Prevention is at the Heart of Coronary Artery Disease Care
New medications and treatment advances are helping patients manage heart disease risk factors and effectively prevent cardiac complications.
During the past few decades, new medications and minimally invasive treatment options have given doctors more tools to combat coronary artery disease (CAD). These advances—combined with public health education initiatives focused on prevention and early detection—have caused heart disease death rates to fall for men, women, and most racial and ethnic groups in the United States.
However, heart disease continues to be the No. 1 killer of men and women in the U.S.—a ranking the disease has held since 1950. Although these advances have certainly been game-changing for people with CAD, Victoria Shin, MD, an interventional cardiologist at Torrance Memorial Medical Center, says heart disease prevention may actually be the best medicine: “Eighty percent of cardiovascular disease can be prevented—and it all comes down to understanding your risk factors and taking steps to manage them."
New Medications Reduce CAD Risk
One of the mainstays of CAD prevention is lipid-lowering therapy, which includes a class of medications called statins that reduce cholesterol levels. Most patients with high cholesterol should be on a statin, and most of them can tolerate it without issues. A small subset of patients can be intolerant to statins due to debilitating muscle aches. These patients who cannot take statins now have access to alternative cholesterol-lowering drugs, including ezetimibe, bempedoic acid and injectable medications in the PCSK9 inhibitor class (e.g., evolocumab), which are administered once every two weeks.
“Decades of research show that statins are safe and they save lives,” says Dr. Shin. “However, for patients who can’t take statins, there are now alternatives—although they are more expensive and may not be covered by insurance.”
Researchers have found that colchicine—an older medication initially used to treat gout—has anti-inflammatory benefits that reduce the risk of cardiovascular events in those with underlying CAD. Recent studies have also shown that certain diabetes medications, including GLP-1 agonists and SGLT2 inhibitors, help reduce cardiovascular risk as well.
“GLP-1 agonists and SGLT2 inhibitors can be helpful for people who are at increased risk of cardiac disease due to a combination of diabetes, obesity, high blood pressure and high cholesterol,” Dr. Shin says.
Minimally Invasive Therapies Promote Faster Recovery
When medication isn’t enough to manage CAD, less-invasive treatment options can reduce the need for open-heart surgery. “New devices and techniques are allowing us to treat more people with angioplasty and stenting, a less-invasive procedure than coronary artery bypass graft surgery,” says Dr. Shin. “We offer laser therapy to remove plaque from arteries and use drug-coated balloons that deliver medication directly to the artery wall to prevent renarrowing.”
People with valve disease also have access to new, catheter-based valve procedures that are performed through a small incision—without needing to open the chest. Minimally invasive procedures include transcatheter aortic valve replacement (TAVR) to treat a narrowed aortic valve; MitraClip and TriClip procedures to treat leaky mitral and tricuspid valves; and Watchman procedures to prevent blood clots from forming in the left atrial appendage and causing a stroke in people with atrial fibrillation (A-Fib) who are unable to take blood thinners.
Same Disease, Different Experiences
Although the risk factors for CAD indeed are the same, men and women may experience and discuss symptoms differently. “Women are more likely to describe nonspecific symptoms like tiredness or indigestion,” says Dr. Shin. “Also, different communication styles may lead men to convey symptoms more directly, while women may be indirect.”
But one thing is true for both sexes: It’s easier to prevent CAD than to treat it — especially after it causes a life-threatening cardiac event.
“Getting screened and managing your risk factors are the keys to prevention, and it’s not one-size-fits-all,” says Dr. Shin. “Your situation isn’t exactly the same as anyone else’s, so we will personalize your care to meet your needs.”
What Lipoprotein(a) Means for Your Heart Disease Risk
Research has shown that high levels of lipoprotein(a), or Lp(a), may increase your risk for heart disease. Lp(a) is a variant of low-density lipoprotein (LDL), commonly referred to as “bad cholesterol.”
“Lp(a) is considered to be a bad actor because it is ‘stickier’ than the other particles and thereby more likely to cause plaque buildup and blockages in your arteries,” said Dr. Shin. “However, unlike LDL cholesterol, elevated Lp(a) is genetic—not responsive to current medications or dietary changes.”
Normal Lp(a) levels are below 30 mg/dL. A level of 31–50 mg/dL indicates a high risk for cardiac disease, and above 50 mg/dL suggests a very high risk. Dr. Shin says she usually tests her patients’ Lp(a) level at least once to help guide their treatment. If the number is high, this can be a useful tool for convincing people to take serious action to improve their cardiac health.
“If I have a patient with an elevated LDL and/or Lp(a), I’m going to recommend very aggressive management of risk factors. I sometimes even recommend a Coronary Calcium Score test to risk-stratify even further. It is not always necessary if the blood tests already tell us what we need to know about a patient’s risk, but sometimes patients need more convincing to be compliant with medications and lifestyle modifications. Depending on what we find, we can intervene early—which could save a life.”
