How Is Coronary Artery Disease Treated?
Treatment for coronary artery disease (CAD) may
include lifestyle changes, medicines, and medical procedures. The goals of
treatments are to:
- Relieve symptoms
- Reduce risk factors in an effort to slow, stop,
or reverse the buildup of plaque
- Lower the risk of blood clots forming, which can
cause a
heart
attack
- Widen or bypass clogged arteries
- Prevent complications of CAD
Lifestyle Changes
Making lifestyle changes can often help prevent or
treat CAD. For some people, these changes may be the only treatment needed:
- Follow a heart healthy eating plan to prevent or
reduce
high
blood pressure and
high
blood cholesterol and to maintain a healthy weight
- Increase your physical activity. Check with your
doctor first to find out how much and what kinds of activity are safe for you.
- Lose weight, if you're overweight or obese.
- Quit smoking, if you smoke. Avoid exposure to
secondhand smoke.
- Learn to cope with and
reduce stress.
Follow a Heart Healthy Eating Plan
For a heart healthy eating plan, go to the National
Heart, Lung, and Blood Institute's (NHLBI's)
Aim
for a Healthy Weight Web site. This site provides practical tips on healthy
eating, physical activity, and controlling your weight.
Therapeutic Lifestyle Changes
(TLC). Your doctor may recommend TLC if you have high cholesterol. TLC
is a three-part program that includes a healthy diet, physical activity, and
weight management.
With the TLC diet, less than 7 percent of your daily
calories should come from saturated fat. This kind of fat is mainly found in
meat and poultry, including dairy products. No more than 25 to 35 percent of
your daily calories should come from all fats, including saturated,
trans, monounsaturated, and polyunsaturated fats.
You also should have less than 200 mg a day of
cholesterol. The amounts of cholesterol and the different kinds of fat in
prepared foods can be found on the Nutrition Facts label.
Foods high in soluble fiber also are part of a
healthy eating plan. They help block the digestive track from absorbing
cholesterol. These foods include:
- Whole grain cereals such as oatmeal and oat bran
- Fruits such as apples, bananas, oranges, pears,
and prunes
- Legumes such as kidney beans, lentils, chick
peas, black-eyed peas, and lima beans
A diet high in fruits and vegetables can increase
important cholesterol-lowering compounds in your diet. These compounds, called
plant stanols or sterols, work like soluble fiber.
Fish are an important part of a heart healthy diet.
They're a good source of omega-3 fatty acids, which may help protect the heart
from blood clots and inflammation and reduce the risk for heart attack. Try to
have about two fish meals every week. Fish high in omega-3 fats are salmon,
tuna (canned or fresh), and mackerel.
You also should try to limit the amount of sodium
(salt) that you eat. This means choosing low-sodium and low-salt foods and "no
added salt" foods and seasonings at the table or when cooking. The Nutrition
Facts label on food packaging shows the amount of sodium in the item.
Try to limit alcoholic drinks. Too much alcohol will
raise your blood pressure and triglyceride level. (Triglycerides are a type of
fat found in the blood.) Alcohol also adds extra calories, which will cause
weight gain. Men should have no more than two alcoholic drinks a day. Women
should have no more than one alcoholic drink a day.
See the NHLBI's
"Your
Guide to Lowering Your Cholesterol With TLC" for more information.
Dietary Approaches to Stop Hypertension
(DASH) eating plan. Your doctor may recommend the DASH eating plan if
you have high blood pressure. The DASH eating plan focuses on fruits,
vegetables, whole grains, and other foods that are heart healthy and lower in
salt/sodium.
This eating plan is low in fat and cholesterol. It
also focuses on fat-free or low-fat milk and dairy products, fish, poultry, and
nuts. The DASH eating plan is reduced in red meat (including lean red meat),
sweets, added sugars, and sugar-containing beverages. It's rich in nutrients,
protein, and fiber.
The DASH eating plan is a good heart healthy eating
plan, even for those who don't have high blood pressure. See the NHLBI's
"Your
Guide to Lowering Your Blood Pressure With DASH" for more information.
Increase Physical Activity
Regular physical activity can lower many CAD risk
factors, including LDL ("bad") cholesterol, high blood pressure, and excess
weight. Physical activity also can lower your risk for
diabetes and raise your levels of HDL cholesterol (the "good"
cholesterol that helps prevent CAD).
Check with your doctor about how much and what kinds
of physical activity are safe for you. Unless your doctor tells you otherwise,
try to get at least 30 minutes of moderate-intensity activity on most or all
days of the week. You can do the activity all at once or break it up into
shorter periods of at least 10 minutes each.
