Coronary heart disease (CHD) is treated in a number of ways, depending on its severity. For many women, CHD is managed with lifestyle changes and medications. Others may need more invasive procedures, perhaps even surgery, and medication. In any case, once CHD develops, it requires lifelong management.

Although great advances have been made in treating CHD, changing your lifestyle habits remains the single most effective way to stop the disease from progressing.

1. Diet. Changing your dietary habits remains the single most effective way to stop atherosclerosis from progressing to coronary heart disease. Changing your diet to one low in saturated fat and cholesterol reduces blood cholesterol, a primary cause of atherosclerosis. Eating less fat should also help you lose weight. The DASH (Dietary Approaches to Stop Hypertension) diet, endorsed by the major heart organizations, is one strategy for lowering high blood pressure. It is rich in lower-calorie foods such as fruits and vegetables and whole grains and low in sodium.

   The "Therapeutic Lifestyle Changes (TLC) Diet" plan, developed by the NHLBI calls for less than seven percent of your calories to come from saturated fat and for less than 200 mg of dietary cholesterol. Twenty-five to 35 percent or fewer of total daily calories can come from fat, provided most of these calories are from unsaturated fat, which doesn't raise cholesterol. Sodium intake should be limited to no more than 2,400 mg per day. In addition, the guidelines encourage the use of certain foods rich in soluble fiber to boost the diet's LDL-lowering power.

2. Exercise. You also can benefit from exercise. Recent research finds that even moderate amounts of physical activity are associated with lower death rates from coronary heart disease. However, if you have severe CHD you may have to restrict your exercise somewhat, so check with your health care professional to find out what kinds and amounts of exercise are best for you.

3. Weight loss. If you are overweight, losing weight can help lower blood cholesterol levels. It is also the most effective lifestyle change to reduce high blood pressure, another risk factor for atherosclerosis and heart disease. The best way to lose weight is through a combination of diet and exercise.

4. Smoking. Smoking is the number one preventable cause of CHD. Quitting smoking dramatically and immediately lowers the risk of a heart attack and also reduces the risk of a second heart attack in people who have already had one.

Medications for CHD

In addition to lifestyle changes, medications are prescribed according to the type of CHD you have, how serious it is, and other health conditions you may have. The symptoms of angina can generally be controlled by beta blocker drugs that decrease the workload on the heart, by nitrates (including nitroglycerin) that dilate the arteries, by calcium channel blockers (CCBs) that relax the arteries, and by other classes of drugs.

The tendency to form clots can be reduced by taking aspirin or by other drugs called platelet inhibitory and anticoagulant drugs, which help keep blood thin. Beta blockers and angiotensin converting enzyme inhibitors (ACE), and statins, have also been shown to reduce the risk of recurrent heart attack.

Medications Prescribed for Heart Disease

The most common medications prescribed for those with heart disease are:

• Angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB). These drugs stop production of a chemical that makes blood vessels narrow. They are primarily used to reduce blood pressure and when the heart has been damaged. There is evidence it may also reduce the risk of having a second heart attack. Research finds that using ACE inhibitors during pregnancy, especially after the first three months, can cause low blood pressure, severe kidney failure, too much potassium, or even death in the newborn. Therefore, it is important that you check with your doctor immediately if you think that you may be pregnant.

• Aspirin. Low-dose aspirin—up to 325 mg per day—helps prevent heart attacks when taken daily upon the recommendation of a health care professional. Today, the American Heart Association and the U.S. Preventive Services Task Force recommend that people at high risk for heart attack or stroke discuss taking a daily, low-dose aspirin with their health care professionals.

  However, a study presented at the 2005 American College of Cardiology meeting and published in the New England Journal of Medicine in March 2005 found that low-dose aspirin did not appear to prevent first heart attacks in healthy women younger than 65, although it did significantly reduce their risk of ischemic stroke.

  So it's very important that you check with your health care provider about whether or not aspirin therapy is right for you. If you already are taking low-dose aspirin therapy, check with your health care professional before stopping it if you have questions about the latest study.

