Treatment options for coronary heart disease 

Treatment
Pros
Cons
Lifestyle changes

Making simple lifestyle changes, such as stopping smoking and eating healthily, can help reduce the risk of further heart disease.

  • Can help prevent further problems, such as heart attacks
  • May help control blood pressure and cholesterol levels
  • Cannot always prevent heart disease

Medication

ACE (angiotensin-converting enzyme) inhibitors

ACE inhibitors, such as captopril and enalapril, are prescribed to treat high blood pressure (hypertension).

  • Effective in most people aged under 55
  • Side effects can include dizziness, tiredness, headaches and a persistent dry cough
  • Not suitable during pregnancy and breastfeeding
  • Less effective in black people and people aged 55 or over
Angiotensin II receptor antagonists

Angiotensin II receptor antagonists can be prescribed to treat high blood pressure (hypertension).

  • An option for people unable to take or tolerate ACE inhibitors
  • Side effects can include headaches, dizziness, nasal congestion, back and leg pain, and diarrhoea
  • Less effective in black people and people aged 55 or over
  • Not suitable during pregnancy
Calcium channel blockers

Calcium channel blockers can help reduce blood pressure by relaxing the muscles that make up the walls of your arteries, causing them to widen.

  • Effective in black people and people aged 55 or over
  • Side effects can include face flushing, headaches, swollen ankles, dizziness, tiredness and skin rashes (although only temporary)
  • Not suitable for people with a history of liver disease
Thiazide diuretics

Diuretics can lower blood pressure by reducing the amount of water in your blood and widening your arteries.

  • Can help other medications, such as ACE inhibitors and beta-blockers, work better
  • Can reduce stress on the heart
  • Side effects can include going to the toilet more often and dizziness
  • May not be suitable for people with diabetes or any condition that causes vomiting or diarrhoea
  • Can put a strain on the kidneys

 

Beta-blockers

Beta-blockers, such as acebutolol and propanolol, are used to treat high blood pressure and angina.

  • An option for people who do not respond to other medication
  • Safer to use during pregnancy than other medications
  • Common side effects can include tiredness, cold hands and feet, slow heartbeat, diarrhoea and nausea
  • Rarer side effects can include sleep disturbances, nightmares and impotence
Statins

Statins, such as simvastatin and pravastatin, can be used to reduce the level of cholesterol in your blood.

  • May help reduce the chance of a heart attack or a stroke
  • Can be used to treat high cholesterol that runs in the family (familial hypercholesterolaemia)
  • Not suitable for people with a history of liver disease
  • Side effects can include muscle pain and stomach problems
  • Must be taken for life
  • Should not be taken if you are pregnant or breastfeeding
Low-dose aspirin

Low-dose aspirin is prescribed to reduce the risk of angina or a heart attack by preventing your blood from clotting.

  • May help reduce the chance of a heart attack or a stroke in someone at risk
  • Can help reduce the chance of blood clots forming
  • Not suitable for people with a history of stomach ulcers, kidney disease or liver disease
  • Usually taken for life
  • Side effects can include stomach problems and internal bleeding
Nitrates

Nitrates are used to reduce blood pressure and lessen any heart pain by widening and relaxing your blood vessels.

  • Can help reduce pain in the heart
  • May reduce the chance of a heart attack
  • Side effects can include headaches, face flushing, dizziness and feeling faint
  • May become less effective if used for a long period of time
  • Not suitable for people with low blood pressure, disease of the heart muscle (cardiomyopathy), or aortic stenosis (a disease of the heart valve)

Procedures and surgery

Coronary angioplasty

Coronary angioplasty, also known as a percutaneous coronary intervention (PCI), involves inserting a small balloon into an artery to widen it and improve blood flow. A wire mesh tube (stent) is used to ensure the artery doesn't narrow again. 

  • Can help relieve symptoms that fail to respond to medication
  • Short recovery time
  • In around 1 in 25 cases, the coronary artery narrows significantly, meaning further treatment is needed
Coronary artery bypass graft (CABG)

A coronary artery bypass graft involves inserting a blood vessel from elsewhere in your body, usually your chest or leg, next to a blocked artery to direct blood flow around the blockage.  

  • Particularly effective in people aged over 65, people with diabetes, and people with extensive disease or poor heart muscle function
  • Can have a long recovery time and pain after the operation
Heart transplant

A heart transplant involves replacing a diseased or damaged heart with a healthy donor heart.

  • Can improve long-term quality of life
  • Donor hearts are not widely available
  • Long recovery time
  • Risks include the rejection of the donor heart by the body, infection, and narrowing of the arteries connected to the new heart