How is Coronary Artery Disease Treated?

Coronary artery disease (CAD) is a leading cause of death around the world. Managing risk for CAD and understanding its signs and symptoms are important parts of a treatment plan. Prevention and treatment go hand in hand. Making lifestyle changes is the first step in treating CAD. Drugs or surgery may be needed.^1,2

Healthy eating

The basics of healthy living form the core concepts of treating CAD. Many of the benefits of a heart-healthy lifestyle impact one another.^2-5 Eat a heart-healthy diet. There are many recommended diets such as the Mediterranean, keto, or DASH. But you can’t go wrong with these basic steps:

• More fruits and vegetables
• Whole grains, nuts, and legumes
• Reduce bad fats by not eating fried or processed foods
• Low-fat proteins like fish and poultry
• Limit intake of salt, sugar, red meat, alcohol and white starches
• Avoid or limit caffeine and alcohol

Other lifestyle changes

Get regular exercise. Leading an active lifestyle can help you live longer. Benefits may include:^2,4

• Improving blood pressure and cholesterol levels
• Weight control
• Better management of diabetes and other health conditions

Don’t smoke. We already know smoking isn’t good for the lungs, but it can damage the blood vessels of the heart as well. Manage stress. Long-term stress contributes to several negative health effects, including coronary artery disease.² Stress causes the body to release hormones that cause the heart to speed up. This creates a racing feeling and makes the heart work harder.

Manage weight. Diet and exercise are key. Being overweight makes other risk factors for CAD worse.^2,4 Manage blood pressure. Controlling blood pressure helps reduce hardening of the arteries which can narrow the channel for blood flow.^2,4 Keep diabetes and cholesterol under control. High cholesterol levels in the blood can increase the risk of plaque formation. Together with blood sugar management you can help reduce the risk of complications for heart disease.^2,4

Drugs to treat CAD

There are many different kinds of drugs to treat coronary artery disease:^2,3,5,6

• Cholesterol medications - there are a range of cholesterol-lowering medications. Some common ones include statins, PCSK9 inhibitors, resins, and lipid-lowering therapies like niacin and fibrates.
• Aspirin - a daily aspirin or another blood thinner can reduce the ability of the blood to clot. This may help prevent buildup in the coronary arteries.
• Beta-blockers - these drugs slow the heart rate and reduce blood pressure which can lower the heart's demand for oxygen.
• Calcium channel blockers - these drugs can help improve symptoms of chest pain and are used in combination with or instead of beta-blockers.
• Ranolazine - prescribed to treat chest pain (angina), it improves blood flow to help the heart work more efficiently.
• Nitroglycerin - controls chest pain by temporarily widening the coronary arteries and reducing the heart's demand for blood. Nitroglycerin can quickly relieve pain or discomfort.
• ACE inhibitors - vasodilators work to lower blood pressure by widening blood vessels. This improves blood flow which makes it easier for the heart to work properly. These drugs also block the effects of harmful stress hormones.
• ARBs - Angiotensin II Receptor Blockers (ARBs) are an alternative for ACE inhibitors and offer similar benefits.

Be sure to follow the instructions for each drug that you take. Do not stop taking any drug, even if you are feeling better.^3,6 Report any sudden change in the way you feel to your healthcare team.

Procedures to treat CAD

There are different kinds of procedures available to treat more severe CAD.^2,3,7

Cardiac catheterization is performed as a diagnostic tool to identify coronary blockages or to evaluate the pressures and cardiac output of the heart. A long thin catheter is inserted into an artery in the groin or arm which is threaded up through the arteries around the heart. Contrast or dye is injected, and x-rays are taken to see if there are blockages in the arteries.⁷ Catheterization is also used for certain procedures like coronary angioplasty or stenting if blockages are found.

A stent is a wire mesh tube that is permanently placed in a blocked coronary artery. It is a minimally invasive procedure done by catheterization. The stent is placed on the end of the wire that is guided into the blocked coronary artery.⁷ When in place, a balloon inflates to press the stent open to widen the blocked artery. It is permanently positioned in the artery to reduce the chance of another blockage developing.^1-2 Multiple stents can be placed in the same artery and in separate arteries. The goal is to relieve chest pain and improve blood flow to the heart.

Coronary bypass graft surgery (CABG) is a common open-heart surgery that reroutes blood flow around a clogged artery. The procedure uses healthy arteries or veins taken from other parts of the body, called grafts.⁷ A surgeon sews them into the aorta and then into the coronary artery to bypass the blockage. This improves the supply of blood and oxygen to the heart. Bypass surgery reduces the risk of a heart attack and improves the ability to engage in physical activity.²