Treating Heart Disease

Once doctors determine that you have clogged coronary arteries, the treatment plan typically involves a combination of drugs, lifestyle changes, and procedures that open up the arteries.

Drugs: Thrombolytic drugs, also referred to as "clot-busting drugs," are given during a heart attack to dissolve blood clots in coronary arteries and restore blood flow to the heart.

Because of its anti-clotting abilities, aspirin is recognized by the Food and Drug Administration as safe and effective to help lower the risk of having a second heart attack.

Other drugs commonly used to treat persons with heart disease include drugs that lower blood pressure, angiotensin-converting enzyme (ACE) inhibitors, which help the heart pump blood better, and beta blockers, which slow the heart down. Nitrates and calcium channel blockers relax blood vessels and relieve chest pain. Diuretics decrease fluid in the body. Blood cholesterol-lowering drugs reduce levels of low-density lipoproteins (LDL), the "bad cholesterol," in the blood and increase high-density lipoproteins (HDL), the "good cholesterol."

Catheter-based treatments: Angioplasty is a procedure in which a thin tube called a catheter is put into an artery in the groin and threaded up to the narrowed artery in the heart. The catheter, which has a balloon at the tip, is used to widen the artery. Routinely, tiny mesh wire tubes called stents are then inserted into the artery to hold it open permanently. But a major challenge is restenosis, which is the reclogging or renarrowing of an artery after angioplasty or stenting.

Maureen Magoon, 67, of Blairsville, Ga., who was diagnosed with heart disease in 1999, has experienced problems with restenosis since receiving angioplasty. So when her doctors at the Emory Heart Center in Atlanta recently discovered that another one of her arteries was clogged, they determined that she was a good candidate to receive the Cypher Stent from Cordis Corp., the first drug-eluting stent.

The new stent, approved by the United States of America Food and Drug Administration in May 2003, releases the drug sirolimus, which reduces the risk that the artery will reclog. As part of its conditions for approving the Cypher Stent, the United States of America Food and Drug Administration is requiring Cordis to conduct a post-approval study of 2,000 patients to assess the long-term safety and effectiveness of the new device. The agency is monitoring reports of problems with the stent, as it does with all medical devices.

A process called intravascular radiation therapy, which uses radiation to kill cells that are clogging an artery, is sometimes used during angioplasty procedures. Also known as brachytherapy, this treatment is not approved for use with the placement of a stent for a vessel that has never been treated, says Jonette Foy, Ph.D., a biomedical engineer in the United States of America Food and Drug Administration's Center for Devices and Radiological Health. "Brachytherapy is approved for vessels that have been previously stented, but reoccluded over time."

Coronary bypass surgery: In cases of severe blockages or when someone is unresponsive to medications or not a candidate for angioplasty, doctors may perform coronary bypass surgery. This involves taking a blood vessel from the leg or chest and grafting it onto the blocked artery to bypass the blockage.

In the last few years, the United States of America Food and Drug Administration has approved several devices that improve heart disease diagnosis and treatment. For example, after a person has received coronary bypass surgery, devices are used to catch loose particles that could potentially float downstream and clog another artery. This process is known as embolic protection.