India leads the world in coronary artery disease (CAD) cases, with common symptoms like chest pain, breathlessness, and palpitations. Chest pain often signals significant arterial blockage. Timely treatment—especially within 3 hours—via primary angioplasty can save heart muscle and prevent lasting damage. Lifelong medication (statins and blood thinners), along with proper diet, exercise, and lifestyle changes, is crucial. Prevention strategies focus on at-risk individuals and emphasize balanced lifestyle, with minimal side effects from medications like statins.

Shahid Akhter, Editor, Healthyouonline, spoke to Dr. Jaideep C. Menon, Head of the Department of Cardiology at Sree Narayana Institute of Medical Sciences (SNIMS), Kerala, to understand the signs, management, treatment, and prevention strategies of Coronary Artery Disease (CAD) in the Indian context.

Jaideep C.Menon

Coronary Artery Disease (CAD)

India is at the epicenter of coronary artery disease. We are the global capital of coronary artery disease. We have more coronary artery disease than any other country on earth. 

Coronary Artery Disease (CAD): Sign & Symptoms

The most common symptoms of cardiac disease that we face in day-to-day practice are dyspnea on exertion, palpitations, and chest pain. Disney on exertion is the breathlessness that one develops with activity. 

The activity may be of various levels. Some have it with mild activity. In some it comes down only with strenuous activity. By palpitation, I mean the irregularity of the heart rate or the sense that one's heart is beating, which is usually not seen in individuals. But if it is there with minimal activity, that could pertain to a cardiac disease. 

The most important of the three symptoms that I have listed so far is chest pain or angina discomfort. Angina discomfort is pain related to the blood supply to the heart being thwarted to an extent. Now remember that chest pain would only appear if the blockage to the coronary arteries is above 70%. If one has a 95% blockage to the coronary arteries, one tends to have chest pain even at rest. 

In patients who have a blockade of about 90%. This pain would be brought about by minimal activity. When I say minimal activity, it would mean just scrubbing a floor or taking a vigorous bath. One other symptom that I would like to highlight is patients tend to have just been more on a full stomach. So if you have a full meal and you do a minimal activity, one tends to have more symptoms as also chest pain tends to be more in the early morning hours. This is actually a very well documented effect.

Coronary Artery Disease (CAD): Management

When we see coronary artery disease patients actually present in two ways. One is they may present to the emergency room with sudden onset chest pain. When you have sudden onset chest pain related to the heart secondary to a myocardial infarction, the best treatment modality is a primary angioplasty. The other treatment modality available is a thrombolysis or a dissolution of the clot. 

Let me explain further. When one has a blockage to the heart which is present, suddenly the blockage is secondary to a cholesterol block on which blood clots. So when I dissolve the clot, I am reestablishing flow only to a certain extent. It'll never be 100% flow reestablishment. Whereas by doing a primary angioplasty, what I am doing is I am removing the cholesterol clot, as also I am removing the clot, which is to say that I am able to reestablish the lumen size or the arterial size to 100%. So definitely a primary angioplasty would be the best treatment modality available to a patient who comes in with sudden onset chest pain. But remember that this has to be done within a period of three hours. The best benefits are gotten when it is done within three hours, because each hour we call it the golden hour. If you do it in one hour, you're saving or salvaging a lot of tissue. 

The longer the time delay, the more the tissue loss. Why again pick on this brain? Just like the heart does not have the capacity to regenerate. If muscle or brain tissue is lost, it is lost for life. If you have a large myocardial infarction and then go and do a bypass or an angioplasty, you still do not improve as much because the heart muscle is already lost too.  

You have reestablished tissue. So again, coming back, the best treatment for an acute myocardial infarction would be a primary angioplasty, failing which one could still do a primary thrombolysis therapy, which can be done for a period of six hours. 

Coronary Artery Disease (CAD): Treatment Lifelong ?

When I say treatment lifelong. What I mean is at least two sets of medicines, one medicine for cholesterol and one medicine to keep the blood thin, have to be continued lifelong. If one is diabetic or hypertensive. Corresponding treatment for the same should be added to what one is already on; the side effects with medicines definitely are that if a medicine has an effect, it will definitely have a side effect. 

Coronary Artery Disease (CAD): Side Effects 

But the side effect profile is very minimal. It's very uncommon that somebody comes with side effects. Many people tell us that if you have a stat to know the cholesterol-lowering drug, you may first become diabetic or first have kidney disease, which is seen in a very, very small, minuscule number of people. And that should not prevent somebody from taking medicines.

But to put things in perspective, if I give 1000 people a statin, only eight of them would come with symptoms related to a statin. That is 992 people who would benefit from this. So that benefit is what we are actually focusing on. 

Coronary Artery Disease (CAD): Preventive

when we are talking of the preventive strategy. We're talking of two levels, actually: one in patients who already have heart disease and the second in patients who have not had heart disease but who are at risk for disease. 

Now coming to the first subset of people who already had heart disease. One of the things that I tell all my patients is about a stool with three legs. For a stool to have stability, all three legs should be the same length, the same as for a cardiac patient to have stability. One has to depend on the three legs of one diet and nutrition, exercise, and medicines. 

Medicines alone are not going to treat anyone ever. You have to put in a component of diet and nutrition and exercise also. 

Coronary Artery Disease (CAD): Exercise Modality

What should be the exercise modality? It actually can be anything that a patient is comfortable with or that an individual is comfortable with. When I say a brisk walk, I mean walking at a speed of six kilometers per hour. 

When I put in 40 minutes of walking, I covered about 4.4km. That would be ideal for an aged person. For a person less than the age of 50 without any knee problems. He could put in 20 minutes of exercise on a treadmill. Swimming is an excellent means of exercise, but pools are not available everywhere. Jogging, too, if it's in a high-rise, is also an excellent means of exercise.

It can be a brisk jog of between 12 and 18 minutes. Does a lot of good to individuals with heart disease.