Coronary Artery Disease

Treatment

Treatment is tailored to each patient, depending on the cause and severity of the coronary artery disease (CAD). Treatment options comprise:

Medications

Medications can help prevent the progression of coronary artery disease. If the disease is present, prescription drugs can improve blood flow to the heart. Some of the more common medications include:

• Cholesterol-lowering medications. By decreasing the amount of cholesterol in the blood, especially LDL (the "bad" form of cholesterol), these drugs decrease the primary material that deposits on the coronary arteries. Examples include statins, niacin, fibrates and bile acid sequestrants.
• Aspirin. This common over-the-counter medication may be recommended as an anti-platelet, which thins the blood, and as an anti-coagulant, which reduces the tendency for blood to clot and block a coronary artery, causing a heart attack. Other anti-platelet drugs or anti-coagulants may be prescribed as well.
• Beta-blockers. These drugs help make the heart's job of pumping blood easier by relaxing the heart, slowing its rhythm, decreasing blood pressure and lowering the heart's demand for oxygen. They include metoprolol, atenolol and propranolol.
• Nitroglycerin. This drug, as a tablet, spray or skin patch, helps relieve chest pain (angina) by opening narrowed blood vessels and improving blood flow to the heart muscle. The patient may also receive nitrates, a longer-lasting form of nitroglycerin.
• Calcium channel blockers. These medications help to open coronary arteries to increase blood flow to the heart muscle. They can also help reduce high blood pressure.
• ACE inhibitors (angiotensin converting enzyme inhibitors). Similar to beta-blockers, these help lower blood pressure and make the heart's job of pumping blood easier. In addition, ACE inhibitors have shown significant benefits for patients in recovering from a heart attack. They include ramipril, lisinopril, enalapril and captopril.
• Vitamins. Folic acid, B-6 and B-12 are vitamins that help to decrease homocysteine in the blood. Homocystiene has been associated with accelerated clogging of the arteries (atherosclerosis). In specific situations, some patients may be prescribed L-arginine or Omega-3 fatty acids.

Surgical and Other Invasive Procedures

When medications and lifestyle adjustments cannot relieve the chest pain symptomatic of coronary artery disease, surgery may be necessary to restore adequate function to the heart. Patients may benefit from one or more of these surgical treatment options:

• Catheter-assisted procedures. A thin, flexible tube (catheter) is inserted into the patient's artery, usually in the leg, and then is threaded through the arteries to the heart. Read more about heart catheterization.


Angioplasty involves moving a balloon-tipped catheter to the coronary artery obstruction, then inflating the balloon to widen the artery opening.

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• Coronary angioplasty and stents. Angioplasty opens blocked coronary arteries to allow blood to flow more freely to the heart. When the catheter tip reaches a blocked artery, a small balloon expands in the artery to push open the blood vessel. To help prevent the artery from closing again, the heart surgeon will typically insert a small wire tube (stent) in the coronary artery to help keep it open. The stent may be plain, drug-coated or a drug time-release stent (eluting stent.)
• Radiation brachytherapy. In cases where coronary artery blockage reoccurs, the patient may benefit from brachytherapy. In this procedure, the coronary artery segment is reopened during angioplasty and exposed to radiation. The procedure is performed in the catheterization laboratory in collaboration with radiation oncologists and radiation physicists.
• Atherectomy. A catheter is inserted into the blocked artery and one of several types of small devices remove plaque build-up.
• Coronary artery bypass surgery. Bypass surgery, also called coronary artery bypass grafting (CABG), creates a detour around a blocked coronary artery with a new blood vessel, or graft. A short piece of blood vessel (graft) is taken from another location in the body and surgically placed onto the heart muscle, around the blocked coronary artery. Blood flows through the new graft to the heart. If more than one artery is blocked, each can be bypassed. Heart surgeons at Mayo Clinic regularly perform more than 1,000 coronary bypass operations each year, using innovative techniques. Read more about bypass surgery.

Healthy Lifestyle Programs

Adopting a healthy lifestyle is one of the best treatments for coronary artery disease. Either by itself or in combination with medical treatments, a healthy lifestyle can prevent or slow coronary artery disease. All patients with coronary artery disease can benefit from healthy lifestyles.

Mayo Clinic offers patients and their families an array of services to help change unhealthy habits into a healthy lifestyle. These services include:

• Regular exercise and physical activity. Patients receive medical guidance in building habits for regular exercise, including those recovering from heart attacks and those who have low physical strength for exercise.
• Smoking cessation assistance. Mayo Clinic offers programs to help people quit using tobacco. Cigarette smoking and other uses of tobacco are a leading cause of coronary heart disease. Mayo Clinic research has identified numerous successful ways that help patients succeed in quitting smoking.
• Heart-healthy diet and nutrition. Counselors advise patients and their families on healthy diets and nutrition to reduce the risk of another heart attack, including reducing salt intake to help reduce blood pressure and advice on losing weight. In addition, patients and their families will learn about other factors that contribute to heart attacks, including managing stress and limiting alcohol consumption.

Cardiac Rehabilitation Program.

Many patients have benefited from Mayo Clinic's cardiac rehabilitation program while recovering from a heart attack or other conditions caused by coronary artery disease. The program starts with a walking schedule for the first six to eight weeks after surgery and progresses to more vigorous, supervised physical training.

Regular Medical Check-Ups

Regular medical check-ups are recommended to identify heart problems before they become serious. Patients who have high blood pressure, high cholesterol and/or diabetes need to control those conditions in order to lower their risks for coronary artery disease.

Mayo Clinic cardiologists coordinate care with patients' primary care physicians to help patients comply with efforts to control risk factors for coronary artery disease. They also help with medication needs and, when needed, cardiac rehabilitation.

Gene Therapy

One of the newest, and still investigational, developments in treatment of coronary artery disease is gene therapy. Mayo Clinic has been an international leader in researching and using gene therapy to treat heart disease.

To restore blood flow to the heart, genes and growth factor proteins may be injected directly into the heart or through a catheter-delivery system. These materials may stimulate new vessels to grow (angiogenesis), helping restore blood flow to the heart.

Other Treatments

Mayo investigators are studying a number of investigational treatments of coronary artery disease such as spinal cord stimulation or medications designed to affect the linings of coronary arteries.