Evidence-based coronary artery disease (CAD) management — risk reduction, medical therapy, and preventive cardiology — by board-certified FACC cardiologists at Cross County Cardiology, NJ.

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What Is Coronary Artery Disease?

Coronary artery disease (CAD) is the most common form of heart disease and the leading cause of death in the United States. It occurs when atherosclerotic plaque — a buildup of cholesterol, calcium, inflammatory cells, and fibrous tissue — accumulates within the walls of the coronary arteries that supply blood to the heart muscle. Over time, this buildup narrows the arteries (stenosis), reducing blood flow to the heart. Plaque rupture triggers the formation of a blood clot that can completely block a coronary artery, causing a heart attack (myocardial infarction).

Risk Factors for Coronary Artery Disease

• Modifiable: High blood pressure, high LDL cholesterol, smoking, diabetes, obesity, physical inactivity, poor diet, excessive alcohol, chronic stress
• Non-modifiable: Age (men ≥45, women ≥55), male sex, family history of premature CAD (first-degree relative with CAD before age 55 in men, 65 in women)

CAD Symptoms

Stable Angina — Chest pain, pressure, tightness, or discomfort triggered by exertion or emotional stress and relieved by rest or nitroglycerin. Indicates significant coronary stenosis but not an active blockage.

Unstable Angina — Chest pain occurring at rest, with minimal exertion, or with increasing frequency and severity. A medical emergency requiring immediate evaluation.

Shortness of Breath — May indicate reduced heart muscle function from chronic ischemia or prior heart attack.

Silent CAD — Many patients have significant coronary disease without classic symptoms. Routine cardiovascular risk assessment is essential for early detection.

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Diagnosing Coronary Artery Disease

At Cross County Cardiology, we use a combination of clinical evaluation, risk scoring (Framingham, ASCVD, HEART score), and non-invasive testing to assess CAD risk and severity. Diagnostic tools include stress testing (exercise treadmill, nuclear stress test, stress echocardiogram), coronary calcium scoring (CAC score), and echocardiography. For definitive coronary artery visualization, we coordinate coronary CTA or cardiac catheterization referrals through our hospital affiliates.

CAD Treatment Options

Aggressive Cardiovascular Risk Reduction — The foundation of CAD management. We optimize every modifiable risk factor including LDL cholesterol (targeting <70 mg/dL for high-risk patients), blood pressure, blood sugar, smoking cessation, weight, and physical activity.

High-Intensity Statin Therapy — Statins are the cornerstone of CAD medical therapy, reducing LDL cholesterol and providing plaque-stabilizing effects beyond cholesterol lowering. We titrate to target LDL levels and add PCSK9 inhibitors or ezetimibe when statins alone are insufficient.

Antiplatelet Therapy — Aspirin and/or P2Y12 inhibitors (clopidogrel, ticagrelor, prasugrel) prevent blood clot formation on vulnerable plaques and are essential after coronary interventions.

Beta-Blockers & ACE Inhibitors — Reduce cardiac workload, control angina, and provide survival benefit particularly after myocardial infarction.

Nitrates — Used for acute and preventive angina management by dilating coronary vessels.

Referral for Revascularization — When medical therapy is insufficient or in appropriate anatomical situations, we coordinate referral for percutaneous coronary intervention (PCI/stenting) or coronary artery bypass grafting (CABG) through our surgical and interventional colleagues.

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Why Choose Cross County Cardiology for CAD

• Board-certified FACC preventive and general cardiologists
• Comprehensive in-office stress testing and echocardiography
• Intensive lipid management including PCSK9 inhibitor prescribing
• Post-MI and post-intervention cardiac rehabilitation coordination
• Affiliated with Mount Sinai and Hackensack Meridian for interventional procedures
• 5 NJ locations with same-week appointments

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Frequently Asked Questions

Can coronary artery disease be reversed?

Significant regression of atherosclerotic plaque is difficult to achieve but is possible with very aggressive LDL lowering (LDL <50-70 mg/dL), lifestyle optimization, and certain medications. More importantly, evidence-based medical therapy powerfully reduces the risk of plaque rupture, heart attack, and cardiovascular death even without reversal of existing stenosis.

What is the difference between angina and a heart attack?

Angina is chest pain caused by temporary reduced blood flow to the heart that resolves with rest or medication. A heart attack occurs when blood flow is completely blocked, causing irreversible damage to heart muscle. A heart attack is a medical emergency — call 911 immediately for chest pain not relieved by rest or nitroglycerin.

How low should my cholesterol be if I have CAD?

For patients with established coronary artery disease, guidelines recommend an LDL cholesterol goal of less than 70 mg/dL (very high-risk patients may benefit from LDL below 55 mg/dL). Our cardiologists will determine your specific target and prescribe appropriate lipid-lowering therapy.

What is a coronary calcium score and should I get one?

A coronary artery calcium (CAC) score is a CT scan that detects calcified plaque in the coronary arteries. It is a powerful predictor of future cardiovascular events, especially in intermediate-risk patients where it can guide the decision to start statin therapy. Our cardiologists will advise you on whether CAC scoring is appropriate for your risk profile.

Can I exercise with coronary artery disease?

Yes — supervised aerobic exercise is a cornerstone of CAD management and secondary prevention. We recommend cardiac rehabilitation for post-MI and post-revascularization patients. All exercise programs should be cleared and supervised by your cardiologist, with intensity guided by stress test results.

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