Europa Trial
Home
Sitemap
General Public Heathcare Professionals Virtual Press Office
 

Coronary Artery Disease
What is CAD?
What are the symptoms of CAD?
What causes CAD?
Who is at risk for CAD?
How to detect CAD?
How is CAD treated?

What is a clinical trial?

EUROPA in brief

EUROPA Latest News

Glossary
Home : General public : How CAD is treated
How CAD is treated

Modification of the lifestyle

Drugs
Antianginal drugs
Secondary prevention

Interventions on the coronary arteries
Coronary bypass
Coronary angioplasty or coronary dilatation
Modification of the lifestyle

It is mandatory to quit smoking and an aggressive risk factor modification is warranted: the blood pressure should be normalized in case of hypertension. Lipid lowering drugs have to be prescribed to normalize high blood levels of cholesterol. Glycemic control in diabetics is important.

In all cases, it is recommended to adjust the body weight and to perform daily exercise.

Drugs

Antianginal drugs

Their aim is to prevent or attenuate angina pectoris episodes.


  Nitroglycerine and its derivatives

Nitroglycerine is used primarily to treat angina pectoris episodes, in the form of tablets to be chewed or a spray; it acts almost immediately (the episode disappears after 1 to 2 minutes). Any person suffering from coronary artery disease is advised to always have some readily available and to check the expiry date marked on the packet.
If the episode does not attenuate quickly after taking a tablet or using a spray, you can take another tablet or use the spray again, but no more than that.
Nitroglycerine derivatives can also be used as a “long term” antianginal treatment. They are then prescribed in so-called “delayed action” forms which are released gradually into the body, or in the form of patches stuck on the skin.

  Beta-blockers


Beta-blockers reduce the heart's workload by reducing the resting heart rate and above all during exertion.
They are also used in the treatment of hypertension and sometimes heart failure.

  Calcium channel-blocking agents


These drugs reduce the passage of calcium in the cells and have a relaxing effect on the artery walls: the result is both a dilatation of the coronary arteries and a fall in blood pressure. Some can also reduce the heart rate.

  Metabolic agents

Thanks to a specific metabolic mechanism of action, these agents prevent symptoms of angina and improve ergometric parameters, thus offering a reliable protection to all coronary patients.

These agents reduce the metabolic damage caused by the lack of oxygen in the tissue.

 
  Other antianginal drugs


Other drugs are available or are being studied, this being an area where the research departments of pharmaceutical laboratories are very active.

Whatever antianginal drug has been prescribed, you must never stop the treatment abruptly, particularly when taking beta-blockers.


Secondary prevention

  Antithrombotic drugs

They prevent the formation of blood clots in the coronary arteries or they can even dissolve the clots that have caused an infarction.

  - Platelet aggregation inhibiting drugs

Some of these drugs are very powerful and are administered via an intravenous perfusion during acute coronary syndromes. Others taken orally are easily digestible.

  - Oral anticoagulants (anti-vitamin K)

These drugs prevent the formation of blood clots. They act on the blood-clotting by preventing certain vitamin K-dependent factors from forming: this explains their gradual action over time and the necessity of a strict control to avoid bleeding. The many interactions, either with other drugs (aspirin and non steroidal anti-inflammatory drugs), or with the person’s diet (green vegetables, cabbage… foodstuffs containing vitamin K), necessitate meticulous and restrictive controls by means of regular blood tests.

These are not indicated in an emergency situation but are sometime used for the follow-up of a myocardial infarction.

  - Anticoagulants administered by injection

These products, heparin and its derivatives, are used during hospitalisation in the first few days after an infarction, to treat patients suffering from unstable angina or those undergoing an angioplasty or a coronary bypass, (or in the case of a venous disease). Patients must be kept under regular observation with blood tests. Some forms of heparin (low molecular weight heparin) can also be used outside the hospital environment; injections are given by a nurse but are also self-administered after a short learning period.

  Cholesterol lowering drugs


These drugs, such as statins, lower bad cholesterol in the blood

  Drugs under investigation

 
The EUROPA study investigated the use of an ACE-inhibitor, perindopril, in secondary prevention of Coronary Artery Disease irrespective of the patients’ risk.


After suffering an infarction many other kinds of drugs can be used, in particular to treat heart failure and to modify your risk factors.


Interventions on the coronary arteries

Coronary bypass
The principle consists of creating a bridge to bypass the constricted area of the coronary artery. Two kinds of bypasses can be used:
in a vein bypass, a vein is taken from the leg and one side is attached to the aorta and the other to the coronary artery further up from the constricted segment.
arterial bypasses generally use the internal mammary artery which usually supplies blood to the wall of the thorax. This artery is by nature almost always healthy and it is not indispensable for the wall of the thorax. It is deviated from its usual route and is implanted on the coronary artery beyond the constriction.

In general, a coronary bypass is only used for patients who have several coronary arteries that are affected. The surgeon then implants several bypasses during the same operation.

The length of hospitalisation after a bypass is about a week, with a spell in an intensive care unit immediately after the operation.

Techniques have been developed over the last few years where the bypass is carried out without stopping the heart (so called “beating heart” bypasses) and sometimes using videosurgery where only a small opening is made in the thorax.




Coronary angioplasty or coronary dilatation

Percutaneous coronary angioplasty or coronary dilatation is used to treat stenoses without having to operate.


The intervention starts like a coronarography, the cardiologist passes a very flexible metal guide through the constricted area of the artery. Along this guide is then passed a tube with an inflatable bladder on the end. When the bladder has crossed the constricted area, it is inflated with liquid for a few seconds to a few minutes to compress the atheromatous plaque which is obstructing the artery and dilate the constricted segment.
If the result is inadequate, further inflations can be practiced. To obtain the best result immediately, it is often necessary to complete the dilatation by implanting a small tube or stainless steel lattice called a “stent” or coronary “endoprosthesis”, which is applied against the internal wall of the artery by inflating the bladder. The stent is left in place in the artery to support the wall.

Coronary angioplasty is a less invasive “revascularisation” technique than a bypass and it does not even require a general anaesthetic. A recurrence of the stenosis can still occur within the 4 to 6 weeks following the dilatation. This risk has however lessened considerably thanks to the use of a new generation of “active” stents coated with a drug which prevents restenosis.

Stenosis: constriction of an artery
Ischaemia: circulatory deficiency of the blood in a tissue


This website is intended for an international audience. Drug related information may refer to unlicensed products or uses which may not be approved in your own country and you should therefore consult your local prescribing information.
This site is published and updated by the EUROPA study investigators. Site last updated March 21st 2006
To report a suspected side-effect with a Servier drug, please click here.
Terms of use - ©2005 EUROPA All rights reserved