Even if you don't think you have risk factors for heart attack, if you are a woman with diabetes, peripheral vascular disease or chronic renal disease, you need to be concerned and do something.  You are at a high risk of having a heart attack.  In fact, you are at the same risk as someone who has already had a heart attack.

Some risk factors (things that increase the chance of getting a disease or developing a condition) for coronary artery disease and heart attack are beyond our control, such as:

• Genetics: a family history of heart disease and early heart attack can increase one's risk of heart attack
• A history of coronary artery disease, high blood pressure, and other heart problems
• Age: the heart muscle weakens with age, so that men over 45 and women over 55 are at a higher risk of having a heart attack
• Diabetes: uncontrolled diabetes increases the risk of developing coronary artery disease
• Peripheral arterial disease (clogged vessels in the arms and legs):  people with PAD may form blood clots, increasing their risk of death from heart attack or stroke
• Chronic renal disease: kidney disease can be a cause or a consequence of cardiovascular disease.  It is also closely related to hypertension and diabetes.

Other risk factors, such as not getting enough exercise, smoking, and having too much cholesterol in the blood, are controllable.  They relate to how we live, and we can always change that if we try.  It's especially important for women at increased risk to live in a "heart-healthy" way.   

If you are at increased risk, your doctor will probably want to do tests before recommending prevention or treatment measures.  See Key Point 1 for more information on tests.

There are a number of ways to treat heart disease.

Medicines
The list of medicines now used to treat heart and cardiovascular disease would include:

• Blood pressure reducers, such as:
• Beta blockers: drugs that slow down the heart rate, correct arrhythmias (irregular heartbeat) and reduce blood pressure, all of which helps lower the heart's workload
• Vasodilators: drugs that open ("dilate") the arteries, lowering blood pressure and, therefore, the heart's workload
• Calcium-channel blockers: another class of drugs that dilate blood vessels
• Diuretics: drugs that help eliminate excess fluid to aid the heart in working more efficiently
• Blood clot reducers, including:
• Anticoagulant drugs:  often called "blood thinners," though they don't actually thin the blood, nor do they dissolve clots already present.
• Antiplatelet agents:  stop blood platelets (substances in blood that promote clotting) from clumping together to form clots.
• Aspirin 
• Thrombolytic drugs: dissolve blood clots already present.  To be effective thrombolytics must be given within one hour of start of symptoms.
• Cholesterol reducing medicines
• Statins: currently considered the most important and effective group of LDL-cholesterol reducing medicines. They slow cholesterol production and increase the liver's ability to remove the LDL-cholesterol already there.  Because the body makes more cholesterol at night, these drugs are usually taken in the evening, at dinner or before bed.  Side effects appear to be minimal and studies show that people using statins have reported 20 to 60 percent lower LDL-cholesterol levels.
• Bile acid sequestrants:  bind with bile acids in the intestines that contain cholesterol.  Then they are eliminated during defecation, reducing the amount of cholesterol in the blood.  Often, these drugs are prescribed in combination with statins. 
• Fibrates:  lower the level of triglycerides (the main component of fat and therefore another major cause of atherosclerosis) in the blood. 
• Nicotinic acid:  a non-prescription cholesterol lowering substance.  It's a form of niacin, the water-soluble B vitamin.  When taken in high doses, well above the suggested daily amount, it can be effective in lowering LDL-cholesterol and triglyceride levels. 
• Antiarrhythmic drugs that regulate the heartbeat
• Digitalis: a drug that strengthen the heartbeat 

Percutaneous Coronary Intervention (PCI)
PCI basically refers to a procedure known as angioplasty.  Angioplasty is the process of opening or widening a narrowed blood vessel. The procedure was first used in the 1970s to treat coronary artery disease. Now it is being applied to other arteries.  For example, angioplasty of the carotid arteries (which carry blood to the brain) is now seen as a way to help prevent stroke. 

In angioplasty, a small tube called a catheter is threaded up into the arteries to the site of the blockage.  (If the catheter reaches the heart, the process is called coronary catheterization.)  When the blockage is reached, a tiny balloon at the end of the catheter is inflated to open the narrowed blood vessel. (The procedure is also known as "balloon angioplasty.")  After the blood vessel has been widened, the balloon and catheter are removed.  The procedure may also involve using a tiny umbrella-like filter (called a "distal protection device") at the end of the catheter to catch any particles that break free from the artery and prevent them from traveling to and blocking some other blood vessel.

A more recent development is to combine a balloon angioplasty with the placement of a stent. A stent is a tiny tube made of a metallic mesh; it looks something like a wire cage or spring. It's put inside a blood vessel to keep it open and unblocked.  After a blocked blood vessel has been opened by balloon angioplasty, a stent can be slid along the catheter and put in place.  The  most recent development in PCI is to coat the stent with medicines to help prevent further blockages; this type of stent is known as a "drug-eluting stent."  Usually a balloon angioplasty and/or a stent work permanently, but sometimes the procedure has to be repeated after several years.

All forms of PCI are considered "invasive" procedures, because they involve entering the body, but "non-surgical" because no major incisions are involved. 

Besides PCI, there is another non-surgical way of treating coronary artery disease called atherectomy.  In this procedure, the doctor opens the affected artery and, depending on the type of blockage, uses one of several techniques and instruments to physically remove the blockage.

Surgical Options
The best known is popularly called "bypass surgery," technically called "coronary artery bypass grafting" (CABG or "cabbage").  As its name implies, its purpose is to allow blood to bypass or go around a blocked artery.  During the procedure, blood vessels from other parts of the body (usually arteries from the chest and arm and veins from the leg) are grafted into place to create a detour around the blockage in the coronary artery. This process is also known as revascularization.

Other surgical options depend, of course, on the nature and severity of the CAD and problems the CAD has caused.  For example, CAD can lead to an irregular heartbeat (arrhythmia), which is often treated by implanting a pacemaker in a person's chest.  A pacemaker is a tiny device that sends electrical signals to the heart to restore its regular rhythm.  In the most serious situations, when CAD has led to a severe, very damaging heart attack, a heart transplant may be needed.