coronary artery disease (CAD). While genetic predisposition does play a role, recent
research indicates that lifestyle and environmental factors play an even greater role.

Atherosclerosis, the main cause of CAD, can make the coronary blood vessels (those that
supply the heart muscle) stiffen and more prone to forming blood clots. High levels of
LDL cholesterol, often referred to as "bad" cholesterol, increase the risk of CAD. 

Illustration by Verywell

Common Causes
CAD develops as a slow process in which the arteries that supply blood to the heart
muscle become narrow, stiff, and diseased on the inside.

An accumulation of cholesterol, inflammation, and calcium in these diseased arteries

forms plaques, which can protrude into the channel of the artery. Accumulation of
plaques makes the arteries more likely to form blood clots, which can interrupt blood
flow to the heart muscle.

There are several known causes of CAD.

 Atherosclerosis: A disease of the arteries throughout the

body, atherosclerosis develops over time. Atherosclerosis causes the smooth,
elastic lining of the arteries to become hardened, stiffened, and swollen. It is
characterized by a build-up of plaque inside the arteries. Atherosclerosis is the
leading cause of CAD. 
 Hypertension: Chronically high blood pressure can contribute to or cause CAD.
Over time, excessive pressure on the arteries may interfere with the normal
structure of the arteries, as well as their ability to dilate (widen) and constrict
(narrow) as they should. 
 High cholesterol: Elevated cholesterol has long been known to contribute to
CAD. Excess cholesterol and fat in the blood can damage the inner lining of the
arteries. There has been controversy over whether having a high blood cholesterol
level is caused by diet, genetics, or inherent metabolism. Certainly, for some
people, a change in diet can lower cholesterol levels; for others, a change in diet
has no impact. High cholesterol levels are likely caused by a combination of
factors that are different for everyone.
 Diabetes: Type I and type II diabetes both increase the chances of developing
CAD, and there is a higher chance of CAD if your blood sugar is not well
controlled.1 
 Obesity: If you weigh more than is considered healthy, you are at an increased
risk of developing CAD. This may have to do with lipid (fat molecule)
metabolism or hypertension that results from obesity, although obesity itself is
associated with an elevated risk of CAD, even when blood pressure and
cholesterol levels are normal.
  Inflammation: Inflammation causes damage to the inner lining of the blood
vessels of the heart. There are a number of causes of inflammation, including
stress, a high-fat diet, dietary preservatives, infection, and illnesses, and they are
all believed to contribute to CAD. C-reactive protein (CRP) and fibrinogen, two
inflammatory proteins that are associated with an increased risk of CAD, can be
measured to assess for inflammation, but the implications of the results are not
definitive.
 CRP is a protein released into the bloodstream any time there is active
inflammation in the body. The fact that elevated CRP levels are associated with
an increased risk of heart attack supports the proposed relationship between
inflammation and atherosclerosis.
 Fibrinogen is a blood-clotting factor. Most acute myocardial infarctions (heart
attacks) are now known to be due to acute thrombosis, the sudden formation of a
blood clot at the site of an atherosclerotic plaque. 

 Typically, CAD is caused by atherosclerosis, which can result in the narrowing of

arteries.

Genetics
There appears to be a genetic component to CAD, and people who have a genetic risk of
developing the illness may need to take chronic medication to reduce their risk of heart
attack and other complications of CAD. Some of the genetic defects associated with CAD
cause alterations of cholesterol metabolism or vascular disease; some make a person
more prone to inflammation; and some cause CAD without a well-understood
mechanism. 

A study from Canada identified 182 genetic variants associated with CAD.2 The
researchers described this as further evidence that CAD is polygenic, which means there
are many genes that can cause the disease. In general, genes that are associated with a
polygenic disease can be inherited together but may be inherited in a variety of
combinations. The genetic abnormalities studied were particularly common in young
people, which is defined as younger than age 40 for men and younger than age 45 for
women.
In general, genetic causes of CAD are more prevalent in young people with CAD, who
are less likely than older individuals to have had long-term illnesses or lifestyle factors
that contribute to CAD over time.
Genetic alterations that result in certain identifiable problems have also been discovered.
One study, for example, found that the LDLR rs688 TT genotype is associated with
increased susceptibility to CAD in patients, and LDLR  rs688 can be used as a
predisposing genetic marker for CAD, though the researchers said further studies were
needed to confirm their findings.3

Genetic susceptibility to CAD may be inherited, and some of the genetic mutations may
arise even without an identifiable hereditary cause. In other words, a person can develop
a mutation even if it did not come from their parents. 
Lifestyle
6 Lifestyle Changes That Can Help Coronary Artery Disease

There are a number of lifestyle factors that increase the risk of developing CAD. These
choices and habits surely look familiar, as they are implicated in myriad health concerns.
Though changing them may take great effort, it's effort well-placed.

 Smoking: One of the leading causes of atherosclerosis and CAD, smoking

exposes your body to a variety of toxins that damage the internal lining of the
blood vessels, making them prone to forming atherosclerotic plaques and blood
clots.4 
 Diet: An unhealthy diet can contribute to CAD due to high cholesterol, high-fat
content, and exposure to preservatives that are not beneficial for the body. A
healthy diet is rich in fresh fruits and vegetables, as well as the healthy fats found
in nuts, legumes, lean meat, and fish. This type of diet contains vitamins,
minerals, and antioxidants, which can help reduce unhealthy fats and harmful
atherosclerosis-producing substances in the body. 
 Sedentary lifestyle: Exercise produces hormones and chemicals that increase the
level of healthy fats in the body that are known to reduce the damage that
contributes to atherosclerosis; without exercise, you miss out on this important
benefit. In addition, a sedentary lifestyle contributes to obesity, which increases
the risk of developing CAD. 
 Stress: Stress produces a number of hormones that can increase burden on the
heart, as well as cause damage to the blood vessels. Unlike some of the other
lifestyle risk factors, it is unclear how much of a role stress plays in CAD, but
experimental models suggest there is a connection.