Causes of Coronary Artery Disease

CAD has one mechanism - atherosclerotic plaque in the coronary arteries - fed by a well-mapped set of risk factors. Some you cannot change; most you absolutely can. The list is the to-do list.

Cannot be changed (but can be planned around)

• Age: risk climbs after 45 in men, after menopause in women
• Family history: a parent or sibling with early CAD (father/brother before 55, mother/sister before 65) raises your risk meaningfully - screening matters more for you
• South Asian ethnicity: the genetic package - more belly fat at lower weights, higher triglycerides, lower HDL, earlier diabetes

Can be changed - the heavy lifters

• High LDL cholesterol: the raw material of plaque. The single most proven target - every 39-point LDL drop cuts heart-attack risk about a fifth
• Diabetes and prediabetes: damages artery walls and doubles-triples CAD risk; India is the world capital
• High blood pressure: the silent wall-stresser accelerating plaque
• Tobacco in any form: smoking, and yes, gutkha and chewing tobacco too - they damage arteries and promote clots. Quitting is the fastest risk reduction available
• Belly fat: the waist measurement predicts heart risk better than weight alone - the classic Indian "thin outside, fat around organs" pattern

Can be changed - the supporters

• Physical inactivity: sedentary work plus no walking is the urban default - and a risk factor
• Unhealthy food pattern: refined carbs, fried food, excess salt and sugar, few vegetables
• Chronic stress and poor sleep: both measurably tied to CAD
• Excess alcohol; air pollution (an underappreciated Indian contributor)

The stacking principle

Risk factors multiply, not add. A 45-year-old diabetic smoker with high LDL and a family history is not at "some" risk - he is the patient in the cath lab at 50. The reverse is equally true: every factor brought under control compounds protection.

One-line summary

CAD is built by cholesterol, diabetes, blood pressure, tobacco and belly fat on a foundation of age, genes and South Asian risk - and every controllable factor controlled multiplies protection.