Types of treatment

1. Cardiovascular disease can be treated in three main ways: by lifestyle changes, by medicines and by surgery.
2. Most treatments aim to slow the build-up of fatty deposits, to widen or bypass a narrowed artery, or to replace a part of the heart that no longer works.
3. Doctors choose a treatment by weighing its benefits against its risks, its cost and how quickly it works.
4. Many patients receive more than one type of treatment, such as a stent followed by daily medicines and a change of diet.

Lifestyle changes

1. Lifestyle changes are usually the first treatment offered, and they are also advised alongside every other treatment.
2. Eating less saturated fat lowers blood cholesterol, so fatty deposits build up more slowly.
3. Eating less salt lowers blood pressure, which reduces damage to the lining of the arteries.
4. Regular aerobic exercise strengthens the heart muscle, lowers blood pressure and helps with weight loss.
5. Stopping smoking allows the lining of the arteries to recover and removes carbon monoxide from the blood.
6. Drinking less alcohol lowers blood pressure and helps with weight loss.
7. Lifestyle changes have clear benefits.
   1. They are cheap or free, and they have no side effects.
   2. They also reduce the risk of other diseases, such as type 2 diabetes, several cancers and bronchitis.
8. Lifestyle changes also have drawbacks.
   1. They work slowly and cannot clear an artery that is already badly narrowed, so on their own they cannot help a patient in immediate danger.
   2. They only work if the patient keeps to them for the rest of their life, which many people find difficult.

Medicines

1. Statins reduce the amount of cholesterol made by the liver, which lowers blood cholesterol and slows the formation of new fatty deposits.
   1. Statins reduce the risk of heart attacks and strokes, and they are taken as a daily tablet.
   2. They must be taken for life, and some people get side effects such as muscle pain, headaches or, rarely, liver damage.
   3. They take several weeks to have an effect, so they prevent future problems rather than treat an emergency.
2. Anticoagulants, such as warfarin, make the blood less likely to clot, and a daily low dose of aspirin has a similar effect by stopping platelets sticking together.
   1. This reduces the chance of a clot forming on a fatty deposit and blocking a coronary artery or an artery to the brain.
   2. The main risk is excessive bleeding, because cuts and internal injuries take longer to stop bleeding.
3. Antihypertensive drugs lower blood pressure, so the artery walls are damaged less and the heart does not have to work as hard.
   1. Some antihypertensive drugs cause side effects such as dizziness, headaches or swollen ankles.
4. Medicines do not need an operation, they are relatively cheap and they can be started without a stay in hospital.
5. However, medicines control the disease rather than cure it, and most must be taken every day for life.

Stents and bypass surgery

1. A stent is inserted using a thin tube called a catheter, which is passed into an artery in the groin or wrist and guided up to the narrowed coronary artery.
2. A small balloon inside the stent is inflated at the narrowed section, which squashes the fatty deposit against the artery wall and expands the mesh.
3. The balloon is then deflated and removed, leaving the stent in place to hold the artery open.
4. Stents have several benefits.
   1. Blood flow to the heart muscle is restored almost immediately, so a stent can be fitted in an emergency during a heart attack.
   2. The patient usually needs only a local anaesthetic and can often go home within a day or two.
   3. Recovery is much quicker than after open-heart surgery.
5. Stents also have drawbacks.
   1. A blood clot can form on the stent, so the patient must take drugs that reduce clotting afterwards.
   2. The artery can narrow again over time.
   3. There is a small risk of bleeding, infection or damage to the artery during the procedure.
6. In coronary bypass surgery, a length of healthy blood vessel is taken from the patient's leg, arm or chest and attached to the coronary artery above and below the blockage.
7. Blood then flows through the new vessel and bypasses the narrowed section.
8. Bypass surgery is used when several arteries are blocked or when a blockage is too long for a stent.
9. It can relieve chest pain and improve blood flow to the heart muscle for many years.
10. However, it is major surgery under a general anaesthetic, with risks of infection, blood loss and stroke, and recovery takes several weeks.

Replacing heart valves

1. A faulty heart valve may not open fully or may not close properly, so blood flows backwards and the heart has to work harder.
2. A damaged valve can be replaced with a mechanical valve made of metal or plastic, or with a biological valve taken from a pig, a cow or a human donor.
3. Mechanical valves last for many years, but blood can clot on them, so the patient must take anticoagulants for the rest of their life.
4. Biological valves do not need lifelong anticoagulants, but they wear out and may need replacing after $10$ to $20$ years.
5. Both types involve heart surgery, with the risks of infection and blood loss that any major operation carries.

Heart transplants and artificial hearts

1. A heart transplant is used when the heart is so badly damaged that it can no longer pump enough blood around the body, a condition called heart failure.
2. The donor heart usually comes from a person who has died, and its tissue type must match the patient's as closely as possible.
3. The patient's immune system recognises the antigens on the donor cells as foreign, and lymphocytes may attack and destroy the new heart in a process called rejection.
4. To prevent rejection, the patient must take immunosuppressant drugs for the rest of their life.
5. These drugs weaken the whole immune system, so the patient is more likely to catch serious infections.
6. There are far fewer donor hearts than patients who need them, so many people wait a long time for a transplant.
7. An artificial heart is a mechanical pump that can take over the pumping of blood while a patient waits for a donor heart.
8. Artificial hearts are made from materials that do not cause rejection, but blood can clot on them, they carry a risk of infection and the patient's movement is limited by the power supply.
9. Artificial hearts are not yet a permanent replacement for most patients.