Management of Coronary Artery Disease

• Tofu and soybean
• Canola oil
• Walnuts and flaxseed

Physical Activity

Exercise improves cardiovascular health by increasing HDL ("good") cholesterol, improving thrombolytic activity, and enhancing collateral circulation. A common framework for developing an exercise plan is the FITT formula:

• Frequency (How often)
• Intensity (How hard)
• Type (e.g., Isotonic exercise like brisk walking or swimming)
• Time (Duration)

Lipid-Lowering Pharmacotherapy

When lifestyle changes alone are insufficient to manage cholesterol and lipoprotein levels, several classes of drugs are utilized.

Statins

Statins (e.g., atorvastatin, pravastatin, simvastatin) are the most common treatment. They work by inhibiting cholesterol synthesis in the liver and increasing hepatic LDL receptors, which allows the liver to remove more LDL from the blood.

• Risks: While rare, statins can cause liver damage and rhabdomyolysis (the breakdown of skeletal muscle).

Niacin (Nicotinic Acid)

Niacin is a water-soluble B vitamin that is highly effective at increasing HDL levels—more so than any other lipid-lowering drug. It also lowers LDL and triglycerides.

• Side Effects: Common issues include facial flushing, pruritus (itching), and orthostatic hypotension.

Fibrates and Bile Acid Sequestrants

• Fibrates (e.g., fenofibrate, gemfibrozil): These are most effective for lowering triglycerides and increasing HDL, though they have minimal impact on LDL.
• Bile Acid Sequestrants (e.g., colesevelam, colestipol): These increase the conversion of cholesterol to bile acids, reducing total cholesterol and LDL.

Warning: Bile acid sequestrants can interfere with the absorption of other medications, such as warfarin or beta blockers.

Cholesterol Absorption Inhibitors

Drugs like ezetimibe (Zetia) selectively inhibit the absorption of both dietary and biliary cholesterol across the intestinal wall.

Antiplatelet Therapy

To prevent the formation of a thrombus that could lead to a myocardial infarction (MI), antiplatelet therapy is essential.

• Aspirin: Low-dose aspirin ($81\text{ mg}$) is highly recommended for men over 45 and high-risk women (those with a calculated CAD risk $> 20\%$).
• Clopidogrel: If a patient is intolerant to aspirin or has a high risk of gastrointestinal (GI) bleeding, clopidogrel may be substituted.

Summary of Pharmacological Management

The management of CAD is a lifelong commitment. Because the disease is progressive, patients must continuously monitor their lipid levels, blood pressure, and lifestyle habits to prevent the transition from stable angina to acute coronary syndromes.