Coronary heart disease - Causes 

Coronary heart disease (CHD) is usually caused by a build-up of fatty deposits on the walls of the coronary arteries. The fatty deposits, called atheroma, are made up of cholesterol and other waste substances.

The build-up of atheroma on the walls of the coronary arteries makes the arteries narrower and restricts the flow of blood to the heart. This process is called atherosclerosis. Your risk of developing atherosclerosis is significantly increased if you:

• smoke
• have high blood pressure
• have a high blood cholesterol level
• do not take regular exercise
• have diabetes

Other risk factors for developing atherosclerosis include:

• being obese or overweight
• having a family history of CHD:  the risk is increased if you have a male relative with CHD under 55 or a female relative under 65

Cholesterol is a fat made by the liver from the saturated fat that we eat. Cholesterol is essential for healthy cells, but if there is too much in the blood it can lead to CHD.

Cholesterol is carried in the blood stream by molecules called lipoproteins. There are several different types of lipoproteins, but two of the main ones are low-density lipoproteins (LDL) and high-density lipoproteins (HDL).

LDL, often referred to as bad cholesterol, takes cholesterol from the liver and delivers it to cells. LDL cholesterol tends to build up on the walls of the coronary arteries, increasing your risk of heart disease. HDL, often referred to good cholesterol, carries cholesterol away from the cells and back to the liver, where it is broken down or passed from the body as a waste product.

In the UK, the current government recommendation is that you should have a total blood cholesterol level of less than 5mmol/litre, and an LDL cholesterol level of under 3mmol/litre and this should be even lower if you have symptoms of CHD.

Want to know more?

• High cholesterol
• HEART UK: the cholesterol charity

High blood pressure (hypertension) puts a strain on your heart and can lead to CHD.

Blood pressure is measured at two points during the blood circulation cycle. The systolic pressure is a measure of your blood pressure as the heart contracts and pumps blood out. The diastolic pressure is a measure of your blood pressure when your heart is relaxed and filling up with blood.

Blood pressure is measured in terms of millimetres of mercury (mmHg). When you have your blood pressure measured, the systolic pressure is the first, higher number to be recorded. The diastolic pressure is the second, lower number to be recorded. High blood pressure is defined as a systolic pressure of 140mmHg or more, or a diastolic pressure of 90mmHg or more.

Want to know more?

• Blood Pressure Association: the basics

Smoking is a major risk factor. Carbon monoxide (from the smoke) and nicotine both put a strain on the heart by making it work faster. They also increase your risk of blood clots.

Other chemicals in cigarette smoke damage the lining of your coronary arteries, leading to furring of the arteries. If you smoke, you increase your risk of developing heart disease by 24%.

A thrombosis is a blood clot within an artery (or a vein). If a thrombosis occurs in a coronary artery (coronary thrombosis), it will cause the artery to narrow, increasing your chance of having a heart attack as the blood clot prevents the blood supply from reaching the heart muscle. Coronary thrombosis usually happens at the same place as where atherosclerosis is forming (furring of the coronary arteries).