By Dr Ananya Mandal, MD
Coronary artery disease is a widespread problem and claims millions of lives worldwide every year. The condition has severe effects on heart health and causes potentially fatal complications such as heart attacks.
Therapy for coronary artery disease generally involves three types of approach. These include:
- Medical management with drugs that reduce cholesterol, blood pressure and blood sugar
- Coronary angioplasty and implantation of coronary stents
- Coronary artery bypass grafting (CABG)
Medical management of coronary artery disease
Various drugs are available that can help to correct and control risk factors in coronary artery disease. Examples are given below.
- Statins such as atorvastatin, pravastatin and simvastatin are used to lower cholesterol. Other cholesterol lowering agents include niacin, fibrates and resins.
- Blood pressure lowering medications available include:
- Beta blockers such as atenolol and metoprolol
- Calcium channel blockers such as amlodipine
- ACE inhibitors such as enalapril and captopril
- Angiotensin receptor blockers such as losartan and candesartan
- Diuretics such as hydrochlorothiazide
- Examples of drugs that can be used to control blood sugar include:
- Sulphonylureas such as glimepiride and gliclazide
- Thiazolidinediones such as pioglitazone
- Nitrates can be used to treat angina, a common complication of coronary artery disease. Examples include glyceryl trinitrate and isosorbide mononitrate.
- Antiplatelet medications such as aspirin and clopidogrel help to reduce the risk of heart attacks in high risk individuals.
Surgical measures and coronary interventions
Sometimes, more aggressive therapy is needed to restore and improve blood flow. One coronary intervention is coronary angioplasty and stent placement. This is also called percutaneous coronary revascularization. A long thin tube is passed into the affected part of the artery and a deflated balloon placed in the narrowing. This balloon is then inflated, which pushes fatty deposits or plaques against the artery walls. A stent or thin piece of mesh is left in position to keep the artery open. Sometimes these stents are laced with slowly eluting medications to prevent inflammation and re-narrowing of the artery.
Another procedure is coronary artery bypass grafting (CABG). Here, a surgeon creates a graft using blood vessels from the leg or another part of the body that can be used as a channel to bypass a blocked artery. This procedure is performed as open-heart surgery and is generally only used in cases where multiple blockages are present.
Reviewed by Sally Robertson, BSc