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Heart Disease - Rehabilitation for Patients with Coronary Artery Disease (CAD)

Rehabilitation for patients with coronary artery disease (CAD) should focus on modifying dietary and lifestyle factors that contribute to heart disease and drug therapy to lower blood pressure, cholesterol levels, etc.

Lower Cholesterol Levels:

  • Low-density lipoproteins (LDL cholesterol): an overabundance of LDL cholesterol causes atherosclerosis a narrowing of coronary arteries due to plaque build up on artery walls. Blood clots can form on plaque surfaces, further blocking the blood supply to the myocardium (heart muscle) and resulting in myocardial infarction (heart attack).
  • High-density lipoproteins (HDL cholesterol): HDL carries cholesterol away from the heart back to the liver where it is eventually removed from the body. High HDL cholesterol removes excess LDL cholesterol from artery walls, reducing arteriosclerosis (narrowing of arteries).
Total cholesterol (mg/dL) LDL cholesterol (mg/dL) HDL cholesterol (mg/dL)
Ideal: Less than 200 Borderline high risk: 200-239
High risk: 240 and over
Ideal: less than 130 Borderline high risk: 130-159
High risk: 160 or higher
Ideal: 35 or higher
High risk: lower than 35

LDL cholesterol levels can be reduced by limiting consumption of saturated fats (whole-fat dairy products, cheeses, red meats), increasing physical activity, and weight reduction when appropriate. Increased consumption of monounsaturated fats (olive oil, nuts, fatty fish) has been shown to reduce LDL cholesterol and increase HDL cholesterol, lowering CAD risk. Drug therapy for cholesterol reduction includes statins, bile acid resins, nicotinic acid and fibrates.

Lower Blood Pressure: Hypertension (high blood pressure) results from arterial narrowing, which causes blood to be pumped with greater force against the artery walls. Hypertension can be corrected by dietary changes (i.e., avoiding salt, increasing consumption of fruits, vegetables, and low-fat dairy products). Drug therapy includes beta blockers, ACE inhibitors, and calcium channel blockers.

(mm Hg) Ideal Normal High Normal Hypertension
Systolic (top number) Less than 120 Less than 130 130-139 140 or higher
(bottom number)
Less than 80 Less than 85 85-89 90 or higher

Quit Smoking: Smoking causes atherosclerosis, thrombosis (blood clots), coronary artery spasm (abnormal constriction of the muscle fibers of the coronary artery) cardiac arrhythmia (abnormal heartbeat) and other disorders which increase the risk of myocardial infarction (heart attack). Further, research shows smoking to reduce HDL cholesterol levels.

Lose Weight: Obesity increases strain on the heart, raises blood pressure and cholesterol, and increases diabetes risk. Weight reduction can be achieved with modifications to diet and increased physical activity.

Increase Physical Activity: Regular exercise helps control blood cholesterol levels, decreasing the risk of obesity or diabetes, and lowering blood pressure levels in some patients.

Reduce Stress: Research indicates a possible relationship between stress and CAD. Hypertension (high blood pressure) and high cholesterol are associated with stress, as are an increased tendency to smoke, gain weight, and/or decrease physical activity. Patients should be encouraged to minimize stress and seek professional counseling or stress management when appropriate.

Updated: Updated: February 29, 2008