Medicines for Coronary heart disease

What it is

Coronary heart disease (CHD), also called coronary artery disease or ischaemic heart disease, is a major type of heart disease in which the coronary arteries — the blood vessels that supply the heart muscle with blood and oxygen — become narrowed by a build-up of fatty deposits (atherosclerosis). This narrowing reduces the blood flow to the heart muscle, which can cause problems, particularly when the heart needs more blood (such as during exertion). Coronary heart disease is a leading cause of ill health and death, but, like other cardiovascular disease, much of it is preventable, and it can be managed. The main ways it can cause problems are: angina — chest pain, tightness, or discomfort (sometimes spreading to the arm, neck, jaw, or back, often brought on by exertion or stress and relieved by rest), which occurs when the narrowed arteries cannot supply enough blood to the heart during increased demand; and heart attack (myocardial infarction) — which occurs when the blood supply to part of the heart is suddenly blocked (often by a blood clot forming on a fatty deposit), causing damage to the heart muscle, and which is a medical emergency. Coronary heart disease can also contribute to heart failure and heart rhythm problems. The risk factors are those of cardiovascular disease generally — including high blood pressure, high cholesterol, smoking, diabetes, being overweight, physical inactivity, an unhealthy diet, and a family history. It may cause no symptoms until angina or a heart attack occurs. Managing coronary heart disease and reducing its risks involve a healthy lifestyle, managing risk factors, and, where needed, medicines and procedures. The key messages are that coronary heart disease can cause angina and heart attacks, that much of it is preventable and manageable by reducing risk factors and healthy living, that treatments are available, and that the symptoms of a heart attack are a medical emergency.

How it is treated

Coronary heart disease is managed by reducing the risk factors, relieving symptoms, and reducing the risk of heart attacks and other problems, through lifestyle, medicines, and, where needed, procedures. A cornerstone is a heart-healthy lifestyle and managing risk factors: not smoking (and stopping smoking), a healthy diet, regular physical activity, a healthy weight, drinking within limits, and controlling blood pressure, cholesterol, and diabetes — these reduce the progression of the disease and the risk of heart attacks. Medicines play an important role and may include: medicines to reduce the risk of a heart attack and manage the disease (such as those that lower cholesterol, reduce the risk of blood clots, and lower blood pressure or reduce strain on the heart); and medicines to prevent or relieve angina. For angina or more significant narrowing, procedures to improve the blood flow to the heart may be considered — such as a stent (angioplasty, in which a narrowed artery is widened and held open) or, in some cases, heart bypass surgery — depending on the individual. If a heart attack is suspected — chest pain or tightness that may spread to the arm, neck, jaw, or back, often with breathlessness, sweating, or feeling sick — it is a medical emergency: emergency services should be called immediately, as prompt treatment to restore the blood flow (with clot-busting medicines or, more usually, an emergency procedure to open the artery) saves heart muscle and lives. After a heart attack or diagnosis of coronary heart disease, cardiac rehabilitation (a programme of exercise, education, and support) and ongoing management help recovery and reduce future risk. Because coronary heart disease may be silent until angina or a heart attack occurs, and because reducing risk factors makes a real difference, knowing and managing your cardiovascular risk (including through health checks) is important. The reassuring messages are that coronary heart disease is largely preventable and manageable, that lifestyle changes and treatments substantially reduce symptoms and the risk of heart attacks, and that prompt emergency treatment of a heart attack saves lives — so recognising the emergency symptoms and acting immediately is vital.