Management Guidelines for Coronary Artery Disease

Coronary artery disease, where the arteries carrying blood to the heart become clogged, is the most common type of heart disease and is the leading cause of heart attacks. Coronary artery disease also can weaken the heart over time because the buildup in the arteries prevents an adequate supply of blood from reaching the heart, leading to changes in heart rhythm and heart failure. The guidelines for managing coronary artery disease focus on lifestyle changes, medicines to relieve symptoms or slow the buildup of plaque, and surgical procedures to unclog or re-route blocked arteries.

Lifestyle Changes

• The leading treatment recommendation to manage coronary artery disease is to make changes to the patient's lifestyle--most of these changes involve modifying diet and increasing exercise. The guidelines suggest that patients should follow a heart-healthy diet that focuses on less red meat, low- or reduced-fat dairy products, whole grains, fruits, vegetables and lean fish and meat. Achieving and maintaining a blood pressure of 120/80 mm/Hg is critical, as is controlling cholesterol levels. Doctors recommend that patients should keep their LDL cholesterol below 100 mg/dL. Patients who smoke should stop; the guidelines even recommend that patients with coronary artery disease avoid second-hand smoke as much as possible. Another leading lifestyle change mentioned in most treatment guidelines is learning how to better manage stress. A frequent trigger for heart attacks is a stressful event. Patients who develop healthy ways to manage stress--such as exercise--will fare better than those who manage stress in unhealthy ways--such as by overeating or smoking.

Medicines Can Help Support Lifestyle Changes

• Guidelines for coronary artery disease recommend drug therapy for a number of reasons. Perhaps the changes in lifestyle or diet weren't reducing the patient's risk for a heart attack. The patient may also still suffer symptoms or continue to exhibit high blood pressure or high cholesterol. Concerns about clotting (which can lead to a heart attack) are also a major reason for starting drug therapy. Drugs to help relieve or treat these symptoms include such options as aspirin or other anticoagulants (for clots), statins (for cholesterol), nitroglycerin (to dilate the blood vessels), ACE inhibitors (for patients at high risk of a heart attack) and beta blockers (for abnormal heart rate and blood pressure). Doctors may also prescribe fish oil supplements. These supplements, rich in omega-3 fatty acids, can help reduce cholesterol levels and triglycerides and prevent coronary artery disease from worsening.

Surgical Procedures

• If a patient's symptoms are serious enough, or if his symptoms do not respond well to the drugs or changes in diet and lifestyle, the guidelines recommend that the doctor consider surgical procedures. Most procedures for coronary artery disease involve either unblocking a partially blocked artery (angioplasty) or bypassing the blocked part of an artery (coronary artery bypass graft).

  Angioplasty is a procedure where a surgeon threads a thin wire up a patient's veins to get to the blocked part of the artery. The wire usually has a balloon or other device attached. Once the surgeon gets the wire to the clogged part of the artery, he inflates the balloon to unblock the artery and restore normal blood flow. Sometimes surgeons also place a stent in the artery to prevent it from becoming blocked again. Stents are small mesh tubes that keep the blood vessel open.

  Coronary artery bypass graft (bypass surgery, or CABG) is a procedure where a surgeon takes a piece of a vein or artery from another part of the patient's body and surgically attaches it to the coronary artery to bypass the blockage. Re-routing the blood flow in this way is a complicated procedure, but it does improve blood flow to the heart and can prevent a heart attack.

  A key part of the recommendations for these surgical procedures is an intensive exercise and educational program that involves a team of doctors, nurses, dietitians, physical therapists and mental health counselors to help the patient recover fully from the procedure.