How Coronary Artery Disease Is Treated
Coronary artery disease (CAD) is a serious condition that can have life-altering complications if it is not treated. Lifestyle changes such as
exercise and smoking cessation, which can slow the progression or reverse the disease, are usually recommended. Prescriptions, such as statins and
beta blockers; specialised procedures, such as angioplasty; or surgeries, such as coronary artery bypass may also be necessary, depending on the
severity of your disease.
Coronary artery disease develops over time, and you can adapt some of your habits to slow the progression of atherosclerosis and cholesterol build-up.
These lifestyle changes have even been shown to help decrease the degree of disease over time. Moreover, other treatments for CAD are unlikely to be
helpful in the long term unless you also take these steps:
- Smoking cessation: Smoking damages the inner lining of the coronary arteries. Stopping will prevent further damage and give your body the opportunity to remodel cells and tissues, including those in the inner lining of your arteries. Over time, your CAD can improve as a result.
- Diabetes control: If you have diabetes, it's important that you keep your blood sugar at optimal levels. Uncontrolled diabetes can lead to worsening heart disease, as well as other complications. Management of diabetes involves a combination of dietary strategies and medication.
- Heart-healthy diet: Eating a diet that's low in saturated fats and trans fats prevent the worsening of CAD. As you work to make this change, choose lean sources of protein, such as seafood, nuts, and fat-free or low-fat dairy products. Fruits, vegetables, and whole grains, all of which are high in antioxidants, have the added benefit of also helping to reverse the disease.
- Exercise: Exercise helps to maintain target cholesterol levels. In general, try to get 30 to 60 minutes of activity on most days. If you have a heart arrhythmia or a congenital heart defect, talk to your doctor about any necessary exercise restrictions before you begin a program.
- Stress management: Stress may exacerbate CAD by releasing hormones that raise blood pressure and damage the lining of the blood vessels. Managing stress is not an easy feat. At-home strategies include relaxation, time management, focusing on your priorities, building healthy relationships, and avoiding emotionally toxic people and situations. However, many people cannot manage stress without professional help. If you feel that stress is a major part of your life, discuss it with your doctor.
If you have CAD, there is a very high chance that you may need to take one or more prescription medications. Some of these medications treat CAD itself,
actually preventing the disease from worsening inside the blood vessels.
Other medications, while they do not directly treat CAD, are necessary to reduce the chances of having a heart attack or a stroke, or to help in dealing with
the consequences and complications of the condition.
For example, medications may help prevent blood vessel constriction (narrowing) if you have high blood pressure or may help your heart function if you have
a damaged heart muscle from a heart attack.
Reducing CAD Progression
Your doctor may opt for one or more of the following:
- Statins: Statins are used to lower cholesterol. They're typically prescribed to prevent cholesterol build up in your blood vessels, which is one of the major contributors to CAD. Lipitor (atorvastatin), Lescol (fluvastatin), Altoprev (lovastatin), and Zocor (simvastatin) are some examples. The most common side effect is muscle pain. Less common side effects include liver damage, increased blood sugar levels, and neurological effects such as confusion or memory loss.
- Repatha (evolocumab): Evolocumab has been shown to quickly decrease LDL-C levels (a type of harmful cholesterol) in those with a genetic disorder called familial hypercholesterolemia. It is a fully human antibody that interacts with proteins and with the liver to lower LDL, an unhealthy fat that contributes to CAD.
- Antibiotics: Antibiotics are used to treat heart infections such as endocarditis and bacterial pericarditis, which can exacerbate CAD. If you have a heart infection, your doctor will do a blood test to determine the cause of your infection and prescribe an antibiotic or a combination of them based on the results. You will likely need to get these drugs intravenously (via an IV), which will likely require hospitalisation for at least a week. Once your doctor can see that the infection is clearing, you may be able to go to a clinic for intravenous treatments or even have them at home.
Preventing Blood Clots
Blood clots can cause heart attacks and strokes if you have atherosclerotic disease. Prescriptions that can help prevent blood clots include:
- Antiplatelet medications: These drugs are used to stop blood clots from forming by preventing the platelets in your blood from sticking together. Plavix (clopidogrel), Effient (prasugrel), and Brilinta (ticagrelor) are examples. Potential side effects include headaches, dizziness, nausea, constipation, diarrhoea, indigestion, abdominal pain, nosebleeds, and bruising easily.
