Coronary Artery Disease

Medications

Many people have trouble correctly taking their medicines for coronary artery disease. Often, they need to take several medicines at different times of the day. And some people struggle to afford the medicines. But medicines are often a key part of treatment, and people who do not take them as prescribed have an increased risk of complications and death.⁷ Find out more about how to take medicines properly.

Medicines to treat symptoms and prevent complications

If you have symptoms of coronary artery disease, your doctor may prescribe some of the following medicines to control symptoms and, in some cases, slow the progression of the disease:

• Aspirin and other antiplatelet medications help prevent blood clots in your coronary arteries. This can decrease your risk of heart attack and stroke. For more information, see:

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

• Beta-blockers slow your heart rate and lower your blood pressure to reduce the amount of work your heart has to do. They also reduce angina.
• Statins lower your cholesterol and may reduce your risk of a future heart attack. Your doctor may use the National Cholesterol Education Program's (NCEP) guidelines to help decide if you need treatment with medicine to lower cholesterol.
• Nitrates (nitroglycerin and long-acting nitrates) relieve chest pain and other symptoms of angina.
• Calcium channel blockers slow your heart rate and lower your blood pressure to reduce your heart's workload. They also help widen (dilate) your coronary arteries and reduce angina.
• Ranolazine (Ranexa) relieves chest pain when nitroglycerin, beta-blockers, and calcium channel blockers don't work. 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.
• Angiotensin-converting enzyme (ACE) inhibitors lower your blood pressure and reduce the strain on your heart. They may also reduce your risk for a future heart attack or heart failure.
• Angiotensin II receptor blockers (ARBs) lower your blood pressure and reduce the strain on your heart. If you cannot tolerate certain side effects of an ACE inhibitor, your doctor may prescribe an ARB instead.

Anticoagulants may also be used after an angioplasty, atherectomy, or bypass surgery. The anticoagulant warfarin may be used if you have heart disease as well as atrial fibrillation or other complications.

What to Think About

Medicines for angina

Stable angina can often be controlled with medicine. For more help with controlling angina, see the topic Quick Tips: Taking Charge of Your Angina.

If angina symptoms become worse, your doctor may need to adjust your medicines. But if angina symptoms still get worse and medicines don't help, you may need angioplasty or bypass surgery. For angina that gets worse quickly or occurs at rest (unstable angina), you may need hospitalization and urgent angioplasty, stenting, or bypass surgery. For more information, see the topic Heart Attack and Unstable Angina.

Do not use erection-enhancing medicines such as sildenafil (Viagra), vardenafil (Levitra), or tadalafil (Cialis) if you take nitroglycerin or other nitrates for angina. Combined, these two drugs can cause a serious drop in blood pressure.

If you are taking an erection-enhancing medicine and seek treatment for angina, tell the doctor about your use of this medicine so you don't get nitroglycerin or another type of nitrate. There are other medicines that may work instead to ease your chest pain.

Aspirin

Aspirin, ibuprofen, and naproxen are all nonsteroidal anti-inflammatory drugs (NSAIDs) and can relieve pain and inflammation. But only aspirin will reduce your risk for heart attack. Don't substitute ibuprofen or naproxen for low-dose aspirin therapy. If you need to take an NSAID for a long time, talk with your doctor to see if it is safe for you.

For more information, see:

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

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Author:	Robin Parks, MS	Last Updated: January 8, 2008
Medical Review:	Caroline S. Rhoads, MD - Internal Medicine Robert A. Kloner, MD, PhD - Cardiology Ruth Schneider, MPH, RD - Diet and Nutrition
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