How to Control and Prevent Coronary Artery Disease

CAD is truly a disease of the Western lifestyle, brought on by high-fat diets, wide waistlines, cigarette smoking, and grinding stress. The inflammation that contributes to CAD is exacerbated by all that modern life offers, including fatty meats, processed foods, and desk jobs that discourage exercise.

Cancer may be scarier, but the fact is, more people die from CAD than from any other disease.

The mechanism is fairly simple. Plaque-a collection of dead cells, cholesterol, and other gunk-builds up on the walls of coronary arteries. This process is helped along by inflammation, which makes LDL (“bad”) cholesterol denser and stickier and more likely to glom onto those walls. As the plaque grows, it narrows the artery and impedes the flow of blood to the heart. A piece of ruptured plaque or a clot that forms on top of the plaque could block the flow altogether (and also trigger more inflammation as the body sends immune cells to the rescue). The result: a heart attack. CAD can also lead to congestive heart failure.

If lifestyle is a main contributing factor for CAD, it’s also a main treatment approach. So be prepared to change your diet, manage your stress, and get more exercise.

Our Best Advice

To control CAD and help prevent a first or second heart attack, as well as reduce the incidence of angina, or chest pain, do the following.

1. Take 81 milligrams buffered aspirin daily with food.
2. Take 1 to 2 grams fish oil daily.
3. Make olive oil, vegetables and fruit, whole grains, and fish the mainstays of your diet.
4. Spend at least 30 minutes a day in some sort of physical activity. Walking, bicycling, swimming, working out with weights, gardening-all have been found to reduce your risk of CAD, heart attack, and stroke.
5. Choose one stress management technique (such as yoga, meditation, qi gong, or t’ai chi) and practice it every day.

Why It Works

When plaque ruptures, numerous cells rush to the site to repair the damage. Among them are platelets, particles that help blood clot. But the last thing you want in a coronary artery is a blood clot. Aspirin helps prevent clots. It also quells the inflammation that contributes to artery blockage. Because daily aspirin use carries some risks, talk to your doctor before starting.

The heart benefits of fish oil, rich in omega-3 fatty acids, are many, including reducing the risk of irregular heart beats that could lead to sudden death, reducing the risk of blood clots, and, most important, reducing inflammation.

Southern Europeans have protected themselves from CAD for centuries by emphasizing plant-derived oils (especially olive oil) and fish oils over animal fats like butter, whole grains over refined grains, and plant-based food over red meat and dairy. Today we call this approach to eating the Mediterranean diet. One analysis of no fewer than 147 studies dealing with diet and heart disease found “compelling” evidence that this eating strategy helps fight CAD.

Olive oil alone contributes to CAD protection; recent evidence finds it has significant anti-inflammatory powers, much like aspirin. It’s also rich in antioxidants called phenols, shown to retard the buildup of LDL cholesterol on coronary arteries. Choose extra virgin olive oil; it’s higher in antioxidants and tastes better.

Regular moderate exercise decreases the risk of death from CAD by improving circulation, enabling your body to use oxygen more efficiently, and helping you lose excess weight. In one of many studies showing the benefits of exercise, CAD patients who exercised had healthier arteries, had lower cholesterol and triglyceride levels, and could exercise longer than patients who didn’t.

Believe it not, chronic stress contributes to CAD. Amazingly, getting those stress hormones under control not only reduces the risk of CAD but can actually help open up clogged arteries.

Other Medicines

Herbs and Supplements

Hawthorn. This herb is one of the most widely prescribed heart remedies in Europe. It improves blood flow by relaxing blood vessels. It also strengthens the heart’s pumping powers, helping prevent a serious complication of CAD, heart failure, which brings with it shortness of breath. Take 60 milligrams three times a day of the Crataegutt extract found in products such as HeartCare by Nature’s Way.

B vitamins. Supplementing with vitamins B6, B12 and especially folic acid reduces levels of homocysteine, a protein associated with heart disease. (In fact, in one study, people with the most homocysteine in their blood had double the heart attack risk of people who had the least.)

Take a B complex vitamin supplement that contains at least 400 micrograms folic acid, 50 milligrams vitamin B6, and 500 micrograms B12 daily. If you’ve had angioplasty, in which the surgeon inserted a stent to prop open the artery, talk to your doctor before taking these supplements; some studies suggest that high doses like those we recommend could raise the risk of restenosis, in which the artery becomes clogged again.

Coenzyme Q10 (CoQ10). Levels of this natural substance, found in many foods and in every cell of the body (especially the heart), are frequently low in heart disease patients. It helps maintain healthy heart muscle tissue and also acts as an antioxidant. Most research emphasizes its benefits for those with heart failure, but several small studies indicate it can help angina sufferers better tolerate physical activity. Take 100 to 300 milligrams a day.

L-carnitine. This amino acid, highly concentrated in the cells of the heart, helps those cells generate energy and use oxygen more efficiently. Studies find taking 500 milligrams three times a day helps angina patients exercise longer and more safely. We recommend 1 gram twice a day.

