Optimal Medical Treatment

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Important Information About the Risk Calculation

  1. The risk results shown in this program are estimates.
  2. The results show your current potential risks & benefits of this treatment option. However, this result is not an actual prediction. It will only give you a general idea of your future risk with this option.
  3. Your actual risks may or may not be the same as the estimates shown. This program shows the estimated health risks of people with your same age, gender, and risk factor levels. Every person is different. Your current health status, your medical history and the traits you inherited from your family make you unique. This program is not meant to provide medical or other professional advice. Talk with your doctor or other healthcare professionals for information specific to you and for advice in making final decisions on managing your care and improving your health.

The results of this questionnaire indicate that patients like you may benefit from just medical therapy and lifestyle modifications, thus possibly avoiding or postponing an intervention such as Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Graft procedure (CABG). Your specific situation may require a different recommendation that will depend on factors that cannot be evaluated here. Medical therapy, even in combination with lifestyle modifications, will not improve the blood flow to your heart, but may well stop the progression of the disease of atherosclerosis and thus provide you with an acceptable quality of life.

 Optimal medical treatment of coronary artery disease

Treatment for Coronary artery disease (CAD) is aimed at controlling symptoms and slowing or stopping the progression of disease. How you are treated is based on many factors determined by your symptoms, a physical exam, and a variety of diagnostic tests. In many cases, medications may be the first line of treatment, particularly if your heart function is excellent, your symptoms  stable, and you are also able to make lifestyle changes that include diet, exercise, weight loss and cessation of smoking.

As many as 70% of patients who are treated in the US with Percutaneous Coronary Intervention (PCI) have chronic stable angina. Recent studies have shown that patients with coronary artery disease who have symptoms of chronic stable angina can be treated adequately with optimal medical therapy.

Read here what the symptoms of coronary artery disease (CAD) are and what constitutes “stable angina”:

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Stable angina

Stable angina is chest pain or discomfort that typically occurs with activity or stress. The pain usually begins slowly and gets worse over the next few minutes before going away. It quickly goes away with medication or rest, but may happen again with additional activity or stress.

Stable angina is predictable chest pain. Although less serious than unstable angina, it can be very painful or uncomfortable.

Symptoms of Angina



Sensations in chest of squeezing, heaviness, pressure, weight, vise-like aching, burning, tightness.

Pain that is pleuritic, sharp, pricking, knife-like, pulsating, lancinating, choking

Radiation to shoulder, neck, jaw, inner arm, epigastrium (can occur without chest component); band-like discomfort).

Involves chest wall; is positional, tender to palpation; can be inframammary; radiation patterns highly variable

Relatively predictable.

Random onset

Lasts 3–15 min Abates when stressor is gone or nitroglycerin is taken.

Lasts seconds, minutes, hours, or all day

Variable response to nitroglycerin

Classification and Severity of Angina

Class I

No angina with ordinary physical activity (e.g., walking, climbing stairs)Angina with strenuous or prolonged exertion

Class II

Early-onset limitation of ordinary activity (e.g., walking rapidly or walking>2 blocks; climbing stairs rapidly or climbing >1 flight); angina maybe worse after meals, in cold temperatures, or with emotional stress

Class III

Marked limitation of ordinary activity

Class IV

Inability to carry out any physical activity without chest discomfort. Angina occurs during rest

According to several recent studies, PCI can be safely deferred in patients with coronary artery disease and chronic stable angina, even in those with extensive, multi-vessel disease, as long as optimal medical therapy and lifestyle modifications are instituted and maintained. As an initial management approach, optimal medical therapy without routine PCI can be implemented safely in the majority of patients with stable coronary artery disease (From: The Courage trial: Optimal Medical Therapy with or without PC, NEJM, April12,2007)

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Long term medications commonly used to treat Coronary Artery Disease

  • Aspirin: Used to prevent blood clots forming in the heart arteries in patients with coronary artery disease.  Aspirin has been shown to improve survival after a heart attack, and is almost always prescribed (except when you have an allergy).
  • Beta blockers: A class of medications that relax the blood vessels and slow the heart rate. It thereby improves blood flow to the heart, decreases blood pressure and symptoms of angina, and has been shown to improve survival after a heart attack.  
  • Ranolazine  is a new medication used to treat chronic angina. It works by improving blood flow to the heart and decreases the occurrence of angina attacks. It is used in combination with other medications.  
  • Ace inhibitors: Often used in patients if heart muscle is not pumping as well as it should. Ace inhibitors have been shown to improve survival after a heart attack. 
  • Lipid management – is essential for all patients with coronary artery disease who have higher than normal blood lipid levels. 

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Modify Risk Factors

By decreasing your risk factors, you can improve your long term survival and quality of life.

Risk factors can be divided into:

  • Non-modifiable risk factors – risk factors you cannot change
  • Modifiable risk factors – those you can change

Risk factors you cannot change:

  • Male gender. The risk of heart attack is greater in men than in women, and men have heart attacks earlier in life than women. However, at age 70 and beyond, men and women are equally at risk.
  • Advanced age. Coronary artery disease is more likely to occur as you get older, especially after age 65.
  • Family history of heart disease. If your parents have heart disease (especially if they were diagnosed with heart disease before age 50), you have an increased risk of developing it.

Risk factors you can change:

  • Stop cigarette smoking and the use of tobacco products

Smoking is directly related to an increased risk of heart attack and its complications. If you smoke, ask your doctor about counseling, nicotine replacement medications and programs to help you quit. You and your family should try to avoid second hand smoke. Learn more about smoking and your heart.

A high-fat diet can contribute to increased fat in your blood. Follow a low-fat, low-cholesterol eating plan. When proper eating does not control your cholesterol levels, your doctor may prescribe medications. Most patients with coronary artery disease should target a LDL cholesterol less than 70 – 100 mg/dl and an HDL more than 40 mg/dl. 

High blood pressure can damage the lining of your coronary arteries and lead to coronary artery disease. Check your blood pressure on a regular basis. Most patients with coronary artery disease should target a systolic blood pressure of less than 130 mm Hg.  A healthy diet, exercise, medications and controlling sodium in your diet can help control high blood pressure.

High blood sugars are linked to the progression of coronary artery disease. If you have diabetes, it is important to maintain a HbA1c less than 7 percent. You can control high blood sugar through monitoring blood sugars, diet, exercise, and medications. 

A regular exercise program helps to regain or maintain your energy level, lower cholesterol, manage weight, control diabetes and relieve stress. Check with your doctor first before beginning an exercise program. if safe, 30 minutes per day of sustained aerobic exercise is recommended.

  • Achieve and maintain your ideal body weight

Obesity is defined as being very overweight with a body mass index (BMI) of greater than 30.  When you are very overweight, your heart has to do more work, and you are at increased risk of high blood pressure, high cholesterol levels and diabetes. Ask your doctor what your ideal weight should be. A healthy diet and exercise program aimed at weight loss can help improve your health. Learn more about weight management.

  • Control Stress and Anger

Uncontrolled stress or anger is linked to increased coronary artery disease risk. You may need to learn skills such as time management, relaxation, or yoga to help lower your stress levels.

  • Eat a diet low in saturated fat and cholesterol

Ask your doctor, based on your lipid results, how strict your diet should be. Most people should eat a low fat diet (less than 7 percent of calories from saturated fat). A registered dietitian is a good source for dietary information. Learn more about nutrition strategies.

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