Angina: Causes & Treatments
Angina is a type of chest pain. It can also be an uncomfortable, tight or heavy sensation in your chest, and may spread to your arms, neck, jaw, shoulders, back or even your stomach. According to the British Heart Foundation, some people describe angina as a dull, persistent ache (i). It can also make you feel short of breath.
To make things a bit complicated, angina often feels different from one person to another. You may get the ache or tightness in your arm or neck. But someone else may experience pain in their chest. The severity of symptoms can vary too, with some people feeling just mild discomfort while for others the sensation can be far more painful.
What causes it?
Angina is usually a symptom of coronary heart disease (i), which is caused by atherosclerosis. This is when your coronary arteries have become narrowed by a build-up of fatty deposits (atheroma) in one or more parts of the artery walls. The bigger the build-up of fatty deposits, the narrower your arteries become - and that can mean not enough blood is being pumped through to your heart. When this happens, it can cause the sensation of angina.
Usually, you may experience angina when you're exerting yourself physically - or in other situations when your heart beats faster than normal, such as when you get excited or anxious.
Less commonly angina can also be caused by heart valve disease, hypertrophic obstructive cardiomyopathy, hypertensive heart disease, arrhythmias (irregular heartbeats), arteritis (inflammation of the walls of the arteries) and anaemia.
The good news is that angina pain doesn't often last for very long, and the sensation should ease within 10 minutes if you stop and rest or within a few minutes of taking angina medication. But if one of your coronary arteries becomes blocked by a piece of atheroma that's broken off, it can cause a blood clot. And that can lead to a heart attack.
There are two main types of angina: stable and unstable.
If your angina is stable, it means your symptoms are regular or predictable (that is, they are brought on by exercise or another obvious trigger). It also means your symptoms improve if you rest or take angina medication.
This is more serious than stable angina as attacks are more unpredictable and the symptoms may not improve after resting or taking medication. According to the National Institute of Health and Care Excellence (NICE), unstable angina usually requires immediate admission or referral to hospital (ii). This is because it’s a sign that the blood supply to your heart – as well as the function of your heart – is compromised, which leaves you at a higher risk of having a heart attack.
Angina: are you at risk?
Some people are more likely to get coronary heart disease - and therefore more likely to experience angina - than others. Your age is important, as angina is much more common among older adults than in younger people. It's also more common in men than women, with eight per cent of men and three per cent of women aged 55 - 64 years old having or having had, angina (iii). But other things are known to increase your risk for angina too, including the following:
If you smoke any type of tobacco, it can damage the walls of your arteries, which can lead to your arteries narrowing. Smoking also makes your blood carry less oxygen around your body, which can increase your risk of having a blood clot (thrombosis).
This is also a risk factor for angina. If you eat a diet that's high in saturated fat (that is, mostly animal fat), you're more likely to have raised cholesterol levels.
It's important to keep your diabetes well controlled because otherwise the excess glucose in your blood can lead to damaged arteries.
Lack of physical activity
This can affect your changes of having angina because not doing enough exercise can lead to other risk factors, such as having high blood pressure and type 2 diabetes. And if you don't do much exercise, you could risk being overweight or obese - which also boosts your chances of having a higher risk of angina, since being overweight or obese can increase your blood pressure and make you more likely to develop type 2 diabetes.
If a close relative has had premature heart disease, you too could have a higher risk. According to the British Heart Foundation, having a family history of premature heart disease means your father or brother has, or had, angina or a heart attack before they were 55, or your mother or sister has, or had, angina before they were 65 (iv).
Medical treatments for angina
The only way to find out if you have angina is to see your GP, who can refer you for tests. Many tests are used to diagnose angina, including electrocardiograms (ECGs), coronary CT scans and coronary angiograms, and you may need one or a combination of them.
If diagnosed, it's highly likely that you'll have to take one or more types of medication every day to reduce your risk of having a heart attack or stroke. Most people with angina also use medicines that provide fast relief whenever they get symptoms. The most common angina medications include the following:
These help the muscle in the walls of your blood vessels to relax and widen, which allows your blood to flow more easily. Glyceryl trinitrate (GTN) is usually given in a spray, and is used to relieve angina symptoms when you get them (it acts quickly and should relieve your symptoms within a few minutes). Some people are given nitrates in tablet form or in skin patches.