- Anticoagulants: Anticoagulants keep blood clots from forming and prevent any blood clots that you have from getting bigger with a mechanism that is different from that of antiplatelets. They also prevent blood clot formation in diseased vessels to reduce the risk of a stroke or heart attack. Examples of anticoagulants include Coumadin (warfarin), heparin, Pradaxa (dabigatran), and Eliquis (apixaban). Side effects may include excessive bleeding, dizziness, weakness, hair loss, and rashes.
Improving Heart Function
This goal is centred around helping to prevent complications related to CAD. Prescription options include:
- Angiotensin-converting enzyme (ACE) inhibitors: ACE inhibitors work by relaxing your blood vessels and helping your heart to work more efficiently. They are used in CAD to prevent your coronary blood vessels from having too narrow a lumen (opening), which is more likely to be obstructed by a blood clot. Examples of ACE inhibitors are Lotensin (benazepril), Vasotec (enalapril), Capoten (captopril), and Monopril (fosinopril). Potential side effects include a dry cough, high potassium levels in your blood, dizziness, fatigue, headaches, and loss of your sense of taste.
- Angiotensin II receptor blockers: These medications work by helping your blood vessels dilate so that you are less likely to experience blockage of your coronary vessels. Examples of angiotensin II receptor blockers include Atacand (candesartan), Teveten (eprosartan), Avapro (irbesartan), and Cozaar (losartan). Side effects can include dizziness, high potassium levels in your blood, and swelling of the body.
- Angiotensin receptor neprilysin inhibitors (ARNIs):Entresto (sacubitril/valsartan) contains a combination of angiotensin II receptor blockers and neprilysin inhibitors that helps your blood vessels dilate, improves blood flow to and lessens the strain on your heart, and reduces the amount of salt your body retains. Potential side effects are dizziness, light-headedness, or a cough.
- Beta blockers: These medications help reduce your blood pressure by blocking epinephrine to help your heart beat slowly and less forcefully and to dilate your blood vessels. Commonly prescribed beta blockers include Sectral (acebutolol), Tenormin (atenolol), Kerlone (betaxolol), and Zebeta (bisoprolol). Side effects may include cold hands and feet, fatigue, and weight gain.
- Calcium channel blockers: Calcium channel blockers partially block the effect of calcium on heart muscle cells and blood vessels to reduce blood pressure and slow down the heart rate. Calcium channel blockers include Norvasc (amlodipine), Cardizem and Tiazac (diltiazem), Plendil (felodipine), and Sular (nisoldipine). Side effects can include constipation, headache, perspiration, drowsiness, rash, dizziness, heart palpitations, nausea, and swelling in your feet or legs.
- Diuretics: Diuretics prevent fluid and sodium from building up in your body to decrease your blood pressure. Examples of diuretics include Midamor (amiloride), Bumex (bumetanide), Diuril (chlorothiazide), and Hygroton (chlorthalidone). While they're generally fairly safe, you will probably notice increased urination. Other possible side effects include low sodium levels in your blood, dizziness, dehydration, headaches, muscle cramps, joint problems, and erectile dysfunction.
- Vasodilators: Also known as nitrates, vasodilators lessen your heart's workload by allowing your blood vessels to relax and dilate, increasing blood and oxygen to your heart. Because they can have a lot of side effects, vasodilators are generally only prescribed if other methods aren't working to control your blood pressure. Commonly prescribed vasodilators include Isordil (isosorbide dinitrate), Natrecor (nesiritide), nitro-glycerine tablets, and Apresoline (hydralazine). Side effects can include fast heartbeat, heart palpitations, fluid retention, nausea, vomiting, skin flushing, headaches, unusual hair growth, and joint or chest pain.
For Heart Attack or Arrhythmia Due to CAD
- Aldosterone antagonists: These potassium-sparing diuretics are used for heart failure and can help you live longer while improving your symptoms if you have suffered a heart attack due to CAD. Aldactone (spironolactone) and Inspra (eplerenone) are available options. One potential side effect is dangerously high potassium levels in your blood, so close monitoring by your doctor is necessary.
