Coronary Heart Disease Treatment

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Your treatment for coronary heart disease depends on how serious your symptoms are and any other health conditions you have. If you are experiencing a heart attack, for example, you may need emergency treatment. If your healthcare provider diagnoses you with coronary heart disease based on symptoms and tests, your treatment may include heart-healthy lifestyle changes in combination with medicine to prevent a heart attack or other health problems. Your provider will consider your 10-year risk calculation when deciding how best to treat your coronary heart disease.

Your provider may recommend adopting lifelong heart-healthy lifestyle changes.

• Aim for a healthy weight. Losing just 3% to 5% of your current weight can help you manage some coronary heart disease risk factors, such as high blood cholesterol and diabetes. Greater amounts of weight loss can also improve blood pressure readings.
• Be physically active. Routine physical activity can help manage coronary heart disease risk factors such as high blood cholesterol, high blood pressure, or overweight and obesity. Before starting any exercise program, ask about what level of physical activity is right for you.
• Heart-healthy eating may include the DASH (Dietary Approaches to Stop Hypertension) eating plan. A heart-healthy eating plan includes fruits, vegetables, and whole grains and limits saturated fats, sodium (salt), added sugars, and alcohol.
• Manage stress. Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health.
• Quit smoking. Visit Smoking and Your Heart and Your Guide to a Healthy Heart. Although these resources focus on heart health, they include basic information about how to quit smoking. For free help and support to quit smoking, you can call the National Cancer Institute's Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848). Talk to your doctor if you vape. There is scientific evidence that nicotine and flavorings found in vaping products may damage your heart and lungs.
• Get enough good-quality sleep. The recommended amount for adults is 7 to 9 hours of sleep a day.

Some medicines can reduce or prevent chest pain and manage other medical conditions that may contribute to your coronary heart disease.

• ACE inhibitors and beta blockers help lower blood pressure and decrease how hard your heart is working.
• Calcium channel blockers lower blood pressure by allowing blood vessels to relax.
• Medicines to control blood sugar, such as empagliflozin, canagliflozin, and liraglutide, can help lower your risk for complications if you have coronary heart disease and diabetes.
• Metformin controls plaque buildup if you have diabetes.
• Nitrates, such as nitroglycerin, dilate your coronary arteries and relieve or prevent chest pain from angina.
• Ranolazine treats coronary microvascular disease and the chest pain it may cause.
• Statins or non-statin therapies control high blood cholesterol. You may need statin therapy if you have a higher risk of coronary heart disease or stroke or if you have diabetes and are between ages 40 and 75.
• Non-statin therapies may be used to reduce cholesterol when statins do not lower cholesterol enough or cause side effects. Your healthcare provider may also prescribe non-statin drugs, such as ezetimibe, bile acid sequestrants, alirocumab, or evolocumab to lower cholesterol or gemfibrozil or fenofibrate to reduce triglycerides. They may also recommend omega-3 fatty acids as a supplement to your healthy diet.

You may need a procedure or heart surgery to treat more serious coronary heart disease.

• Percutaneous coronary intervention (PCI) opens coronary arteries that are narrowed or blocked by the buildup of plaque. A small mesh tube called a stent is usually implanted after PCI to prevent the artery from narrowing again.
• Coronary artery bypass grafting (CABG) improves blood flow to the heart by using normal arteries from the chest wall and veins from the legs to bypass the blocked arteries. Surgeons typically use CABG to treat people who have severe coronary artery disease in multiple coronary arteries.
• Transmyocardial laser revascularization or coronary endarterectomy treats severe angina linked to coronary heart disease when other treatments are too risky or did not work.