Coronary Heart Disease (cont.)
Medical Treatment: Medications
Coronary artery disease decreases blood supply to the heart from the blocked coronary artery. The lower blood flow may fail to meet the heart's demand for oxygen. Treatment aims to balance blood supply to the heart with heart oxygen demand, and prevent worsening of coronary heart disease.
Aspirin: When taken daily or every other day, aspirin reduces the risk of developing angina or heart attack by reducing the tendency of your blood to clot.
- It reduces the chance that a clot will form over a
rupturing plaque in the coronary artery, a common underlying phenomenon in
heart attack (myocardial infarction).
- Side effects of aspirin include ulcers or bleeding problems.
- Talk to your health care provider before starting aspirin.
Beta-blockers: Beta-blockers decrease your heart rate and blood pressure, thus reducing your heart's demand for oxygen. Clinical trials have shown prevention of future heart attacks and sudden death.
Nitroglycerin: This medication reduces chest pain both by decreasing your heart's oxygen demand and by dilating the coronary arteries, increasing the oxygen supply.
- Sprays or tablets placed under your tongue are designed to be taken when you need instant relief from angina.
- Long-acting nitroglycerin tablets or skin patches work slowly over many hours.
Calcium channel blockers: Calcium channel blockers dilate the coronary arteries to improve blood flow. They also reduce blood pressure, and slow heart rate.
ACE inhibitors: Angiotensin-converting enzyme (ACE) inhibitors work by dilating blood vessels, increasing blood flow.
- They recently have been shown to reduce the numbers of cardiac events, heart attacks, and deaths in people with coronary heart disease, unrelated to their blood pressure lowering effect. Therefore, additional beneficial tissue effects on blood vessels and heart muscle is thought to occur.
- They are immensely useful in people with diabetes and those with weakened heart muscles.
Statins: Statin drugs work by reducing the amounts of lipids (cholesterol and other fats) in your blood.
- This changes the inner lining of the blood vessels so plaques are less likely to form or get large.
- They slow or stop the progression of coronary heart disease and also deter repeat heart attacks.
- Recently, clinical trials have shown beneficial effects immediately after a heart attack or threatened heart attack, even before the fat lowering effect is maximal, meaning they stabilize the plaque.
- Examples include atorvastatin (Lipitor), pravastatin (Pravachol), simvastatin (Zocor), lovastatin (Mevacor), and rosuvastatin (Crestor).
Vibhuti N Singh, MD, MPH, FACC, FSCAI
Francisco Talavera, PharmD, PhD
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