lifestyle counseling and preventive care.

Mount Sinai Heart understands that each individual requires a personalized approach that is tailored to address specific cultural, lifestyle, and genetic differences. "For instance, the Hispanic population living in the United States has a high prevalence of diabetes, metabolic syndrome, and hypertension, which may require a different approach to treatment and prevention," says Mario Garcia, MD, Professor of Cardiology and Director of Non-Invasive Cardiology.

Signs and Symptoms

In popular media, a heart attack victim clutches his or her chest and falls to the ground. However, symptoms of coronary artery disease are often far less obvious, ranging from mild discomfort to extreme pressure or pain. If one or more of signs or symptoms is present, call a doctor or seek emergency care immediately. Signs and symptoms of a heart attack include:

• Pressure, tightness, and a squeezing pain in your chest
• Shortness of breath
• Pain radiating down your arm, shoulders, jaw, neck, and back, particularly on the left side
• Dizziness, sweating, weakness
• Anxiety, feeling of impending doom
• Indigestion or nausea and vomiting

Bruce Darrow, MD, PhD, Assistant Professor of Cardiology, notes how widely symptoms for heart attack can vary and advises patients to heed the messages their bodies send them.

"Patients will come in with the sense that something just isn't right," says Dr. Darrow. "That is a symptom that I have learned to take very seriously."

Different Symptoms for Women

Women will often experience the same type of pressure or pain in the chest that men do. But they have a greater chance of experiencing less obvious symptoms:

• Excessive fatigue
• Pressure in the chest or middle of the back
• Cold sweats

"It's important for women to understand that heart disease is also a woman's disease," says Mary Ann McLaughlin, MD, Associate Professor of Cardiology and Director of the Women's Cardiac Assessment and Risk Evaluation (CARE) Program. "The warning signs of heart attack in women can differ from the classic ones, and Mount Sinai cardiologists are well versed and very knowledgeable about the specific risks for women."

As part of her mission to help women take heart disease seriously, Dr. McLaughlin gives talks at middle schools and nursing homes, country clubs and churches. She participates in health fairs, where she and her colleagues check blood pressure, measure body mass index, and offer cooking demonstrations. Dr. McLaughlin has been a regular on television shows such as "Martha" and is widely quoted in newspapers and magazines.

If you feel you or anyone you know is at risk for heart disease, or you want to learn more about prevention, please call Mount Sinai Heart for a consultation at 1-800-MD-SINAI (1-800-637-4624). Your consultation will include a comprehensive lifestyle evaluation and a customized prevention plan.