Coronary Artery Disease
Treatment Overview
Treatment for coronary artery disease (CAD) depends upon how far the disease has already progressed. Coronary artery disease is the buildup of plaque on the inside of the coronary arteries, the blood vessels that supply oxygen-rich blood to heart muscle. As you review your treatment options, consider the following:
- No matter what medical treatment you receive, lifestyle changes—including quitting smoking, following a heart-healthy diet, and exercising—are critical to managing the disease. For more information on lifestyle changes, see:
- If your doctor approves, take an ASA each day to reduce your risk of heart attack.
- If your high blood pressure and high cholesterol cannot be controlled with lifestyle changes, you and your doctor may consider a more aggressive approach, including medications to lower these risk factors.
- If you have frequent chest pain that makes normal everyday activities difficult, your doctor may recommend medicines.
- If medicines do not relieve your chest pain, your doctor may recommend angioplasty with stent placement to open clogged coronary arteries. Or sometimes coronary artery bypass surgery may be necessary.
Initial treatment
After you have been diagnosed with coronary artery disease, your doctor will strongly advise that you make lifestyle changes such as quitting smoking, following a heart-healthy diet, and exercising. With these measures, you may be able to halt the progression of the disease and improve the quality and length of your life.
Quitting smoking may be the most important step you can take to reduce your risk. Avoid second-hand smoke too. In one study, people with CAD who continued to smoke had a 43% greater chance of sudden death from a heart attack than those who quit.9 Your doctor will strongly advise that you quit and will possibly prescribe medicine and therapy to help you do so. Studies show that nicotine replacement therapy, use of the medicines bupropion (Zyban or Wellbutrin) or varenicline (Champix), and supportive therapy significantly increase long-term success in quitting.10 For more information, see the topic Quitting Tobacco Use.
ASA is also recommended for almost everyone who has CAD to help reduce the risk of having a heart attack.11 The best dose of ASA has not been established, but 75 mg a day seems to be as effective in preventing heart attack as higher doses and has fewer side effects.12 One low-dose ASA contains 81 mg; one regular-strength ASA contains about 325 mg. Talk with your doctor before starting ASA therapy. For more information, see:
If you have average to high cholesterol, a cholesterol-lowering medicine such as a statin may be prescribed.
If you have angina, your doctor may prescribe medicines, including nitroglycerin and other nitrates which relax arteries and increase blood flow, and beta-blocker medicines, which decrease the heart's workload. Calcium channel blockers may be used to treat angina when beta-blockers are not tolerated or for other types of angina, including variant, or Prinzmetal's, angina. If these medicines do not relieve your chest pain, your doctor may prescribe a partial fatty acid oxidation inhibitor (ranolazine).
An angiotensin-converting enzyme (ACE) inhibitor is often prescribed, particularly for those with diabetes or heart failure. Studies have shown that ACE inhibitors save lives and reduce the risk of heart attack in people with CAD.5
Your doctor will recommend that you start an exercise program, such as walking, swimming, cycling, or jogging, for at least 30 minutes on most, preferably all, days of the week. Studies show that exercise effectively reduces the number of fatal heart attacks in people with CAD.13
If you have metabolic syndrome, your doctor will probably recommend that you increase your physical activity and lose weight. Metabolic syndrome—which is characterized by excess body fat and other factors—increases your risk of coronary artery disease.
Avoid getting sick from the flu. Get a flu shot every year.
Factors that affect the choice of treatment in coronary artery disease include the severity of your chest pain, the results of your tests, and your preferences.
Ongoing treatment
After your initial treatment, you will be monitored regularly by your doctor. He or she will want to know whether you have succeeded in making necessary lifestyle changes and whether those changes have been effective in controlling your risk factors for coronary artery disease.
For example, your blood pressure, cholesterol, and weight will be checked to see whether more aggressive treatment is needed. If you are taking medicines, your doctor will ask you whether you have any side effects. You will be asked whether the medicines you take for angina decrease the pain quickly, and whether your angina is less frequent.
