Coronary Artery Disease (CAD): Management, Medications, and Treatment Options

If you have been diagnosed with coronary artery disease (CAD) — also known as coronary heart disease — you may wonder which treatment options are available to you.

Coronary artery disease is a common heart condition where the blood vessels that bring blood and oxygen to your heart (called your coronary arteries) become narrow due to inflammation and cholesterol deposits (plaques).1 Coronary artery disease treatment can include medications, surgical procedures, and lifestyle changes.2

Medications for Coronary Artery Disease

Medications used to treat coronary artery disease can help improve the function of your heart or manage your symptoms.3 Your coronary artery disease treatment options depend on your symptoms. Some medications may have side effects — talk to your healthcare provider about which medications are right for you.

Statins for Coronary Artery Disease

High cholesterol is a major risk factor for developing coronary artery disease. If you have high cholesterol or other risk factors for coronary artery disease, your healthcare provider may prescribe a statin. Statins can lower your bad cholesterol (LDL cholesterol) level by up to 50 percent.4

Statins are in a class of medications called HMG CoA reductase inhibitors. They work by blocking the protein in your liver that makes cholesterol called HMG CoA reductase. This can make a big difference in your cholesterol levels because your liver makes about 75 percent of the cholesterol in your body.5

There are several different statins available, including:5

  • Atorvastatin (Lipitor®)
  • Fluvastatin (Lescol®)
  • Lovastatin (Mevacor®)
  • Pitavastatin (Livalo®)
  • Pravastatin (Pravachol®)
  • Rosuvastatin (Crestor®)
  • Simvastatin (Zocor®)

Side Effects of Statins

Most people don’t have side effects while taking statins, but you should be aware of the possible side effects and talk to your healthcare provider if you notice any side effects that bother you or don’t go away.5

The most common side effects of statins include:5

  • Headache
  • Nausea
  • Diarrhea or constipation
  • Gas or bloating
  • Muscle pain

Blood-Thinning Medications for Coronary Artery Disease

Blood thinners — also known as antiplatelet medications — reduce your risk of a heart attack or stroke by preventing clots from forming.6 You may take a blood thinner to prevent coronary artery disease symptoms or after a surgical procedure or having a stent placed (percutaneous coronary intervention).4

Examples of blood-thinning medications used to treat coronary artery disease include:6

  • Low-dose aspirin — this is the most common blood-thinning medication used to treat coronary artery disease
  • Clopidogrel (Plavix®)
  • Ticagrelor (BrilintaTM)
  • Prasugrel (Effient®)

Side Effects of Blood Thinners

Possible side effects of blood thinners include:7

  • Bleeding in the stomach or intestines
  • Diarrhea
  • Stomach pain or nausea
  • Itching
  • Skin rash

Beta-Blockers for Coronary Artery Disease

Beta-blockers reduce your risk of a heart attack or developing an irregular heart rhythm (arrhythmia) by decreasing your blood pressure and slowing your heart rate.3,8 They work by blocking the effect of hormones like adrenaline.9 While beta-blockers can help with chest pain or improve outcomes for patients with systolic heart failure (also known as heart failure with reduced ejection fraction, or HFREF), they are not useful for coronary artery disease patients with normal heart function.

Beta-blockers used include:6

  • Atenolol (Tenormin®)
  • Bisoprolol (Zebeta®)
  • Metoprolol (Toprol® or Lopressor®)

Side Effects of Beta-Blockers

Most people have no side effects or mild side effects while taking beta-blockers. If you experience side effects, they usually get better over time. Possible side effects include:9

  • Feeling dizzy or lightheaded
  • Feeling tired
  • Cold hands or feet
  • Difficulty sleeping or strange dreams
  • Difficulty with sex
  • Shortness of breath

Blood Pressure Medications

If you have high blood pressure, your healthcare provider may prescribe a blood pressure medication to keep coronary artery disease from getting worse.3

The most common types of blood pressure medications are angiotensin-converting enzyme (ACE) inhibitors — such as lisinopril (Zestril®) and enalapril (Vasotec®) — and angiotensin II receptor blockers (ARBs) — such as losartan (Cozaar®) and valsartan (Diovan®).10,11

If you can’t take one of these medications, you may take a calcium channel blocker (CCB) such as amlodipine (Norvasc®) or diltiazem (Cardizem®).12

Side Effects of Blood Pressure Medications

Many people have few or no side effects while taking blood pressure medications. People that have side effects usually notice that they get better over time. Common side effects can include dizziness, headaches, and tiredness.6

ACE inhibitors may also cause a dry cough.10 Calcium channel blockers can cause flushing and swelling in your lower legs and feet.12

