A plain-language guide to how CAD develops, how it is managed medically, and the surgical options when medications and stenting are insufficient.
Coronary artery disease (CAD) is the leading cause of death in South Africa and worldwide. It develops when the arteries supplying the heart muscle with blood become narrowed or blocked by a build-up of fatty deposits called plaque — a process known as atherosclerosis.
How Does It Develop?
Plaque accumulates over years, often silently. Risk factors that accelerate the process include hypertension, diabetes, dyslipidaemia, smoking, obesity, and a family history of heart disease. As the arteries narrow, the heart muscle receives less oxygen-rich blood — particularly during exertion — causing the hallmark symptom of angina (chest tightness or pain).
Medical Management First
The first line of treatment for most patients is lifestyle modification and medication. Statins reduce plaque formation; beta-blockers and nitrates relieve angina; antiplatelet agents such as aspirin reduce clot risk. Many patients do well on this regimen for years.
When medical therapy is insufficient, a cardiologist may recommend coronary angiography — an X-ray of the heart arteries — to map the disease. If a discrete blockage is found, a percutaneous coronary intervention (PCI, or "stenting") may open it.
When Surgery Becomes Necessary
Coronary artery bypass grafting (CABG) is recommended when:
- ›Three or more coronary arteries are significantly blocked (triple-vessel disease)
- ›The left main coronary artery is involved (a high-risk pattern)
- ›The heart's pumping function is reduced (low ejection fraction)
- ›Previous stenting has failed (restenosis)
- ›Diabetes is present alongside multi-vessel disease (where bypass shows superior outcomes to stenting)
During CABG, the surgeon harvests a blood vessel from elsewhere in the body — typically the internal mammary artery from the chest wall, or the saphenous vein from the leg — and creates a detour (bypass) around the blocked segment. Blood then flows through the graft, restoring circulation to the starved heart muscle.
What to Expect
Modern CABG is safe, with complication rates that continue to improve. Most patients spend five to seven days in hospital, return to light activity within four to six weeks, and experience durable relief of angina. Many randomised trials show that bypass offers better long-term survival than stenting for complex disease patterns.
If you have been told you may need a surgical opinion regarding coronary artery disease, I encourage you to arrange a consultation. Understanding your options thoroughly — with your own surgeon — is the most important step you can take.