Treatment

Acupuncture Allergies Alzheimer's Disease Androgen Anxiety Disorders Asthma Atherosclerosis Attention Deficit Hyperactivity Disorder Bacterial Vaginosis Biofeedback Bipolar Disorder Birth Control Pills Blood Donation and Transfusion Breast Augmentation and Reduction Breast Cancer Breastfeeding Breast Reconstruction Caregiving Cervical Cancer Chiropractic Chlamydia Cholesterol Chronic Fatigue Syndrome Clinical Trials Colon Cancer Contraception Depression Diabetes Dry Eye Syndrome Eating Disorders Endometriosis Epilepsy Estrogen Fibroids Fibromyalgia Fitness Flu/Colds Gastroesophageal Reflux Disease (GERD) Genetic Testing Genital Herpes Glaucoma Gonorrhea Health Insurance Heart Disease Hepatitis High Blood Pressure HIV/AIDS Homeopathy Human Papillomavirus Hypnosis Hysterectomy Incontinence Infertility Irritable Bowel Syndrome Legal Health Tools Liposuction Lung Cancer Lupus Macular Degeneration Medication Safety Menopause Menstrual Disorders Metabolic Syndrome Migraine Multiple Sclerosis Naturopathy Nonsurgical Aesthetic Procedures Nutrition Obesity Ocular Allergies Oral Health Osteoarthritis Osteopathic Medicine Osteoporosis Ovarian Cancer Overactive Bladder Pain Management Pelvic Organ Prolapse Pelvic Pain Peripheral Arterial Disease Polycystic Ovary Syndrome Pregnancy Premenstrual Syndrome Preparing for Surgery Progesterone Rheumatoid Arthritis Schizophrenia Scleroderma Sexual Dysfunction Sinusitis Sjogren's Syndrome Skin Cancer Skin Health Sleep Disorders Smoking Stress Stroke Substance Abuse Tai Chi Teen Health Thyroid Disorders Trichomoniasis Urinary Tract Conditions Urinary Tract Infection Uterine Cancer Varicose Veins Violence Against Women Vulvodynia Weight Management Yeast Infections Yoga

Heart & Home: Heart Health Guide Learn how to lower your risk of heart disease in the NWHRC's Heart Health Guide. The Heart & Home campaign is sponsored by Bed Bath & Beyond, REDBOOK magazine and the NWHRC: Partnering to help women get heart healthy.

Healthy From the Heart Learn about the treatment options for coronary artery disease in our Healthy From the Heart brochure. Disponible en Español.

Lifestyle changes (Diet, exercise, weight loss):

1. Diet

   Changing your dietary habits remains the single most effective way to stop atherosclerosis from progressing. Changing your diet to one low in saturated fat and cholesterol reduces blood cholesterol, a primary cause of atherosclerosis. Although saturated fat and trans fats are definitely bad for you, other types of fat, such as polyunsaturated fats found in fish (omega-3) and nuts/flaxseed, or monounsaturated fats found in olive oil, may actually be good for you.

   Eating less saturated fat and reducing calories in general should also help you lose weight. Reducing sodium intake is important for both the prevention and treatment of high blood pressure. The DASH (Dietary Approaches to Stop Hypertension) diet, endorsed by the major heart organizations, is one strategy for lowering high blood pressure. It is rich in lower-calorie foods such as fruits and vegetables and whole grains and low in sodium.

   The "Therapeutic Lifestyle Changes (TLC) Diet" plan, developed by the NHLBI calls for less than seven percent of your calories to come from saturated fat and for less than 200 mg of dietary cholesterol. Twenty-five to 35 percent or fewer of total daily calories can come from fat, provided most of these calories are from unsaturated fat, which doesn't raise cholesterol. Sodium intake should be limited to no more than 2,400 mg per day. In addition, the guidelines encourage the use of certain foods rich in soluble fiber to boost the diet's LDL-lowering power.

2. Exercise

   You also can benefit from exercise. Recent research finds that even moderate amounts of physical activity are associated with lower death rates from coronary heart disease. For optimal benefits, the American Council on Exercise (ACE) suggests 30 minutes of moderate aerobic exercise, such as walking, at least four times a week, or 20 minutes of vigorous aerobic exercise, such as running, at least three times a week. Being physically fit and active provides cardiovascular benefits independent of weight loss.

3. Weight loss

   If you are overweight, losing weight can help lower blood cholesterol levels. It is also the most effective lifestyle change to reduce high blood pressure, another risk factor for atherosclerosis and heart disease. The best way to lose weight is through a combination of diet and exercise.

Pharmacologic (drug) therapies:

1. Anti-platelet (or blood-thinning) medications

   All people with atherosclerosis or those at high risk of atherosclerosis, such as those with diabetes, should take a daily aspirin for heart protection. Those who continue to have problems with atherosclerosis or those with recurrent cardiovascular events despite aspirin therapy should take another blood thinning agent such as clopidogrel (Plavix). Those with stents in their coronary arteries should take aspirin for life and Plavix for at least six to nine months after the stent is inserted to prevent clotting around the stent.

2. Cholesterol-lowering therapies

   Cholesterol-lowering medications that may be recommended include:

   • Statins

     The three main bile acid sequestrants currently prescribed in the US are cholestyramine resin (Questran), colestipol (Colestid) and colesevelam (WelChol). They typically lower cholesterol by 10 to 20 percent and are available as powders, tablets or granules. These drugs work by binding with bile acids that contain cholesterol in the intestines. They can be prescribed alone or in combination with a statin. A bile acid sequestrant may be prescribed in combination with another drug if you have high triglycerides or a history of severe constipation.

