Treatment for coronary artery disease (CAD) depends upon how far the disease has already progressed. Coronary artery disease is the buildup of plaque on the inside of the coronary arteries, the blood vessels that supply oxygen-rich blood to heart muscle. As you review your treatment options, consider the following:

• No matter what medical treatment you receive, lifestyle changes-including quitting smoking, following a heart-healthy diet, and exercising-are critical to managing the disease. For more information on lifestyle changes, see:

  Exercising for a healthy heart.

  Eating a heart-healthy diet.

• If your doctor approves, take an aspirin each day to reduce your risk of heart attack.
• If your high blood pressure and high cholesterol cannot be controlled with lifestyle changes, you and your doctor may consider a more aggressive approach, including medications to lower these risk factors.
• If you have frequent chest pain that makes normal everyday activities difficult, your doctor may recommend medicines.
• If medicines do not relieve your chest pain, your doctor may recommend angioplasty with stent placement to open clogged coronary arteries. Or sometimes coronary artery bypass surgery may be necessary.

Initial treatment

After you have been diagnosed with coronary artery disease, your doctor will strongly advise that you make lifestyle changes such as quitting smoking, following a heart-healthy diet, and exercising. With these measures, you may be able to halt the progression of the disease and improve the quality and length of your life.

Quitting smoking may be the most important step you can take to reduce your risk. Avoid secondhand smoke too. In one study, people with CAD who continued to smoke had a 43% greater chance of sudden death from a heart attack than those who quit.⁹ Your doctor will strongly advise that you quit and will possibly prescribe medicine and therapy to help you do so. Studies show that nicotine replacement therapy, use of the medicines bupropion (Zyban or Wellbutrin) or varenicline (Chantix), and supportive therapy significantly increase long-term success in quitting.¹⁰ For more information, see the topic Quitting Tobacco Use.

Aspirin is also recommended for almost everyone who has CAD to help reduce the risk of having a heart attack.¹¹ The best dose of aspirin has not been established, but 75 mg a day seems to be as effective in preventing heart attack as higher doses and has fewer side effects.¹² One low-dose aspirin contains 81 mg; one regular-strength aspirin contains about 325 mg. Talk with your doctor before starting aspirin therapy.

If you have average to high cholesterol, a cholesterol-lowering medicine such as a statin may be prescribed.

If you have angina, your doctor may prescribe medicines, including nitroglycerin and other nitrates which relax arteries and increase blood flow, and beta-blocker medicines, which decrease the heart's workload. Calcium channel blockers may be used to treat angina when beta-blockers are not tolerated or for other types of angina, including variant, or Prinzmetal's, angina. If these medicines do not relieve your chest pain, your doctor may prescribe a partial fatty acid oxidation inhibitor (ranolazine).