How to minimise risk of coronary heart disease and reclogging of artery?
Q: Dear doctor, I am 71y old and my coronary angiography report (14.07.02) is as follows: LV: Normal Left mainstem: Atheroma LAD: 60-80% proximal LAD disease Left circumflex: Atheroma RCA: Dominant, heavy atheroma, ecstatic and aneurysmal vessel with a long segment of 50% tubular disease in proximal PLA Conclusion: Single vessel disease with good LV systolic function Treatment: Coronary angioplasty and uncoated stent insertion in LAD on 29/8/03. Medication: Aspirin 75mg, Clopidogrel 75mg, Atenolol 50mg, Ramipril 10mg, Simvastatin 40mg Questions: 1. In addition to taking Aspirin, should Clopidogrel be continued for the whole life or for a limited period of 9 to 12 months in order to avoid the risk of re-stenosis of inserted uncoated stent and further stenosis of RAC? Usually Clopidogrel is given for 4 weeks after stent insertion. 2. I am tea-totaller, non-smoker and very particular in taking low fat cholesterol free diet, maximum fruit and vegetables, regular one hour brisk walk and less salt. What more would you suggest to minimise the risk of my coronary heart disease and further clogging of RCA? 3. When should my next angiogram be done to examine the condition of arteries, particularly the RCA?
A:1. Clopidogrel for at least one year. There is very clear evidence that 1 year is better than one month. Clopidiogrel, however, does not reduce restenosis. Aspirin is for life. 2. You are already on Statins. These need to be continued life-long unless there is a sound reason to discontinue. Side effects etc are exceptionally low. 3. Ramipril also is very useful in preventing new events and is a long-term therapy. 4. Life-style changes which you are on are equally important. 5. A stress thallium test is recommended once in a year to look for any ischemia in the territory of right coronary artery and also in other regions including the LAD. If there is any evidence of significant reversible ischemia, an angiogram is indicated. If stress thallium or stress echo is normal and you have no symptoms, angiography is not required.