What Comes Next: Coronary Artery Disease
Making Sense of Your Diagnosis
Reviewed by Columbia Interventional Cardiovascular Care Faculty, September 2025
If you’ve just been diagnosed with coronary artery disease, you may be feeling anxious and uncertain about what it means for your health. Many people have a lot of questions at the beginning of their treatment.
Our What Comes Next series is designed to help you feel more confident and informed by answering some of the most common questions we hear from patients navigating the same diagnosis.
I’ve Been Diagnosed With Coronary Artery Disease (CAD). How Serious Is My Condition?
Coronary artery disease (CAD) occurs when the blood vessels that supply the heart muscle become narrowed or blocked due to a process called atherosclerosis which is a buildup of plaque - a mix of cholesterol, calcium, and other substances. This reduces blood flow to your heart and can lead to chest pain, heart attacks, or even heart failure over time.
CAD can be serious, especially if the narrowing in your coronary arteries is significant or if you’re already experiencing symptoms like chest pain (angina), shortness of breath, or fatigue. CAD is a progressive condition, but it can often be managed and stabilized with lifestyle changes and the right treatment, including medications and procedures in selected cases.
Do I Need a Procedure Right Away?
Not always. Your cardiologist will guide you through the best option for your individual case, based on non-invasive tests such as stress imaging or CT scans of your heart. Based on the findings, your cardiologist may recommend an angiogram which is a procedure to take pictures of the coronary arteries with contrast dye under X-ray.
Your treatment plan depends on the severity of blockages, your symptoms, and your overall health. Some people can manage CAD with medications, diet, exercise, and close monitoring.
Severe cases may need procedures to reduce the risk of permanently damaging the heart and relieve symptoms. Minimally invasive procedures used to treat CAD are angioplasty, which opens the artery using a special balloon usually followed by a drug-eluting stent, which is a mesh scaffolding that is expanded to keep the artery open.
Surgery for CAD is coronary artery bypass surgery, which is an open-heart surgery that takes an artery and/or vein from another part of your body and uses it to restore blood flow to the heart muscle. Bypass surgery is more extensive and is used when multiple arteries are blocked or if stents are less likely to be effective.
I Don’t Have Any Symptoms. Could My CAD Still Be Serious?
Yes. Some people don’t feel any symptoms until the disease is quite advanced or until a heart attack occurs. Others may experience subtle signs - like shortness of breath, fatigue, or discomfort in the neck, jaw, or back - that can be easy to overlook.
Even without symptoms, untreated CAD can lead to significant complications. That’s why it’s important to follow your cardiologist’s recommendations, even if you’re feeling okay.
Can I Avoid A Procedure?
Many patients manage CAD without procedures. Lifestyle changes - like improving your diet, exercising regularly, quitting smoking, and managing stress - combined with medications to control cholesterol, blood pressure, and blood sugar can slow or even stop the progression of CAD.
However, if your arteries are significantly blocked or you’re experiencing frequent symptoms, your doctor may recommend a stent procedure or bypass surgery to improve blood flow.
What Medications Will I Need?
Most patients with CAD are prescribed a combination of medications to reduce strain on the heart, lower cholesterol, prevent blood clots, and manage blood pressure. These might include:
- Statins to lower cholesterol
- Aspirin or antiplatelet medications to prevent clots
- Beta-blockers or ACE inhibitors to reduce blood pressure and workload on the heart
- Nitrates to relieve chest pain
Your exact combination will depend on your risk factors and other health conditions
Can My Blockages Be Reversed?
Plaque buildup itself can’t always be reversed, but it can be stabilized through aggressive lifestyle changes and medications. Studies show that with the right treatment, plaque can stop growing and stabilize, reducing your risk of heart attacks and preventing further reduction in blood flow to the heart.
What Could Happen Without Treatment?
CAD increases your risk for:
- Heart attack
- Heart failure
- Abnormal heart rhythms (arrhythmias)
- Sudden cardiac arrest
However, with proper treatment and regular follow-up, these risks can be dramatically reduced. Managing CAD is about preventing complications - and that’s very possible with today’s therapies and close follow-up with your cardiologist.
How Will I Know If It's Getting Worse?
Signs CAD may be progressing include:
- Chest discomfort that happens more often, lasts longer, or occurs at rest
- Needing more nitroglycerin to relieve symptoms
- Worsening shortness of breath or fatigue with less activity
- New swelling in the ankles or feet
- Dizziness, fainting, or new irregular heartbeats
If you notice these symptoms, contact your cardiologist right away. For severe or persistent chest pain, call 911 right away.
Can CAD Come Back After Treatment?
CAD is a chronic condition, and the risk of progression remains - even after stents or bypass surgery. That’s why ongoing follow-up, taking medications as prescribed, and healthy lifestyle habits are so important.
Is there a Cure for CAD?
There’s no permanent cure for CAD, but it can often be controlled. Treatments -whether medical, procedural, or surgical - can relieve symptoms, reduce risks, and improve quality of life. Many people with CAD go on to live long, active lives.
How Much Can I Expect to Improve?
Most people experience significant improvements - especially if symptoms like chest pain or fatigue were limiting their daily activities. With treatment, regular exercise, and healthier lifestyle habits, many people report feeling better and can lead a longer and more active life.
Will Treating CAD Help Me Live Longer?
Yes. Treating CAD - whether through medications, procedures, and lifestyle changes - can significantly reduce your risk of heart attack and increase both lifespan and quality of life.
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