- Antiarrhythmic medications: Antiarrhythmic medications help regulate your heartbeat and are used to treat arrhythmias that can occur if CAD causes a heart attack affecting the pacemaker of the heart. Commonly prescribed antiarrhythmics include Cordarone (amiodarone), Tambocor (flecainide), Rhythmol (propafenone), and quinidine. Side effects may include taste changes, appetite loss, sensitivity to sunlight, diarrhoea, and constipation.
- Digitalis: Also known as Lanoxin (digoxin), this medication is used for heart failure and certain heart arrhythmias. Common potential side effects are dizziness, fainting, and slow or fast heartbeat.
Aspirin (acetylsalicylic acid), an over-the-counter antiplatelet medication, has long been recommended for prevention of blood clots for people who
are at risk of heart attacks and strokes. It may be recommended for you if you have CAD.
While you can get it without a prescription, you should still consult with your doctor before taking it. Do not start taking aspirin based on the advice of a
friend or something you may have read. If you are taking any other blood thinners, you should not take aspirin, as the effects of more than one blood thinner
add up to produce a dangerous risk of bleeding.
If lifestyle changes and medications aren't effectively treating your CAD, your doctor may recommend surgery or specialised procedures.
Procedures are especially useful when you have an area of severe CAD in your arteries. If you have not had a heart attack or a stroke, surgical treatment
can prevent you from having one. However, even if you have experienced a heart attack or a stroke, interventional treatment is often necessary to prevent
additional events resulting from your CAD.
Options that will be considered include:
- Percutaneous coronary interventions (PCI): Also known as angioplasty, PCI involves threading a tube with a deflated balloon attached to it through one of your veins to your coronary artery. Once it is positioned in the target location of CAD within an artery, the balloon is then inflated to widen the narrow or blocked regions in your coronary artery. This expansion allows blood to flow through your coronary artery much more freely.
- Endarterectomy: For some people with the atherosclerotic disease, surgically removing fatty build-up from the arterial walls can "clean" the inside of the artery to open up an area of partial or complete blockage.
- Coronary artery bypass graft (CABG): A CABG is a major surgical procedure that is used when your coronary artery is blocked. Your surgeon will use an artery or vein from your leg, arm, or chest to replace a severely diseased coronary vessel. This procedure reroutes blood around the blockage in your coronary vessel, allowing the blood and oxygen to flow more freely. You may have one or several grafts done, depending upon how many areas of blockage you have.
- Stent placement: A stent is a wire mesh tube that is placed inside an artery, either surgically or percutaneously (through a needle puncture of the skin), remaining in the artery to help keep it open.
Complementary Medicine (CAM)
There are functional foods and supplements that may help in treating CAD. Evidence shows that these supplements may reduce CAD, but you should not use them as a replacement for medication or surgery if you have severe disease.
It's a good idea to talk to your doctor before increasing or adding these to your diet.
- Flaxseed: A number of studies have shown that supplementing your diet with flaxseed may reduce bad cholesterol if your cholesterol is already high. You can mix flaxseed with food and drinks. Talk to your doctor about how much you should consume, as ingesting too much can cause problems like constipation or even bowel obstruction. Flaxseed also might not be good for people with certain other health conditions.
- Omega-3 fatty acids: The omega-3 fatty acids in fish may help decrease triglycerides, lower your cholesterol, and reduce inflammation. In fact, if you have an atherosclerotic disease or have recently had a heart attack, the American Heart Association recommends that you take omega-3 fish oil supplements every day to help treat your disease. You can get the same benefits from eating fish that are rich in omega-3 fatty acids at least twice a week. Tuna, salmon, mackerel, lake trout, herring, and sardines have the highest amounts, but most other fish are beneficial as well.
- Garlic: In a review of studies, it was found that garlic supplements have the potential to help prevent heart disease, as well as treat it. The studies included in the review used different types of garlic preparations such as garlic powder, aged garlic extract, or garlic oil. In general, the aged garlic extract had the most consistent effect. The studies showed that garlic supplementation had a positive effect on risk factors for atherosclerotic disease such as calcium build-up in the coronary arteries, artery stiffness, and a biomarker of inflammation called C-reactive protein. Garlic is very safe and the most common side effects are body odour and bad breath, which can be minimised if you take your garlic in capsule form instead of eating it raw. However, garlic may cause some digestive issues like abdominal pain, bloating, gas, and, rarely, allergic reactions.