Treatment of Coronary Artery Disease
Treatment is based on your age, overall health and medical history. If lifestyle changes are not enough to control heart disease, your physician may prescribe medications to treat certain risk factors such as high cholesterol or high blood pressure. Appropriate medications depend upon the presence of other health conditions and the severity of the heart condition.
Risk Factor Modification
Risk factor modification includes smoking, elevated cholesterol levels, elevated blood glucose levels, lack of exercise, poor dietary habits, being overweight/obese and elevated blood pressure.
- Antiplatelets: Used to decrease the ability of platelets in the blood to stick together and cause clots. Examples includeaspirin, clopidogrel (Plavix®), ticlopidine (Ticlid®), and dipyridamole (Persantine®).
- Anticoagulants: Also described as blood thinners, these medications work differently than antiplatelets to decrease the ability of the blood to clot. An example of an anticoagulant is warfarin (Coumadin®).
- Antihyperlipidemics: Used to lower lipids (fats) in the blood, particularly low density lipid (LDL) cholesterol. Statins are a group of antihyperlipidemic medications and include simvastatin (Zocor®), atorvastatin (Lipitor®) and pravastatin (Pravachol®), among others.
- Bile acid sequestrants: Colesevelam, cholestyramine and colestipol, as well as nicotinic acid (niacin), are types of medications that may be used to reduce cholesterol levels.
- Antihypertensives: Used to lower blood pressure, several different groups of medications act in different ways to lower blood pressure.
Procedures for Coronary Artery Disease Treatment
- Atherectomy: A specialist cuts away the blocked area inside the artery by a tiny device on the end of a catheter.
- Coronary angioplasty: In balloon angioplasty, a cardiologist inserts a narrow, flexible tube (a catheter) into the groin and guides it along blood vessels to the narrowed coronary artery. At the tip of the catheter is a tiny balloon inflated to stretch open clogged arteries and flatten any plaque that may be blocking blood flow. When the balloon is deflated, a wire-mesh tube called a stent is inserted to keep the artery open.
- Coronary artery bypass: Commonly referred to as "bypass surgery," this procedure often is performed in individuals with angina (chest pain) and coronary artery disease (where plaque has built up in the arteries). Surgeons create a bypass by grafting a piece of a vein above and below the blocked area of a coronary artery, enabling blood to flow around the obstruction. Veins usually are taken from the leg, but arteries from the chest or arm sometimes are used to create a bypass graft.
- Coronary artery bypass grafting (CABG): This open heart surgical procedure transplants a healthy blood vessel from another part of your body. The harvested artery, or graft, serves as a detour route for blood flow, which travels around the obstructed coronary artery. Traditional CABG requires an incision down the chest. The heart must be stopped and placed on a heart-lung machine. However, a new wave of minimally invasive techniques is enabling surgeons to perform CABG while the heart continues pumping.
- Coronary artery stent: A tiny coil is expanded inside the blocked artery to open the blocked area. The coil is left in place to keep the artery open.
- Laser angioplasty: A laser vaporizes the blockage in the artery. Angioplasty offers numerous advantages over CABG. Although angioplasty does not involve surgery or a heart-lung machine, and recovery is much quicker, angioplasty is not an appropriate treatment for all cases of coronary artery disease. Your age, overall health, related medical conditions and severity of blockage are factors that can influence the choice of therapy.
- Percutaneous coronary intervention (PCI): This is angioplasty in the coronary arteries to permit more blood flow into the heart. PCI is also called percutaneous transluminal coronary angioplasty (PTCA).