How Is Coronary Heart Disease Treated?

Treatments for coronary heart disease (CHD) include lifestyle changes, medicines, and medical procedures. Treatment goals may include:

• Relieving symptoms.
• Reducing risk factors in an effort to slow, stop, or reverse the buildup of plaque.
• Lowering the risk of blood clots forming. (Blood clots can cause a heart attack.)
• Widening or bypassing clogged arteries.
• Preventing complications of CHD.

Lifestyle Changes

Making lifestyle changes often can help prevent or treat CHD. Lifestyle changes might be the only treatment that some people need.

Follow a Healthy Diet

A healthy diet is an important part of a healthy lifestyle. Following a healthy diet can prevent or reduce high blood pressure and high blood cholesterol and help you maintain a healthy weight.

For information about healthy eating, 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 blood 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 found in some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods.

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 types of fat in prepared foods can be found on the foods' Nutrition Facts labels.

Foods high in soluble fiber also are part of a healthy diet. They help prevent the digestive tract 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 rich in fruits and vegetables can increase important cholesterol-lowering compounds in your diet. These compounds, called plant stanols or sterols, work like soluble fiber.

A healthy diet also includes some types of fish, such as salmon, tuna (canned or fresh), and mackerel. These fish are a good source of omega-3 fatty acids. These acids may help protect the heart from blood clots and inflammation and reduce the risk of heart attack. Try to have about two fish meals every week.

You also should try to limit the amount of sodium (salt) that you eat. This means choosing low-salt and "no added salt" foods and seasonings at the table or while cooking. The Nutrition Facts label on food packaging shows the amount of sodium in the item.

Try to limit drinks that contain alcohol. 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 drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day. One drink is a glass of wine, beer, or a small amount of hard liquor.

For more information about TLC, go to the NHLBI's "Your Guide to Lowering Your Cholesterol With TLC."

Dietary Approaches to Stop Hypertension (DASH). 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 low in fat, cholesterol, and sodium.

DASH also focuses on fat-free or low-fat milk and dairy products, fish, poultry, and nuts. The DASH eating plan is reduced in red meats (including lean red meats), sweets, added sugars, and sugar-containing beverages. It's rich in nutrients, protein, and fiber.

The DASH eating plan is a good healthy eating plan, even for those who don’t have high blood pressure. For more information, go to the NHLBI’s "Your Guide to Lowering Your Blood Pressure With DASH."

Be Physically Active

Routine physical activity can lower many CHD risk factors, including LDL ("bad") cholesterol, high blood pressure, and excess weight.

Physical activity also can lower your risk for diabetes and raise your HDL cholesterol level. HDL is the "good" cholesterol that helps prevent CHD.

Talk with your doctor before you start a new exercise plan. Ask him or her how much and what kinds of physical activity are safe for you.

People gain health benefits from as little as 60 minutes of moderate-intensity aerobic activity per week. The more active you are, the more you will benefit.

For more information about physical activity, go to the U.S. Department of Health and Human Services' "2008 Physical Activity Guidelines for Americans," the Health Topics Physical Activity and Your Heart article, and the NHLBI's "Your Guide to Physical Activity and Your Heart."

Maintain a Healthy Weight

Maintaining a healthy weight can lower your risk for CHD. A general goal to aim for is a body mass index (BMI) of less than 25.

BMI measures your weight in relation to your height and gives an estimate of your total body fat. You can use the NHLBI's online BMI calculator to figure out your BMI, or your doctor can help you.

A BMI between 25 and 29.9 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 CHD. Your doctor or other health care provider can help you set an appropriate BMI goal.

For more information about losing weight or maintaining a healthy weight, go to the Health Topics Overweight and Obesity article.

Quit Smoking

If you smoke, quit. Smoking can raise your risk for CHD and heart attack and worsen other CHD risk factors. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.

If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.

For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the NHLBI's "Your Guide to a Healthy Heart."

Manage Stress

Research shows that the most commonly reported "trigger" for a heart attack is an emotionally upsetting event—particularly one involving anger. Also, some of the ways people cope with stress—such as drinking, smoking, or overeating—aren't healthy.

Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health. Having supportive people in your life with whom you can share your feelings or concerns can help relieve stress.

Physical activity, medicine, and relaxation therapy also can help relieve stress. You may want to consider taking part in a stress management program.

Medicines

You may need medicines to treat CHD if lifestyle changes aren't enough. Medicines can:

• Reduce your heart’s workload and relieve CHD 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 procedure or surgery (for example, angioplasty or coronary artery bypass grafting (CABG))

Medicines used to treat CHD include anticoagulants (AN-te-ko-AG-u-lants), also called blood thinners; aspirin and other anticlotting 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.

Procedures and Surgery

You may need a procedure or surgery to treat CHD. Both angioplasty and CABG are used to treat blocked coronary arteries. You and your doctor can discuss which treatment is right for you.

Angioplasty

Angioplasty is a nonsurgical procedure that opens blocked or narrowed coronary arteries. This procedure also is called percutaneous (per-ku-TA-ne-us) coronary intervention, or PCI.

A thin, flexible 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 compress the plaque against the wall of the artery. This restores blood flow through the artery.

During the procedure, the doctor may put a small mesh tube called a stent in the artery. The stent helps prevent blockages in the artery in the months or years after angioplasty.

For more information, go to the Health Topics Angioplasty article.

Coronary Artery Bypass Grafting

CABG is a type of surgery. 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.

For more information, go to the Health Topics Coronary Artery Bypass Grafting article.

Cardiac Rehabilitation

Your doctor may prescribe cardiac rehabilitation (rehab) for angina or after CABG, angioplasty, or a heart attack. Almost everyone who has CHD can benefit from cardiac rehab.

Cardiac rehab is a medically supervised program that may help improve the health and well-being of people who have heart problems.

The cardiac rehab team may include doctors, nurses, exercise specialists, physical and occupational therapists, dietitians or nutritionists, and psychologists or other mental health specialists.

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 personal 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 rehab team will help you learn how to cope with the stress of adjusting to a new lifestyle and deal with your fears about the future.

For more information, go to the Health Topics Cardiac Rehabilitation article.

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