Coronary Artery Disease: How CT Angiography Catches It Early

Coronary artery disease (CAD) is the leading cause of death worldwide, yet it often develops silently over many years without any warning signs. By the time symptoms appear, the disease may already be advanced. Coronary CT angiography offers a powerful non-invasive way to detect plaque buildup and artery narrowing in their earliest stages, opening the door to prevention rather than reaction.

This article explains why coronary artery disease is so dangerous in its silent phase, how CT angiography compares to other screening methods, who should consider early screening, and what steps you can take after detection to protect your heart.

The Silent Nature of Coronary Artery Disease

Coronary artery disease begins when cholesterol, fat, and other substances accumulate inside the walls of the arteries that supply blood to the heart muscle. This process, called atherosclerosis, starts as early as the teenage years in some individuals and progresses gradually over decades. During most of this time, the patient feels perfectly healthy.

The reason CAD remains silent for so long is that arteries have a remarkable ability to compensate. In the early stages, the artery wall expands outward (positive remodeling) to accommodate plaque without reducing the internal channel. Blood flow remains adequate, and standard tests like resting ECG appear normal. It is only when plaque has narrowed the artery by more than 50-70% that symptoms like chest pain (angina) or shortness of breath may begin, often during exercise or stress.

Tragically, for some patients, the first symptom of CAD is a heart attack. Studies show that up to 50% of heart attacks occur in people who had no prior symptoms. The plaque does not need to be severely obstructive to cause a heart attack; even a small, vulnerable plaque can rupture and trigger a blood clot that suddenly blocks the artery.

Why Early Detection Matters

Detecting coronary artery disease early, before symptoms develop, fundamentally changes the approach from emergency treatment to planned prevention. When plaque is identified at the mild or moderate stage, proven interventions can slow progression, stabilize plaque, and dramatically reduce the risk of future heart attacks.

• Statin therapy: Cholesterol-lowering medications can stabilize plaque and even cause mild regression over time. Starting early maximizes long-term benefit.
• Blood pressure control: Keeping blood pressure within target ranges reduces stress on artery walls and slows plaque progression.
• Lifestyle modification: Diet changes, regular exercise, smoking cessation, and weight management have proven effects on reducing cardiovascular events.
• Aspirin therapy: In selected patients with confirmed plaque, low-dose aspirin reduces the risk of clot formation on vulnerable plaques.
• Diabetes management: Tight blood sugar control reduces the accelerated atherosclerosis seen in diabetic patients.

Without early detection, these interventions are only initiated after a cardiac event, when significant, irreversible damage may have already occurred. The shift from reactive to preventive cardiology is one of the most important advances in modern heart care.

"The biggest tragedy in cardiology is not the heart attack itself — it is the heart attack that could have been prevented," says Dr. Shahoo Mazhari, Consultant Cardiologist at DCDC. "With CT angiography, we can see plaque building up years before it becomes dangerous. That window of opportunity is priceless."

How CT Angiography Detects Early CAD

Coronary CT angiography (CCTA) uses a specialized CT scanner with ECG synchronization to capture high-resolution images of the coronary arteries. A contrast dye injected through an IV highlights the arteries, allowing the reporting physician to visualize the entire coronary tree in detail.

What makes CT angiography uniquely valuable for early detection is its ability to see the artery wall, not just the lumen. Traditional invasive angiography (catheterization) shows only the open channel inside the artery and may miss plaque that has expanded outward without yet narrowing the lumen. CT angiography, by contrast, can identify:

• Non-obstructive plaque: Plaque that has not yet caused significant narrowing but is present in the artery wall
• Plaque composition: Whether plaque is calcified (stable), non-calcified (higher risk), or mixed
• Positive remodeling: Outward expansion of the artery wall, which may indicate vulnerable plaque
• Stenosis severity: The degree of lumen narrowing from minimal to complete occlusion
• Anomalous coronary anatomy: Congenital variations that may carry independent risk

This comprehensive assessment provides a complete picture of coronary artery health that no other non-invasive test can match.

