Treatments for Coronary Artery Disease

Even though the treatments for heart disease have advanced a lot over the years, experts agree that lifestyle modifications remain the single most effective way to combat coronary heart disease (CHD). When lifestyle modifications are not enough, additional treatments such as medication and perhaps surgery may be needed to treat this form of heart disease.

Lifestyle changes specifically shown to help in reducing your risk or improving the symptoms of heart disease include:

  1. Quit smoking.
  2. Maintain a normal blood pressure.
  3. Keep your cholesterol levels within normal range.
  4. Engage in regular physical activity. Check with your doctor to see which type of exercise is best for you.
  5. Maintain as near normal body weight as possible.
  6. When diabetes is present, keep blood glucose levels within normal range.
  7. Reduce the amount of stress in your life.

Medications are often used to treat the symptoms of CHD. Commonly prescribed medications include:

  1. Nitrates. Nitroglycerin is one type of nitrate medication that is often prescribed to treat CHD. Nitrates dilate the arteries that supply the heart with blood. In doing so, they increase the flow of blood and oxygen to the heart. Nitrates also reduce the workload of the heart by decreasing the amount of blood returning to the heart for pumping to the rest of the body.
  2. Beta-blockers. Atenolol and metoprololl are two commonly prescribed beta-blocker medications. Beta-blockers slow the heart rate and decrease the force needed to contract the heart muscle. In doing so, beta-blockers reduce the workload of the heart.
  3. Calcium channel blockers. Nifedipine, verapamil and diltiazem are examples of commonly prescribed calcium channel blockers. These medications open up the coronary arteries and may also decrease the heart muscle’s needs for blood and oxygen.
  4. Aspirin. Aspirin has the ability to stop blood clots from forming within the coronary arteries. It reduces the risk of heart attack (myocardial infarction) in people who have CHD. Studies have shown that a daily baby aspirin is just as effective as an adult aspirin. Check with your doctor before taking aspirin.

Other medications that are often used to treat the risk factors that can cause or worsen CHD include:

  1. Cholesterol-lowering medications. When diet and exercise fail to lower levels of cholesterol and other blood fats, medication may be needed. Some examples of cholesterol-lowering medications include lovastatin, colestipol, fluvastatin, pravastatin, atorvastatin, cholestyramine, gemfibrozil, rosuvastatin and niacin.
  2. Blood pressure-lowering medications. High blood pressure causes the heart to enlarge. Untreated, it increases the risk of stroke, heart attack and kidney and heart failure. Many different types of medication are used to treat high blood pressure. Your physician can determine which medications are best for you.

When lifestyle modifications and medications aren’t enough to treat the symptoms of CHD, or when your physician determines your risk of heart attack is too great because of severe blockages in the coronary arteries, surgical treatments may be advised. Surgical options include:

  1. Coronary angioplasty. Often called balloon angioplasty, or percutaneous transluminal coronary angioplasty (PTCA), this procedure involves the placement of a catheter in the coronary artery that is diseased. Once the catheter is in place, a tiny balloon is repeatedly inflated and deflated to stretch or break open the blocked area. By opening the affected coronary arteries, blood and oxygen flow to the heart muscle can be improved. Stents are usually left in the artery to help maintain potency.
  2. Coronary artery bypass surgery. Often referred to as CABG, this major operation involves opening the chest wall and inserting a graft (usually taken from a vein in the leg) into the coronary artery that is blocked. By placing a graft in the diseased artery, blood can then bypasses the obstruction. If more than one coronary artery is blocked, multiple grafts can be inserted.

Angiogenic therapy

Clinical trials are examining the efficacy and safety of a new technique known as angiogenic therapy. The administration of angiogenic growth factors may emerge as a potential treatment for patients with coronary artery disease (CAD) that cannot be helped by angioplasty or bypass surgery. Fibroblast growth factor (FGF) and vascular endothelial growth factor (VEGF) may be effective in growing new blood vessels (called neovascularization or neo-angiogenesis) in heart patients after either direct administration of the growth factor or gene therapy directly into the heart muscle or into a partially blocked coronary artery. The first clinical studies with these compounds in patients with CAD have shown promising results.

All treatments for CHD are aimed at relieving symptoms and reducing the risk of a heart attack. None of the treatments are considered a cure for heart disease. Optimal management of coronary heart disease will always include lifestyle changes aimed at reducing your risk factors.