Coronary artery disease (angina)
Also called: coronary heart disease, CAD, CHD, ischaemic heart disease, angina, stable angina, chronic coronary syndrome
Coronary artery disease happens when fatty deposits narrow the arteries that feed the heart. It often causes angina (chest pain or tightness on effort) and can lead to a heart attack. Medicines, a healthy lifestyle and sometimes a stent or bypass keep it under control.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
The heart muscle gets its blood from the coronary arteries. In coronary artery disease, fatty deposits called atheroma build up inside the walls of these arteries over many years (atherosclerosis). The arteries become narrow, so less blood reaches the heart, especially when it has to work harder. The main symptom is angina: a heavy, tight or squeezing pain in the chest that comes on with effort or stress and settles with rest or a nitrate spray or tablet. Some people have no symptoms until they have a heart attack.
Heart and blood vessel diseases are the leading cause of death in the world. The World Health Organization estimates that about 19.8 million people died from them in 2022, and heart attacks and strokes caused most of these deaths. More than three in four of these deaths happen in low- and middle-income countries.
Coronary artery disease cannot usually be cured, but it can be controlled well. Treatment has two aims: to relieve angina so you can live an active life, and to lower the risk of a heart attack. This means stopping smoking, eating well, being active and taking medicines every day. If angina is still troublesome despite medicines, an operation to open or bypass the narrowed artery may help.
In Pakistan: what studies show
Global Burden of Disease estimates show the death rate from coronary heart disease in Pakistan rose by 29.62% between 1990 and 2019, the biggest rise in its region. Hospital studies show many heart attack patients are smokers, often young, and in one Lahore hospital only 48.2% were given a strong statin.
- Global Burden of Disease estimates show that the death rate from coronary (ischaemic) heart disease in Pakistan rose by 29.62% between 1990 and 2019, the largest rise of any country in the Eastern Mediterranean region.[1] (modelled estimate, data 1990-2019)
- In the same Global Burden of Disease analysis, the heart disease burden linked to metabolic risks (such as high blood pressure, high cholesterol and high blood sugar) rose by 42.54% in Pakistan from 1990 to 2019, again the highest rise in the region.[1] (modelled estimate, data 1990-2019)
- In a community survey of 3,143 adults aged 40 or older in low-income areas of Karachi in 2004-2005, 6.1% of men and 4.0% of women had definite coronary artery disease (past history plus heart-attack signs on the ECG).[2] (population-based cross-sectional survey, data 2004-2005)
- In one hospital study at the Pakistan Institute of Medical Sciences, Islamabad, of 120 young people aged 20 to 35 with a first heart attack, 68.3% were smokers.[3] (descriptive cross-sectional, data 1 Feb 2016 - 31 Jan 2018)
- In a study of 1,132 heart attack patients treated with emergency stenting (primary PCI) at a cardiology institute in Multan in 2023, the average age was only 53.51 years.[4] (descriptive cross-sectional, data 1 Apr 2023 - 30 Sep 2023)
- In the same Multan study of 1,132 heart attack patients, 57.6% were smokers.[4] (descriptive cross-sectional, data 1 Apr 2023 - 30 Sep 2023)
- In the same Multan study, 30.7% of the heart attack patients had diabetes.[4] (descriptive cross-sectional, data 1 Apr 2023 - 30 Sep 2023)
- In one Lahore hospital study of 411 patients admitted with a heart attack or unstable angina, almost all (99.3%) were given a statin, but only 48.2% got a high-intensity (stronger) statin.[5] (single-centre observational, data Feb 2019 - Dec 2019)
What we do not know yet: There is no recent national survey of how common coronary heart disease is in Pakistan; the best community data are from Karachi in 2004-2005. There are no national figures on access to angiography and stenting, and the Multan authors note that primary PCI is sometimes completely unavailable in some areas; long-term use of heart-protecting medicines after discharge is also not measured. No Pakistan-specific angina guideline was found.
