Coronary artery disease (CAD) is a serious condition. In fact, the Centers for Disease Control and Prevention (CDC) report that it is the leading cause of death for both men and women. If you have been diagnosed with CAD, it is important that you follow your doctor’s instructions regarding treatment. The goals of treatment include:
- reducing or relieving symptoms
- slowing, stopping, or reversing the buildup of plaque
- improving blood flow in your coronary arteries
- preventing complications
The specific treatment that is right for you will depend on the severity of your illness.
For many people with CAD, lifestyle changes may be the only treatment needed. This is especially true if you are diagnosed early. Making your day-to-day life healthier can make a big difference in your cardiovascular health.
Smoking is a major risk factor for CAD. If you are a smoker, the number one thing you can do to improve your heart health and reduce complications of CAD is to quit smoking. If you need help breaking the habit, talk to your doctor about programs and medications that might help.
Increase Physical Activity
Regular physical activity can lower levels of LDL (bad) cholesterol, reduce your blood pressure, and help you lose weight. These changes, in turn, can all reduce your risk for CAD-related complications. Talk to your doctor about the exercise level that is right for you.
Achieve and Maintain a Healthy Weight
Being overweight or obese severely increases your CAD risk. If you are carrying extra unhealthy pounds, the National Heart, Lung, and Blood Institute (NHLBI) recommends that you should aim to reduce your weight by 5 to 10 percent within your first year of treatment. This amount of weight loss can reduce your risk for CAD-related complications. Eventually, you should aim to lose enough weight to bring your body mass index (BMI) down to less than 25. BMI is a measurement of your weight in relation to your height and an estimate of your total body fat.
Follow a Heart-Healthy Diet Plan
Besides helping you maintain a healthy weight, heart-healthy diets can lower your blood pressure, improve your lipid profile, and give you more energy to increase physical activity. A heart-healthy diet includes fresh fruits and vegetables, whole grains, and lean protein such as chicken, fish, and legumes. Avoid processed foods heavy in salt and fats. Reduce your intake of cheese, eggs, and cream. Stay away from hydrogenated and partially hydrogenated fats.
Chronic stress is a serious health risk. Too much stress can increase your blood pressure. Typical responses to overwhelming stress—drinking, smoking, and overeating—are not heart-friendly.
If lifestyle changes alone are not enough, your doctor may prescribe medications. Drugs can play an important role in treating the complications of CAD. For example, cardiac drugs can control high blood pressure and promote blood flow in patients with heart failure.
Medications to Treat Angina
If you have angina, your doctor may prescribe short- or long-acting nitrates to reduce the pain. Nitroglycerin dilates blood vessels, allowing the heart to pump blood through them with less effort. Beta blockers are also often prescribed to patients with angina.
Medications to Suppress Platelet Activity
Platelets help your blood to clot. This is important when you have an injury that causes bleeding. Platelet activity can form blood clots inside your blood vessels. These clots can reduce or block the flow of blood. Drugs that suppress platelet activity make it more difficult for them to form clumps within the arteries. This reduces your chances of heart attack. Some examples of this type of medication include:
- clopidogrel (Plavix)
- eptafibitide (Integrilin)
- ticlopidine (Ticlid)
Of these medications, only aspirin is given on a preventive basis to reduce risk.
Medications to Reduce Cholesterol
If diet and exercise are not enough to lower your cholesterol, your doctor may prescribe daily medications to help keep your cholesterol at a healthy, stable level. Examples of drugs that can help reduce your cholesterol include:
Bile Acid Sequestrants to decrease LDL
- cholestyramine (Questran)
- colesevelam (Welchol)
- colestipol (Colestid)
Fibrates to decrease triglycerides and increase HDL
- fenofibrate (TriCor)
- gemfibrozil (Lopid)
Statins to decrease LDL and triglycerides and slightly increase HDL
- atorvastatin (Lipitor)
- fluvastatin (Lescol)
- lovastatin (Mevacor)
- pravastatin (Pravachol)
- rosuvastatin (Crestor)
- simvastatin (Zocor)
Niacin to decrease LDL and triglycerides and increase HDL
- (Niaspan, Nicolar)
If you’ve had a heart attack in the past, your doctor may prescribe something in this group of medications. Beta blockers can slow your heart rate and decrease your blood pressure, reducing your risk for future heart attacks. They work by blocking the effects of epinephrine (adrenaline).
Some examples of beta blockers include:
- atenolol (Tenormin)
- carvedilol (Coreg)
- metoprolol (Toprol XL)
- nadolol (Corgard)
- propranolol (Inderal LA)
- timolol (Blocadren)
Calcium Channel Blockers
Calcium channel blockers work by blocking calcium from entering the cells of the heart and blood vessel walls. Blocking the influx of calcium helps control blood pressure by decreasing the workload of the heart. It also relaxes and widens blood vessels, allowing blood to flow more easily.
Some examples of calcium channel blockers include:
- amlodipine (Norvasc)
- bepridil (Vascor)
- felodipine (Plendil)
- isradipine (DynaCirc CR)
- nicardipine (Cardene SR)
- nifedipine (Adalat CC, Procardia XL)
- nimodipine (Nimotop)
ACE Inhibitors and ARBs
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) act on the angiotensin system of the kidneys to prevent increases in blood pressure and to prevent the remodeling of the heart that can occur in response to the stress of heart attack. These types of medications can lower your risk for future strokes or heart attacks.
Some examples of ACE inhibitors include:
- benazepril (Lotensin)
- captopril (Capoten)
- enalapril (Vasotec)
- fosinopril (Monopril)
- lisinopril (Prinivil, Zestril)
- moexipril (Univasc)
- perindopril (Aceon)
- quinapril (Accupril)
- ramipril (Altace)
- trandolapril (Mavik)
Some examples of ARBs include:
- irbesartan (Avapro)
- losartan (Cozaar)
- telmisartan (Micardis)
- valsartan (Diovan)
Surgery may be required if medications fail. Patients who have had surgery may be given medications to help keep their other coronary arteries healthy or to prevent a recurrence of disease.
Coronary Artery Bypass Grafting (CABG)
In CABG surgery, a section of a vein or artery from elsewhere in the body, such as the leg, is grafted to the narrowed coronary artery. This graft detours the blood around the diseased portion of the vessel so that it can reach the heart.
Angioplasty involves threading a long, narrow balloon into the artery and inflating it to compress plaque against the wall of a narrowed artery and open the artery.
A screen-like mesh tube called a stent may be placed during angioplasty or in a separate procedure. The stent reinforces the weakened coronary artery and helps to keep it open. Some stents slowly release medication to help keep the artery open.
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