Coronary artery disease (CAD), also referred to as coronary heart disease, is a thickening of the small blood vessels, the coronary arteries, that supply blood, oxygen, and nutrients to the heart muscle. When cholesterol and fat collect inside the coronary arteries and narrow the passage, heart muscles are deprived of oxygen and nutrients. This can cause conditions such as arrhythmia (an irregular heart beat) or angina (chest pain or discomfort that results from poor blood flow through the vessels to the heart muscles). When blood supply to a portion of the heart muscle is blocked completely, the portion of the heart muscle may stop working, resulting in a heart attack.

Coronary artery disease is the leading cause of death in men and women in America. According to the World Health Organization (WHO), coronary artery disease kills more than 7 million people each year. And WHO predicts that in 2020, 11.1 million people will die from CAD.

Lifestyle

Changing your diet and lifestyle is the best way to lower cholesterol and to reduce your risk of coronary artery disease. Here are some tips:

• Control your blood pressure, and monitor often, especially if you have been diagnosed with high blood pressure already. If you are already taking blood pressure medications, be sure to take them regularly.
• Watch your weight. Obesity and the sedentary lifestyle that often leads to it have been shown to increase the risk of CAD, high blood pressure, and high cholesterol levels. Following some of the tips below will help you control your weight in addition to reducing your overall risk for CAD.
• Eat foods low in cholesterol and saturated fats, like fish, vegetables, fruits, oatmeal, whole grains, and beans.
• Avoid using too much butter, trans fat margarines, or polyunsaturated oils. Replace them with canola oil or olive oil.
• Exercise regularly to make your heart stronger and reduce the risk of heart disease. It is recommended on average to get at least 30 minutes of exercise each day. Consult your doctor before starting a new exercise regimen and to determine the appropriate duration and type of exercise for you.
• Avoid nicotine in any form. It can increase your blood pressure and make your heart beat faster.
• Talk to your doctor about taking vitamins as a form of prevention. Vitamin E may lower the risk of heart attack and B vitamins may prevent CAD. However, you should consult your doctor before regularly taking these vitamins.

Cholesterol lowering medications

“Bad” cholesterol plays a crucial role in coronary artery disease. If lifestyle changes alone are not effective in lowering cholesterol within a year, a doctor will often prescribe medication. These medications work by lowering the “bad” cholesterol level or raising the amount of “good” cholesterol. The effects of medication can be maximized when combined with lifestyle changes.

Cholesterol lowering medications include:

• Statins: Statins are considered a first-line treatment for anyone with high cholesterol. They are also helpful in preventing coronary artery disease in people at risk. Statins work by lowering the cholesterol level in the body and strengthening the lining of the blood vessels.

• Resins: Resins attach themselves to bile acids, which are made using cholesterol, and carry them out of your body. This causes the body to use more cholesterol for bile acid production, which in turn lowers the cholesterol level.

• Fibrates: Fibrates lower the triglycerides in your body, which are believed to increase the risk of heart disease. Fibrates also raise your “good” cholesterol. 

• Niacin: Niacin helps extract energy from the food you eat. When taken in excess, niacin, like fibrates, lowers triglycerides and raises “good” cholesterol.

Antiplatelets

The main job of antiplatelets is to stop blood clots from forming. When blood clots block the arteries, especially in the case of coronary artery disease, it prevents blood from reaching parts of the body and can be dangerous. The most recognizable antiplatelet is aspirin, which can be taken daily in low dose form. However, for people with certain conditions such as asthma or stomach ulcers, taking aspirin daily can pose risks, so you should not start taking aspirin before talking with your doctor. Other antiplatelet drugs include the prescription medications clopidogrel and ticlopidine.

Beta blockers

Beta-adrenergic blocking agents, or beta blockers, focus on the hormone epinephrine. Since epinephrine can raise blood pressure and heart rate, beta blockers make the heart pump slower, controlling blood pressure. It is also effective in preventing heart attacks in people who have already had one.