Moderate-intensity activities include brisk walking,
dancing, bowling, bicycling, gardening, and housecleaning.
More intense activities, such as jogging, swimming,
and various sports, also may be appropriate for shorter periods. See the
NHLBI's
"Your
Guide to Physical Activity and Your Heart" for more information.
Maintain a Healthy Weight
Maintaining a healthy weight can decrease risk
factors for CAD. If you're overweight, aim to reduce your weight by 7 to 10
percent during your first year of treatment. This amount of weight loss can
lower your risk for CAD and other health problems.
After the first year, you may have to continue to
lose weight so you can lower your body mass index (BMI) to less than 25.
BMI measures your weight in relation to your height
and gives an estimate of your total body fat. A BMI between 25 and 29 is
considered overweight. A BMI of 30 or more is considered obese. A BMI of less
than 25 is the goal for preventing and treating CAD.
You can calculate your BMI using the NHLBI's
online calculator, or your
health care provider can calculate your BMI.
For more information on losing weight and
maintaining your weight, see the Diseases and Conditions Index
Overweight
and Obesity article.
Quit Smoking
If you smoke or use tobacco, quit. Smoking can
damage and tighten blood vessels and raise your risk for CAD. Talk to your
doctor about programs and products that can help you quit. The U.S. Department
of Health and Human Services also has information on how to
quit smoking.
You also should avoid exposure to secondhand smoke.
Reduce Stress
Research shows that the most commonly reported
"trigger" for a heart attack is an emotionally upsetting
eventparticularly one involving anger. Also, some of the ways people cope
with stress, such as drinking, smoking, or overeating, aren't heart healthy.
Physical activity can help relieve stress and reduce
other CAD risk factors. Many people also find that meditation or relaxation
therapy helps them reduce stress.
Medicines
You may need medicines to treat CAD if lifestyle
changes aren't enough. Medicines can:
- Decrease the workload on your heart and relieve
CAD symptoms
- Decrease your chance of having a heart attack or
dying suddenly
- Lower your cholesterol and blood pressure
- Prevent blood clots
- Prevent or delay the need for a special procedure
(for example,
angioplasty
or coronary
artery bypass grafting (CABG))
Medicines used to treat CAD include anticoagulants
(AN-te-ko-AG-u-lants), aspirin and other antiplatelet (an-ty-PLAYT-lit)
medicines, ACE inhibitors, beta blockers, calcium channel blockers,
nitroglycerin, glycoprotein IIb-IIIa, statins, and fish oil and other
supplements high in omega-3 fatty acids.
Medical Procedures
You may need a medical procedure to treat CAD. Both
angioplasty and CABG are used as treatments.
Angioplasty opens blocked or narrowed coronary
arteries. During angioplasty, a thin tube with a balloon or other device on the
end is threaded through a blood vessel to the narrowed or blocked coronary
artery. Once in place, the balloon is inflated to push the plaque outward
against the wall of the artery. This widens the artery and restores the flow of
blood.
Angioplasty can improve blood flow to your heart,
relieve chest pain, and possibly prevent a heart attack. Sometimes a small mesh
tube called a
stent
is placed in the artery to keep it open after the procedure.
In CABG, arteries or veins from other areas in your
body are used to bypass (that is, go around) your narrowed coronary arteries.
CABG can improve blood flow to your heart, relieve chest pain, and possibly
prevent a heart attack.
You and your doctor can discuss which treatment is
right for you.
Cardiac Rehabilitation
Your doctor may prescribe cardiac rehabilitation
(rehab) for angina or after CABG, angioplasty, or a heart attack. Cardiac
rehab, when combined with medicine and surgical treatments, can help you
recover faster, feel better, and develop a healthier lifestyle. Almost everyone
with CAD can benefit from cardiac rehab.
The cardiac rehab team may include doctors, nurses,
exercise specialists, physical and occupational therapists, dietitians, and
psychologists or other behavioral therapists.
Rehab has two parts:
- Exercise training. This part helps you learn how
to exercise safely, strengthen your muscles, and improve your stamina. Your
exercise plan will be based on your individual abilities, needs, and interests.
- Education, counseling, and training. This part of
rehab helps you understand your heart condition and find ways to reduce your
risk for future heart problems. The cardiac rehab team will help you learn how
to cope with the stress of adjusting to a new lifestyle and with your fears
about the future.
For more information on cardiac rehab, see the
Diseases and Conditions Index
Cardiac
Rehabilitation article.
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