Coronary Artery Disease: Medications

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Medications

Many people have difficulty correctly taking their medicines for coronary artery disease (CAD). Often, they need to take several medicines at different times of the day. Also, for some people, the medicines are not affordable. But medicines are often an essential key to treatment, and people who do not take them as prescribed have an increased risk of complications and death. ⁵

Medication Choices

Medications to treat symptoms and prevent complications

If you have symptoms of coronary artery disease, the following medicines may be prescribed to control symptoms and, in some cases, slow its progression:

• Aspirin or other antiplatelet medications help prevent blood clots in your coronary arteries.
• Beta-blockers slow your heart rate and lower your blood pressure to reduce the amount of work your heart has to do. They also reduce angina.
• Statins lower your blood cholesterol and may reduce your risk of a future heart attack. The National Cholesterol Education Program's (NCEP) guidelines provide a general reference to determine when to begin treatment with medicine to lower cholesterol.
• Nitrates (nitroglycerin and long-acting nitrates) relieve chest pain and other symptoms of angina.
• Calcium channel blockers slow your heart rate and lower your blood pressure to reduce your heart's workload. They also help dilate your coronary arteries and reduce angina.
• Partial fatty acid oxidation inhibitors (pFOX inhibitors), which include ranolazine (Ranexa), relieve chest pain and other symptoms of angina. This medicine does not affect heart rate or blood pressure, unlike the other medicines that relieve angina. Your doctor may prescribe ranolazine if your chest pain is not relieved by beta-blockers, nitrates, or calcium channel blockers.
• Angiotensin-converting enzyme (ACE) inhibitors lower your blood pressure and reduce the strain on the heart. They may also reduce your risk of a future heart attack or developing heart failure.
• Angiotensin II receptor blockers (ARBs) lower your blood pressure and reduce the strain on the heart. If you cannot tolerate certain side effects of an ACE inhibitor, your doctor may prescribe an ARB.

Anticoagulants may also be used following an angioplasty, atherectomy, or bypass surgery. The anticoagulant warfarin may be used if you have CAD as well as atrial fibrillation or other complications.

What to Think About

Stable angina can often be controlled using medicine. If angina symptoms become worse, medicines can be adjusted. But angioplasty or bypass surgery may be necessary if angina symptoms get worse despite appropriate medication therapy. For angina that gets worse quickly or occurs at rest ( unstable angina), hospitalization and urgent angioplasty, stenting, or bypass surgery may be needed. For more information, see the topic Heart Attack and Unstable Angina.

Although nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, relieve pain and inflammation much like aspirin does, do not substitute NSAIDs for aspirin, because they will not decrease your risk of another heart attack. If you need to take NSAIDs for a long time, talk with your doctor to see if it is safe for you. Some research suggests that long-term use of these medicines may raise your risk for CAD.

If you need both aspirin and a pain reliever every day, talk to your doctor about what pain reliever you should take. If you take uncoated aspirin and ibuprofen at the same time, the aspirin may not work as well to prevent a heart attack. You may be able to use acetaminophen instead of ibuprofen to treat your pain. But if ibuprofen is your only option, avoid taking it during the 8 hours before and the 30 minutes after your aspirin dose. ²² For example, you can take ibuprofen 30 minutes after your aspirin dose. If you take ibuprofen once in a while, it does not seem to cause problems.

Experts do not know if NSAIDs other than ibuprofen interfere with uncoated aspirin. Also, experts do not know if people who take a daily coated aspirin should be concerned about ibuprofen or other NSAIDs interacting with the aspirin. Talk to you doctor if you take these medicines every day.

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Last updated:	May 29, 2007
Author:	Robin Parks, MS
Reviewed By:	Caroline S. Rhoads, MD - Internal Medicine, Ruth Schneider, MPH, RD - Diet and Nutrition
Editors:	Kathleen M. Ariss, MS, Pat Truman