Optimal Treatment Approaches for Coronary Heart Disease and Heart Failure

For patients suffering from coronary heart disease and heart failure, especially during stable periods when acute heart failure is not occurring, oral medications are recommended to prevent disease progression and improve symptoms. A well-established regimen known as the "Golden Triangle" is often advised. This includes the use of aldosterone receptor inhibitors, beta-blockers, and either ACE inhibitors (ACEI) or angiotensin receptor blockers (ARB). These drug classes work synergistically to enhance heart function and reduce the risk of complications.

Key Medications in the Golden Triangle

1. Aldosterone Receptor Antagonists

Spironolactone is a representative drug in this category. It plays a crucial role in preventing vascular remodeling and improving long-term outcomes for heart failure patients by reducing fluid retention and lowering blood pressure.

2. Beta-Blockers

Metoprolol and bisoprolol are commonly prescribed beta-blockers. These medications help prevent left ventricular remodeling, improve myocardial ischemia, and stabilize both heart rate and blood pressure. They are essential in reducing the heart's workload and preventing further deterioration.

3. ACE Inhibitors (ACEI)

Examples include perindopril and benazepril. These drugs help dilate blood vessels, reduce strain on the cardiovascular system, and slow the progression of heart failure. They are particularly effective in improving survival rates among patients.

4. Angiotensin Receptor Blockers (ARBs)

Drugs like telmisartan and irbesartan serve as alternatives to ACE inhibitors, especially for patients who experience side effects such as coughing. ARBs also help relax blood vessels and reduce the burden on the heart muscle.

Advanced Therapies for Enhanced Outcomes

In some cases, sacubitril/valsartan may be used in place of traditional ACEI or ARB medications. This combination drug has demonstrated superior benefits in managing heart failure and reducing hospitalization risks. Additionally, SGLT2 inhibitors like empagliflozin and dapagliflozin can be introduced into the treatment plan. These medications not only help control blood sugar levels but also significantly improve heart failure prognosis and enhance the overall quality of life for patients.