According to the Centers for Disease Control and Prevention (CDC), more than a half-million Americans die of heart disease each year–about one out of every four deaths.

Among those, coronary artery disease (CAD) is the most common cause of death in the United States. CAD occurs when cholesterol collects on damaged areas of the inner walls of the coronary arteries, restricting vital blood flow.

Symptoms of CAD

Many people with coronary artery disease exhibit no symptoms of any kind. When symptoms do occur, men and women often experience symptoms differently.

Men, for example, typically have angina (chest pain) while exerting themselves. They might have aching, burning, or pressure in the middle of the chest, on the left side, and down the left arm, jaw, back, or shoulder blades. Symptoms may also include shortness of breath or becoming more winded from normal activity and exercise.

Women might also experience these symptoms, including angina, but also have unexplained nausea and sweating. They may also feel more fatigued than usual.

Smoking and CAD

More than 30 percent of heart-related deaths in the United States can be attributed to smoking. Smoking damages the lining of the arteries and the heart.

“Nicotine and other chemicals from the cigarettes damage the lining of the arteries and heart, then when there is damage, the cholesterol passes through the artery and builds up in those areas,” says Joseph Gunasekera, MD, FACC, a cardiologist with Kettering Health. “When the cholesterol builds up in the wall, then the artery starts to narrow. Continuing to smoke majorly increases your risk.”

While some proponents insist it is safer to use electronic cigarette vapor for the smoker’s nicotine fix, “vaping” can lead to the same problems. The primary component, nicotine, is still flooding the arteries and creating damage that allows plaque to collect and constrict the blood vessels.

Risks and prevention

There are five primary risk factors for coronary artery disease:

• Family history
• Diabetes
• Smoking
• High cholesterol
• High blood pressure

A family history of coronary artery disease may suggest a genetic predisposition, but you can still help reduce your risk by managing the other four factors. Starting with your diet, eat fewer red meats and more fish and chicken, choose baked rather than fried, and add more fruits, vegetables, and whole grains.

Smokers can reduce their risk significantly by quitting now, and everyone should increase their exercise level. Walking, running, or swimming are great options to help improve cardiovascular health.

Diagnosis

There is a simple test for CAD called the coronary calcium score (CCS). Like a mini-CAT scan of your heart, the test takes approximately five minutes, and it can tell the doctor how much hard plaque is built up in your arteries. You get a score based on the results–the ideal score is 0. A calcium score under 100 is mild, and over 400 is severe. A score between 100-400 is considered intermediate or moderate.

“I’ve had people with no symptoms at all,” Dr. Gunasekera explained. “We went ahead and had the test done, then learned they had a very high score of over 1,000. Those patients were referred for treatment for potentially life-threatening, serious blockages in the heart that they didn’t even know they had.”

The CCS test costs only $99, and while it is typically not covered by insurance, it is always worth the investment to catch potential hard buildup inside the arteries before a heart attack or other life-threatening event occurs.