Medication, lifestyle changes are first treatment for heart

Dear Dr. Roach: I had pain in my chest, so I went to the emergency room. My blood pressure was in the 200 range, and they did an echocardiogram and stress test. Both came out negative, but the cardiologist did an angiogram, and they found I have clogged arteries. They told me they couldn’t put in a stent because the artery was too small. They put me on medication: aspirin, Imdur, carvedilol and atorvastatin 80 mg. I quit smoking. What else can I do? — L.L.

Dear L.L.: Coronary artery disease remains the most dangerous condition in the developed world. Most women don’t realize it is much more likely a cause of death than cancer. Any blockage in the arteries of the heart needs to be treated aggressively.

Heart blockages are always treated with medication, but they are also often treated by opening up the arteries. This is most typically done by a balloon procedure to open the blockage, followed by placement of a metal stent. Surgery is much less commonly done now, and is reserved for people with blockage in the left main coronary artery.

How much benefit comes from stenting an artery remains controversial. A recent study suggested minimal benefit when added to medical therapy, which is what you are on. People with more severe blockages seem to benefit more from stent or bypass surgery. The judgment of your cardiologist is critical, and if they don’t want to do stenting, then medical therapy is an appropriate choice.

Quitting smoking is the most important, but a more plant-based diet and regular, moderate exercise have large benefits in reducing heart (and other) risks.