What's the treatment for coronary artery disease?
Medical treatment generally includes medications, risk factor reduction, along with close follow-up with your health care team. Angioplasty or coronary interventions to open the clogged artery may also be used depending on the location and severity of the coronary artery disease. Coronary interventions may include balloon angioplasty, stenting, and atherectomy
(plaque removal).
Pharmacologic therapy should be a part of the treatment plan for every patient with documented coronary artery disease. Antiplatelet therapy should be prescribed for every patient, and an antianginal agent should be given to those who need it. Unless they are contraindicated, an angiotensin-converting enzyme (ACE) inhibitor and a beta blocker are recommended for all patients who have a history of MI.
Aspirin is the mainstay of antiplatelet therapy for patients who have coronary artery disease or symptoms suggestive of coronary artery disease. Aspirin inhibits both cyclo-oxygenase and the synthesis of thromboxane A2. For patients who have known vascular disease (eg, MI, stroke, or claudication), aspirin at 75 mg/d to 325 mg/d reduces the incidence of MI, stroke, and vascular death by approximately 33%.
Clopidogrel (Plavix), a thienopyridine derivative, blocks adenosine diphosphate induced platelet activation. Clopidogrel is indicated as an alternative for patients who cannot take aspirin. In fact, the Clopidogrel versus Aspirin in Patients at Risk of Ischaemic Events (CAPRIE) trial demonstrated the superiority of clopidogrel over aspirin in patients with documented atherosclerotic vascular disease. Compared with aspirin, clopidogrel treatment produced a statistically significant 0.53% reduction in the absolute risk of stroke, MI, or death (5.30% for clopidogrel v 5.83% for aspirin; p = 0.043). The dramatic cost difference between aspirin and clopidogrel is the likely reason that clopidogrel is not used more widely.
Beta-blockers, calcium channel blockers, and nitrates are the mainstays of antianginal therapy. Unless contraindications exist, all patients who have a history of angina pectoris should carry sublingual nitroglycerin. Beta-blockers are recommended as first-line therapy for the management of stable angina in all patients with established coronary artery disease. Contraindications to beta blockade include severe bradycardia, high-degree atrioventricular block, and sick sinus syndrome. Depression, asthma, and peripheral vascular disease are relative contraindications. The initial target heart rate should be 55 bpm to 60 bpm at rest, although some patients may require more aggressive beta blockade for adequate angina control. Dose-limiting symptoms include lethargy, fatigue, insomnia, nightmares, worsening asthma, or worsening claudication.
The main surgical treatment for coronary artery disease is coronary artery bypass grafting or CABG. This creates a ‘bypass route" for blood to flow around the clogged vessels to your heart. Recent advancements in CABG surgical treatments include minimally invasive approaches to this operation; however, this approach is not for everyone and would require an evaluation from a cardiothoracic or "heart" surgeon.
The safest, simplest treatment for coronary artery disease is lifestyle change. These include weight loss in obese patients, quitting smoking, diet and medications to lower high cholesterol, regular exercise, and stress reduction techniques (meditation, biofeedback, etc.).
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