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Coronary heart disease (CHD) is the most common cause of death and disability in the United Kingdom. It causes around 94,000 deaths in the UK each year and around one in five men and one in seven women will die from the disease.
Coronary heart disease is usually caused by atherosclerosis, where fatty deposits (atheroma) develop in the walls of the arteries. Atherosclerosis causes symptoms when it partially or completely blocks the arteries that supply the heart muscle with blood. This manifests as a number of conditions including stable angina (where atheroma restricts blood flow) and acute coronary syndromes (where clot formation occurs on the atheroma and causes an abrupt narrowing or complete blockage of the artery). These are described in the relevant sections of this website.
There are two ways to improve blood flow to heart muscle when the arteries become blocked. Percutaneous Coronary Intervention (PCI) and surgical coronary artery bypass grafting (CABG).
PCI is performed under local anaesthetic. Wires are passed through the hand into the heart. A small balloon is inserted and inflated to widen the narrowing. In most cases a ‘stent’, a metal mesh scaffold, is then implanted to keep the artery open.
PCI is used in a stable setting to alleviate the symptoms of angina, and in a more urgent or emergency setting to restore coronary blood flow during a heart attack. The majority of PCI procedures in the United Kingdom are for those patients who have had a heart attack. There is clear research evidence that PCI can be life saving and can reduce recurrent heart attacks in this setting.
Patients who have required PCI or those with coronary artery disease, often need to make lifestyle changes and take medications to reduce their chance of progressive disease, heart attack or stroke. Lifestyle changes such as regular exercise, weight loss, reduction in unhealthy foods and increase in foods shown to improve life are all essential steps.
It is common for patients with coronary artery disease to require medications. Most patients require an anti-platelet medication – commonly known as blood thinners. The most commonly known drug is Aspirin. There are others, including Clopidogrel, Prasugrel and Ticagrelor. Those patients with recent PCI will commonly need to take two blood thinners in combination.
It is also common for patients with coronary artery disease to take medications that help reduce cholesterol levels. Blood cholesterol levels correlate with heart attack risk, and reduction in cholesterol levels also correlate with reduction in heart attack risk. This has been shown in many studies over the last 30 years. Statins are the most common medications used in this situation. Some studies show that statins can delay the progression of coronary artery disease.
Those patient with angina, that is a chest tightness on exertion relieved by rest, will also require other medications to help reduce the symptoms and improve heart function. Your Cardiologist can speak to you in detail about these medications, which include beta-blockers, calcium-channel inhibitors, and nitrate tablets.