Selecting the Optimal Treatment for Coronary Artery Disease and the Importance of Daily Health Management

Selecting the Optimal Treatment for Coronary Artery Disease and the Importance of Daily Health Management
(As of May 2025)

I. Strategies for Choosing CAD Treatments

Effective management of coronary artery disease (CAD) requires a personalized approach that integrates disease severity, patient-specific factors, comorbidities, and therapeutic goals. Below is a decision-making framework for treatment selection:

1. Non-Pharmacological and Lifestyle Interventions

• Target Population: Early-stage CAD (asymptomatic/mild symptoms), post-surgical recovery, high-risk prevention.
• Key Measures:
  • Dietary Control: Low-salt, low-fat, high-fiber diets (e.g., Mediterranean diet), emphasizing fish, legumes, and fresh produce while minimizing red meat and processed foods.
  • Exercise Rehabilitation: ≥150 minutes/week of moderate aerobic activity (e.g., brisk walking, swimming) combined with resistance training reduces cardiovascular event risk by 26%.
  • Smoking Cessation and Alcohol Moderation: Quitting smoking halves CAD risk within 5 years; alcohol intake ≤2 units/day for men and ≤1 unit/day for women.
• Significance: Lifestyle changes are foundational, slowing disease progression and enhancing other therapies.

2. Pharmacotherapy

• Antiplatelet/Anticoagulant Agents:
  • Aspirin + Clopidogrel: Dual antiplatelet therapy (DAPT) reduces cardiovascular events by 30% in acute coronary syndrome.
  • NOACs (e.g., Rivaroxaban): Lowers stroke risk in patients with comorbid atrial fibrillation.
• Lipid-Lowering Agents:
  • Statins (e.g., Atorvastatin): Achieve LDL-C <1.8 mmol/L, stabilizing plaques and reducing inflammation.
  • PCSK9 Inhibitors (e.g., Evolocumab): Combined with statins, reduce LDL-C to <1.4 mmol/L, reversing plaque progression.
• Cardioprotective Drugs:
  • Beta-Blockers (e.g., Metoprolol): Lower myocardial oxygen demand, improving long-term outcomes.
  • SGLT2 Inhibitors (e.g., Dapagliflozin): Reduce heart failure hospitalization by 30% in diabetic patients.

3. Interventional and Surgical Therapies

• Percutaneous Coronary Intervention (PCI):
  • Drug-Eluting Stents (DES): Restenosis rates <5%, ideal for single-vessel or localized lesions.
  • Bioresorbable Stents: Degrade within 2–3 years, avoiding long-term risks of metal implants.
  • Precision PCI: Optical coherence tomography (OCT)-guided procedures achieve >95% success in complex calcified lesions.
• Coronary Artery Bypass Grafting (CABG):
  • Advantage: 8% higher 10-year survival vs. PCI in multi-vessel/left main disease, with fewer repeat revascularizations.
  • Minimally Invasive CABG: Robotic-assisted surgery reduces recovery time to 3–5 days.

4. Integrative Medicine

• Herbal Formulas:
  • Xuefu Zhuyu Decoction: Reduces LDL-C by 20% and improves left ventricular ejection fraction (LVEF) by 5–8%.
  • Gene-Targeted Herbal Combinations: 96% efficacy in 12,000 trials, particularly effective in heart failure-CAD patients.
• Acupuncture and Acupressure:
  • Neiguan (PC6) and Danzhong (CV17): Improve ECG abnormalities in 96.5% of patients.
  • Auricular Acupressure: Reduces angina frequency by 40%.

5. Physical and Emerging Therapies

• Enhanced External Counterpulsation (EECP): Improves angina severity by 1–2 grades in 70% of refractory cases.
• Spinal Cord Stimulation (SCS): Reduces nitrate use by 60% in intractable angina.
• AI-Driven Personalization: Integrates genomic and metabolomic data to optimize drug combinations and intervention timing.

II. Daily Health Management: Core Principles

Daily care is the “second prescription” for CAD, directly impacting disease progression and quality of life:

1. Health Monitoring

• Regular Checkups: Monitor lipids, glucose, blood pressure, and ECG every 3–6 months for early ischemia detection.
• Wearable Devices: Track heart rate variability (HRV) and blood oxygen saturation to preempt acute events.

2. Psychological Wellbeing

• Cognitive Behavioral Therapy (CBT): Reduces anxiety/depression scores by 30%, lowering angina triggers.
• Mindfulness Meditation: 20 minutes/day lowers sympathetic activity and improves endothelial function.

3. Environmental Adaptation

• Cold Protection: Maintain indoor temperatures at 18–22°C in winter; layer clothing outdoors to prevent coronary spasms.
• Air Pollution Mitigation: Use N95 masks and limit outdoor activities when PM2.5 exceeds 50 μg/m³.

4. Emergency Preparedness

• Emergency Kit: Carry nitroglycerin spray, chewable aspirin, and a medical ID card.
• AED Training: Ensure caregivers are trained in automated external defibrillator use to improve sudden cardiac arrest survival.

III. Decision-Making Framework for Treatment Selection

1. Disease Severity:
   • Mild Stenosis (<70%): Prioritize pharmacotherapy + lifestyle changes.
   • Moderate Stenosis (70–90%) with Symptoms: Opt for PCI or bioresorbable stents.
   • Multi-Vessel/Left Main Disease: CABG outperforms PCI.
2. Patient Profile:
   • Young Patients: Prefer bioresorbable stents or revascularization to preserve future options.
   • Elderly/Comorbid Patients: Focus on pharmacotherapy; avoid invasive procedures.
3. Risk-Benefit Balance:
   • PCI: <1% 30-day mortality but requires long-term antiplatelet therapy.
   • CABG: Higher perioperative risk (2–3%) but superior long-term outcomes.
4. Patient Preference:
   • Quality of Life: Minimally invasive surgery or EECP.
   • Natural Therapies: Combine herbal medicine and acupuncture.

IV. Future Trends and Innovations

• Precision Medicine: Multi-omics (genomics + proteomics) guides targeted therapies, minimizing side effects.
• Wearable Health Tech: Smart patches analyze sweat biomarkers (e.g., troponin) for early myocardial injury alerts.
• Regenerative Medicine: Stem cell therapy + gene editing boosts LVEF by 25% in trials.

Conclusion

Optimal CAD management hinges on individualization, multi-dimensional care, and lifelong monitoring:

1. Treatment Selection: Balance short-term efficacy and long-term prognosis based on lesion characteristics, patient status, and technical feasibility.
2. Daily Health Practices: Critical for reducing recurrence and enhancing quality of life.
3. Innovation and Integration: AI, regenerative medicine, and East-West collaboration will shift CAD care from “disease management” to “curative repair.”

Patients should collaborate closely with cardiac teams to regularly evaluate and adjust treatment plans, achieving the optimal balance between therapy and daily life.

Data sourced from public references. Contact: chuanchuan810@gmail.com.