Coronary artery disease
If your doctor finds that you have coronary artery disease, several
treatment approaches are possible, depending on the seriousness of the
disease. Many people are able to manage coronary artery disease with
lifestyle changes and medications. Other people with severe coronary
artery disease may need coronary angioplasty or surgery.
Although great advances have been made in treating coronary artery
disease, changing your habits remains the single most effective way to
stop the disease from progressing. Here are the most beneficial changes
you can make:
Smoking is a major risk factor for coronary artery disease. Quitting
smoking dramatically lowers your risk of a first or second heart
If you know that you have coronary artery disease, changing your
diet to one low in fat — especially saturated fat — and cholesterol
will help reduce high blood cholesterol, a primary cause of
atherosclerosis. It's important to keep your cholesterol low after a
heart attack to help lower your risk of having another one. Eating
less fat should also help you lose weight. If you're overweight,
losing weight can help you further lower blood cholesterol. Eating a
diet rich in fruits and vegetables and having at least one to two
servings of fish a week also can reduce your risk of a heart attack.
Even moderate amounts of physical activity — 30 minutes a day — can
lower your risk of death from coronary artery disease. However,
people with severe coronary artery disease may need to restrict
their exercise somewhat. If you have coronary artery disease, check
with your doctor to find out what kinds of exercise are best for
In addition to lifestyle changes, your doctor may recommend drug therapy
to treat coronary artery disease. Medications to prevent or treat
coronary artery disease include:
Cholesterol is a large part of the deposits that can narrow heart
arteries. A high level of cholesterol in your blood increases your
risk of coronary artery disease. Cholesterol-lowering drugs, also
called lipid-lowering drugs, help lower the level of "bad"
cholesterol in your blood while raising the level of "good"
cholesterol. One type of cholesterol, HDL, actually helps protect
against coronary artery disease. Examples of cholesterol-lowering
drugs include statins, niacin, fibrates and bile acid sequestrants.
Aspirin, as well as other blood thinners, can reduce the tendency of
your blood to clot, which may help prevent obstruction of your
These drugs slow your heart rate and decrease blood pressure, which
in turn decreases your heart's demand for oxygen. Beta blockers also
have been shown to reduce the risk of death in people during and
after a heart attack. In addition, they're beneficial for people
with a weakened heart muscle and congestive heart failure.
Nitroglycerin tablets, spray and patches can control chest pain
(angina) by both opening up your coronary arteries and reducing your
heart's demand for blood.
These medications cause the muscles that surround your coronary
arteries to relax and the vessels to open more, increasing blood
flow to your heart. They also control high blood pressure.
Angiotensin-converting enzyme (ACE) inhibitors.
These drugs allow blood to flow from your heart more easily,
decreasing your heart's workload. ACE inhibitors are the mainstay
treatment for congestive heart failure, which can be a complication
of coronary artery disease.
that lower blood pressure, such as diuretics.
These medications help open up your blood vessels, including those
to your heart, decreasing your heart's workload.
You may need to take drugs for your heart indefinitely, or you may take
medications temporarily until a risk factor for coronary artery disease
is better under control.
Procedures to restore and improve blood flow
Types of procedures to improve coronary blood flow (revascularization)
Also known as angioplasty or stent placement, this is a common
treatment for severe blockage of the coronary arteries. Only a small
cut is required in your skin to put the catheter into the blood
vessel. In this procedure, a doctor inserts a catheter with a small
balloon at the tip into an artery in your groin or arm. The catheter
is then threaded to the region of a coronary artery that's narrowed.
When the catheter reaches the blockage, the balloon is inflated to
widen the artery and improve blood flow. Often small wire tubes (stents)
are placed into the area where the blockage occurred to keep the
artery from narrowing again. However,
drug-eluting stents are not appropriate or necessary in all
situations, and long-term results are still pending. If percutaneous
coronary intervention doesn't widen the artery or if complications
occur, you may need bypass surgery.
This requires open heart surgery. It's a procedure used to create a
route for blood to go around a blocked stretch of a coronary artery.
A blood vessel, usually taken from your leg or chest, is grafted
directly onto a narrowed artery, bypassing the blocked area. If more
than one artery is blocked, a bypass can be done on each. The blood
can then go around the obstruction to supply your heart with enough
blood to relieve chest pain.
In this procedure, a catheter is inserted into an artery. The
catheter is equipped with a diamond-shaped device that rotates up to
200,000 times a minute to shave plaques off your artery walls.
Research into new ways to treat coronary artery disease is yielding
possibilities. Here are some areas of current research:
following coronary angioplasty.
The majority of people who undergo coronary angioplasty for coronary
artery disease receive small wire tubes (stents) to hold the
arteries open longer. Generally, stents work well at keeping
arteries open. However, in some people, blockage reoccurs following
coronary angioplasty. Researchers are studying whether treating
narrowed coronary arteries with radiation at the time of angioplasty
prevents new blockages from forming.
Scientists are using genes that produce growth factor proteins to
stimulate growth of new blood vessels (angiogenesis) and restore
blood flow to the heart. They're studying delivery of the genes and
proteins to the heart via a direct injection into the heart through
a small incision or by a catheter-delivery technique.
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