You will probably have to continue the medicines you are taking, which may include a beta-blocker, angiotensin-converting enzyme (ACE) inhibitor, nitroglycerin, statins, and ASA. These medicines reduce your risk of having a heart attack. Your doctor will assess how well these medicines are working and whether dosages need to be adjusted or alternative medications tried.
If you have not been successful in making healthy lifestyle changes on your own, your doctor may recommend that you attend a cardiac rehabilitation program. Your cardiac rehab team, consisting of several health professionals, will assist you with a supervised program of aerobic and resistance training exercises, education and programs to reduce your risk factors for heart problems, stress management programs and counselling for depression, and nutritional counselling.
If angina keeps you from exercising or enjoying other activities, you may want to talk to your doctor about having angioplasty to improve blood flow to your heart. You would also continue taking medicines and leading a healthy lifestyle. For more information, see:
Treatment if the condition gets worse
Sometimes coronary artery disease continues to progress despite treatment. This may be caused by continued smoking or other unhealthy choices. Other times, symptoms get worse because the coronary artery disease has already progressed to an advanced state.
If heart failure develops, your doctor will probably add an angiotensin-converting enzyme (ACE) inhibitor and a diuretic, which can prevent worsening of heart failure in addition to improving symptoms.
If you begin to have abnormal heart rhythms (arrhythmias), your doctor might recommend a pacemaker or medicines to control your heart rate.
Revascularization procedures that help restore blood flow to the heart may be recommended if you continue to have frequent or disabling chest pain despite the use of medicines, or you are found to have severe blockages in your coronary arteries. Revascularization procedures include angioplasty with stenting, and coronary artery bypass surgery (CABG).
When deciding between bypass surgery or angioplasty, your doctor will evaluate:
- Whether the left main coronary artery
is blocked. Because the left main coronary artery performs the essential function of supplying blood to the left ventricle, the heart's main pump, bypass surgery rather than angioplasty is usually performed when it is blocked.
- The number of coronary arteries that are blocked. Bypass surgery may be needed if more than one coronary artery is blocked.
- The function of the left ventricle. People with mild to moderately reduced left ventricle function may benefit more from bypass surgery. On the other hand, people with significantly reduced function of the left ventricle may not be good candidates for surgery because of their greater risk of having complications.
- The function of the heart valves. If one of your heart valves is defective, bypass surgery combined with heart valve surgery may be required.
- Whether you have diabetes. If you have diabetes, the chances are higher that your arteries will become narrowed again (restenosis) after angioplasty. CABG is usually the preferred surgery for people with diabetes.
What to Think About
Keep the following questions in mind as you think about your treatment options for coronary artery disease.
- Will this treatment improve my symptoms?
- Will this treatment help prevent future heart problems?
- Am I likely to live longer with this treatment?
- What are the risks of this treatment?
- What are the long-term results of this treatment based on my current symptoms, risk factors, and test results? If I choose this treatment, will I need more surgery or tests? Can a heart attack or other problems be caused by this treatment?
Hospice palliative care
If your coronary artery disease gets worse, you may want to think about hospice palliative care. Hospice palliative care is a kind of care for people who have diseases that do not go away and often get worse over time. It is different from care to cure your illness, called curative treatment. Hospice palliative care focuses on improving your quality of life—not just in your body, but also in your mind and spirit. Some people combine hospice palliative care with curative care.
Hospice palliative care may help you manage symptoms or side effects from treatment. It can also help you cope with your feelings about living with a long-term disease, make future plans around your medical care, or help your family better understand your disease and how to support you.
If you are interested in hospice palliative care, talk to your doctor. He or she may be able to manage your care or refer you to a doctor who specializes in this type of care.
For more information, see the topic Hospice Palliative Care.
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| Author: | Douglas Dana Robin Parks, MS | Last Updated: September 21, 2007 |
| Medical Review: | Anne C. Poinier, MD - Internal Medicine Caroline S. Rhoads, MD - Internal Medicine Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology Robert A. Kloner, MD, PhD - Cardiology Ruth Schneider, MPH, RD - Diet and Nutrition | |
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