Arginine. Another amino acid, arginine can also help CAD patients. Studies find that taking 6 to 8 grams a day can help them better tolerate exercise with less risk of chest pain. It seems to work by increasing nitric oxide production, which improves blood flow by dilating blood vessels.

Prescription Drugs

Nitrates. Fast-acting nitrates, such as nitroglycerin, are pills or sprays used to abort an angina attack. Nitrate medications also come in slow-acting preparations like patches and ointments, which provide longer-term angina prevention.

Beta-blockers. These are the drugs of choice for older CAD patients with angina. They help prevent chest pain and heart attacks by lowering blood pressure and reducing the heart’s demand for oxygen. Commonly prescribed beta-blockers include Sectral (acebutolol), Tenormin (atenolol), and Zebeta (bisoprolol).

ACE inhibitors. Drugs such as Altace (ramipril), Vasotec (enalapril), and Lotensin (benazepril) open up arteries by interfering with production of the vessel-constricting chemical angiotensin. This reduces the risk of a heart attack, especially for people whose CAD is accompanied by heart failure or diabetes.

Calcium channel blockers. These drugs lower blood pressure and slow the heart rate, but they’re generally less effective against angina than ACE inhibitors and beta-blockers. Some calcium channel blockers, such as Norvasc (amlodipine) and Cardene (nicardipine), however, do appear to help angina patients.

Other Approaches

Surgery. Two major but common surgical procedures eliminate artery blockages that cause CAD. They are:

1. Angioplasty.A narrow tube is threaded from the groin into the coronary artery and a tiny balloon is inflated in the artery. The balloon clears the blockage by pressing the plaque against the vessel wall. Then a metal tube called a stent is implanted in the vessel to keep the artery open. Today, stents come coated with special drugs to prevent the plaque from reforming.
2. Bypass surgery. This procedure transplants sections of artery from elsewhere in the body to create detours, or bypasses, around blocked arteries. It’s much more invasive than angioplasty because it involves opening up the chest, so it carries higher risks and requires a much longer recovery time. Still, most people are out of the hospital in three to five days. Why would anyone go with bypass surgery instead of angioplasty? One reason: A recent study found that bypass delivered longer-lasting results than angioplasty, which opens up relatively small sections of artery. With angioplasty, repeat procedures may be necessary.

Enhanced external counterpulsation (EECP). Common in China and making inroads here, EECP is a noninvasive alternative to angioplasty and bypass surgery. Pressurized cuffs are placed around the leg and inflated and deflated. This alters blood flow to the heart, improving heartbeat efficiency. Studies find it reduces angina episodes in 73 percent of CAD patients. A typical EECP course consists of 35 one-hour daily treatments.

Flaxseed. Flaxseed is the richest food source of omega-3 fatty acids and lignans, an antioxidant. Together they retard plaque buildup, the hallmark of CAD. Take 1 tablespoon of flaxseed oil daily, or include 3 tablespoons of the freshly ground seeds in meals throughout the day (try it sprinkled over salads or yogurt, or mixed into sauces).

Prevention

Maintain a healthy weight. Obesity, especially belly fat, increases your chances of coronary artery disease, probably by increasing the risk of other contributors to CAD, including high cholesterol, high blood pressure, and diabetes.

Stop smoking. Smoking greatly increases your risk for CAD and at least doubles your risk of a heart attack. The tobacco smoke constricts blood vessels and weakens blood’s ability to carry oxygen to the heart. It also raises cholesterol levels and encourages blood clotting. See 10 Ways to Quit Smoking for advice on quitting.

Control your blood pressure and cholesterol. These are serious risk factors for CAD. See Heart Healthy Foods that Lower Cholesterol for advice.

Prevent or control diabetes. Diabetes increases inflammation, which contributes to CAD, and damages the lining of blood vessels, making plaque buildup more likely.

A healthy diet and regular exercise are your frontline defenses, but also consider Glucophage (metformin), especially if blood sugar levels are already high. Studies suggest this medication not only helps prevent diabetes in people with insulin resistance or metabolic syndrome but may also protect against heart disease directly, probably by decreasing blood fats known as triglycerides.

Consume alcohol in moderation. Whether alcohol is good or bad for you depends on how much you drink. Studies find that light daily consumption (one drink for women, two for men) can protect against CAD. We don’t quite know how, but one possibility is that it increases production of nitric oxide, thus improving blood flow. It also seems to prevent blood clots. If you like it, quaff red wine, whose antioxidants are believed to work together with the alcohol itself to provide strong heart protection. Just don’t drink too much alcohol or the risks will quickly outweigh the benefits.

Drink your antioxidants. Antioxidants make cholesterol less harmful to arteries. Green tea and black tea, dark grape juice, and pomegranate juice are all rich in antioxidants. A study of more than 3,000 Saudi Arabians found those who drank the most black tea every day were least likely to develop heart disease. Other studies find similar results with green tea.

Take a daily multivitamin. Among the likely benefits of taking a daily multi are a lower homocysteine level and less oxidation of “bad” cholesterol (remember, oxidation makes cholesterol more likely to stick to artery walls). Aside from the all-important B vitamins, make sure it includes magnesium, potassium, and zinc. A growing body of research finds that people with low levels of those minerals are more likely to develop heart disease.