Coronary Heart Disease Treatment

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Treatment for coronary heart disease depends on how serious your symptoms are and any other health conditions you have. Symptoms are likely to worsen as plaque builds up in the coronary arteries.

If your healthcare provider diagnoses you with coronary heart disease, treatment may include heart-healthy lifestyle changes, medicines, or procedures to prevent a heart attack or other health problems.

Your provider will consider your 10-year or lifetime risk calculation and work with you to set up a treatment plan.

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. Use a chart to record how much physical activity you get and track when you do strength exercises.
• 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 quality sleep. During sleep, your body can work to repair your heart and blood vessels. Not getting enough hours of sleep or 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 night.
• 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 glucose (sugar in your blood). High levels of glucose 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.

TIP SHEET

Put Your Heart into Getting Active & Eating Healthy 

Learn tips for adopting a heart-healthy lifestyle.

Read the tip sheet

Some medicines can reduce or prevent chest pain and manage health conditions that can worsen coronary heart disease. Tell your healthcare provider about all the medicines you take and any complementary health strategies you use, such as taking dietary supplements to lower your cholesterol or medication to control your blood pressure and stress level.

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 medicines to relax your blood vessels and help your heart beat with less force:

• ACE inhibitors, beta blockers, and angiotensin-receptor 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 recommend medicines to help manage cholesterol levels in your blood:

• Statins , such as atorvastatin and rosuvastatin, can help control high blood cholesterol and slow plaque buildup. Talk with your provider about statin therapy if you have a high risk of coronary heart disease or stroke, or if you have diabetes and are between ages 40 and 75. Your provider may stop the treatment if you are pregnant or planning a pregnancy. Learn how to take statins safely.
• Non-statins are medicines that can help lower your cholesterol levels if you cannot take statins. Your provider may also prescribe them along 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 non-statins that you inject under your skin every 2 to 4 weeks to help remove cholesterol from your blood. 
• Medicines to lower your blood triglycerides can also help control blood 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.

Some medicines can help manage health conditions that are risk factors for coronary heart disease:

• Medicines to control blood sugar can help lower the risk of complications for people with diabetes and coronary heart disease. Diabetes medicines may also aid in weight loss, further reducing heart disease risk. SGLT2/1 inhibitors are approved for people with diabetes and chronic kidney disease to lower their risk of complications of coronary heart disease.
• Medicines for weight management, such as semaglutide or tirzepatide may help lower the risk of coronary heart disease for people with overweight or obesity. To be effective, you should use these medicines in combination with a healthy diet and regular physical activity.
• Dual-antiplatelet therapy combines aspirin and another medicine to block platelets from forming blood clots . Your provider may recommend this therapy if you are at high risk for developing clots due to a heart attack, stroke, stent placement, or percutaneous coronary intervention (PCI).
• Low-dose aspirin (75 to 100 milligrams daily) acts as a blood thinner. Providers generally recommend aspirin only for adults diagnosed with or at high risk for coronary heart disease. If you have had a heart attack or stroke, your healthcare provider may ask you to take a daily low dose of aspirin to help prevent another heart attack or stroke. Aspirin is not safe for people who have a high risk of bleeding.
• Medicine to lower inflammation. Your provider may prescribe colchicine, a medicine that helps control inflammation linked with coronary heart disease.
• Certain complementary and alternative approaches may help manage some coronary heart disease risk factors. Some supplements, such as beta carotene and vitamin E, do not help and may even harm you. Multivitamins and chelation therapy do not seem to help stop plaque buildup or reduce complications of coronary heart disease. Talk with your provider before taking supplements for this purpose. Read more about the use of dietary supplements in cholesterol management.

You may need a procedure or heart surgery to treat serious coronary heart disease and lower your risk of complications:

• Percutaneous coronary intervention (PCI), also called coronary angioplasty , opens coronary arteries that are narrowed or blocked by the buildup of plaque. During the procedure, your healthcare provider may also implant a small mesh tube, or stent, in your artery to prevent it from narrowing again. 
• 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. 
• Transmyocardial laser revascularization or coronary endarterectomy treat severe angina linked to coronary heart disease when other treatments are too risky or do not work.
• Bariatric (weight loss) surgery can help lower the risk of coronary heart disease and other problems that affect the blood vessels of 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 possible benefits and risks.