Can you explain the metabolic mechanisms that take place during coronary artery blockage?

Yes: A coronary artery blockage of myocardial infarction (heart attack) occurs when an atherosclerotic plaque ruptures losing its fibrous cap and lipid core thereby exposing type-4 collagen which is very prothrombotic (clot promoting). It is the blood clot forming at the ruptured plaque that shuts down the coronary artery.

Short answer....: Cholesterol and fat damage the lining of the blood vessel, and cause vessel injury and inflammation manifest as a blockage. Cholesterol lowering, especial statin medications help stop this process. Hope that helps.