  For women who should be on aspirin therapy, it doesn't take much to get the benefits. Studies find that between 75 and 100 milligrams, known as "low-dose aspirin therapy," is enough to reduce the risk for heart attack or angina. Most aspirin brands come in low-dose formulations of 81 mg. The upper dosage for aspirin in women at a high risk for heart disease is 325 milligrams.

  Aspirin is also important if you think you're having a heart attack. First, the American Heart Associations recommends, call 911. Then chew two 81 mg aspirin tablets unless you have any allergies to aspirin or serious bleeding issues. Once you receive medical attention, the aspirin therapy should be continued. Studies find that aspirin taken during a heart attack reduces the risk of death by 23 percent.

  Aspirin's cardioprotective benefits stem from its unique ability to make blood cells that are partially responsible for forming clots less sticky. Aspirin also soothes inflammation in the arteries, which helps protect blockages from breaking off.

  Aspirin has a downside, however. Because it acts on the overall system that affects bleeding, aspirin also increases the risk of gastrointestinal bleeding, either from an ulcer or gastritis, and the risk of a rare but dangerous form of stroke caused not by a blood clot, but by bleeding in the brain. This fact, and the lack of strong enough evidence to support a change in labeling, led the U.S. Food and Drug Administration panel in December 2003 to vote against including "primary prevention of heart attack" in the indications for use of aspirin on the medication's label.

• Anticoagulants (Coumadin and warfarin). These drugs protect against stroke due to atrial fibrillation (abnormal heart rhythm) by reducing the risk of blood clots. It is also used for some women with heart disease or other types of stroke.

• Beta blockers. These drugs reduce the heart's workload and are used for high blood pressure, chest pain and to prevent a repeat heart attack.

• Blood cholesterol-lowering agents.

Cholesterol-lowering medications that may be recommended include:

• Statins. Six statin drugs are available in the U.S.: atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor), pravastatin (Pravachol), and simvastatin (Zocor), and rosuvastatin (Crestor). These highly effective drugs typically produce a 20 to 60 percent reduction in LDL cholesterol levels. They also provide the added benefits of some increase in HDL cholesterol and some reduction in triglyceride levels. Make sure you talk about any potential side effects from statins with your health care provider. If you start to experience any side effects such as muscle aches or dark urine, stop taking the drug immediately and call your health care professional.

• Nicotinic acid. More commonly known as niacin, this compound is a water-soluble B vitamin. Unfortunately, you can't lower your cholesterol by taking a vitamin supplement; to have such an effect, it must be taken in doses well above the daily vitamin requirement. Although nicotinic acid is inexpensive and available over the counter, never take it to lower your cholesterol without guidance from a health care professional because of potential side effects. The extended release form is available by prescription as Niaspan. Niacin has broadly positive effects on cholesterol: it lowers LDL cholesterol by 10 to 20 percent and triglyceride levels by 20 percent to 50 percent, while lifting HDL cholesterol levels 15 percent to 35 percent.

• Bile acid sequestrants. The three main bile acid sequestrants currently prescribed in the U.S. are cholestyramine resin, colestipol (Colestid), and colesevelam (WelChol). They typically lower cholesterol by 10 to 20 percent and are available as powders, tablets, or granules. These drugs work by binding with bile acids that contain cholesterol in the intestines. They can be prescribed alone or in combination with a statin. A bile acid sequestrant may also be prescribed in combination with another drug if you have high triglycerides or a history of severe constipation.

• Fibrates. These drugs reduce triglycerides by 20 to 50 percent and usually raise HDL cholesterol 10 percent to 15 percent. The most widely used fibrate in the U.S. is gemfibrozil (Lopid). Other fibrate medications include fenofibrate (TriCor) and Clofibrate (Atromid-S, Abitrate). Fibrates are not recommended as the sole drug therapy for women with heart disease for whom LDL cholesterol reduction is the main goal.

• Cholesterol absorption inhibitors. This new class of drugs lowers cholesterol by preventing it from being absorbed in the intestine. The first approved drug in this class is ezetimibe (Zetia). Studies find it lowers LDL cholesterol by about 25 percent. Zetia, which reduces intestinal absorption of cholesterol, may work best in combination with a statin, which reduce liver production of cholesterol, providing a dual mechanism for reducing cholesterol levels.