     Make sure you talk to your health care professional to see if you are a candidate for statin therapy. If you experience any side effects such as muscle aches or dark urine, stop taking the drug immediately and call your health care professional.

   • Nicotinic acid

     More commonly known as niacin, this compound is a water-soluble B vitamin. Unfortunately, you can't lower your cholesterol by taking a vitamin supplement; to have such an effect, it must be taken in doses well above the daily vitamin requirement. Although nicotinic acid is inexpensive and available over the counter, never take it to lower your cholesterol without guidance from a health care professional because of potential side effects. The extended release form is available by prescription as Niaspan. Niacin has broadly positive effects on cholesterol: It lowers LDL cholesterol by 10 to 20 percent and triglyceride levels by 20 percent to 50 percent, while lifting HDL cholesterol levels 15 percent to 35 percent.

   • Bile acid resins

     The three main bile acid sequestrants currently prescribed in the US are cholestyramine resin (Questran), colestipol (Colestid) and colesevelam (WelChol). They typically lower cholesterol by 10 to 20 percent and are available as powders, tablets or granules. These drugs work by binding with bile acids that contain cholesterol in the intestines. They can be prescribed alone or in combination with a statin. A bile acid sequestrant may be prescribed in combination with another drug if you have high triglycerides or a history of severe constipation.

   • Fibrates

     These drugs reduce triglycerides by 20 to 50 percent and usually raise HDL cholesterol 10 percent to 15 percent. The most widely used fibrate in the US is gemfibrozil (Lopid). Other fibrate medications include fenofibrate (TriCor) and Clofibrate (Atromid-S, Abitrate). (Fibrates are not recommended as the sole drug therapy for women with heart disease for whom LDL cholesterol reduction is the main goal.

   • Cholesterol absorption inhibitors

     This new class of drugs lowers cholesterol by preventing it from being absorbed in the intestine. The first approved drug in this class is ezetimibe (Zetia). Studies find it lowers LDL cholesterol by about 25 percent. Zetia, which reduces intestinal absorption of cholesterol, may work best in combination with a statin, which reduces liver production of cholesterol, providing a dual mechanism for reducing cholesterol levels.

3. Drugs for peripheral arterial disease

   If you have severe pain or cramping in your legs when you walk, your health care professional may recommend clopidogrel (Plavix), cilostazol (Pletal), pentoxifylline (Trental) and prostaglandins.

   If you take medication to improve your cholesterol, lower blood pressure or treat other heart disease symptoms, be sure to ask about potential side effects, interactions with other medications, food or beverages, and when and how you should take the prescribed medications. Knowing more about your medication will help you adhere to the schedule that has been prescribed for you.

Revascularization procedures for atherosclerosis

In the past, opening arteries damaged by atherosclerosis around the heart meant performing bypass surgery (open heart surgery), requiring that the chest be opened surgically and blood flow redirected around the damaged artery. Now, however, alternatives to open heart surgery, such as balloon angioplasty, allow for a quicker, less painful recovery. However, not everyone is a candidate for balloon angioplasty and some people still require surgery.

1. Coronary angioplasty or balloon angioplasty

   Your health care professional positions a catheter with a tiny balloon on its tip in the narrowed coronary. The balloon is inflated and deflated to stretch or break open the narrowing and improve the passage for blood flow. Typically, your doctor will insert a stent, a small scaffolding designed to prop the artery open. As the balloon inflates, it expands the stent. Angioplasty is not surgery, and it is performed while you are awake. It typically takes about one or two hours.

   If angioplasty doesn't widen the artery or if complications occur, bypass surgery may be needed. Patients with certain types of blockages may not be candidates for angioplasty, and may be referred for bypass surgery.

   One continuing challenge cardiologists face in treating atherosclerosis is that plaque deposits may return (a condition referred to as restenosis). Even patients who've had angioplasties sometime require future treatments to widen arteries clogged with new blockage. Today, new drug-coated stents markedly decrease the rates of restenosis compared to the older generation of stents. Additionally, new drugs and new types of stents are in development, and the future is promising for further advancements in this area.

2. Atherectomy

   If your arteries have hardened too much, they may tear during angioplasty. In those instances, your doctor may choose to clear your arteries with similar procedures, such as atherectomy. In this procedure, a small cutting instrument at the end of a catheter grinds plaque off artery walls. Sometimes a small vacuum takes the plaque away after it is ground off the vessel wall. Other times a Rotablator with a diamond tip that spins between 140,000 and 200,000 times per minute grinds the plaque into minuscule pieces that are flushed out of the blood stream.

3. Endarterectomy

   This surgical procedure, performed under general anesthesia, removes plaque from your arteries. For your carotid arteries, the surgeon makes a cut in your neck, opens the artery there, and removes plaque until the inside of the artery is clean and smooth.

4. Coronary artery bypass

   In this surgery, a blood vessel (usually taken from the leg, arm or chest) is sewn onto the blocked artery so blood can bypass the blocked area. Several bypasses can be performed if several arteries are blocked. Bypass surgery relieves symptoms of heart disease but does not cure it. You will still need to make lifestyle changes like those described earlier.