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Understanding Calcified Coronary Artery Disease And How To Prevent It
The heart is the first organ to start its function as the embryo is formed inside the mother's womb. It continues to perform its functions tirelessly until its end. It beats nearly 275 crores times, on average, for an individual with a lifespan of 75 years. In this journey of tireless work, oxygen and nutrients are needed for it to execute its functions, which are provided by the blood carried by the three blood vessels of the heart itself. They are the left anterior descending artery, left circumflex artery and right coronary artery. Due to various modifiable and non-modifiable risk factors, these blood vessels get clogged by cholesterol-based materials, leading to pathway blockages.
What happens when the pathways (coronary arteries) that carry this blood become hard, narrowed, and inflexible? This condition, known as calcified coronary artery disease, is a growing concern worldwide. In rare cases, such calcified diseases (nodular calcium) can trigger heart attacks too. Most of us have heard of blocked arteries due to cholesterol; however, few know about such calcium deposits that can form in the artery walls. Even with modern medical tools, these calcium deposits make blockages stiff and challenging to treat.
In this article, we will discuss calcified coronary artery disease, why it happens, how common it is, the possible symptoms it can create and how it can be treated, to help you understand your heart better.
What are coronary arteries and why do they calcify?Coronary arteries are the lifeline tubes or the blood vessels that run on the surface of the heart and carry oxygen-rich blood to the heart muscles. Healthy arteries are smooth, elastic, and flexible. However, over time, due to various risk factors like age, being of the male sex, genetics, diabetes, high blood pressure, smoking, cholesterol levels, reduced physical activity and poor eating habits, fatty deposits, known as plaques begin accumulating inside these tubes or blood vessels. This process is called atherosclerosis in medical terms. Over the years, such plaques harden themselves into calcium, similar to that seen in our bones, converting our soft, jogging-friendly cushioned road (elastic blood vessels) into a hard, rough mountain road. This process leads to the formation of calcified coronary artery disease (cCAD). To a certain extent, such calcified coronary vessels are not dangerous as they do not lead to heart attacks frequently as compared to non-calcified, fat-rich blockages; however, one form of calcified CAD, known as nodular calcium, in which the calcium protrudes into the lumen and touches the blood, is a proven risk factor for heart attacks.
Risk factors for CAD and calcified CADThere are several risk factors for CAD: elderly individuals are at a higher risk; factors such as having diabetes mellitus, high cholesterol levels and high blood pressure (hypertension) also contribute to the risk. Other risk factors include chronic kidney disease, smoking, having a family history of heart disease, and sedentary lifestyles and unhealthy diets.
When does the soft plaque change into hard plaque? The reason for this is still not fully known; what is known is that it takes years for the plaque to harden.
How common is calcified CAD?Calcified CAD can be identified through various modalities such as conventional coronary angiograms, intra-vascular ultrasound (IVUS), optical coherence tomography (OCT) and computer tomography (CT). CT-based calcium scoring for coronary artery diseases is often called coronary artery calcium (CAC). This CAC score is often used in clinical practice to identify calcified diseases. Though the presence of CAC proves CAD, the absence of CAC does not rule out CAD, especially in young patients.
The prevalence of the disease varies based on the modality used to identify the calcium. In general, nearly 20-25% of CAD cases are diagnosed to have CAC by coronary angiograms, while this number rises to nearly 65% using IVUS.
Why is it important know the about presence of calcium?Identifying calcified CAD is very important in asymptomatic patients who need treatment for the same, either using bypass surgery or angioplasty (stenting). The grafting site for bypass should ideally be calcium-free for better short-term and long-term results. It is very important in angioplasty also. Imagine trying to open a metal pipe with a balloon inside: it is very hard and cannot be opened, and this is what it is like for calcified CAD. Such hard blockages are difficult to open by conventional balloon angioplasties without dedicated tools, leading to stent under-expansion, which might result in poorer short-term and long-term outcomes. The chances of potential adverse events during angioplasties are higher with calcified CAD. In short, calcified coronary disease is tougher to treat and riskier to ignore.
How does this disease present?The symptoms are the same as any other CAD. Usually, it causes exertional chest pain, breathing problems, fatigue, palpitations and rarely, a heart attack. In case, you have any of the above symptoms, please consult your doctor.
How can it be prevented?The best way to prevent Calcified CAD is to prevent CAD itself. The most important culprit for CAD is bad cholesterol (LDL). Keeping it low for a long time is a proven strategy for reducing CAD. The bad cholesterol burden is depicted in medical terms as 'LDL-C-years' similar to pack-years of smoking. In addition to this, all the risk factors described above should be kept under control.