• Calcium-channel blockers. These drugs reduce the heart's pumping strength and relax blood vessels. They are used for high blood pressure and chest pain.

• Digitalis. This drug makes the heart contract harder. It's used when the heart's pumping function is weak and to slow some fast heart rhythms.

• Diuretics. These drugs reduce fluid buildup in the body and are used for high blood pressure.

• Nitrate (including nitroglycerin). These drugs relax blood vessels and alleviate chest pain.

Medications for Heart Attack—the Sooner, the Better

If you are taken to the hospital with a heart attack, thrombolytic (clot dissolving) medications, such as streptokinase and tissue plasminogen activator (tPA), may be injected to restore blood flow, but they should be administered within three to six hours, before extensive damage has occurred. Urgent treatment with coronary angioplasty and stents may also be performed. The sooner you get to a hospital for treatment, the better the chances are of preventing extensive damage to the heart. Additionally, if you think you are having a heart attack, you should take an aspirin immediately.

Other Treatments for Heart Disease

Many women can control CHD with lifestyle changes and medication, but other treatments, including surgery may be recommended if you continue to have frequent or disabling angina despite the use of medications, or for people who are found to have severe blockages in their coronary arteries.

Non-surgical treatment

Coronary angioplasty or balloon angioplasty begins with a procedure similar to what's used with coronary angiography. While the goal of coronary angiography is to show the presence, location and severity of blockages caused by atherosclerosis, coronary angioplasty goes a step further. During this procedure, the catheter positioned in the narrowed coronary artery has a tiny balloon at its tip. The balloon is inflated and deflated to stretch or break open the narrowed artery and improve blood flow. The balloon-tipped catheter is then removed. Sometimes a small flexible structure called a stent is left in place to keep the artery open.

Strictly speaking, angioplasty is not surgery. It is done while you are awake and may require one to two hours. If angioplasty does not widen the artery or if complications occur, bypass surgery may be needed.

One continuing challenge cardiologists face in treating atherosclerosis is that plaque deposits may return (a condition referred to as restenosis). Even people who've had angioplasties sometime require future treatments to widen arteries clogged with new blockage. Today, new drug-coated (drug-eluting) stents markedly decrease the rates of restenosis compared to the older generation of stents—called bare metal stents. Drug eluting stents (DES) became available in 2003 and 2004 and have been monitored by the FDA ever since.

The FDA recently announced that it is continuing to monitor the safety of drug-eluting stents after new data revealed a small but significant risk of stent thrombosis (clotting) in patients who have drug-coated stents. Stent thrombosis can lead to increased risk of heart attack and, in some cases, even death. The FDA plans to convene a public panel of outside experts to review and discuss the data to be provided by stent manufacturers on the potential for increased thrombosis risk. The FDA also continues to closely evaluate information related to the duration of treatment with the drug clopidogrel (Plavix), which is used in combination with aspirin to help prevent clotting in patients with DES.

However, the FDA also stated that these drug-coated stents remain safe and effective devices, and they should continue to be used according to FDA-approved indications. Additionally, new drugs and new types of stents are in development, and the future is promising for further advancements in this area.

Arthrectomy. In this procedure, a small cutting instrument at the end of a catheter grinds plaque off artery walls. Sometimes a small vacuum takes the plaque away after it is ground off the vessel wall. Other times a Rotablator with a diamond tip that spins 140,000 to 200,000 times per minute grinds the plaque into minuscule pieces that are flushed out of the blood stream.

Surgical treatments

• Coronary artery bypass. During this procedure, a blood vessel, usually taken from the leg or chest, is grafted from the aorta onto the blocked artery, bypassing the blocked area. If more than one artery is blocked, several bypasses can be performed. This enables the blood to go around the obstruction and supply the heart with enough blood to relieve chest pain and prevent a heart attack.

Bypass surgery relieves symptoms of heart disease but does not cure it. You will typically need to take medications and make changes in your lifestyle after the operation.