Coronary Artery Disease: Treatment Overview

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Treatment Overview

Treatment for coronary artery disease focuses on taking steps to manage symptoms and reduce the risk of heart attack and stroke. For example:

• If your doctor agrees, take a low-dose aspirin each day to reduce your risk of heart attack.
• If you can't control your high blood pressure and high cholesterol with healthier habits, you may need to take medicines. They can help you manage these health problems and lower your risk.
• Your doctor may also suggest medicines if you often have chest pain that makes it hard to do everyday activities.
• If medicines don't help your chest pain, your doctor may suggest procedures to improve blood flow to the heart. Angioplasty with or without stent placement is one way to open clogged coronary arteries. Or sometimes coronary artery bypass graft surgery may be needed.
• No matter what kind of treatment you get, healthy habits such as quitting smoking, eating a heart-healthy diet, and getting regular exercise are important. You can start today:

  Interactive Tool: Are You Ready to Quit Smoking?

  Heart disease: Eating a heart-healthy diet

  Heart disease: Exercising for a healthy heart

What to Think About

Keep these questions in mind as you think about your treatment options:

• Will this treatment improve my symptoms?
• Will this treatment help prevent future heart problems?
• Am I likely to live longer with this treatment?
• What are the risks of this treatment?

Some things that can affect your choice of treatment include the severity of your chest pain, your test results, and your feelings about treatment.

Initial treatment

Lifestyle changes are the first step for anyone with coronary artery disease. But sometimes lifestyle changes are not enough. You may also need medicines.

Lifestyle changes

When you're first diagnosed with heart disease, your doctor will strongly advise you to make lifestyle changes. These include quitting smoking, eating a heart-healthy diet, and getting regular exercise. These healthy habits can slow or even stop the disease and improve the quality and length of your life.

Quit smoking. It's the best thing you can do to reduce your risk of future problems. And avoid secondhand smoke. People with heart disease who keep smoking have a 43% greater chance of dying from a heart attack than those who quit.⁸

Your doctor may prescribe medicine and counseling to help you quit. Nicotine replacement therapy, the medicines bupropion (Zyban or Wellbutrin) and varenicline (Chantix), and counseling can help you quit for good.⁹ For more information, see the topic Quitting Tobacco Use.

Eat a heart-healthy diet. This can help you keep your disease from getting worse. It means:

• Eat more fruits, vegetables, whole grains, and other high-fiber foods.
• Choose foods that are low in saturated fat, trans fat, and cholesterol.
• Limit salt.
• Stay at a healthy weight by balancing the calories you eat with how much physical activity you get.
• Eat more foods that are high in omega-3 fatty acids, such as fish.

Start an exercise program (if your doctor says it's safe). Try walking, swimming, biking, or jogging for at least 30 minutes on most, if not all, days of the week. You may need to start slow and build up to this amount. Any activity you enjoy will work, as long as it gets your heart rate up. In people with heart disease, exercise reduces the chances of having a fatal heart attack.¹⁰

Medicines

Aspirin.Your doctor will probably recommend that you take an aspirin every day. Aspirin can reduce the risk of having a heart attack in people with heart disease.¹¹ Lower doses seem to work as well as higher doses to prevent heart attacks, and they have fewer side effects. Talk with your doctor before you start taking aspirin. For more information, see:

Should I take daily aspirin to prevent heart attack or stroke?

Cholesterol. If you have average to high cholesterol, your doctor may prescribe a medicine to lower your cholesterol, such as a statin. For more information, see:

Should I take statins for high cholesterol?

Chest pain. If you have chest pain (angina), your doctor may prescribe medicines such as:

• Nitroglycerin and other nitrates, which relax arteries and increase blood flow.
• Beta-blockers, which decrease the heart's workload.
• Calcium channel blockers, which may be used to treat angina if you can't take beta-blockers.
• Ranolazine, if nitroglycerin, beta-blockers, and calcium channel blockers don't help your chest pain. Unlike other medicines used to treat angina, ranolazine doesn't affect heart rate or blood pressure. Most of the time, it is taken with nitrates or beta-blockers.
• An ACE inhibitor. ACE inhibitors save lives and reduce the risk of heart attack in people with heart disease.⁷

Ongoing treatment

After you start treatment for coronary artery disease, your doctor will want to keep track of how you are doing. He or she will want to know if you've made lifestyle changes and if they have helped. For example, your blood pressure, cholesterol, and weight will be checked. These measures will help your doctor find out if lifestyle changes are working.

If you take medicines, your doctor will want to know if you feel any side effects. If you take medicine for chest pain (angina), your doctor will want to know how well it works. Does the medicine ease your pain quickly? Do you get chest pain less often?

You will likely need to keep taking medicines that lower your cholesterol and blood pressure and that reduce your risk of having a heart attack. Your doctor will also want to check how well these medicines work for you. If they're not working, he or she may want you to try a different dose or take a different kind of medicine.

It can be hard to make lifestyle changes on your own. If you need help, talk to your doctor about cardiac rehabilitation. In cardiac rehab, a team of health professionals provides education and support to help you make new, healthy habits.

Treatment if the disease gets worse

Sometimes coronary artery disease gets worse even with treatment. If you start to have abnormal heart rhythms (arrhythmias), your doctor might suggest a pacemaker or medicines to control your heart rate.

If your chest pain keeps getting worse even though you are taking medicines, you may need procedures to improve blood flow to your heart. They are also done when the coronary arteries are severely blocked. These procedures include angioplasty with or without stenting and coronary artery bypass graft (CABG) surgery.

When deciding between bypass surgery and angioplasty, your doctor will think about several things, such as how many arteries are blocked and whether you have diabetes. To learn more, see the Surgery section and the Angioplasty and Other Treatment section of this topic.

Also see:

Should I have angioplasty for stable angina?

Should I have coronary artery bypass surgery?

Coronary artery disease can lead to heart failure and the need for other medicines. These medicines can help you feel better and prevent your heart failure from getting worse.

Palliative care

If your coronary artery disease gets worse, you may want to think about palliative care. Palliative care is a kind of care for people who have diseases that do not go away and often get worse over time. It is different from care to cure your illness, which is called curative treatment.

Palliative care focuses on improving your quality of life—not just in your body, but also in your mind and spirit. Some people combine palliative care with curative care.

Palliative care may help you manage symptoms or side effects from treatment. It can also help you and your family to:

• Cope with your feelings about living with a long-term disease.
• Make future plans around your medical care.
• Understand your disease and how to support you.

If you are interested in palliative care, talk to your doctor. He or she may be able to manage your care or refer you to a doctor who specializes in this type of care.

For more information, see the topic Palliative Care.

Last updated:	May 29, 2008
Author:	Robin Parks, MS
Reviewed By:	Caroline S. Rhoads, MD - Internal Medicine, Ruth Schneider, MPH, RD - Diet and Nutrition
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC