August 15, 2025, 3:55 am | Read time: 5 minutes
Coronary heart disease is a stealthy threat that often reveals itself at the worst possible moment. What many don’t know: For about half of those affected, sudden cardiac death is the first symptom. Cardiologist and FITBOOK expert Christopher Schneeweis explains why the disease is so insidious, which warning signs to look out for, and how modern therapies can save lives.
Elevated LDL cholesterol and ApoB-100 levels are key risk factors for arteriosclerosis and thus for coronary heart disease (CHD). Too much of it in the blood can slowly narrow the vessels—a large number of those affected only notice it when it’s almost too late. In the worst case, sudden cardiac death is the first symptom of coronary heart disease. Cardiologist and FITBOOK expert Dr. Christopher Schneeweis explains in a FITBOOK interview why it is so dangerous, how it develops, which symptoms to be aware of, and how the disease is treated.
FITBOOK: What exactly is coronary heart disease?
Dr. Christopher Schneeweis: “Coronary heart disease is colloquially referred to as vascular calcification. We cardiologists understand it as deposits in the coronary arteries that can ultimately lead to either heart attacks or circulatory disorders of the heart.”
“In the worst case, sudden cardiac death is the first symptom of coronary heart disease”
What is the most common complication of coronary heart disease?
“Often, the deposits in the coronary arteries, known as plaques, cause no symptoms in the initial stage. This process occurs in our vessel walls without us noticing. The first symptom of a heart attack would be sudden cardiac death. About 50 percent of patients who suffer a heart attack experience sudden cardiac death. It’s very important: A heart attack doesn’t necessarily announce itself. In the worst case, sudden cardiac death is the first symptom of coronary heart disease.”
“There are sometimes different symptoms between women and men”
What are other possible signs of coronary heart disease?
“The symptom that many directly associate with coronary heart disease is the acute pressure sensation in the chest. The pain can radiate to the left arm or jaw area. But these don’t necessarily have to be present, as there are sometimes different symptoms between women and men. Women can also have complaints in the upper abdominal region or nausea, as well as discomfort in the shoulder blades or shoulders. Coronary heart disease cannot be directly ruled out based on a single symptom.”
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“The most common cause is cholesterol deposits in the vessel walls”
What is the cause of coronary heart disease?
“The most common cause of coronary heart disease is ultimately cholesterol deposits in our vessel walls. Why this happens is not yet fully understood. What we do know is that primarily LDL cholesterol and the component ApoB-100 (Apolipoprotein B-100, Ed.) migrate into the vessel wall. ApoB-100 is the transporter protein for all these atherogenic proteins, like LDL cholesterol, IDL cholesterol, VLDL cholesterol, and lipoprotein(a). The LDL with the ApoB-100 component migrates into the vessel wall, changes, and oxidizes. Then, macrophages, which essentially want nothing more than to heal this process, come into play. The macrophages absorb the LDL cholesterol and grow into so-called foam cells. These emit inflammatory messengers that signal inflammatory reactions outwardly. As a result, more inflammatory cells migrate in, leading to deposits known as plaques.”
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“The most common treatment is dilating the vessels and inserting a stent”
How is the disease treated?
“We must try to reduce the underlying issues, such as elevated LDL cholesterol or ApoB-100 levels. This means we use medications. Lipid-modifying therapies ensure that the specific cholesterol levels mentioned decrease. We aim not only to stabilize the plaque so that it hopefully doesn’t rupture but also to prevent the plaque from increasing. Then we look at whether these deposits have already led to circulatory disorders of the heart. This can be determined using different methods. Depending on the type of circulatory disorder, we have treatment concepts such as the cardiac catheter examination, where these deposits can be treated. The most common treatment for stable coronary heart disease is dilating the affected areas of the vessels and inserting a stent, a vascular support. It prevents the plaque from re-forming or a new narrowing from occurring. It’s very important to minimize risk factors.”
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You mentioned that a heart attack, as an acute complication of coronary heart disease, plays a primary role. How is this treated?
“A patient diagnosed with an acute heart attack by the emergency doctor must be taken directly to a clinic that has a cardiac catheter lab available. There, it is possible to reopen the blocked vessel and quickly restore blood flow to the heart.”
About FITBOOK Expert Dr. Schneeweis
Dr. Christopher Schneeweis is a specialist in internal medicine and cardiology. He trained at institutions such as the Justus Liebig University Giessen, Charité Berlin—where he worked for more than seven years at the German Heart Center of Charité—and the Cardioangiological Centrum Bethanien in Frankfurt/Main. With his podcast “Heart Check” and as @doc_schneeweis on Instagram, he makes medical knowledge accessible to laypeople. The cardiologist is a protagonist of the third season of FITBOOK Experts; other experts include dermatologist Dr. Emi Arpa and dentist Dr. Anne Heinz.