Pakistan studies cited
- Sadeghi M, Jamalian M, Mehrabani-Zeinabad K, et al. The burden of ischemic heart disease and the epidemiologic transition in the Eastern Mediterranean Region: 1990-2019. PLoS One 2023;18(9):e0290286. doi:10.1371/journal.pone.0290286. PMID 37669274. Open source
- Jafar TH, Qadri Z, Chaturvedi N. Coronary artery disease epidemic in Pakistan: more electrocardiographic evidence of ischaemia in women than in men. Heart 2008;94(4):408-413. Open source
- Mudassir M, Iqbal J, Arshad MS, et al. Risk Factors of Premature Coronary Artery Disease. Journal of Rawalpindi Medical College 2021;25(1). doi:10.37939/jrmc.v25i1.1589. Open source
- Akhtar A, Saleemi MS, Zarlish QM, et al. Experience and Outcomes of Primary Percutaneous Coronary Intervention in a Tertiary Care Hospital in South Punjab, Pakistan. Cureus 2023;15(12):e50024. doi:10.7759/cureus.50024. Open source
- Mahmood MM, Nawaz MJ. Prescription of statins after acute coronary syndrome; a single-centre observational study. Journal of the Pakistan Medical Association 2023;73(3):646-649. doi:10.47391/JPMA.4328. Open source
Symptoms
- Chest pain or discomfort (angina): a heaviness, tightness, squeezing or dull ache, usually in the centre of the chest
- Pain that spreads to the arms, neck, jaw, back or upper stomach
- Pain brought on by physical effort, stress, strong emotion, cold weather or a heavy meal
- Pain that usually eases within about 10 minutes with rest or a nitrate spray or tablet
- Discomfort that may feel like indigestion
- Shortness of breath, especially on effort
- Feeling sick, dizzy or sweaty during an attack
- No symptoms at all in some people until a heart attack happens; this is more common in older people and people with diabetes
Causes and risk factors
Causes
- Atherosclerosis: a slow build-up of fatty deposits (atheroma) inside the walls of the coronary arteries, which narrows them
- Narrowed arteries cannot carry enough blood when the heart works harder, which causes angina
- A fatty deposit can crack and a blood clot can form on it, suddenly blocking the artery and causing a heart attack
- Less often, the small heart blood vessels tighten when they should not (vasospastic or microvascular angina), even when the large arteries look clear
What makes it more likely
- Smoking or using other tobacco
- High blood pressure
- High cholesterol (fats in the blood)
- Diabetes
- Being overweight or obese
- Not being physically active and an unhealthy diet
- Drinking too much alcohol
- Getting older (men over 45 and women over 55) and a family history of heart disease
Complications
The biggest danger is a heart attack. This happens when a blood clot suddenly blocks a coronary artery and part of the heart muscle is starved of blood. It can damage the heart for good and can kill if it is not treated quickly. Over time, coronary artery disease can also weaken the heart so that it cannot pump well (heart failure), which causes breathlessness and fluid build-up in the lungs and legs. Angina that is not controlled can limit work, exercise and daily life, and worry about the heart can lead to stress, anxiety or low mood. Heart attacks and strokes together cause most deaths from heart and blood vessel disease.
When to see a doctor
- Possible heart attack: chest pain or pressure that does not go away with rest, or lasts more than 15 minutes. Call emergency services for an ambulance or get to a hospital emergency department straight away
- Chest pain that spreads to the arms, neck, jaw, back or stomach, or comes with sweating, feeling sick, light-headedness or breathlessness: call for an ambulance now, do not drive yourself
- Angina that is not relieved 5 minutes after a second dose of your nitrate spray or tablet: call for emergency help
- Chest pain that comes on at rest, or angina that is becoming more frequent, more severe or longer lasting: get urgent medical advice the same day
- New breathlessness, especially when lying flat, or swelling of the legs
- Fainting, or a very fast, slow or irregular heartbeat with chest pain
Diagnosis
A doctor first asks about your symptoms, your medical and family history, smoking and lifestyle, and checks your blood pressure, cholesterol and blood sugar. An ECG (electrical tracing of the heart) and blood tests are usual early tests. Depending on how likely heart disease seems, the doctor may then arrange a CT coronary angiogram (a scan with dye that shows narrowing in the arteries) or a stress test, which looks at the heart while it works harder, using exercise, ultrasound (stress echocardiogram), MRI or a nuclear scan. An echocardiogram (ultrasound of the heart) shows how well the heart pumps.
The 2024 European guideline advises starting with an estimate of how likely coronary disease is, and using one test after another rather than relying on a single test. Invasive coronary angiography, where a thin tube is passed to the heart and dye is injected, is used when an operation to open or bypass an artery is being considered.
Treatment
- Learn about angina and its triggers, stop smoking, eat a healthy diet, keep active and reach a healthy weight. Cardiac rehabilitation (a supervised exercise and education programme) helps after a heart attack or procedure.
- Carry a short-acting nitrate spray or tablet to relieve an attack, or to use just before an activity that brings on angina. Sit down when you use it, because it can make you light-headed. Your doctor will explain how to use it and when to repeat it.
- To prevent angina, the first medicine is usually a beta blocker or a calcium channel blocker. If one does not suit you, the other is tried; if angina continues, the two may be combined. Your doctor decides the medicine and the dose.
- If these are not enough or cannot be used, a long-acting nitrate or another anti-angina medicine such as ivabradine, nicorandil or ranolazine may be added by your doctor.
- To lower the risk of a heart attack or stroke, most people are offered low-dose aspirin (unless the bleeding risk is high) and a statin. Blood pressure and diabetes are treated, and an ACE inhibitor is often added for people with diabetes.
- If angina stays troublesome despite the best medicines, or tests show severe narrowing, a coronary angiogram is done and the artery may be opened with a balloon and stent (angioplasty, PCI) or bypassed with a graft (coronary artery bypass surgery, CABG).
- Keep taking your medicines every day, attend follow-up visits, and tell your doctor if angina gets worse or changes.
