Lifestyle changes and angina treatment: what efficacy?

Options for managing your angina might include lifestyle changes, medicines, or angioplasty and stenting. Discover their characteristics and benefits. 

Angina pain: what are we talking about?^1-3 

Blocked heart arteries can cause a type of chest pain called angina. Angina pain is a symptom that means the heart is not getting enough blood and oxygen. It is an uncomfortable feeling, tightness, heaviness, or pain in your chest, which may spread to your arms, neck, jaw, shoulders, back, or stomach. People sometimes describe the feeling as a dull ache. The symptoms are not the same for everyone. Some people may feel the pain or tightness only in their arm, neck, stomach, or jaw. For some people, the pain or tightness is severe, while others may feel nothing more than a mild discomfort or pressure. 

The most common cause of angina is coronary heart disease. In some people, the coronary arteries can become narrowed because fatty deposits, called atheroma, have built up within the artery walls. This process is called atherosclerosis, and it is what causes coronary heart disease, whose risk factors include:  

• Smoke any form of tobacco 

• Have high blood pressure 

• Have a high blood cholesterol level 

• Take too little physical activity 

• Are overweight or obese 

• Have diabetes 

• Have a family history of premature heart disease. 

Having coronary heart disease can increase your risk of having a heart attack, which happens when a coronary artery becomes blocked by a blood clot. This is why it is important to treat blockages that cause angina to avoid a heart attack and other complications. 

Type of pain and angina treatments^1,2 

The type of treatment depends on the type of angina pain. The most common types of anginas are:  

• Chronic stable angina: this angina pain occurs when your heart is working hard enough to need more oxygen, such as during moderate or vigorous exercise or mental stress. The pain can go away when you rest. The pattern of pain — how long it lasts, how often it occurs, what triggers it, and how it responds to rest or treatment — remains stable for at least 2 months. Angina is arbitrarily defined as stable when the angina episodes are stable over a period of 3–6 month. If your angina is stable, you might be able to control it with lifestyle changes and medicines. 

• Unstable angina: this is either new or changed angina pain. The pain is believed to be coming from the heart muscle. If you have a history of stable angina, the pain is different than usual. For example, the pain may feel worse, or it may last longer than usual. The pain might occur during lighter levels of activity, or it does not get better with rest or medicine. Unstable angina is dangerous and a warning sign of a heart attack. If you have new or changed chest pain, seek medical care right away. Unstable angina requires treatment right away in a hospital. This may involve medicines or a procedure. 

Managing angina pain with lifestyle changes^1-3 

Making lifestyle changes to keep your heart healthy is an important part of angina treatment. It includes: 

• Quit smoking: smoking is a major cause of coronary heart disease. Any type of smoking will make your condition worse. This includes cigarettes, pipes and cigars, and all other types of tobacco products such as shisha. If you need help quitting, talk to your health care team about therapies that can help, such as using products to help you stop, or joining a stop-smoking group. 

• Eat a healthy, balanced diet: with limited amounts of saturated fat, trans fat, salt, and sugar. Include each day at least 5 portions of a variety of fruits and vegetables, whole grains, lean meats, and low-fat dairy products in your diet. 

• Stay active: regular exercise and activity help control diabetes, high cholesterol, and high blood pressure, all risk factors for heart disease. Talk to your health care team about starting a safe exercise plan. If your angina occurs with activity, pace yourself and take rest breaks. Doing even a small amount is better than doing nothing. 

• Manage weight: ask your doctor what a healthy weight is for you and how to achieve it. If you need to lose weight or reduce your waist size, the best way to do this is by reducing your calorie intake by cutting down on the amount of fat and sugar in your diet, and increasing your daily physical activity, with the aim of doing a total of 150 minutes a week. 

• Treat medical conditions: get treatment for health conditions that can increase your risk of angina, such as diabetes, high blood pressure, and high blood cholesterol. 

• Reduce stress: if you have angina, it is important to learn how to relax. Find ways to help reduce and manage emotional stress, such as getting more exercise, practicing mindfulness, and connecting with others in support groups. You also need to identify situations that make you feel stressed and learn ways to cope with them effectively. 

What are the angina treatment options?^1-3 

Medicines 

Several medicines can improve angina pain symptoms, including:

• Aspirin and other anti-platelet medicines, such as clopidogrel, that prevent blood clotting. Most people with angina or coronary heart disease are prescribed low-dose aspirin. This makes it easier for blood to flow through narrowed heart arteries. 
• Nitroglycerin, which widens the heart arteries. It can help control or relieve angina pain. Nitroglycerin is available as a fast-acting spray or tablets, as slow-release tablets, or as skin patches. 

• Beta blockers, which help the heart to beat more slowly and with less forcen so that it needs less oxygen, blood, and nutrients. This eases angina pain. 

• Statins, which are often prescribed to treat high cholesterol. They also might help prevent fatty deposits called plaque from clogging heart arteries. 

• Calcium channel blockers, which relax and widen blood vessels, increasing blood flow to the heart. It is used to reduce the frequency of angina attacks. 

• Ranolazine, which might be given with or instead of beta blockers for angina. It is typically used if angina symptoms do not improve with other medicines. 

Angioplasty and stent placement 

If your angina symptoms are not relieved by lifestyle changes and medicines, you may be advised to have a coronary angioplasty. Also called percutaneous coronary intervention, it increases blood flow through a blocked artery and decreases angina pain. During an angioplasty, a doctor inserts a thin, flexible tube called a catheter into a blood vessel, usually in the groin or wrist. A tiny balloon is on the end of the tube. The doctor inflates the balloon to widen the artery. A small metal mesh tube called a stent may be placed to keep the artery open. This process can take 30 minutes to several hours. You usually stay in the hospital at least overnight.  

Coronary artery bypass grafting 

If unstable angina or stable angina affects some of the main heart arteries and does not improve with stenting and other treatments, heart bypass surgery may be needed. It is open-heart surgery. Most patients leave hospital between 5 and 7 days after their surgery. Coronary bypass surgery has proved to be highly effective in reducing the symptoms of angina. 

Enhanced external counterpulsation therapy (EECP) 

EECP therapy might be recommended for some people whose angina does not improve with other treatments. For this therapy, large cuffs are wrapped around your legs. Air pressure causes the cuffs to inflate and deflate in time to your heartbeat. You typically need 5 one-hour treatments a week for 7 weeks. 

How to choose between angina treatment options? 

You and your care team should discuss the pros and cons of each treatment to decide which is best for you. For most people, first steps include medicines and lifestyle changes. If those do not work for you, angioplasty and stenting can be another option. Talk to your doctor if you think your treatment is not controlling your angina pain well enough.