Untreated coronary heart disease can have fatal consequences. Fortunately, scientists and researchers are always hard at work to develop new and improved treatments for this disease. There are multiple options for symptom management, as not all medicines are suitable for all patients and you can almost expect to have to try different medicines and different doses before you find a regime that works for you.
1. Aspirin
Studies have shown taking low-dose aspirin every day stops blood clots from forming in your arteries, reducing your risk of having a heart attack or a stroke.
2. Antiplatelet therapy
Antiplatelet therapy comprises medications that help lower the risk of a heart attack by preventing blood clots. Aspirin is an example of this, but there are many more. Antiplatelet therapy is usually prescribed to patients who have had coronary angioplasty and stent implantation, have had multiple heart attacks, or suffer from angina (chest pain).
It is important to keep in mind that you should not stop taking your antiplatelet medication unless your doctor tells you to, as it can be dangerous to stop, particularly if you have a stent. Some common anti-platelet medications include low-dose aspirin, clopidogrel, tricagrelor and prasugrel.
3. Warfarin
Similar to other anti-clotting medications, warfarin helps stop the formation of blood clots. It also helps treat existing blood clots. If you are on warfarin, you will need to have regular blood tests to ensure that you are taking the right dose and that it’s working appropriately. You also need to make sure to eat and drink properly as certain foods, alcohols, herbs and vitamins can negatively interact with warfarin. Discuss this with your doctor before you start taking warfarin, but also always read the package insert.
4. Novel anticoagulant therapies
Novel anticoagulant therapies (NOACs) are new generation of anticoagulant therapies that do not require blood testing. Some examples of NOACs include dabigatran, apixaban and rivaroxaban.
5. Statins
Statins are prescribed to patients who have high cholesterol levels. Statins work by increasing the metabolism of “bad” cholesterol (LDL) by boosting the number of LDL receptors in the liver. When there is less LDL in your body, your risk of a heart attack goes down. You may, again, need to try several different types before you find the right one. Common statins include atorvastatin, simvastatin, rosuvastatin, and pravastatin.
6. Beta blockers
Beta blockers blocks the effect of specific hormones that help slow down your heart beat and ameliorate your blood flow. They can help prevent angina and improve your blood pressure.
7. Nitrates
Nitrates help widen your blood vessels, and are also referred to as vasodilators. They help relax your blood vessels, which widens them and allows more blood to go through. Nitrates can help reduce your blood pressure and relieve heart pain. Nitrates come in an array of forms, including:
- Tablets
- Sprays
- Skin patches, including glyceryl trinitrate and isosorbide mononitrate
In some cases, nitrates can have some side effects such as headaches, dizziness and flushed skin. Ask your doctor what type of nitrates are available. There are two main types of nitrates:
- Short-acting nitrates work quickly and relieve angina symptoms within just a few minutes. They are either administered as a spray or tablet (which goes under your tongue). A common short acting nitrate is glyceryl trinitrate.
- Long-acting nitrates also help prevent symptoms of angina. However, unlike short-acting nitrates, they don’t relieve angina within a few minutes. Usually, you take long-acting nitrates as a tablet that you swallow.
8. Angiotensin-converting enzyme (ACE) inhibitors
ACE inhibitors are prescribed for high blood pressure. Examples of ACE inhibitors include drugs such as ramipril and lisinopril. ACE inhibitors function by blocking the activity of angiotensin II, a type of hormone that causes blood vessels to become narrow. This helps stop your heart from working too hard and increases blood flow. If you take ACE inhibitors, you have to make sure to constantly monitor your blood pressure and kidney function, since these medications can negatively affect them. In fact, 10 percent of people who take ACE inhibitors experience kidney problems. Adverse effects associated with ACE inhibitors include dizziness and dry cough.
9. Angiotensin II receptor antagonists
Angiotensin II receptor antagonists function in a similar manner to ACE inhibitors as they help lower your blood pressure by blocking the activity of angiotensin II. Many people are prescribed angiotensin II receptor antagonists as an alternative to ACE inhibitors, as angiotensin II receptor antagonists do not lead to a dry cough.
10. Calcium channel blockers
Calcium channel blockers help reduce your blood pressure by relaxing the walls of your blood vessels, widening them and improving blood flow. Examples of commonly used calcium channel blockers include:
- Amlodipine
- Verapamil
- Diltiazem
Side effects associated with this class of drugs include headaches and facial flushing. Many people who experience these side effects find that they decrease with time.
11. Diuretics
Diuretics are a type of drug that increase the water and salt content in your urine, leading to reduced water retention and decreased blood pressure.
- Pitt, B., Waters, D., Brown, W. V., van Boven, A. J., Schwartz, L., Title, L. M., ... & McCormick, L. S. (1999). Aggressive lipid-lowering therapy compared with angioplasty in stable coronary artery disease. New England Journal of Medicine, 341(2), 70-76.
- Hannan, E. L., Wu, C., Walford, G., Culliford, A. T., Gold, J. P., Smith, C. R., ... & Jones, R. H. (2008). Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease. New England Journal of Medicine, 358(4), 331-341.
- McPhee, S. J., Papadakis, M. A., & Rabow, M. W. (Eds.). (2010). Current medical diagnosis & treatment 2010. New York:: McGraw-Hill Medical.
- Photo courtesy of SteadyHealth
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