CT Angiography vs Other Screening Methods

Several tests are used in cardiac evaluation, but they differ significantly in what they can detect, particularly regarding early disease. Understanding these differences helps patients and physicians choose the most appropriate screening tool.

The key advantage of CT angiography is its ability to detect non-obstructive plaque, which accounts for the majority of plaques that cause heart attacks. A stress test may be completely normal in a patient with multiple non-obstructive plaques, giving false reassurance. CT angiography provides a more complete and earlier assessment.

Who Should Be Screened for Coronary Artery Disease?

Not everyone needs a coronary CT angiogram, but certain groups benefit significantly from proactive screening. Current guidelines and expert consensus suggest discussing screening with your cardiologist if you fall into one or more of the following categories:

Intermediate Cardiovascular Risk

Patients classified as intermediate risk based on standard risk calculators (10-year risk of 7.5-20%) benefit most from CT angiography. The scan results can reclassify patients into lower or higher risk categories, directly influencing treatment decisions.

Family History of Heart Disease

A first-degree relative (parent or sibling) who developed heart disease before age 55 (men) or 65 (women) is a significant risk factor. Standard risk calculators often underestimate risk in patients with strong family histories, making imaging-based screening particularly valuable.

Diabetes

Diabetes accelerates atherosclerosis and is considered a "coronary artery disease equivalent" by many guidelines. Diabetic patients often develop extensive plaque without symptoms due to diabetic neuropathy affecting pain sensation. Early screening can identify disease that would otherwise remain undetected until a major event.

Smokers and Former Smokers

Smoking is one of the strongest modifiable risk factors for CAD. Both current smokers and those who quit within the last 15 years carry elevated risk. CT angiography can reveal the cumulative damage of smoking on the coronary arteries.

Concerning Symptoms

Patients experiencing atypical chest pain, unexplained shortness of breath, or exercise intolerance that does not clearly fit other diagnoses may benefit from CT angiography to rule out or confirm coronary disease as the underlying cause.

Cardiovascular Risk in Dubai's Population

Dubai's diverse, multicultural population includes groups with particularly elevated cardiovascular risk profiles. Understanding these demographic patterns helps explain why proactive cardiac screening is especially relevant in the UAE.

South Asian populations (Indian, Pakistani, Bangladeshi, Sri Lankan), which represent a significant portion of Dubai's residents, have well-documented higher rates of coronary artery disease, often developing it at younger ages than Western populations. This is attributed to a combination of genetic factors, dietary patterns, insulin resistance, and the high prevalence of diabetes and metabolic syndrome.

Middle Eastern populations also face elevated cardiovascular risk due to high rates of diabetes (the UAE has one of the highest diabetes prevalence rates globally), smoking, sedentary lifestyles, and dietary factors. The combination of young, working-age populations with multiple risk factors makes screening programs particularly impactful in this region.

Additionally, the demanding work environments and lifestyle stressors common in Dubai can contribute to unmanaged risk factors. Many expatriates may not have had regular cardiac evaluation in their home countries, making a comprehensive screening opportunity valuable upon arrival or during routine health checkups.

This pattern is one we see regularly at DCDC. A 47-year-old South Asian man visited our center for a routine health checkup. He had no symptoms whatsoever — no chest pain, no shortness of breath. However, he mentioned that his father had suffered a heart attack at age 52 and his uncle had undergone bypass surgery at 55. Based on his family history, ethnicity, and mildly elevated cholesterol, we recommended a screening CT angiogram even though most standard guidelines would not have flagged him for testing at his age. The results revealed significant non-calcified plaque in two coronary arteries with moderate stenosis that would have gone undetected for years without imaging. He was started on aggressive preventive therapy immediately. This case underscores why population-specific risk factors must be considered alongside age-based screening criteria.

