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Health condition · Clinically reviewed

Coronary artery disease, from angina to a heart team plan.

The UK’s leading cause of death, and one of the most treatable. Modern pathways start with CCTA, aggressive risk factor control and a heart team where revascularisation is needed.

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A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE NG185, ESC 2019 chronic coronary syndrome and JBS3 risk guidance.

  • 03

    Current for 2026

    Reflects modern UK cardiology practice including CCTA-first pathways, high-intensity statins, PCSK9 inhibitors and heart team decisions.

Key facts

Coronary artery disease at a glance.

The essentials, in plain English. What it is, how it presents, how it is diagnosed and how modern UK cardiology treats it.

  • What it is

    Atherosclerotic narrowing of the coronary arteries. Reduced myocardial perfusion causes angina, heart attack, heart failure, arrhythmia and sudden cardiac death.

  • Also called

    Ischaemic heart disease (IHD) or coronary heart disease (CHD). The spectrum runs from stable angina to acute coronary syndrome (unstable angina, NSTEMI, STEMI).

  • How common

    The single leading cause of death in the UK. Presentation is often silent until the first heart attack.

  • Who is at risk

    Smokers, people with hypertension, high LDL cholesterol or Lp(a), diabetes, obesity, family history, and South Asian heritage carry higher risk.

  • First-line imaging

    NICE NG185 recommends CT coronary angiography (CCTA) as the first test for stable chest pain of suspected cardiac origin.

  • Treatment mix

    Aggressive risk factor control, high-intensity statin, antiplatelet therapy, anti-anginals and, where indicated, PCI or CABG chosen by a heart team.

Why this guide matters

A modern pathway, not a wait-and-see.

UK guidance has shifted decisively toward earlier imaging, tighter LDL targets and heart team decisions. The three points below shape the rest of this page.

  • CCTA is the first test

    NICE NG185 puts CT coronary angiography first for stable chest pain of suspected cardiac origin. It rules out obstructive disease quickly and safely.

  • Risk factors do the heavy lifting

    Blood pressure, LDL cholesterol, smoking, glucose and weight change outcomes more than any single procedure. They are the treatment.

  • A heart team chooses PCI or CABG

    For complex disease, cardiology and cardiothoracic surgery decide together. Choosing well matters as much as the operation itself.

How the diagnosis is made

From first chest pain to a clear plan.

The steps a UK GP, chest pain clinic or cardiologist will normally follow, in the order NICE NG185 and ESC guidelines recommend.

  1. 01

    Assessing

    History and risk profile

    Character of the chest pain, exertional triggers, radiation and relief, plus a full cardiovascular risk history including smoking, family history and medications.

  2. 02

    Assessing

    Examination

    Blood pressure in both arms, cardiac auscultation, peripheral pulses, screen for abdominal aortic aneurysm and fundoscopy where relevant.

  3. 03

    Assessing

    12-lead ECG

    Resting ECG, and during pain if possible. Looks for ischaemic ST changes, prior infarct, arrhythmia and conduction disease.

  4. 04

    Confirming

    Blood tests

    Full lipid profile, HbA1c, U&Es, thyroid function and full blood count. High-sensitivity troponin is used when acute coronary syndrome is suspected.

  5. 05

    Confirming

    CT coronary angiography (CCTA)

    NICE NG185 first-line imaging for stable chest pain. CAD-RADS scoring, with calcium score as adjunct, rules out obstructive disease with high sensitivity.

  6. 06

    Confirming

    Functional and invasive testing

    Stress echo, stress cardiac MRI or SPECT for functional ischaemia. Invasive angiography with FFR or iFR (and IVUS or OCT) confirms and guides revascularisation.

  7. 07

    Planning

    Risk assessment and MDT

    QRISK3, JBS3 or SCORE2 for global risk. Complex disease is discussed by a heart team of cardiology and cardiothoracic surgery before revascularisation.

Typical timeline: from first visit to a settled plan in a few weeks in most stable patients.

Symptoms

What coronary artery disease looks like.

