Treatment Options

Non-Surgical Treatment for Coronary Artery Disease

Significant Value

The coronary arteries are blood vessels that carry blood and oxygen to the heart muscle. Coronary artery disease occurs when these arteries become clogged with fatty deposits (plaque). As a result, the blood flow and oxygen supply to the heart are decreased causing pain and heart muscle damage. If a blood vessel in the heart becomes completely or mostly blocked, then a heart attack or myocardial infarction may occur. If a blood vessel in the heart becomes only partly blocked, then chest pain (angina) may occur. Chest pain is the most common symptom of CAD. Coronary artery disease is the single leading cause of death in the U.S. It accounts for over 950,000 deaths a year, which is about 1 death every 33 seconds.

The non-surgical treatments for CAD include changes in lifestyle and use of medications. Invasive procedures (surgery), such as coronary artery graft bypass surgery (CABG) or balloon angioplasty with stent placement, may be used for advanced CAD.

The decision of how to treat CAD is based on a number of factors. These factors include the symptoms, the type of blockage, other diseases or conditions that may exist, and personal preference. For those who have stable CAD and find the risk of invasive procedures or surgery unacceptable, non-surgical treatment may be an option.

Two groups of risk factors are associated with CAD. One group of risk factors is called non-modifiable, which means you cannot control or change them. The non-modifiable factors includes a family history of CAD, being a male, being a female after menopause, and being over 45 years of age. The second group of factors is referred to as modifiable risk factors and includes things that can be changed. Modifiable risk factors include activities such as smoking cigarettes, eating a high fat diet, high blood pressure, uncontrolled diabetes, sedentary lifestyle, and obesity. All of the modifiable risk factors can be addressed through lifestyle changes.

Things to Consider

  • This assessment will address changes in lifestyle and use of medications for the non-surgical treatment of coronary artery disease (CAD).
  • About 12.6 million Americans suffer from CAD, however there are ways to help prevent and control it.
  • CAD is the most common type of heart disease and is the leading cause of death for both men and women in the U.S.
  • CAD often leads to a heart attack.

See also:

Results

Significant Value

Will I live longer if I have non-surgical treatment for CAD?

Appropriate changes in lifestyle and use of medications can stop and possibly reverse the affects of CAD. However, for some people with certain types of CAD, non-surgical treatment may have to be combined with more aggressive treatments, such as balloon angioplasty and CABG.

Will non-surgical treatment of CAD improve my quality of life?

Successful non-surgical treatment can improve your physical ability to exercise and your mental and emotional sense of well being. However, the best treatment for CAD is prevention. Prevention can be accomplished through the six lifestyle changes previously mentioned - stop smoking cigarettes, lower high blood pressure, reduce high blood cholesterol, lose extra weight, become physically active, and manage diabetes.

Does non-surgical treatment of CAD make my symptoms better?

For many, the changes in lifestyle and medications used to treat CAD can control the symptoms and also slow or stop the progression of the disease.

Safety

Significant Value

Non-surgical treatment avoids the possible complications associated with the aggressive, invasive alternatives of balloon angioplasty and CABG. Non-surgical treatment may be tried, and if not adequate, can be supplemented with the more aggressive, invasive treatments.

Your health care provider will need to closely monitor lifestyle changes and medication usage associated with non-surgical treatment. If prescribed, medications must be taken as directed. Medications can have side effects. If side effects occur, they should be reported to the doctor. Often, a change in the dose or type of medication, or the use of a combination of medications, can stop the side effects.

Comparison

Moderate Value

Many factors have to be considered to determine the best treatment for each individual. These factors include the number of blockages the individual has, where in the vessels the blockages occur, the general health of the individual, and personal preferences. It has been suggested that the invasive procedures be reserved for people with CAD that is not well controlled by the non-surgical treatment. All treatment options should be discussed with your physician.

Changes in lifestyle can help prevent or control CAD. These changes are:

  • Avoid all tobacco products
  • Lower high blood pressure
  • Reduce high blood cholesterol
  • Lose extra weight
  • Become physically active
  • Manage diabetes

Medications that are used to decrease symptoms of CAD and improve the heart's function include:

  • Aspirin – prevents clots from forming in the arteries
  • ACE (angiotensin converting enzyme) inhibitor – lowers blood pressure and reduces the strain on your heart
  • Beta-blockers – slows the heart rate, which lowers blood pressure and reduces the work on the heart
  • Calcium channel blockers – relaxes blood vessels, which lowers blood pressure and treats heart pain
  • Digitalis – helps the heart contract better and/or slows the heartbeat
  • Diuretic – decreases fluid in the body, which treats high blood pressure
  • Nitroglycerin – relaxes and dilates blood vessels to relieve heart pain
  • Statins – reduces blood cholesterol levels

Invasive procedures or surgery may be required when lifestyle changes and medication use are not able to control CAD symptoms, or when the blood vessel narrowing progresses to a point that the heart muscle is in danger of damage. The two commonly used invasive procedures to treat CAD are balloon angioplasty and CABG. Both of these procedures have risks and may relieve the symptoms of CAD, but do not cure the disease. Following both of these invasive procedures, lifestyle changes are still necessary and medication is also frequently required.

Cost

Significant Value

While the cost for non-surgical treatment is usually less than an invasive surgical procedure, the exact cost will depend on the number and type of medications being taken.

The cost may or may not be covered by your health benefits plan.

Sources

The following are off-site links off-site link :

Circulation.  AHA/ACCF secondary Prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease:  2011 update. Retrieved January 8, 2014 from http://circ.ahajournals.org/content/124/22/2458.full.pdf+html.

MayClinic.com. (2012, June). Coronary artery disease. Retrieved January 8, 2014 from http://www.mayoclinic.com/health/coronary-artery-disease/DS00064/METHOD=print&DSECTION=all.

National Heart, Lung, and Blood Institute. What is coronary heart disease. Retrieved January 8, 2014 from http://www.nhlbi.nih.gov/health/health-topics/topics/cad/.

Next Review Date

1/23/2015

This document has been classified as public information.

Table of Findings

results:  significant value

safety:  significant value

comparison:  moderate value

cost: significant value


total: significant value

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Page modified:January 31, 2014