Used to slow down your heart rate, beta-blockers work by blocking the action of certain hormones. They also help your heart beat with less force and can be effective at reducing episodes of angina.
These help to lower your cholesterol levels by blocking an enzyme that helps to make cholesterol in the liver. If you don't have high cholesterol, experts believe taking statins may help if you have angina or coronary heart disease.
Low-dose aspirin and other antiplatelet medicines may reduce your risk of having a heart attack by reducing your likelihood of having a blood clot. They work by reducing the stickiness of platelets, particles found in the blood that help the blood to clot.
These are medicines that help reduce your blood pressure by preventing a build-up of body fluid. They are usually only given to people who have already had a heart attack or who have a reduced function of their heart's left ventricle.
Other medicines that are used to treat angina include calcium-channel blockers and potassium-channel activators. Some people may also need an angioplasty (or percutaneous coronary intervention) - where a stent is inserted in a narrowed part of an artery to keep it open - or coronary artery bypass graft surgery. These are usually only offered if your angina symptoms are not controlled well enough by taking medication.
Self-help for angina
If you already have angina, there are some lifestyle changes you can make to help prevent your symptoms from getting worse as well as reduce your risk of having a heart attack or stroke. And if you don't have angina, adopting healthy lifestyle changes can help reduce your risk of developing it. Here are some tips to keep your arteries in good shape:
Give up smoking
People who smoke risk having coronary heart disease and angina. That's because not only does smoking cause your arteries to narrow but it also raises your blood pressure. There are lots of stop smoking aids available that may help you quit successfully, such as nicotine patches, gum and lozenges, and you don't need have a prescription to buy them. Click here to find out more about giving up.
High blood pressure
Having high blood pressure can also cause damage to your artery walls. You're more likely to have high blood pressure if you smoke, drink a lot of alcohol, don't do much exercise, if you're overweight or if you have a lot of stress in your life.
Keep your blood pressure normal
According to the British Heart Foundation, if you already have angina, high blood pressure could make your symptoms worse and increase the risk of having a heart attack. High blood pressure makes your heart work harder, which may lead to damage of the arteries. So it's important to keep your blood pressure in check. If you haven't had your blood pressure tested lately, speak to your GP about it. If your blood pressure is higher than it should be, your GP can advise you on the best course of action. To find out more about blood pressure, including how to keep yours healthy, see our guide.
Reduce your cholesterol
If your cholesterol is raised, it can increase your risk of developing heart disease. Your GP can test your cholesterol level and recommend suitable treatment, if necessary. However, if you already have coronary heart disease or angina, it's likely that you'll already be taking statin medicines to keep your cholesterol low. If your cholesterol isn't already high, one way to keep it normal is to reduce the amount of saturated fat you eat (saturated fat is mostly found in animal foods such as meat, butter and other dairy products). Understanding the impact of high cholesterol on your body is an important step towards reducing it.
Eat a healthy diet
Having a nutritious balanced diet is important for all aspects of your health, and the foundation of healthy eating is to aim for at least five portions of fruit and vegetables a day. The British Heart Foundation recommends following a Mediterranean-style diet, since there's evidence it may reduce the risk of high blood pressure, raised cholesterol and type 2 diabetes, all of which are risk factors for heart disease (vi). So think more fish, fruit, vegetables, grains, nuts, pulses and beans, and less meat and dairy foods. And instead of butter, use soya, vegetable and sunflower oils as well as spreads made from these oils - all of which contain polyunsaturated fats, which help to maintain healthy cholesterol levels.
Being overweight or obese can put pressure on your heart, so try to keep your weight healthy for your height. Carrying too much weight around the middle is also a risk where your heart’s concerned, since it can increase your risk of getting diabetes (itself a risk factor for coronary heart disease). So regardless of your weigh, try to aim to keep your waist size under 94cm if you’re a man or 80cm if you’re a woman.
If you need to lose weight, keeping physically active can help. It can also help you to control your blood pressure and cholesterol levels, and reduce your stress levels. So aim to do at least 150 minutes of moderate-intensity activity each week (you should be working hard enough to feel warm and breathe a bit more heavily than usual). Staying active is also important if you have angina - but try not to become too breathless (you should be able to carry on a conversation while walking briskly, for instance). People with angina may also be advised to avoid strenuous activities such as gardening or weight lifting. If in doubt, speak to your GP.
