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Treatments and drugs
By Mayo Clinic staff
Treatment for coronary artery disease usually involves lifestyle changes and, if necessary, drugs and certain medical procedures.
Lifestyle changes
Making a commitment to the following healthy lifestyle changes can go a long way toward promoting healthier arteries:
- Quit smoking.
- Eat healthy foods.
- Exercise regularly.
- Lose excess weight.
- Reduce stress.
Drugs
Various drugs can be used to treat coronary artery disease, including:
- Cholesterol-modifying medications. By decreasing the amount of cholesterol in the blood, especially low-density lipoprotein (LDL, or "bad") cholesterol, these drugs decrease the primary material that deposits on the coronary arteries. Boosting your high-density lipoprotein (HDL, or "good") cholesterol, may help, too. Your doctor can choose from a range of medications, including statins, niacin, fibrates and bile acid sequestrants.
- Aspirin. Your doctor may recommend taking a daily aspirin or other blood thinner. This can reduce the tendency of your blood to clot, which may help prevent obstruction of your coronary arteries. If you've had a heart attack, aspirin can help prevent future attacks. There are some cases where aspirin isn't appropriate, such as if you have a bleeding disorder of you're already taking another blood thinner, so ask your doctor before starting to take aspirin.
- Beta blockers. These drugs slow your heart rate and decrease your blood pressure, which decreases your heart's demand for oxygen. If you've had a heart attack, beta blockers reduce the risk of future attacks.
- Nitroglycerin. Nitroglycerin tablets, sprays and patches can control chest pain by opening up your coronary arteries and reducing your heart's demand for blood.
- Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). These similar drugs decrease blood pressure and may help prevent progression of coronary artery disease. If you've had a heart attack, ACE inhibitors reduce the risk of future attacks.
- Calcium channel blockers. These medications relax the muscles that surround your coronary arteries and cause the vessels to open, increasing blood flow to your heart. They also control high blood pressure.
Procedures to restore and improve blood flow
Sometimes more aggressive treatment is needed. Here are a few options:
- Angioplasty and stent placement (percutaneous coronary revascularization). In this procedure, your doctor inserts a long, thin tube (catheter) into the narrowed part of your artery. A wire with a deflated balloon is passed through the catheter to the narrowed area. The balloon is then inflated, compressing the deposits against your artery walls. A stent is often left in the artery to help keep the artery open. Some stents slowly release medication to help keep the artery open.
- Coronary artery bypass surgery. A surgeon creates a graft to bypass blocked coronary arteries using a vessel from another part of your body. This allows blood to flow around the blocked or narrowed coronary artery. Because this requires open-heart surgery, it's most often reserved for cases of multiple narrowed coronary arteries.
References
- Coronary artery disease. National Lung, Heart, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/Cad/CAD_WhatIs.html. Accessed April 29, 2010.
- Morrow DA, et al. Chronic coronary artery disease. In: Libby P, et al., eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/book/player/book.do?method=display&type=bookPage&decorator=header&eid=4-u1.0-B978-1-4160-4106-1..50057-1&uniq=198193047&isbn=978-1-4160-4106-1&sid=989729689. Accessed April 29, 2010.
- Toth PP, et al. Coronary artery disease. In: Rakel RE. Rakel: Textbook of Family Medicine. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/198193047-17/0/1481/455.html#4-u1.0-B978-1-4160-2467-5..50041-5--cesec46_2228. Accessed April 29, 2010.
- Hall SL, et al. Secondary prevention of coronary artery disease. American Family Physician. 2010;81:289.
- Wilson PWF. Overview of the risk factors for cardiovascular disease. http://www.uptodate.com/home/index.html. Accessed April 29, 2010.
- Body composition tests. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=4489. Accessed April 29, 2010.
- Heart disease. National Center for Complementary and Alternative Medicine. http://nccam.nih.gov/health/heart-disease/. Accessed April 29, 2010.
- Grogan M (expert opinion). Mayo Clinic, Rochester, Minn. May 7, 2010.
- Lovett E, et al. Advising patients about herbs and nutraceuticals: Tips for primary care providers. Primary Care: Clinics in Office Practice. 2010;37:13.
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