The classic mix of stable angina and acute coronary syndrome, plus the atypical presentations that are easy to miss.

  • Stable angina

    Central chest pressure or tightness brought on by exertion, sometimes radiating to jaw or arm, relieved by rest or sublingual GTN.

  • Acute coronary syndrome

    Sudden, prolonged chest pain often with sweating, nausea or breathlessness. Covers unstable angina, NSTEMI and STEMI.

  • Atypical presentation

    Women, older adults and people with diabetes may present with nausea, breathlessness, fatigue, jaw or arm pain rather than classic chest pain.

  • Silent ischaemia

    Some people have no symptoms and disease is picked up incidentally on ECG, calcium score or CCTA.

  • Heart failure

    Chronic ischaemia can weaken the heart muscle, producing ischaemic cardiomyopathy with breathlessness, oedema and fatigue.

  • Arrhythmia

    Atrial fibrillation and ventricular arrhythmias are common, and can be the first sign of underlying coronary disease.

  • Mechanical complications

    Post-infarct papillary muscle rupture, ventricular septal defect or free wall rupture are rare but life-threatening.

  • Red flag - sudden cardiac death

    A first presentation may be cardiac arrest. Any sudden collapse or resuscitated arrest needs urgent cardiology work-up.

Treatment

How coronary artery disease is treated in the UK.

Aggressive risk factor control, guideline-directed medication, and PCI or CABG for the right patients, chosen by a heart team.

  • Lifestyle and risk factor control

    Smoking cessation, a Mediterranean or DASH-style diet, 150 minutes of activity a week, weight management, alcohol moderation and sleep. The single biggest lever in most patients.

  • Antiplatelet therapy

    Low-dose aspirin for lifelong secondary prevention. Dual antiplatelet (aspirin plus a P2Y12 inhibitor) after ACS or stenting for a defined period.

  • High-intensity statin

    Atorvastatin 80 mg or rosuvastatin, targeting LDL below 1.4 mmol/L in high-risk patients. Ezetimibe, PCSK9 inhibitors, inclisiran or bempedoic acid are added where needed.

  • Blood pressure and diabetes

    ACE inhibitor or ARB, beta-blocker, calcium channel blocker or indapamide as needed. SGLT2 inhibitors and GLP-1 agonists give clear cardiovascular benefit in diabetes.

  • Anti-anginal therapy

    Beta-blocker or non-dihydropyridine calcium channel blocker first line. Long-acting nitrate, ranolazine, ivabradine or nicorandil are added for persistent angina.

  • PCI (coronary angioplasty)

    Percutaneous coronary intervention with a drug-eluting stent for symptomatic, complex or acute disease, often FFR-guided. See our guide to coronary angioplasty.

  • CABG (coronary artery bypass)

    Bypass grafting for left main disease, three-vessel disease, diabetes with multi-vessel involvement or reduced left ventricular function. A heart team decides.

  • Cardiac rehabilitation

    Structured, supervised rehabilitation after ACS or revascularisation improves outcomes and quality of life. Every eligible patient should be offered a place.

Related pathways

Where you can read more in detail.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and European society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or cardiologist knows your history and can tell you which parts apply to you. If in doubt, get seen. If you think you are having a heart attack, call 999.

  • NICE. Chest pain of recent onset: assessment and diagnosis (NG185).

  • NICE. Acute coronary syndromes (NG185 series and NG196).

  • European Society of Cardiology. 2019 Guidelines on chronic coronary syndromes.

  • JBS3. Joint British Societies’ consensus recommendations for cardiovascular disease prevention.

  • British Heart Foundation. Patient information on coronary heart disease.

Red flags

When coronary artery disease needs urgent attention.

Most stable coronary disease is managed in the community. These are the situations that are not stable, and where hospital assessment cannot wait.

  • Suspected heart attack

    New severe chest pain lasting more than 15 minutes, especially with sweating, breathlessness or collapse. Call 999 immediately.

