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Coronary Artery Disease

Prevention & Treatment

Monday, Aug. 27, 2007; 7:44 PM

Copyright Harvard Health Publications 2007

Prevention

Table of Contents

You can help to prevent coronary artery disease by controlling your risk factors for atherosclerosis. To do this:

  • Quit smoking.

  • Eat a healthy diet.

  • Reduce your high blood LDL cholesterol ("bad cholesterol").

  • Reduce high blood pressure.

  • Lose weight and exercise to prevent diabetes.

Treatment

Coronary artery disease caused by atherosclerosis is treated with:

  • Lifestyle changes - 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.).

  • Nitrates (including nitroglycerin) - These medications widen blood vessels (vasodilators). Nitrates widen the coronary arteries and increase the blood flow to the heart muscle. They also widen the body's veins, which lightens the heart's workload by temporarily decreasing the volume of blood returning to the heart for pumping.

  • Beta-blockers, such as atenolol (Tenormin) and metoprolol (Lopressor) - These medications decrease the heart's workload by slowing the heart rate and reducing the force of heart muscle contractions, especially during exercise. People who have had a heart attack should stay on a beta-blocker for life to reduce the risk of a second heart attack.

  • Aspirin - Aspirin helps to prevent blood clots from forming inside narrowed coronary arteries. It can reduce the risk of heart attack in people who already have coronary artery disease. Doctors often advise people older than 50 to take a low dose of aspirin every day to help prevent a heart attack.

  • Cholesterol-lowering medications - Statins - such as lovastatin (Mevacor), simvastatin (Zocor), pravastatin (Pravachol) and atorvastatin (Lipitor) - have had the greatest impact on improving the risk of heart attack and death in people with coronary artery disease and those at risk of coronary artery disease. Statins lower LDL cholesterol and may raise HDL cholesterol slightly. Taking a statin regularly also helps to prevent plaques from tearing or breaking, which decreases the chance of a heart attack or worsening of angina. Niacin lowers LDL cholesterol, raises HDL cholesterol, and also lowers triglyceride levels. Medications called fibrates, such as gemfibrozil (Lopid), are used primarily in people with high triglyceride levels. Ezetimibe (Zetia) works within the intestine to decrease the absorption of cholesterol from food.

  • Calcium channel blockers, such as long-acting nifedipine (Adalat, Procardia), verapamil (Calan, Isoptin), diltiazem (Cardizem), amlodipine (Norvasc) - These medications may help to decrease the frequency of chest pain in people with angina.

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