Dedicated tools to treat calcified CADPatients who have exertional symptoms, despite lifestyle modifications and drugs, may be appropriate candidates for complex procedures to handle calcified CAD. The most commonly-used tool to handle such calcified CAD is rotablation (RA), where a small diamond-coated burr is rotated at a rapid speed to break the calcium as an adjunctive device, following which standard devices like stents can be deployed and expanded well, using conventional balloons. Orbital atherectomy is a near-similar technology that could also treat such calcified blocks. Balloon-based technologies like cutting balloons, scoring balloons, super-high pressure OPN balloons, and intravascular lithotripsy (IVL) are also becoming common. IVL is the newest technology, where sound waves are used to crack open the calcium, similar to how kidney stones break. The safe and effective use of such therapies has provided excellent long-term prognoses in such patients.
Healthy lifestyles are crucialCalcified coronary blocks are not problems that we face in the elderly alone, unlike in the Western population. Patients present to us with exertional chest pain or breathlessness. Rarely, it can lead to heart attacks. On a positive note, many patients with such heavily calcified arteries live long and healthy lives after treatment, especially when combined with lifestyle changes and regular follow-ups. Putting your mind towards mindful eating with good exercise and controlling proven risk factors are the pillars of a healthy life.
(Dr. S. Nagendra Boopathy is a specialist in complex coronary and percutaneous valve therapies, and professor of cardiology and senior consultant interventional cardiologist, Sri Ramachandra Institute of Higher Education and Research, Chennai. drsnboopathy@gmail.Com)
Published - June 02, 2025 02:24 pm IST
Living With A Hidden Heart Condition: Asymptomatic Cardiac Disease
Heart disease is often perceived as a condition with clear warning signs—chest pain, shortness of breath, or palpitations. However, for many individuals, heart disease may remain hidden for years, silently progressing without noticeable symptoms. Asymptomatic cardiac disease is a dangerous and often overlooked aspect of cardiovascular health. This condition, where individuals have heart disease but experience no symptoms, poses a significant risk as it can suddenly escalate into life-threatening events such as a sudden cardiac arrest.
Asymptomatic heart conditions, including coronary artery disease (CAD), congenital heart defects, cardiomyopathies, and arrhythmias, may lurk in the body without warning. These conditions may exist from birth, like congenital heart diseases, or develop over time as a result of lifestyle factors, age, or genetics. Young adults, particularly those aged 10–20, may face valvular heart diseases linked to rheumatic fever, while coronary artery disease becomes a significant threat as individuals age, particularly in those over 40.
Coronary Artery Disease (CAD) is one of the most prevalent forms of asymptomatic heart disease. It occurs when the arteries that supply blood to the heart become narrowed or blocked due to the build-up of cholesterol, calcium, and clots. For years, a person may live with this blockage, unaware that it is progressing until the obstruction surpasses 70%, at which point symptoms like chest pain (angina) or, worse, a heart attack may occur. Unfortunately, in some cases, even minimal blockages can rupture and trigger a sudden heart attack, leading to death within hours. Many people with these CAD may go years without any signs of illness, not realizing they are on a path toward a life-threatening cardiac event.
Congenital heart diseases, present at birth, can often remain undetected until later in life. Some individuals may not experience symptoms until they reach their 20s or 30s. While many congenital heart issues can be corrected surgically or managed medically, their asymptomatic nature means routine screenings are essential. Similarly, Cardiac arrhythmias, or irregular heart rhythms, may also be asymptomatic yet fatal. Regular ECGs can detect these silent killers and allow for timely intervention.
The Need for Preventive Cardiac Care
The best defence against the hidden dangers of asymptomatic cardiac disease is a proactive approach to heart health. This includes regular screenings, especially for those with known risk factors like high blood pressure, diabetes, high cholesterol or a family history of heart disease. Given the unpredictability and severity of asymptomatic heart conditions, routine heart health screening becomes essential. For individuals between the ages of 20 and 40, it is advisable to undergo medical screenings including cardiac checks every five years. As one ages, particularly after 40, screenings should become more frequent, ideally every two years or even annually for those with significant risk factors.
Routine cardiac assessments such as ECGs, echocardiograms, and treadmill tests provide critical insights into heart function and can detect issues before they manifest into life-threatening events. Even for those who feel healthy, these tests are tools for detecting asymptomatic heart disease.
