Coronary Artery Disease and Angina

Description

Alternative Names

Managing Heart Disease

The approach for managing any degree of coronary artery disease involves lifestyle changes. Depending on severity and individual conditions, patients may need one or more medications, surgery, or both.

Heart disease may be prevented by recommended healthy diet, regular exercise and to stop smoking if you are a smoker. Follow your health care provider's recommendations for treatment and prevention of heart disease.

Experts have come up with a mnemonic device (ABCDE) for remembering ten factors that are fundamental for management of stable angina and coronary artery disease:

A. Aspirin and anti-angina drugs.

B. Blood pressure and beta-blockers.

C. Cholesterol-lowering agents (typically statins) and cigarettes (stopping).

D. Diet and diabetes control.

E. Exercise and education.

Unstable angina is now usually classified with non-Q myocardial infarction as acute coronary syndrome (ACS) in professional discussions of treatments. ACS usually requires more aggressive treatments, including surgery. [ACS is more fully discussed in Well-Connected Report #12 Heart Attack and Acute Coronary Syndrome.]

Click the icon to see an image about angina.

Important Medications and The Polypill

The most important medications for individuals at high risk for heart disease are aspirin, beta-blockers, and cholesterol-lowering agents (especially statins). A disturbing 2003 study reported that such medications were underused in women who needed them, including women with the greatest risks for heart attack. (Other medications are also necessary for people with specific risk factors, such as high blood pressure and diabetes.)

The Polypill. An intriguing study in 2003 suggested that taking a single daily pill containing a number of heart- and circulatory protective agents could largely prevent heart attacks and stroke in nearly everyone over 55. It would contain the following:

• A statin (such as Lipitor or Zocor). Statins inhibit the liver enzyme hMG-CoA reductase, which is used in the manufacturing of cholesterol. They are the most effective drugs for the treatment of high cholesterol and, according to a 2003 major analysis over 200 studies, they reduce risk for heart events by 60% and stroke by 17%.
• Three blood pressure lowering agents in low doses (e.g., a thiazide diuretic, a beta blocker, and an ACE inhibitor). An important study in 2003 suggested that this approach to lowering blood pressure may reduce the risk of stroke by 63% and heart disease by half. Using low doses of single agents also reduces the risk for side effects.
• Aspirin (low-dose).
• Folic acid. Folic acid lowers homocysteine levels, an amino acid believed to increase the risk for heart disease and stroke.

The experts in the study believed this combination would reduce ischemic heart events by 88% and stroke by 80%. Only 1% and 2% of the population would have to withdraw because of side effects. More research on this is certainly warranted.