Overview of Coronary Heart Disease Treatments

What Are the Best Treatments for Coronary Artery Disease?

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Treating the type of heart disease known as coronary artery disease (CAD) is a little like fighting a war: It's a long-term struggle that has to be fought on many different fronts, and if you let your guard down you may pay a high price. So, if you have been diagnosed with CAD, you and your doctor have a lot to prepare for, and a lot of strategic decisions to make.

This article outlines the things you need to consider as you and your doctor decide on the right approach to treating your heart disease.

Some of these treatments (such as taking steps to slow the progression of the disease) should be adopted by every single patient with CAD. Other options (such as bypass surgery or angioplasty and stenting) are not suitable or even desirable for everyone. To to be sure that everything that should be done is being done, you and your doctor will need to carefully answer all three of the following questions.

1) How Can you Reduce Your Risk of Cardiac Ischemia and Angina?

CAD is caused by atherosclerosis, a disease that causes plaques to form in the walls of your coronary arteries. Those plaques can eventually produce complete blockage of the arteries, which leads to a myocardial infarction (heart attack). But long before that happens, partial blockages are often already in your heart's arteries.

This is important to keep in mind, because partial blockages of the coronary arteries can limit the flow of blood to your heart muscle.

So, while your heart muscle may be getting all the blood it needs while you are relaxed and at rest, these partial blockages can prevent your heart muscle from receiving an adequate amount of oxygen when you are exercising or under stress. During these times -- when your heart requires more oxygen than the partially blocked coronary artery can provide -- your heart muscle experiences ischemia.

The oxygen-starved (ischemic) heart muscle can cause the painful or uncomfortable sensation which we refer to as angina. Because this kind of angina is due to a relatively stable blockage, and because the angina it produces occurs relatively predictably (that is, during a certain amount of exercise), we call it stable angina.

There are two general treatment options for preventing ischemia and stable angina in patients who have CAD.

  • The first approach, and the one we tend to hear more about, is to use so-called "invasive therapy" - that is, to use either bypass surgery or angioplasty and stenting to relieve specific blockages within the coronary arteries.
  • The second approach is to use drug therapy and other forms of non-surgical, non-catheter-based treatment.
Both approaches can be very effective, and each approach carries its own advantages or disadvantages. You will need to talk to your doctor about which approach is more appropriate in your case - but keep in mind that often a combination of these two approaches is best.

Read about bypass surgery here, and angioplasty and stents here.

Read about drug therapy and other non-invasive therapies for ischemia and angina here.

2) How Can You Prevent Heart Attacks and Other Acute Problems with CAD?

In addition to gradually developing blockages in your coronary arteries, you are also at risk for sudden deterioration, which doctors call acute coronary syndrome (ACS). ACS is caused by the sudden formation of a blood clot (thrombosis) within a coronary artery, usually due to rupture of a plaque in the wall of the artery. ACS can cause either unstable angina or a heart attack. Either form of ACS is a medical emergency.

Because anyone with CAD can develop ACS - even patients whose plaques are not yet producing significant blockages (this is what appears to have happened to TV journalist Tim Russert, for instance) - it is extremely important for everyone with CAD to be on treatment to help prevent ACS. Several steps can be taken to help reduce this risk, and you need to talk to your doctor about each of them.

Read about reducing your risk of ACS here.

3) How Can You Slow or Stop the Worsening of CAD?

Atherosclerosis is a chronic, progressive disease that gets worse over time. So no matter what other treatments for CAD you may receive, unless you also take steps to slow or stop the advance of atherosclerosis, you can expect to develop more and more problems as time goes by.

It is possible to slow the progression of CAD with an aggressive program of lifestyle changes and medical treatments, including intensive anti-cholesterol therapy (usually requiring statins), weight control, exercise, smoking cessation, controlling high blood pressure, and careful control of diabetes, if you have it..

Read here about controlling the factors that cause CAD to worsen.

Summing It Up

Doing all of this will not be easy, but it is vitally important to winning the war of heart disease. In many ways, heart disease is also similar to another common disease, cancer. Like cancer, CAD is a life-threatening disease that is very likely to kill you, sooner or later, unless it's adequately treated. And, as with cancer, the treatment is tough. Successful treatment requires a deep commitment, and indeed a requires fundamental change in attitude and in focus. If you had cancer, you would likely adopt that whatever-it-takes attitude. You need to adopt the same attitude now: Your life depends on it.


Fraker TD, Fihn SD, on behalf of the 2002 Chronic Stable Angina Writing Committee. 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina. J Am Coll Cardiol 2007; 50:2264. Available at: http://content.onlinejacc.org/cgi/content/full/j.jacc.2007.08.002 (Accessed September 4, 2008).

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