Drinking more than the recommended amount of alcohol on a regular basis can also raise your angina risk because it can lead to high blood pressure. The UK government currently recommends a maximum of 14 units of alcohol each week, spread over at least three days, for both men and women. Staying within these limits can help keep your blood pressure normal.
Manage your stress levels
Stress and anxiety can increase your heart rate, which may trigger an episode of angina. Learning to stay calm and relaxed, on the other hand, may relieve your symptoms. Try to find out what makes you feel stressed or anxious, then look at relaxation techniques that may help in those situations, such as yoga, meditation or deep breathing (or anything that helps you to wind down).
Natural angina support
If you have angina, it's essential to take the treatments your GP or heart specialist has prescribed for you. There are also some natural complimentary treatments you could use alongside your prescribed medication. However, speak to your GP or heart specialist before starting to take any natural remedies.
Vitamin C and E
Antioxidant vitamins such as vitamin C and E may help protect your heart against the damage caused by free radicals. One study even suggests a deficiency of vitamin E may be linked to coronary artery spasm (vii).
Astaxanthin is also an antioxidant, with scientists believing it’s around 100 times more powerful as an antioxidant than vitamin E (viii). It’s derived from a freshwater microalgae called Haematococcus pluvialis, and is the red pigment in the algae that gives the fish and seafood that eat it their distinctive red/pink colour (salmon, for instance).
Astaxanthin may help with angina that’s caused by high cholesterol, as it’s thought to help maintain a healthy cholesterol balance – that is, by keeping LDL cholesterol levels (‘bad’ cholesterol) lower and HDL cholesterol (‘good’ cholesterol) higher.
Find out more about how cholesterol works in our cholesterol guide.
There’s a growing body of evidence to make the case for astaxanthin’s role in healthy cholesterol. For instance one Korean study found taking astaxanthin for 12 weeks helped lower LDL in volunteers who were overweight (ix). Elsewhere researchers have found astaxanthin supplements may help increase HDL while at the same time reducing triglyceride levels (like cholesterol, triglycerides are a type of fat that can circulate in your bloodstream and cause heart problems if their levels are too high) (x).
It’s easy to add more astaxanthin to your diet if you’re a fish and seafood fan – just eat more salmon, shrimp, crab, lobster, red snapper, rainbow trout and crab. You may, however, struggle to get enough astaxanthin to have an effect on your cholesterol through diet alone. This is because studies typically use supplements containing around 4 - 16mg of astaxanthin, whereas a portion of wild salmon provides less than 4mg. If you want to get a more therapeutic dose of astaxanthin, the easiest way is to take a good-quality supplement.
This mineral is needed by the body for muscle relaxation. It also affects the body in a similar way as calcium-channel blockers, conventional medicines often prescribed for angina. Indeed, a small number of studies have shown that taking magnesium supplements may help improve angina sufferers' ability to exercise with less chest pain (x).
Also known as ubiquinone, CoQ10 is an antioxidant compound made in the body, including the heart. It is thought to help the heart to use energy more effectively and, while best known for treating heart failure (xii), some experts also believe it may be beneficial for people with angina (xiii), particularly with regard to a tolerance for exercise.
Omega-3 fatty acids
Natural nutrition practitioners often recommend a diet low in saturated fat and rich in omega-3 fatty acids for those with heart disease. Fish oils - which are a source of omega-3 fatty acids - are widely thought to be beneficial for people with coronary artery disease. In one study, volunteers taking a low-dose fish oil supplement for 12 weeks were found to have had 41 per cent fewer angina attacks than others taking an olive oil placebo (xiv). The same volunteers taking the fish oils also experienced a 22 per cent reduction in their triglyceride levels after just eight weeks.
Most omega-3 supplements are made from fish oils. However if you’re a vegetarian or vegan you can now get omega-3 products sourced from plant organisms called microalgae. These contain the natural triglyceride (TG) form of omega-3.
Meanwhile supplements that contain both omega-3 fatty acids and CoQ10 are also now available, if you wish to try taking both together.
For more advice to a range of heart conditions, as well as a number of other common health concerns, visit our dedicated health library.
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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.
Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.