"In my practice at DCDC, I see South Asian men developing significant coronary plaque in their mid-40s — a full decade earlier than what textbooks describe for Western populations," says Dr. Shahoo Mazhari, Consultant Cardiologist at DCDC. "If we rely only on age-based guidelines, we miss a critical window. Family history and ethnic background should lower the threshold for screening."

The Calcium Score as a First Step

For patients who want an initial assessment of their coronary health, a coronary calcium score can serve as a useful first step. This quick, low-cost scan takes less than 5 minutes, requires no contrast dye, and quantifies calcified plaque in the coronary arteries.

A calcium score of 0 is very reassuring and is associated with very low short-term cardiovascular risk. However, it does not rule out non-calcified plaque. Patients with elevated calcium scores, or those with a score of 0 but significant risk factors, may then proceed to full CT angiography for a more complete evaluation.

Prevention After Screening: What You Can Do

Early detection is only valuable when followed by meaningful action. Whether your CT angiogram shows clean arteries or early plaque, the following strategies form the foundation of cardiovascular prevention:

• Optimize cholesterol: Target an LDL cholesterol below 70 mg/dL if plaque is present. Statins are the cornerstone of therapy, with additional agents available if targets are not met.
• Control blood pressure: Aim for below 130/80 mmHg. Consistent management reduces arterial wall stress and plaque progression.
• Manage blood sugar: For diabetic patients, HbA1c below 7% reduces cardiovascular complications. Newer diabetes medications (SGLT2 inhibitors, GLP-1 agonists) offer additional heart protection.
• Adopt a heart-healthy diet: Mediterranean-style diets rich in vegetables, fruits, whole grains, fish, and olive oil are associated with significant cardiovascular benefit.
• Exercise regularly: At least 150 minutes of moderate-intensity aerobic activity per week. Exercise improves cholesterol profiles, blood pressure, blood sugar, and weight.
• Stop smoking: Cardiovascular risk begins to decline within weeks of quitting and continues to decrease for years.
• Manage stress: Chronic stress contributes to inflammation and unhealthy behaviors. Mindfulness, adequate sleep, and work-life balance are protective.

Follow-Up After Your CT Angiogram

After your screening CT angiogram, your cardiologist will develop a personalized follow-up plan based on your results. Patients with no plaque may be reassessed in 5-10 years depending on risk factors. Those with non-obstructive plaque typically begin medical therapy and lifestyle modification, with repeat imaging in 3-5 years to monitor stability.

Patients with moderate to severe findings may undergo additional functional testing or, in some cases, invasive angiography. The understanding of your CT angiogram results is essential for making informed decisions about your ongoing care.

Mga Madalas Itanong

Final Thoughts

Coronary artery disease remains the world's leading killer, yet it is also one of the most preventable conditions when detected early. The silent nature of atherosclerosis means that waiting for symptoms is a risky strategy. CT angiography provides a window into the health of your coronary arteries years or even decades before a potential heart attack, giving you and your cardiologist the opportunity to intervene proactively.

If you have risk factors for heart disease, whether it is family history, diabetes, smoking, high cholesterol, or simply being over 40 with concerns, consider discussing coronary CT angiography with your cardiologist. The scan takes minutes, but the information it provides can guide years of effective prevention. For details on pricing and insurance, visit our CT angiogram cost in Dubai guide. In cardiovascular health, what you don't know can hurt you, and early detection changes the equation entirely.

Isinulat ni

Dr. Shahoo Mazhari

Tingnan ang Profile

Consultant Cardiologist

MD, Board Certified in Cardiology

Dr. Shahoo Mazhari is a Consultant Cardiologist specializing in non-invasive cardiac imaging, coronary CT angiography, and preventive cardiology at DCDC Dubai Healthcare City.

Related Articles

• What Is a CT Angiogram?
• Calcium Score Ranges: What Each Score Means for Your Heart
• When Do You Need a CT Angiogram?