Coronary Heart Disease - Treatment - Treatment

Your doctor may recommend that you adopt lifelong heart-healthy lifestyle changes, including:

• Aiming 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.
• Being 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 your doctor what level of physical activity is right for you.
• Heart-healthy eating, such as the DASH (Dietary Approaches to Stop Hypertension) eating plan. A heart-healthy eating plan includes fruits, vegetables, and whole grains and limits saturated fats, trans fats, sodium (salt), added sugars, and alcohol.
• Managing stress. Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health.
• Quitting smoking. Visit Smoking and Your Heart and the National Heart, Lung, and Blood Institute's 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.

Learn more about heart-healthy living.

Your doctor may recommend medicines to manage your risk factors or treat underlying causes of coronary heart disease. Some medicines can reduce or prevent chest pain and manage other medical conditions that may be contributing to your coronary heart disease.

• ACE inhibitors and beta blockers to help lower blood pressure and decrease the heart's workload.
• Calcium channel blockers to lower blood pressure by allowing blood vessels to relax.
• Medicines to control blood sugar, such as empagliflozin, canagliflozin, and liraglutide, to help lower your risk for complications if you have coronary heart disease and diabetes.
• Metformin to control plaque buildup if you have diabetes.
• Nitrates, such as nitroglycerin, to dilate your coronary arteries and relieve or prevent chest pain from angina.
• Ranolazine to treat coronary microvascular disease and the chest pain it may cause.
• Statins and/or non-statin therapies to control high blood cholesterol. Your doctor may recommend statin therapy if you have a higher risk for 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 doctor may prescribe non-statin drugs, such as, ezetimibe, bile acid sequestrants, alirocumab, or evolocumab to lower cholesterol or omega-3 fatty acids, gemfibrozil, or fenofibrate to reduce triglycerides.

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

• Percutaneous coronary intervention (PCI) to open coronary arteries that are narrowed or blocked by the buildup of atherosclerotic 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) to improve 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 obstructive coronary artery disease in multiple coronary arteries.
• Transmyocardial laser revascularization or coronary endarterectomy to treat severe angina associated with coronary heart disease when other treatments are too risky or did not work.