Treatment of stable coronary artery disease

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Submitted by Dr T on June 9, 2011 – 6:54am

Question: 
Hi Dr T,
Hi, my dad had a cardiac infarction last year. He has CAD in the LCX and RCA but the left main is free. He does not drink or smoke, is 65 with no diabetes but had high cholesterol. He is on a cholesterol reducing diet and medication. What are the chances of his getting a fatal heart attack?

You already know your dad has coronary artery disease, diabetes and a high cholesterol, all risk factors. He is also getting what sounds like optimal medical therapy (OMT). In patients whose angina symptoms are well controlled this is often the best treatment, especially when compared to stent procedures. If he continues like this, controls his weight and exercises regularly, he should be OK as long as he is monitored carefully along the way:
https://www.cardiachealth.org/ca-blog/optimal-medical-therapy-what-is-it-anyway/
https://www.cardiachealth.org/ca-blog/medical-therapy-for-stable-coronary-artery-disease/
https://www.cardiachealth.org/risks-benefits/cardiovascular-risk
To evaluate his present treatment, take this test:
https://www.cardiachealth.org/app/
This questionnaire tries to evaluate what option is optimal. Off hand, as a retired cardiac surgeon who advised many patients during my career, I would weigh evidence of insufficient blood supply to his heart against the risks of bypass surgery (very low in a man his age in  otherwise good shape). Coronary Artery Bypass surgery has proven to be much safer than stenting in many publications. Testing for the effect of insufficient blood supply (ischemia) is usually done with a stress test, that should be performed at regular intervals to make sure nothing has changed:
https://www.cardiachealth.org/heart-disease-diagnosis/exercise-stress-tests
Hope this helps,
Dr T
https://www.cardiachealth.org/

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