Dr.Kamini Silvarajan MD/AAAM

Editorial Board: Kamini Silvarajan MD/AAAM

Adult Treatment Coronary Artery Disease

The primary objective of treatment for people with coronary artery disease (CAD) is to reduce the serum low density lipoprotein (LDL – bad cholesterol) level. Current clinical studies verify that reducing the LDL also reduced the short-term susceptibility of cardiovascular disease by as much as 40%. It also brings even bigger risk reduction over the period of time.

In 2012, the Adult Treatment Panel III (ATP III), supported by the National Cholesterol Education Program of the National Institute of Health (NIH), and declared the first major research regarding the management of cholesterol to nearly 10 years. 

The ATP III advises: 

  1. More assertive cholesterol-reducing treatment scheme and appropriate evaluation of people at higher risk for heart diseases;
  2. Full lipoprotein profile as the initial diagnostic test for high level of cholesterol;
  3. Provide better emphasis on treating high level of triglycerides;
  4. Latest cutoff point wherein low level of HDL is considered as major risk for developing CAD;
  5. Newest and more effective lifestyle modification practices to enhance the cholesterol level; and
  6. Intensified attention on metabolic problems (diabetes mellitus).
The ATP III advises that medical doctors (cardiologists) should tailor the intensity of LDL-lowering medications to people with higher risk for heart diseases. It classifies people with different risk factors into three areas based on the 10-year assessment and evaluation for CAD.

ATP III guideline emphasizes the step-by-step treatment plan with 9 progressive and evaluative procedures to monitor and assess the individual’s risk factors and cholesterol profile.

Step 1 
Acquiring a comprehensive lipoprotein profile through blood samples drawn after 9 to 12 hours of fasting (nothing per mouth). 

Step 2 
Determine the clinical manifestation of atherosclerosis (narrowing of arteries) that is related to the development of CAD and other heart diseases. These include peripheral artery disease and carotid artery disease. 

Step 3 
Identify if the person is possessing major risk factors for developing CAD aside from high level of LDL. 

Step 4 
Evaluating the person’s level of 10-year assessment and evaluation for risk factors of cardiovascular diseases. (Presence of CAD and other heart diseases place the person at highest point of risk category). The number of risk factors that are present in an individual is counted (excluding the presence of CAD and high level of LDL). 

Step 5 
Identifies the person’s LDL objective of treatment, need for healthy lifestyle modification (activities of daily living), and LDL level wherein drug therapy is considered as an option. 

Step 6 
If the individual’s LDL is above the risk level then initiating therapeutic lifestyle modification including diet, management of weight, and inducing activity is recommended. The therapeutic lifestyle modification advises eating sufficient calories that can maintain ideal body weight and avoid obesity. 

Step 7 
Consider the drug therapy for people whose LDL exceeded the normal limit. To enhance the cholesterol lowering regimen, therapeutic lifestyle modification must be maintained even drug therapy is practiced. 

Step 8 
Assessing the person’s metabolic state is another indicator for checking their susceptibility rate. People who meet the diagnostic criteria will receive treatment plan for metabolic problems. This include therapies that are focused on lowering blood pressure, increasing the physical activity level, treating obesity, and raising high density lipoprotein (HDL – good cholesterol). 

Step 9 
People with elevated triglycerides level (150 mg per dl or more) must take the steps to manage their weight. They need to increase their physical activity level and if possible, start taking medications that can lower the LDL level. 

Treating Coronary Artery Disease (CAD) is the best method of preventing complications that can occur to the heart. Most importantly, proper diagnosis and prompt pharmaceutical intervention can stop the worsening of the condition- By Edterchelle Soriano