  • Unstable or crescendo angina

    Angina at rest, new-onset severe angina, or a clear step-up in frequency or intensity. Needs same-day hospital assessment.

  • Syncope on exertion

    Fainting or near-fainting during exercise can signal severe coronary or valve disease and needs urgent cardiology review.

  • Resuscitated cardiac arrest

    Any survivor of cardiac arrest needs urgent coronary assessment and, in many cases, an implantable defibrillator.

  • Post-MI mechanical complications

    Sudden deterioration after a heart attack (new murmur, shock, pulmonary oedema) suggests VSD, papillary muscle rupture or free wall rupture.

  • Ventricular arrhythmia

    Sustained ventricular tachycardia or ventricular fibrillation is an emergency and often reflects underlying ischaemic scar.

  • Severe heart failure

    Rapidly worsening breathlessness, orthopnoea and oedema in a patient with known CAD needs urgent review for ischaemic cardiomyopathy.

  • Uncontrolled risk factors

    Very high LDL, uncontrolled blood pressure or newly diagnosed diabetes with symptoms should trigger early cardiology input.

  • Family history of premature CAD

    A first-degree relative with heart attack before 55 (men) or 65 (women) raises the threshold for imaging and lipid work-up, including Lp(a).

Living with it

A treatable condition, with a clear ladder.

Four things that make the biggest difference day to day. Aggressive risk factor control, consistent medication, structured rehab and knowing your warning signs.

A quiet reminder

Consistency beats intensity, every time.

Small, steady habits kept up for years do more for your heart than any short burst of effort.

  1. 01 Prevention

    Treat the risk factors, hard

    Blood pressure, LDL cholesterol, smoking, weight and glucose are the levers that change your long-term risk more than anything else.

  2. 02 Medicines

    Take them, every day

    Aspirin, statin and blood pressure tablets only work if taken consistently. Missing doses is the most common reason plans fail.

  3. 03 Movement

    Cardiac rehab, then keep going

    Supervised rehab after an event or procedure is one of the best-evidenced treatments in cardiology. Aim to keep the habit for life.

  4. 04 Escalate

    Know your warning signs

    New or worsening chest pain, breathlessness at rest or fainting are reasons to seek help fast. Do not wait it out.

Frequently asked

Everything we get asked about coronary artery disease.

Quick answers on diagnosis, medication, stents and bypass.

  • What is coronary artery disease?

    Coronary artery disease (CAD), also called ischaemic heart disease, is a build-up of atherosclerotic plaque in the arteries that supply the heart muscle. Narrowed arteries reduce blood flow and can cause angina, heart attack, heart failure, arrhythmia and sudden cardiac death.

  • What is the difference between stable angina and a heart attack?

    Stable angina is predictable chest pressure on exertion that eases with rest or GTN. A heart attack (part of acute coronary syndrome) is caused by a sudden plaque rupture and clot, with prolonged pain often at rest, and needs emergency care.

  • What test do I need if I have new chest pain?

    NICE NG185 recommends CT coronary angiography (CCTA) as the first-line test for stable chest pain of suspected cardiac origin. A resting ECG and blood tests are done at the same visit, with functional imaging or invasive angiography if needed.

  • Do I really need a statin if my cholesterol is not very high?

    For most people with known CAD, yes. High-intensity statins reduce heart attack and stroke risk regardless of the starting LDL, and most guidelines target LDL below 1.4 mmol/L for high-risk patients, using ezetimibe, PCSK9 inhibitors or inclisiran where needed.

  • How do doctors decide between stents and bypass surgery?

    A heart team (interventional cardiology and cardiothoracic surgery) weighs the pattern of disease, left ventricular function, diabetes and SYNTAX score. Left main and complex three-vessel disease, especially with diabetes, often favours CABG. Focal disease often favours PCI.

  • Can coronary artery disease be reversed?

    Aggressive treatment of the risk factors, particularly LDL cholesterol, blood pressure and smoking, can stabilise and modestly regress plaque, and dramatically lowers the risk of future events. It cannot always “clear” the arteries, but it changes the trajectory.

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