Coronary Artery Disease

Lifestyle changes can help you lower your cardiovascular disease risk factors; manage risk factors you may have, such as diabetes, high blood pressure and unhealthy cholesterol; and prevent CAD from getting worse. Your doctor will likely recommend:

• Changes to diet: A heart-healthy diet high in fruits, vegetables and whole grains and low in salt, sugar, saturated fat and refined carbohydrates can lower blood pressure, help you maintain healthy cholesterol levels and help you reach a healthy weight.
• Exercise: Like diet, physical activity can help you with blood pressure, cholesterol and weight concerns. Aim for 150 minutes of moderate exercise a week.
• Sleep: Sleep gives your body a chance to repair damaged blood vessels. Try to get seven to nine hours of good-quality sleep each night. If you struggle to get enough sleep, talk to your doctor about whether you may have a sleep disorder.
• Smoking cessation: If you smoke, your provider can help you find tools to quit, such as medications, gums and other aids.
• Stress management: Stress may harm your heart, and it drives you to unhealthy behaviors, such as drinking alcohol, smoking and eating unhealthy foods. Find ways to manage stress and consider speaking to a mental health professional if needed.
• Weight loss: A healthy weight protects your heart and reduces many CAD risk factors. If diet and exercise are not enough, your doctor can connect you with a weight management program.

Your doctor might prescribe medicine to lower high blood pressure, address unhealthy cholesterol, prevent blood clots and manage chest pain. Medicine can also manage risk factors, such as obesity or high blood sugar.

Medications for coronary artery disease may include:

• ACE inhibitors and angiotensin-receptor blockers: These lower blood pressure so your heart does not work so hard.
• Aspirin (low dose): This helps prevent blood clots by thinning your blood. Your doctor might prescribe this to prevent a heart attack if you are at high risk or have already had one.
• Beta blockers: This group of medicines blocks the effect of your body’s stress hormones, reducing your heart rate and relieving pressure on your heart.
• Blood thinners: These include antiplatelet drugs and anticoagulants, which stop harmful blood clots from forming.
• Calcium channel blockers: These drugs relax your blood vessels, lowering your blood pressure.
• Colchicine: This medicine helps control inflammation, which can be linked to CAD, reducing your risk of heart attack and stroke.
• Nitroglycerin: This relaxes your blood vessels and can prevent or relieve chest pain.
• Ranolazine: This drug can relieve chest pain and treat coronary microvascular disease, which is caused by damage to small blood vessels in your heart.
• Statins: Statins treat high cholesterol levels by lowering your body’s production of cholesterol and preventing its buildup in your arteries.
• PCSK9 inhibitors: These drugs block the protein PCSK9, which helps your liver remove LDL cholesterol from your blood. Your doctor might prescribe them if you cannot take statins.

If you have advanced CAD or are at high risk of a heart attack or heart failure, you might need surgery. When possible, your surgeon will use nonsurgical or minimally invasive techniques, using small cuts to reduce recovery times.

CAD procedures include:

• Angioplasty and stenting: Your doctor inserts a catheter into one of your arteries and threads a small, deflated balloon at the site of the blockage. The balloon opens, widening the artery. A stent is usually put in place to keep the artery open.
• Coronary artery bypass grafting: Your surgeon will take a healthy piece of blood vessel from your leg, arm or chest. This is used to create a new channel for blood to flow around a blocked or narrowed coronary artery.
• Transmyocardial laser revascularization: This is a procedure where a laser makes small holes in your heart muscle to improve blood flow. It can treat severe chest pain if you are not a suitable candidate for angioplasty or bypass surgery.