An in-depth report on the causes, diagnosis, treatment, and prevention of coronary artery disease (CAD).
Angina; Atherosclerosis; Heart disease
Heart disease prevention is considered important before and after someone is diagnosed with the condition:
Key prevention measures include:
Your doctor should ask about your smoking habits at every visit. Smoking is a chronic condition and often requires repeat therapy using more than one technique.
All patients should start following a heart-healthy diet and exercise regularly, after talking to their doctors. [For more information on diet, see In-Depth Report #43: Heart-healthy diet.]
Statin drugs are the primary medications used for lowering LDL (“bad”) cholesterol levels. For patients without heart disease, the doctor will start or consider medication, increase dosage of medication, or add new medication when:
For patients with heart disease, the doctor will start or consider medication, increase dosage of medication, or add new medication when:
[For more information, see In-Depth Report #23: Cholesterol.]
Keep Blood Pressure Low. People in normal health should have a blood pressure reading of 120/80 mm Hg or less. Blood pressure readings of 120/80 are considered normal, readings of 140/90 or higher indicate hypertension, and readings in between the two are called pre-hypertension. Patients with diabetes chronic kidney disease, or atherosclerosis should maintain blood pressure readings of 130/80 mm Hg or less, while others should be no higher than 140/90 mm Hg.
Depending on blood pressure levels and presence of either risk factors for heart disease or known coronary artery disease, patients may be recommended to try lifestyle changes first or to immediately begin medications. Several of the medications used to treat coronary artery disease also reduce blood pressure. [For more information, see In-Depth Report #14: High blood pressure.]
All patients with diabetes should have their blood sugar (glucose) levels well managed. For most patients, a goal would be to bring HbA1c levels down to 7% or below. [For more information, see In-Depth Report #09: Diabetes - type 1 and In-Depth Report #60: Diabetes - type 2.]
Current American Heart Association (AHA) guidelines recommend:
[For more information on diet, see In-Depth Report #43: Heart-healthy diet.]
People should aim for a BMI index of 18.5 - 24.9. Weight reduction is recommended for obese patients who have high blood pressure, high cholesterol levels, metabolic syndrome, or diabetes.
Some obese patients with coronary artery disease may consider having bariatric surgery (stomach bypass) to lose excess weight. The weight lost after surgery can help improve blood pressure, cholesterol, blood sugar and other factors associated with CAD.
Everyone in normal health should do at least moderate physical activity for a minimum of 30 - 60 minutes on most, if not all, days of the week
Even low amounts of moderate or high intensity exercise (walking or jogging 12 miles a week) can help produce beneficial changes in cholesterol and lipid levels. However, more prolonged exercise is required to significantly change cholesterol levels, notably by increasing HDL ("good cholesterol"). Resistance (weight) training has also been associated with heart protection.
Sudden strenuous exercise (especially snow shoveling) puts many people at risk for angina and heart attack. Patients with angina should never exercise shortly after eating. People with risk factors for heart disease should seek medical clearance and a detailed exercise prescription. And all people, including healthy individuals, should listen carefully to their bodies for signs of distress as they exercise. [For more information, see In-Depth Report #29: Exercise.]
Patients with CAD are considered at high risk for complications from influenza. People with CAD should get an annual flu shot.
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