Lifestyle modifications also play a crucial role in prevention. Maintaining a healthy diet, engaging in regular physical activity, managing stress, and avoiding smoking can significantly reduce the risk of heart disease. Monitoring and controlling cholesterol levels, blood pressure, and blood sugar are critical in preventing the progression of diseases in the arteries.
In conclusion, he silent nature of many heart conditions makes them especially dangerous. But with regular screenings, early detection, and proactive health management, the risks of asymptomatic cardiac diseases can be mitigated. Let's prioritize heart health, because the absence of symptoms does not equate to the absence of disease.
This article is authored by Dr. KRKS Raju, Cardiologist, GVK Health Hub
Dad, 46, Died Of A Heart Attack After Symptoms Were Mistaken For A Stomach Bug
Matthew experienced some of the lesser-known signs of a heart attack before suffering from cardiac arrest13:32, 22 May 2025Updated 13:33, 22 May 2025
A "fit and healthy" dad of two died of a shock heart attack after believing he had a stomach bug. Matthew Clark, 46, initially experienced stomach pains and indigestion in January 2023.
At that time, his whole family, who live in Guildford in Surrey, had been recovering from a stomach bug, so his wife Joanna thought little of it. But shortly afterwards Matthew collapsed and went into cardiac arrest.
Joanna, who goes by the name Jojo, performed CPR on her husband for 11 minutes until an ambulance arrived and took Matthew to hospital. Tragically, he then had a second cardiac arrest and could not be resuscitated.
READ MORE: Paediatric expert says 300 kids in A&E shows trend could 'harm large number'READ MORE: Lung cancer doctors say early sign of disease can appear on your fingertipsA post-mortem revealed draughtsman Matthew had been living with asymptomatic coronary artery disease. This led to a heart attack and subsequent failure of the left bottom chamber of his heart.
Jojo, who was with Matthew for 15 years, said: "I always thought I knew the symptoms of a heart attack. You replay it in your mind hundreds of times, of what went wrong and when.
"However, the paramedics said Matthew's chances of survival were almost zero as he had a full blockage in his coronary artery. The only way he would have survived is if I'd had a defibrillator in my hand the moment he collapsed."
Matthew had experienced some lesser-known warning signs of a heart attack. According to the NHS, a heart attack can cause nausea and tummy pain.
Now, Jojo has shared Matthew's story in partnership with the British Heart Foundation (BHF) in a bid to raise awareness of heart disease symptoms. It comes as the BHF released "worrying" new figures that show that cardiovascular disease fatalities are rising among adults aged under 65 for the first time in decades.
The heart health of the UK has seen a more rapid decline at the onset of the 2020s than in any other decade for over half a century. There's been an increase in both the rate and number of deaths among working-age adults, aged 20 to 64, due to cardiovascular disease.
READ MORE: Teen thought she had 'exam stress' - then doctors found 'shock' brain tumourREAD MORE: Weightlifter, 31, given just 5 years to live after ignoring 'common' symptomsThe death rate escalated to 55 per 100,000 in 2023 from 49 per 100,000 in 2019, marking the first sustained rise in at least a generation. Deaths among working-age adults surged by 18 per cent, from 18,693 in 2019 to 21,975 in 2023, averaging 420 per week. Cardiovascular disease is a broad term encompassing conditions that affect the heart or blood vessels. These include heart attacks, strokes, coronary heart disease, and heart failure, among others.
Specialists at the BHF labelled this trend as "worrying" following decades of progress where deaths from conditions such as heart attack and stroke had nearly halved since the 1960s. This progress was credited to research, medical advancements, and declining smoking rates.
The exact cause of this recent surge in cardiovascular deaths remains unclear. However, it's speculated that several factors could be contributing, including an "increasingly" unhealthy population, growing health inequalities, COVID-19, unprecedented strain on the NHS, and obesity.
SymptomsMatthew suffered both a heart attack and cardiac arrest. These are actually different medical emergencies.
A heart attack occurs when one of the coronary arteries becomes blocked, stopping the heart's supply of blood. The heart can then begin to die due to a lack of oxygen.
In comparison, a cardiac arrest occurs when the heart stops pumping blood around their body causing the patient to stop breathing normally. The BHF says: "Many cardiac arrests in adults happen because of a heart attack.
"This is because a person who is having a heart attack may develop a dangerous heart rhythm, which can cause a cardiac arrest."
Symptoms of a heart attack include:
Whereas, if someone is in cardiac arrest, they collapse suddenly and:
A heart attack and a cardiac arrest are both emergency situations. If you think someone is experiencing either of these you must call 999 straight away.
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