Guidelines to treating heart disease

Recently, seven leading medical societies, including the American Heart Association and the American College of Physicians jointly published revised clinical practice guidelines for treating patients with stable ischemic heart disease — that is, coronary heart disease (CHD) with manageable symptoms. 

CHD is a narrowing of the coronary arteries caused by plaque build-up, which impairs the body’s ability to pump sufficient blood to the heart. CHD can lead to serious complications, such as chest pain (angina), heart attacks, heart failure and irregular heartbeats (arrhythmias). What works if you have CHD Lifestyle interventions and drug therapies: The first step toward keeping heart disease stable is to eliminate unhealthy lifestyle behaviours. 

The guidelines mostly stick with the tried and true: Eat a healthy diet, control your weight, get regular physical activity, quit smoking, avoid second-hand smoke, manage stress and depression. The new guidelines also add a warning to avoid air pollution. Drugs can help prevent a heart attack and reduce symptoms – a fact that the new guidelines strongly emphasize. They suggest that patients with stable CHD be placed on moderate- to high-dose statins. Bile acid sequestrants, niacin or both are recommended if you can’t tolerate statins. 

Two more therapies should also be part of your treatment if you have CHD. They are: A daily aspirin of 75 to 162 milligrams. If you can’t tolerate aspirin, your doctor can prescribe clopidogrel and an annual flu shot. If you have angina, besides taking beta blockers, you should: Use nitroglycerin for immediate relief and take a calcium channel blocker or use a long-acting nitrate if beta blockers are not effective or have adverse effects. What does not work if you have CHD. 

New heart disease guidelines recommend against using some strategies strictly to reduce cardiovascular risk (although they may be beneficial for other conditions). These include: Estrogen therapy for postmenopausal women; Antioxidant supplements containing vitamins C and E and beta-carotene; B6, B12 and folate supplements. Others are: Chelation therapy, which uses a chemical to remove excess heavy metals, such as iron, lead and mercury, from your blood; garlic, coenzyme Q10, selenium and chromium supplements.


This story was published in Newswatch Times on July 11, 2015.

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