Vasodilators

Vasodilators work by opening the blood vessels, allowing more blood and oxygen to reach the heart.  In turn, the heart works less and blood pressure is lowered. Side effects can include dizziness, headache, and an irregular heartbeat.

ACE inhibitors & ARBs

Both ACE inhibitors and ARBs lower blood pressure by targeting the level of angiotensin in your body. Angiotensin is a chemical that narrows the blood vessels, which makes it harder for blood to flow. Angiotensin-converting enzyme (ACE) inhibitors open up the blood vessels while also reducing angiotensin. Angiotensin receptor blockers (ARBs) do not actually lower angiotensin. Instead, they block the chemical from affecting the heart and blood vessels.

Calcium channel blockers

Calcium channel blockers treat high blood pressure and can also lower heart rate.  The medication stops calcium from getting into cells, specifically to the heart and blood vessel walls. This expands the blood vessels and allows for easier blood flow.

Medical Procedures

When lifestyle changes and medication are not enough and the arteries have become dangerously narrow, a medical procedure is a possible solution.

Coronary Angioplasty

In the United States alone, over one million people per year receive a coronary angioplasty. It is a procedure aimed at opening narrow arteries in the heart. The goal is to return blood flow to a manageable state where the heart is not overexerting or damaging itself. A successful angioplasty can reduce angina, the risk of heart attack and stroke, and even death.

An angioplasty is performed by an interventional cardiologist. A catheter is inserted in a blood vessel in your arm or leg. Once inside the blood vessel, the catheter, which is a long, narrow tube, is moved to the affected coronary artery through the visual aid of X-rays. From there, one of four procedures can take place to expand the artery.

• Balloon angioplasty. A small balloon attached to the end of the catheter is slid near the source of blockage. The balloon is then inflated, pushing the materials blocking the artery against the walls and opening the pathway for blood to flow. The balloon and catheter are removed afterwards.

 

• Stenting. This is the same procedure as a balloon angioplasty, but adds a stent as a permanent support for the artery instead of just inflating and exiting. The balloon is placed inside the stent, inserted into the artery, and inflated. The stent then stays open and holds the newly expanded artery in place. Some stents are coated with medication to prevent the artery from collapsing.

 

• Rotablation. Instead of pushing the blockage against the artery walls, there is a procedure that eliminates the plaque completely. Rotablation uses a catheter with a tip shaped like an acorn. The tip sits at the area of blockage and spins at a high speed. This breaks up the plaque into much smaller pieces that are easily taken away in the bloodstream.

 

• Cutting balloon. A cutting balloon is commonly used when plaque has built up over a stent. The balloon is equipped with blades that puncture the plaque and push it into the walls.

Recovery from an angioplasty is between one and two days. An overnight hospital stay may be required, but most people are up and mobile within six hours of the procedure.

Bypass Surgery

Coronary artery bypass graft surgery, or CABG, is the most common type of heart surgery performed in the United States. A CABG involves taking an artery from another part of the body, usually the arm or chest, and sewing it around the blocked artery, allowing a bypass for blood to travel through. A single surgery can bypass up to four blocked arteries.

Bypass surgery is major, open-heart surgery. The day of surgery, the patient will be given anesthesia and put to sleep. A respirator placed in your windpipe will assist in breathing, while a tube is sent down the throat to the stomach to prevent air and liquid from collecting. Finally, a catheter is inserted into the bladder to collect urine.

For bypass surgery, your heart needs to be stopped. To do this, the patient is hooked up to a heart-lung machine, which circulates blood through the body while the heart is at rest. The sternum is opened up, and one end of the replacement vein is attached to the coronary artery. The other end is attached to the ascending aorta, which carries blood from the heart to the rest of the body.

The length of surgery depends on the number of bypasses performed, generally anywhere from two to six hours. Recovery time in the hospital is around a week, with an additional four to ten weeks required for a complete recovery. In 85 percent of people who have bypass surgery, there is a drop in symptoms and a lowered risk of heart attack. Though it is a mostly successful surgery, around 30 percent of people require another procedure in the decade following due to a blocked bypass artery.