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:
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 Smoking.
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. 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.