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 having a heart attack, for example, you may need emergency treatment. If your healthcare provider diagnoses you with coronary heart disease, your treatment may include heart-healthy lifestyle changes in combination with medicines to prevent a heart attack or other health problems. Your provider will consider your 10-year risk calculation and work with you to determine how best to treat your coronary heart disease.

Your provider may recommend adopting lifelong heart-healthy lifestyle changes, such as the following:

• Choose heart-healthy foods. A heart-healthy eating plan includes fruits, vegetables, and whole grains and limits saturated fats,  sodium  (salt), added sugars, and alcohol. Your healthcare provider may recommend following the DASH (Dietary Approaches to Stop Hypertension) eating plan or Therapeutic Lifestyle Changes (TLC) Program. 
• 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 your provider what level of physical activity is right for you.
• Quit smoking. Smoking can damage and tighten your blood vessels. Learn more about how smoking affects your heart and tips to help you 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 provider 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. During sleep, your body can work to repair your heart and blood vessels. Not getting enough hours of sleep or good-quality sleep can raise your risk for heart disease and other health problems. The recommended amount for adults is 7 to 9 hours of sleep a day.
• Aim for a healthy weight. Reaching and maintaining a healthy body weight can help you manage some coronary heart disease risk factors, such as high blood cholesterol, diabetes, and high blood pressure. You can work with your provider to create a weight-loss plan that is right for you.
• Get your blood pressure and cholesterol checked. Your provider can help you get your blood pressure and blood cholesterol to a healthy range.
• Control your blood sugar. High levels of glucose (sugar in your blood) can damage your blood vessels. You can work with your provider to limit how many calories you get each day from added sugars to help lower your risk of heart disease.
• Manage stress. Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health.

Some medicines can reduce or prevent chest pain and manage other medical conditions that may contribute to your coronary heart disease. Tell your healthcare provider about all the medicines you take and any complementary health strategies you use, such as dietary supplements for lowering your cholesterol or meditation for managing your high blood pressure. Together, you and your provider can make a treatment plan that is right for you.

As part of your treatment plan, your provider may prescribe you medicines that widen your blood vessels and help your heart beat with less force:

• 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.
• Nitrates, such as nitroglycerin, dilate your coronary arteries and relieve or prevent angina (chest pain).
• Ranolazine treats coronary microvascular disease and the chest pain it may cause.

Your provider may also prescribe medicines to help manage the levels of cholesterol in your blood:

• Statins, such as atorvastatin and rosuvastatin, can help control high blood cholesterol and slow down plaque buildup. You may need statin therapy if you have a high risk of coronary heart disease or stroke or if you have diabetes and are between the ages of 40 and 75. Your provider may stop the treatment if you are pregnant or planning a pregnancy. Learn how to take statins safely.
• Nonstatins are medicines that can help lower your cholesterol levels if you cannot take statins or you require additional cholesterol lowering. Your provider may also prescribe them in combination with a statin if statins alone are not enough to manage your cholesterol. Ezetimibe and bile acid sequestrants can lower the amount of cholesterol and fat you absorb from food. PCSK9 inhibitors, such as alirocumab and evolocumab, are nonstatins that you inject under your skin every 2 to 4 weeks to help remove cholesterol from your blood.
• Medicines that lower your blood triglycerides can also help manage your cholesterol in combination with a heart-healthy diet. Your provider may prescribe fibrates (such as gemfibrozil or fenofibrate), omega-3 fatty acids, or niacin to help lower your triglyceride levels. However, this type of nonstatin is less effective in lowering your risk of coronary heart disease.

Some medicines can help manage other risk factors for heart disease, such as high blood sugar, overweight and obesity, or diabetes:

• Medicines to control blood sugar, such as empagliflozin, canagliflozin, metformin, and liraglutide, can help lower the risk of complications for people with coronary heart disease and diabetes.
• Medicines for weight management, such as orlistat, semaglutide, and liraglutide, can help lower the risk of coronary heart disease for people with overweight or obesity. To be effective, these medicines should be combined with a healthy diet and regular physical activity.

You may need a procedure or heart surgery to treat coronary heart disease that is more serious:

• Percutaneous coronary intervention (PCI) opens coronary arteries that are narrowed or blocked by the buildup of plaque. During the procedure, your healthcare provider may use shock waves to break up the hardened plaque and may also implant a small mesh tube, or stent, in your artery to prevent it from narrowing again. This can help relieve angina, or chest pain, which happens when the heart cannot get enough oxygen-rich blood. However, this procedure does not protect you from serious complications of coronary heart disease, such as heart failure or cardiac arrest. 
• Coronary artery bypass grafting (CABG) improves blood flow to the heart by using healthy 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. Your provider may recommend this surgery to lower your risk of having a heart attack and other complications.
• Transmyocardial laser revascularization or coronary endarterectomy treats severe angina linked to coronary heart disease when other treatments are too risky or do not work.
• Bariatric surgery can help lower risk of coronary heart disease and other problems that affect the blood vessels for people with obesity, especially for people who also have diabetes. Before choosing this procedure, it is important to talk with your healthcare provider about the benefits and risks of this approach.