Coronary heart disease - Treatment options 

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

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 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 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

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, 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, 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 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 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)

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

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

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