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What are the considerations when treating CAD?

The treatment of coronary artery disease depends on how it's affecting you, how severe the condition may be and whether you have increased risk such as a family history of heart conditions or diabetes. Generally treatments cover lifestyle modifications, hereditary factors, medications and surgery.

Regardless of what’s happened in the past, the aim of treatment is to control your symptoms and, as much as possible, reduce your chances of having a heart attack or stroke in the future.

High risk of coronary artery disease but showing no symptoms

You can be at high risk of coronary artery disease but not yet show signs of it. For instance, you may have diabetes or a high absolute risk score which is a calculation of your total risk from a combination of risk factors. Your doctor may then aim to control your risk factors first by addressing lifestyle factors such as diet and exercise. If lifestyle changes don’t work, your doctor may recommend you take medications to lower your cholesterol and blood-pressure, even if your cholesterol levels and blood pressure aren’t that high.

While low-dose aspirin has been recommended for lowering the risk of symptoms of coronary artery disease, recent medical research suggests that even if you have risk factors for coronary artery disease, if you’ve not experienced angina or had a stroke or a heart attack then there’s not much to be gained by taking low-dose aspirin. Research suggests instead that low-dose aspirin has benefits for people who already have clot damage to their arteries showing up as angina, a heart attack or a stroke. Whether or not you should be taking low-dose aspirin is something you need to talk over with your doctor.

Other heart conditions

If you have an abnormal heart rhythm known as atrial fibrillation, which can be a complication of, and sometimes contribute to, coronary artery disease, then your doctor will probably refer you for more tests and advice. The ‘atria’ referred to in atrial fibrillation are the upper chambers of the heart. In atrial fibrillation, they lose coordination of their rhythm and can beat highly irregularly and become enlarged with a pouch developing (atrial appendage). Clots can form in the appendage and if it’s in the left atrium, these clots can break off and lodge in the brain causing a stroke. In general you’ll probably need to take a medication called warfarin which prevents blood clots. This medication is known as an anti-coagulant.

Angina

If you’re experiencing angina – the main group of symptoms of coronary artery disease – your treatment will depend on whether or not your angina is stable.

Unstable angina is a less common type of angina that can occur in someone who has had stable angina in the past. It is an emergency condition which needs to be taken seriously as it may be a sign that a heart attack is taking place or about to occur. The pattern of symptoms like chest pain, heaviness or discomfort is less predictable than in stable angina, often more severe and can occur frequently and unexpectedly, even when you’re resting. The symptoms of unstable angina may last longer than five minutes and may not resolve with rest or taking angina medication as prescribed. Because unstable angina is an indicator of high heart attack risk, it requires urgent medical assessment. If you think this is what you’re experiencing, you should call an ambulance so you can be treated at hospital.

Stable angina is the most common form of angina. With stable angina, you may feel mild symptoms such as chest, jaw, arm or neck discomfort or pain on exertion. These symptoms tend to be predictable as they’re usually triggered by a similar degree of activity – walking up a flight of stairs or a hill, for example. Generally the discomfort lasts for less than five minutes and responds to resting for a while or medication that relieves angina. Stable angina is not a condition that will disappear, although it can be improved with effective treatment. A care plan should be developed with your doctor that will help you to manage your condition and risks in the long term.

Treatments include medications, medical and surgical procedures, cardiac rehabilitation and lifestyle changes. The main goals of treatment are to:

  • reduce severity and frequency of pain and discomfort
  • prevent or lower the risk of a heart attack and death by treating the underlying condition.

While specialists may debate among themselves about which is better – lifestyle changes, medications, stents or bypass surgery – the reality is that all are important. Having coronary artery disease means you’re at high risk of heart attack and stroke. Surgery and stents can treat a bit of your arterial disease but they don’t replace major action on you and your doctor’s part to reduce your overall risks. In general, the scientific evidence supports aggressive measures to reduce the coronary risk factors in people with coronary artery disease. This may mean taking medications to lower blood pressure and cholesterol levels, as well as changing your diet and taking exercise as advised by your doctor. Even if your risk factors don’t seem that concerning, just by having angina means your risk level of a heart attack and stroke has been increased.

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Disclaimer
This information has been developed and reviewed for Bupa by health professionals. To the best of their knowledge it is current and based on reputable sources of medical research. It should be used as a guide only and should not be relied upon as a substitute for professional medical or other health professional advice.

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