Research suggests that coronary heart disease (CHD) begins with damage to the lining and inner layers of the coronary (heart) arteries. Several factors contribute to this damage. They include:

Smoking, including secondhand smoke
High amounts of certain fats and cholesterol in the blood
High blood pressure
High amounts of sugar in the blood due to insulin resistance or diabetes
Blood vessel inflammation

Plaque may begin to build up where the arteries are damaged. The buildup of plaque in the coronary arteries may start in childhood.

Over time, plaque can harden or rupture (break open). Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. This can cause chest pain or discomfort called angina.

If the plaque ruptures, blood cell fragments called platelets (PLATE-lets) stick to the site of the injury. They may clump together to form blood clots.

Blood clots can further narrow the coronary arteries and worsen angina. If a clot becomes large enough, it can mostly or completely block a coronary artery and cause a heart attack.

In addition to the factors above, low estrogen levels before or after menopause may play a role in causing coronary microvascular disease (MVD). Coronary MVD is heart disease that affects the heart's tiny arteries.

The cause of broken heart syndrome isn't yet known. However, a sudden release of stress hormones may play a role in causing the disorder. Most cases of broken heart syndrome occur in women who have gone through menopause.

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