In addition to lifestyle changes, your healthcare provider may recommend medications or surgery.
Several medications can raise the level of “good” HDL cholesterol and lower the level of “bad” LDL cholesterol in the blood. This helps prevent plaque buildup in coronary arteries.
- Statins block a substance that your liver uses to make cholesterol. Common statins include atorvastatin (Lipitor), lovastatin (Mevacor), rosuvastatin (Crestor), and simvastatin (Zocor). Ask your provider about prescribing a generic form, which is less expensive and equally as effective.
- Niacin (vitamin B-3 or nicotinic acid) helps raise “good” HDL cholesterol and lower “bad” LDL cholesterol. Niacin can cause itching, redness, or a tingling feeling under the skin. To reduce this, don’t drink alcohol or hot beverages right after taking niacin. These effects usually go away. Missing even one or two doses can bring back the side effects.
- Fibric acid or "fibrates" are used when triglycerides (a common type of fat) are high in addition to high "bad" LDL cholesterol.
Blood thinners pills have two common types: antiplatelet and anticoagulation drugs. These help prevent blood clots by different processes.
- Aspirin is a key drug for treating coronary artery disease. The dosage varies from one “baby” aspirin (81 mg) to one regular-strength (325 mg) tablet per day. Side effects often include stomach upset, ulcers, and bleeding problems. Coated aspirin helps prevent stomach problems. However, a person with history of heart disease may be advised by their doctor to keep full-strength aspirin tablets on hand in case of a heart attack.
- Other common antiplatelet drugs used for heart disease include clopidogrel (Plavix) and prasugrel (Effient).
- There are anticoagulant medications that include warfarin (Coumadin), and the newer oral anticoagulants: rivaroxaban (Xarelto), dabigatran (Pradaxa), and apixaban (Eliquis).
These medications all work in different ways to thin the blood and prevent blood clots. A person may take these drugs in addition to aspirin or anti-platelet drugs. Taking these medications exactly as prescribed it important. Missing even one dose puts a person at risk for developing blood clots.
Due to their ability to cause excessive bleeding, these medications are considered high risk medications for older adults. (See the AGS Updated Beer’s Criteria). The healthcare provider should keep a close follow up when prescribing them to older adults, including those with kidney disease.
Nitroglycerin relaxes and widens blood vessels in the heart so that more blood can flow to it. This helps relieve chest pain and makes breathing easier.
Nitroglycerin tablets are usually placed under the tongue so that the drug passes into the bloodstream quickly. Nitroglycerin also comes in a cream, a patch, or a spray.
Since fainting and headaches are possible side effects, sit down before taking nitroglycerin.
Several medications can interact with nitroglycerin and drop blood pressure to unsafe levels. Your provider needs to know everything you are taking, no matter how “harmless’ you think they are. Common among them are medications used for sex, including sildenafil (Viagra), tadalafil (Cialis) and other medications of this class.
Blood Pressure Medications
Treating high blood pressure can reduce angina pain. It can also lower the risk of heart attack and other conditions, such as stroke and kidney disease.
Generally, blood pressure is treated if it is higher than 140/90 mmHg. Lower targets may be necessary in people with diabetes, chronic kidney disease, or other chronic health conditions. The best blood pressure target for an older adult depends on their health, and should be discussed with their healthcare provider.
A special class of blood pressure medications known as "beta blockers" is especially helpful in people with coronary artery disease.
Severely narrowed coronary arteries may require surgery to prevent a heart attack.
Angioplasty and Stent Placement
This is also known as percutaneous coronary intervention, or PCI. The healthcare professional will thread a tiny collapsed “balloon” through a very thin tube into a damaged coronary artery. When the balloon inflates, it opens the blockage. A small stent (a wire mesh cloth) is often left inside the artery to help keep it open. Some stents contain a slow-releasing medication that also helps keep the artery open.
Coronary Bypass Surgery
In this surgery, a new artery is connected (grafted) to the blocked artery, from a point just before the blockage to just after it.
This allows the blood to bypass the blockage. The graft is often a vein taken from another part of your body. Since this procedure requires open-heart surgery, your doctor may recommend it only when multiple coronary arteries are blocked.
Side effects of bypass surgery can include:
- Cognitive impairment (some aspects of memory are affected)
- Functional decline (loss of independence in self-care)
Return to a person’s abilities before the surgery can take several months. To minimize problems:
- Rehabilitation should be started in the hospital as soon as possible after surgery.
- The person needs to participate in a structured cardiac rehabilitation program after leaving the hospital, if possible.
Complications of Coronary Artery Disease
Chronic Stable Angina
A person with coronary artery disease may have chest pain, or angina when the heart muscle requires more oxygen. With stable angina, a person can recognize the things that bring on chest pain. They can change their activities. For example, slowing down or stop exercising will help chest pain improve and eventually go away.
The causes of stable angina usually include:
- Strenuous physical activity
- Large meals
- Cold weather
- Severe emotional stress
- Becomes stronger
- Does not go away after 15 minutes
- Does not go away after three doses of nitroglycerin
- Comes back after first being relieved by nitroglycerin
These may be signs of a heart attack.
Angina pain usually does not last more than a few minutes. Nitroglycerin or another medication can ease the pain.
If you have chronic stable angina, you should notify your doctor if you:
- Have angina symptoms more frequently
- Have angina when you are at rest
- Feel tired more often
- Feel dizzy or faint
- Feel like your heart is skipping beats, or is beating very slowly or very fast
Heart Attack (also called myocardial infarction, or MI)
While you’re waiting for the ambulance, chew a non-coated, full-strength (325 mg) aspirin tablet, or 3 baby aspirin. This helps thin the blood and prevent clots. Be sure to tell the doctor in the emergency room that you have already taken aspirin so you don't receive another dose.
An emergency room doctor can inject you with “clot-busting” drugs to break up any blood clots during or shortly after a heart attack.
Because of better treatment and awareness of heart attack symptoms, most people survive heart attacks. They are able to live full and normal lives after receiving treatment and rehabilitation.
Cardiac rehabilitation programs improve people's exercise capacity, physical function, and quality of life. The programs also help reduce anxiety.
The program typically includes an individualized, medically supervised exercise program. Survival rates are higher for people who have rehabilitation compared with those who don’t. Better participation leads to better outcomes.
A rehabilitation program is either inpatient or home-based.
Heart Attacks in Women
Women may have different signs of a heart attack than men. While chest pain is still the most common symptom, it may be milder or may not be present at all in women.
Women are more likely to have pain in the jaw or back or have some of other symptoms. They are likely to have shortness of breath, nausea and vomiting, or even anxiety.
Most heart attacks in women occur after menopause. Menopause increases the risk in older women because of lower levels of estrogen hormones. This can cause an increase in “bad” LDL cholesterol levels.
Last Updated February 2023