Overview of Coronary Heart Disease Treatments

What Are the Best Treatments for Coronary Artery Disease?

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If you have coronary artery disease (CAD), you should regard its treatment 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 only suitable under specific circumstances. To to be sure that everything that should be done is being done, you and your doctor will need to specifically and carefully answer three questions:

  • What should you do to prevent cardiac ischemia and angina?
  • What should you do to prevent a heart attack and other cardiac emergencies?
  • What should you do to slow or stop the worsening of your CAD?

Your treatment program is incomplete unless you address all three of these critical 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 commonly develop in the coronary arteries. 

This is important to your health, 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.

However, keep in mind that in most people with stable angina, the outcomes with medical therapy are the same as with invasive therapy. You will need to talk to your doctor about which approach is more appropriate in your case — often a combination of these two approaches turns out to be needed.

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

In addition to gradually developing blockages in your coronary arteries, people with CAD 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 people whose plaques are not yet producing “significant” blockages — it is extremely important for everyone with CAD to be on treatment to help prevent ACS. You can take several steps to help reduce this risk, and you need to talk to your doctor about each of them.

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 o, if you have it..

Summing It Up

Doing all of this will not be easy, but it is vitally important to winning the war on your own heart disease. In many ways, heart disease is 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 it often 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.

Sources:

Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients with Stable Ischemic Heart Disease: a Report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2012; 126:e354.

Task Force Members, Montalescot G, Sechtem U, et al. 2013 ESC Guidelines on the Management of Stable Coronary Artery Disease: the Task Force on the Management of Stable Coronary Artery Disease of the European Society of Cardiology. Eur Heart J 2013; 34:2949.

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