Medicines in Pakistan
Medicines a doctor may use, by group. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| Nitrates (short-acting and long-acting) | a short-acting nitrate spray or tablet relieves or prevents an angina attack; a long-acting nitrate is a second-line option to prevent attacks | Glyceryl Trinitrate (7 brands), Nitroglycerin (37 brands), Isosorbide mononitrate (18 brands), Isosorbide 5-mononitrate (1 brand), Isosorbide dinitrate (13 brands) |
| Beta blockers | a first-choice medicine to prevent angina; slows the heart so it needs less oxygen | Bisoprolol fumarate (127 brands), Metoprolol Tartrate (7 brands), Atenolol (27 brands), Propranolol (17 brands) |
| Calcium channel blockers | a first-choice alternative to a beta blocker, or added to one; relaxes the arteries | Amlodipine (175 brands), Nifedipine (17 brands), Verapamil (14 brands) |
| Antiplatelet medicines (blood thinners) | low-dose aspirin lowers the risk of a heart attack; after a stent, two blood-thinning medicines are usually given together for a time | Acetylsalicylic acid (Aspirin) (59 brands) |
| Statins (cholesterol-lowering medicines) | lower cholesterol and the risk of heart attack and stroke; offered to most people with coronary disease | Atorvastatin (86 brands), Rosuvastatin (6 brands), Simvastatin (121 brands) |
| ACE inhibitors | protect the heart and blood vessels; often used when there is also diabetes or high blood pressure | Ramipril (7 brands), Lisinopril (21 brands), Enalapril (37 brands) |
Also used (not yet in our price list): ivabradine, nicorandil, ranolazine, felodipine
Self-care and prevention
Self-care
- Stop smoking and all tobacco, including naswar, chewing tobacco and sheesha; ask for help to quit
- Always carry your nitrate spray or tablets, check they are in date, and keep a spare supply when you travel
- Learn what brings on your angina (effort, stress, cold, heavy meals) and pace yourself; use your nitrate before planned effort if your doctor advised it
- Eat a balanced diet with plenty of fruit, vegetables and whole grains, and less salt, ghee and fried food
- Stay as active as your symptoms allow, building up slowly, and ask your doctor before starting a new activity
- Keep a healthy weight, and avoid alcohol or keep it very low
- Take your medicines every day, even when you feel well, and never stop them without asking your doctor
- Keep blood pressure, blood sugar and cholesterol under control, and seek help for stress, anxiety or low mood
Prevention
- Do not smoke or use any tobacco
- Eat a healthy diet low in salt and saturated fat, with plenty of fruit and vegetables
- Be physically active most days and keep a healthy weight
- Avoid alcohol or keep it very low
- Have regular checks of blood pressure, cholesterol and blood sugar, and treat them if they are raised
Common questions
What is the difference between angina and a heart attack?
Angina is short-lived chest pain caused by a narrowed artery; it usually comes on with effort and settles within about 10 minutes with rest or a nitrate. A heart attack happens when an artery is suddenly blocked. The pain is usually stronger, lasts longer, can start at rest and does not settle with a nitrate. A heart attack is an emergency.
Can coronary artery disease be cured?
The narrowing does not usually go away, but the disease can be controlled. Lifestyle changes and daily medicines relieve angina and lower the chance of a heart attack. A stent or bypass can improve blood flow when medicines are not enough, but you still need to keep taking your medicines and living healthily afterwards.
Do I need a stent if I have angina?
Not always. Many people do well on medicines alone. Guidelines suggest a stent or bypass mainly when angina stays troublesome despite the best medicines, or when tests show severe narrowing of important arteries. Your heart specialist will discuss the benefits and risks with you.
Can I exercise and live a normal life with angina?
Yes. When angina is well controlled, most people can work, exercise and have a normal sex life. Build up activity slowly, carry your nitrate and talk to your doctor before starting something new or very strenuous. Jobs that involve heavy physical work or driving large vehicles may need extra advice.
What should I do if I get chest pain?
Stop and rest, and use your nitrate spray or tablet if you have one. If the pain is not better after the second dose, or if you think you are having a heart attack, call emergency services or get to hospital straight away. Do not drive yourself.
Sources
- NICE. Stable angina: management (CG126) (2016).
- ESC. New Chronic Coronary Syndrome (CCS) Guidelines expand diagnostic tools and ways to prevent major adverse events and enhance quality of life (2024).
- WHO. Cardiovascular diseases (CVDs) (2025).
- NHS. Angina - NHS (2025).
- NHS. Coronary heart disease - Symptoms - NHS (2024).
- NHS. Coronary heart disease - Diagnosis - NHS (2024).
- NHS 111 Wales. NHS 111 Wales - Health A-Z : Coronary heart disease (2024).
- Journal of Rawalpindi Medical College. Risk Factors of Premature Coronary Artery Disease (2021).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.
Related conditions
High blood pressure (hypertension)High cholesterol (dyslipidaemia)Type 2 diabetes mellitusHeart failureStroke