Medications to Relieve Chest Pain

Different treatments are available to treat chest pain (angina): nitrates, beta blockers, statins, calcium channel blockers, and ranolazine. Ranolazine (Ranexa®) is a medication you take every day to treat chronic angina.13

Side Effects of Chest Pain Medication

The most common side effects of nitrates include:6

  • Headache
  • Flushing
  • Dizziness

Common side effects of ranolazine include:13

  • Headache
  • Dizziness
  • Nausea
  • Constipation

Surgery for Coronary Artery Disease

If you have a blocked artery or more serious coronary artery disease, you may need surgery. There are two main procedures used in coronary artery disease treatment — percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).14

Percutaneous Coronary Intervention (PCI)

A PCI is a treatment used to open a blocked artery. This procedure is minimally invasive, and in most cases, you stay awake but don’t feel anything during the process.15

During the procedure, a cardiologist (a doctor who specializes in treating the heart) will insert a flexible tube — called a catheter — into your blood vessels through your arm or the top of your leg. The cardiologist will guide the tube to the blockage and open the artery by inflating a balloon at the end of the catheter. In most cases, they will also place a mesh tube — called a stent — in the artery to keep it open.15

After a PCI, you will likely have to take blood thinning medication to prevent clots from forming.15

Coronary Artery Bypass Grafting (CABG)

CABG — also known as heart bypass surgery — may be used to treat coronary artery disease as a way to prevent a heart attack or in an emergency during a severe heart attack. This surgery requires you to stay in the hospital for several days to recover.16

During surgery, the surgeon will “bypass” blocked or damaged coronary arteries using healthy ones from other parts of your body, such as your arm, chest, or leg. While the surgeon is replacing the blood vessels, your heart will be stopped, and you will be connected to a heart-lung bypass machine that will take over the job of pumping oxygen-rich blood around your body. Some surgical techniques that don’t stop the heart — called off-pump procedures — may be an option for some people.16

After surgery, you will spend several days recovering in the hospital. You will likely have to take medications to treat your coronary artery disease.17

Lifestyle Changes for Coronary Artery Disease

If you have been diagnosed with coronary artery disease, heart-healthy lifestyle changes can help improve your symptoms and slow coronary artery disease progression. Talk to your healthcare provider to find the best lifestyle changes for you.18

Healthy Eating for Coronary Artery Disease

A poor diet is a leading cause of heart disease. Making a few dietary changes can help you prevent coronary artery disease and its complications. In general, you want to increase the amount of heart-healthy foods you eat and limit the amount of food that may cause harm.19

Foods that you should eat in a heart-healthy diet include:20

  • Whole fruits and vegetables
  • Whole grains — oatmeal, brown rice, and whole grain bread
  • Fat-free or low-fat dairy — yogurt and milk
  • Lean meat — chicken, turkey, or 95 percent ground beef
  • Fish that are high in omega-3 fatty acids — salmon, tuna, and trout
  • Eggs
  • Nuts and seeds
  • Tofu
  • Legumes — kidney beans, lentils, chickpeas, and lima beans

Foods you should limit include:20

  • High sodium foods — processed foods, cold cuts, bacon, canned meat, packaged mix for potatoes, canned vegetables, canned soup, soy sauce, instant cake mix
  • Saturated fats — butter, cheese, fatty meat
  • Added sugar — sweetened drinks, soda, cake, pie, ice cream, candy, jam, and syrup
  • Alcohol

Getting Physical Activity

Getting regular physical activity can decrease your risk of several coronary artery disease risk factors, such as obesity, high cholesterol, high blood pressure, and stress.21

The Physical Activity Guidelines for Americans recommend that adults get at least 150 minutes of moderately intense physical activity every week or 75 minutes of vigorous-intensity activity.22,23 A good rule of thumb for judging the intensity of your workout is the talk test. For moderate-intensity exercise, you can talk but not sing. During vigorous-intensity exercise, you usually can’t say more than a few words before you have to stop for breath.23

You can break up 150 minutes per week into smaller daily sessions of about 30 minutes on most days.

Managing Your Stress

Strong emotions, especially anger, can trigger coronary artery disease symptoms, such as angina (chest pain) or a heart attack. Unhealthy ways of coping with stress— such as drinking alcohol, smoking, and overeating — are risk factors for coronary artery disease themselves or contribute to other risk factors, such as obesity and high blood pressure. Healthy ways to manage stress include:24

  • Joining a stress management program
  • Meditation or other relaxation techniques
  • Exercise
  • Talking to friends or family
  • Talking to a professional therapist

The Future of Coronary Artery Disease Treatments

As researchers continue to learn more about coronary artery disease, new ways of detecting and treating coronary artery disease will follow. There are currently numerous clinical trials investigating new procedures and medications to treat coronary artery disease.