Diffuse coronary artery disease is a subtype of coronary artery disease (CAD) in which larger sections of coronary arteries have a high plaque buildup. It is less common than focal CAD and can be more challenging to treat.

Between 2009 and 2012, CAD affected around 7.6% of men and 5.0% of women in the United States.

This article details the symptoms and risk factors for diffuse CAD, as well as steps a person can take to prevent the condition. It also explores a person’s outlook, the complications, diagnosis methods, and treatment options for diffuse CAD.

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A 2022 subanalysis suggests that there is no standardized definition of diffuse CAD and that it relies on visual assessment.

However, older research from 2004 defines CAD as one of the following:

  • long segments of significant plaque buildup measuring 20 millimeters or more
  • multiple blockages in the same artery
  • significant narrowing of the entire length of the coronary artery

The 2022 subanalysis notes that there is also a newer metric to define CAD patterns called the pullback pressure gradient (PPG).

The PPG identifies the focal or diffuse pattern of CAD based on the location and extent of the drops in blood flow pressure along the coronary artery.

This metric provides the pattern of CAD with a numerical value. A value of 0 indicates diffuse CAD, and a value of 1 indicates focal CAD.

Symptoms of diffuse CAD are similar to those of focal CAD. According to a 2023 overview of research, these include:

  • chest pain, which may begin during physical activity
  • chest pain that moves into the jaw, neck, back, or left arm
  • shortness of breath, which may arise during physical activity
  • fainting
  • heart palpitations
  • reduced capacity for exercise
  • swelling of the feet or legs
  • rapid breathing

Some of these symptoms could indicate that diffuse CAD has developed into a life threatening condition, such as heart failure or heart attack.

Anyone with symptoms of a heart attack should seek immediate medical attention. Symptoms include:

  • chest pain
  • weakness
  • lightheadedness
  • pain or discomfort affecting the jaw, neck, back, shoulders, or one or both arms
  • shortness of breath

Diffuse CAD arises when there is a buildup of plaque in the arteries supplying blood to the heart. A paper from 2015 suggests that diffuse CAD can affect those with:

  • diabetes
  • hyperlipidemia — an elevated level of lipids in the blood, which includes cholesterol and triglycerides
  • chronic kidney disease
  • connective tissue disease — a group of conditions that affect the connective tissue
  • multiple stents in the coronary arteries

Other factors that can increase the risk of developing CAD include:

  • advanced age
  • being male
  • family history of CAD
  • high blood pressure
  • obesity
  • smoking
  • poor diet
  • lack of physical activity

Researchers continue to study other CAD risk factors. Some possible risk factors include nonalcoholic fatty liver disease and rheumatoid arthritis.

Doctors diagnose diffuse CAD using the following tests:

  • coronary computed tomography angiography (CCTA), which involves injecting contrast material and using CT scanning equipment to get images of the heart and blood vessels
  • coronary angiogram, which takes an X-ray image of the heart
  • electrocardiogram (EKG or ECG), which measures electrical activity in the heart
  • echocardiography, which is an ultrasound of the heart
  • a stress test, in which doctors measure heart function in response to stressors such as exercise

Surgery is an important part of focal CAD treatment. However, the significant buildups of plaque in those with diffuse CAD can make surgery more challenging.

Despite these challenges, a 2019 study notes that the average person with diffuse CAD could benefit from surgery. A 2017 study found similar results.

A surgeon may perform coronary bypass surgery. During this procedure, a surgeon uses healthy blood vessels from another part of the body, such as the leg or chest, and connects them to the blood vessels near the blocked artery. This creates a new route for the blood to flow through.

For those who are unable to undergo surgery, an interventional cardiologist may perform a stent placement. To do this, the healthcare professional will thread a thin tube with an empty balloon attached to the end through a blood vessel.

They will then place the balloon in the blocked artery and inflate it, allowing them to open the stent and place it into position.

Medications can include:

  • angiotensin-converting enzyme (ACE) inhibitors
  • beta-blockers
  • vasodilators, such as nitroglycerin
  • aspirin
  • cholesterol-lowering medications

It may not be possible to prevent diffuse CAD with complete certainty. However, taking some steps could reduce the risk of developing this condition.

As the 2023 paper makes clear, some risk factors, such as diet and a lack of exercise, are modifiable. A person may benefit from maintaining a healthy lifestyle, which includes:

  • eating a heart-healthy diet
  • taking part in physical exercise
  • quitting smoking, if applicable

CAD is a serious condition and is the most common cause of death in the United States.

According to a 2018 paper, research suggests that people with diffuse CAD have a lower survival rate than people with focal CAD.

However, the survival rate for diffuse CAD varies from person to person. Demographic factors, overall health, and other health conditions can all affect an individual’s outlook.

It is important to contact a doctor as soon as possible if a person experiences any symptoms of CAD.

There are many possible complications of diffuse CAD. According to the 2023 review, some common complications of CAD include:

  • alterations in heart rhythm (arrhythmias)
  • congestive heart failure
  • chest pain as a result of reduced blood flow to the heart (angina)
  • heart attack
  • inflammation of the protective sac surrounding the heart (pericarditis)
  • a bulging artery that can rupture (aneurysm)

CAD refers to a buildup of plaque in the coronary arteries, which supply blood to the heart. Diffuse CAD is when large sections of the coronary artery have this plaque buildup.

Diffuse CAD can sometimes make treating the condition with surgery or stenting more challenging. It also increases the risk of death from CAD complications, including heart failure and heart attack.

However, a surgeon can treat the condition by performing a coronary bypass. For those unable to have surgery, an interventional cardiologist can insert a stent. A healthcare professional may also prescribe medications such as beta-blockers and ACE inhibitors.

People can take steps to prevent or manage diffuse CAD. These include exercising regularly, not smoking, and eating a heart-healthy diet.