Heart Disease - Treating Coronary Artery Disease (CAD)
Treatment of coronary artery disease (CAD) depends on its severity. In some cases, CAD may be kept under control with diet and lifestyle changes or medication. In more severe cases, surgery may be necessary to reduce pain or artery blockage.
Lifestyle changes that may help treat CAD include:
- Changing to a diet low in saturated fat and cholesterol
- Exercising regularly
- Losing weight if overweight or obese
- Quitting smoking
- Minimizing stress
Changing to a diet low in saturated fat and cholesterol, losing weight, and exercising regularly can lower cholesterol. When diet and lifestyle changes are not successful in lowering cholesterol, drug therapy may be considered. According to the American Heart Association, several factors should be taken into account when considering drug therapy for high cholesterol:
- Age (for men, 45 years or older; for women, 55 years or older OR premature menopause without estrogen replacement therapy)
- Family history of premature CAD (a father, brother or son with a history of CAD before age 55, OR a mother, sister or daughter with CAD before age 65)
- Smoking OR living or working every day with people who smoke
- High blood pressure (140/90 mm Hg or higher)
- HDL cholesterol less than 35 mg/dL
- Diabetes (fasting blood sugar of 126 mg/dL or higher)
The following chart summarizes types of drugs used to lower cholesterol and gives examples of specific generic/brand names. Brand names of drugs are shown in parentheses.
|Type of Drug||Examples|
|Bile acid sequestrants||cholestyramine (LoCHOLEST), colestipol (Colestid)|
|Nicotinic acid||niacin/vitamin B3|
|Statins||atorvastatin (Lipitor), lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor)|
|Fibrates||gemfibrozil (Lopid), fenofibrate (Tricor)
Combination drug therapy may also be helpful in lowering cholesterol levels. For example, combining a bile acid sequestrant with either nicotinic acid or lovastatin may significantly lower LDL cholesterol.
Because hypertension (high blood pressure) signals atherosclerosis, steps should be taken to maintain healthy blood pressure levels before more serious problems occurs, such as hypertrophy (thickening of the heart muscle), dilated cardiomyopathy (dilation of the left ventricle), myocardial infarction (heart attack) or stroke. High blood pressure can be treated by reducing sodium intake and maintaining a diet rich in fruits, vegetable, and low-fat dairy products. Exercising, losing weight when appropriate, not smoking, and reducing stress can also reduce high blood pressure. When diet and lifestyle changes are not successful in treating high blood pressure, drug therapy should be considered.
The following chart summarizes types of drugs used to help lower blood pressure and gives examples of specific generic/brand names. Brand names are shown in parentheses.
|Type of Drug||Function||Examples|
|Beta blockers||reduce heart’s workload||nadolol (Corgard), metoprolol (Lopressor, Toprol XL), pindolol (Visken), bisoprolol (Zebeta), acebutolol (Sectral).|
|Diuretics||rid body of excess fluid and salt||hydrochlorothiazide (HydroDIURIL), chlorothiazide (Diuril), furosemide (Lasix), bumetanide (Bumex), spironolactone (Aldactone), triamterene (Dyrenium), metolazone (Zaroxolyn).|
|ACE inhibitors||prevent blood vessel constriction||benazepril (Lotensin), lisinopril (Prinivil), captopril (Capoten), ramipril (Altace), fosinopril (Monopril), moexipril (Univasc).|
|Calcium channel blockers||increase blood flow through the heart and help prevent blood vessel constriction by blocking calcium ions||verapamil (Calan, Isoptin, Verelan), diltiazem (Cardizem, Tiamate, etc.), nifedipine (Adalat)|
In some cases, combination drug therapy may be more effective at treating CAD than using a single drug.
In addition to drugs used to help treat cholesterol or lower blood pressure (see sections above), the following drugs may also be used to help treat CAD:
- Nitrates: Nitrates help relax the myocardium and blood vessels, enabling oxygen-rich blood to reach the heart. Nitrates are commonly used to reduce angina (chest pain) and may also help when administered during myocardial infarction (heart attack) or after angioplasty or stenting. In addition, nitrates may be prescribed to help treat congestive heart failure. Examples of nitrates include: nitroglycerin (Deponit, Nitrek, Nitrol, etc.), isosorbide dinitrate (Dilatrate-SR), etc.
- Antiplatelets: These drugs help prevent thrombi (blood clots). The most commonly used antiplatelet is aspirin.
If lifestyle changes and medications are not sufficient in treating CAD, surgery may be necessary. The two most commonly performed surgeries for CAD are coronary angioplasty (balloon angioplasty or percutaneous transluminal coronary angioplasty) and coronary artery bypass graft. Even with these surgeries, lifestyle changes must also be made to help reduce the chances of further heart problems.
- Coronary angioplasty: Performed in a cardiac catheterization laboratory, this procedure involves placing a catheter with a small balloon on its tip into the patient’s narrowed artery under angiographic guidance. When properly positioned, the balloon is inflated and deflated, moving the plaque build-up further against the artery wall and thereby improving the flow of blood. This procedure may also be called percutaneous transluminal coronary angioplasty (PCTA), coronary artery balloon dilation or balloon angioplasty. Coronary angioplasty may be followed by stenting, a procedure in which a stent (expandable wire mesh tube) is permanently inserted into the artery to keep it open and restore normal blood flow.
- Coronary artery bypass graft: Involves grafting a synthetic vessel or a healthy blood vessel (often taken from the chest or leg) above and below a narrowed artery, bypassing the flow of blood around the narrowed artery. Bypass surgery can relieve symptoms of CAD, such as angina (chest pain) and dyspnea (shortness of breath) and may be used to prevent or treat myocardial infarction (heart attack).
Updated: February 29, 2008