Research helps us to make the best treatment choices we can with the information we have. Research can’t predict what will happen in your case. When research says most people live longer if they have a treatment, there’s no way to know for sure that you will live longer if you have that treatment. But the best way to prepare to make a heart treatment decision is to do your own research – and we’re here to help!
We’ve worked together with plain language experts, artists, and heart health professionals to help you understand what current research says about coronary artery disease (CAD) and diabetes.
Use the red buttons below to search through the information. There is a mix of both ‘easy’ read/view options that everyone can understand, and ‘harder’ options that use more medical terms and language. The Patient Voices Network glossary may be helpful for reading/viewing these resources.
Want your own copy of these resources? Download and Print the Research Guide
HeartHub.ca Research Guide: Understanding the Basics
This picture shows what the heart looks like. Your heart is a muscle, like muscles that move your arm or leg. Your heart pumps blood to supply oxygen to your body through pipes called arteries.
- The red pipes in the diagram are arteries. They are called coronary arteries. Coronary arteries supply blood to the heart muscle to keep the heart alive, so it can pump blood to the rest of your body.
For more detail, see:
- Patient focused information including printable brochures from Patient UK
- Mayo clinic video: “The Heart and Circulatory System – How They Work”
There are many different types of heart disease. One of the most common types is known as coronary artery disease (sometimes called CAD, ischemic heart disease, or just ‘heart disease’). With CAD, your coronary arteries become narrow or blocked by fatty deposits called ‘plaques’. When this happens, your heart doesn’t get enough blood and oxygen. This increases your risk of having a heart attack or dying.
You may have a type of chest pain called angina because less blood gets to your heart muscle. Women can have different symptoms from angina than men.
Photo by BruceBlaus / CC BY-SA / Cropped
An angiogram is one common test used to diagnose (find out) if you have coronary artery disease. Special colourless dye that shows up on x-ray is put into the arteries. Pictures are then taken using an x-ray to see if there is any narrowing or blockages in the arteries.
You will get information about angiogram tests specific to your hospital when you are given your angiogram appointment. This will include what you need to do to prepare for the test. Here are direct links to angiogram information specific to each of BC’s regional health authorities:
- Vancouver Coastal Health:
- Vancouver General Hospital materials
- St. Paul’s Hospital materials (See also St. Paul’s Hospital’s Heart Centre Website)
- Fraser Health
- Interior Health
- Island Health
- Northern Health
After the test, the doctor will tell you:
- if you have coronary artery disease, and
- what can be done about it
Still not sure about having an angiogram? Check out “Should I Have An Angiogram?” from HealthLink BC.
IMPORTANT: If coronary artery disease is found during your angiogram, you may need to make a decision about treatment right away with your doctor. Percutaneous coronary intervention (PCI) can done at the same time as your angiogram.
Here is some information that might help with this decision:
- Preparing for an angiogram? Questions you might want to ask your doctor.
- I have diabetes, what are my treatment options?
- I do not have diabetes, what are my treatment options?
There are 3 treatment options. Your doctor may recommend more than one treatment or no treatment at all.
Click on each of the treatments below to learn more about them. To compare the risks and benefits of each treatment, visit our pros & cons page.
1. Percutaneous Coronary Intervention (PCI)
PCI (also called ‘stenting’ or ‘angioplasty’) helps return blood flow to the heart muscle by widening coronary arteries that have become narrowed or blocked.
You will get information about PCI preparation and recovery specific to your hospital. This is often included with your angiogram appointment information. Here are direct links to information specific to each of BC’s regional health authorities:
- Providence Healthcare (St. Paul’s Heart Centre) / Vancouver Coastal Health
- Fraser Health
- Interior Health
- Island Health – before PCI and after PCI
- Northern Health – Note: PCI is not done at Northern Health hospitals.
More online resources:
- Information about percutaneous coronary intervention (PCI) or angioplasty from HealthLink BC (grade 7 language)
- A video describing percutaneous coronary intervention (PCI) from (Healthwise, 2.18min, easier language)
- A video describing angiogram and PCI (Sunnybrook Hospital – 6 min long)
- A patient story with description and video of PCI (British Heart Association, 5.07 min, some language medical/college level):
2. Coronary Artery Bypass Graft (CABG) Surgery
CABG (sometimes pronounced like “cabbage”) is a surgery that attaches a new healthy blood vessel to your heart to deliver it blood when one or more of your other heart blood vessels have become narrowed or blocked.
You will get information about preparing for heart surgery and what happens after heart surgery from your regional hospital/health authority. Here are links to the available online patient information booklets:
- Providence Healthcare (St. Paul’s Heart Centre) – The Heart Centre also has a 22 minute video of heart surgery available in 7 languages
- Fraser Health
- Vancouver General Hospital
- Interior Health
More online resources:
- Information about coronary artery bypass surgery (HealthLink BC, text, grade 7 language)
- A short video describing coronary artery bypass graft (CABG) surgery (My Health Alberta, 1.50min, easier language)
- Longer video describing CABG (RetinaBd, 4.17 min, college level language):
- Patient story with description and video of procedures for CABG (British Heart Foundation, 5.46 min):
How can I prepare for heart surgery?
- “How can I prepare for heart surgery (coronary artery bypass graft surgery)”? (HealthLink BC, text, grade 7 language)
- The Pacific Open Heart Association is a group of volunteers who have had heart surgery. They can speak to you and give support before or after your surgery: info@pacificopenheart.org
- Preparing for surgery (American Heart Association, video, 2.11min):
Recovery after surgery
- Quick description of recovery after CABG (video, 1.40 min) relevant to BC:
- Road to recovery (American Heart Association, video, 2.15min):
3. Medications
Medications are drugs that you can take yourself to control your coronary artery disease.
- Knowing your medications (Heart and Stroke Foundation of Canada)
- Ask a pharmacist about your medications (translation services are available in 130 languages)
- Information on common medications for heart disease (Fraser Health)
- Videos to help learn about medications (Island Health)
Whatever treatment you have, you may feel better, but YOU WILL NOT BE CURED.
To keep you healthy, you will need to make the lifestyle changes recommended by healthcare professionals.
You can get help to do this by attending a cardiac rehabilitation program. Your healthcare team may recommend a specific program, or you can speak to a HealthLink BC Health Service Navigator (available 24 hours in 130 languages), or use this link to find a program near you.
- Read general information about recovery and support when you have coronary artery disease (Heart & Stroke Canada, grade 7-8 reading level)
- Includes information on relationships, emotions and feelings, support, and cardiac rehabilitation
- Learn about living well with coronary artery disease (Capsana).
- Tells you what to expect after you have percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) surgery, including:
- Going back to everyday activities, driving, work, and sexual activities (pages 4-5)
- Some people may have feelings of depression and anxiety (page 6)
- Tells you what to expect after you have percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) surgery, including:
IMPORTANT: Always follow the advice of your doctor or other health professional. Your health needs may be different from the information on this page.
You should consider having coronary artery bypass graft (CABG) surgery if you have diabetes and your doctor recommends this treatment to restore blood flow to your heart muscle.
Research has found people with diabetes who have CABG surgery for treatment of coronary artery disease generally live longer and have fewer heart attacks than those who have percutaneous coronary intervention.
Important things to note:
- There may be reasons why surgery may not be the right treatment for you. You should talk about treatment choices thoroughly with your doctor and family.
- What are the risks and benefits (pros and cons) of different treatments?
Want to learn a bit more about the research? The bold text below explains some important research findings in plain language. Click on the ‘More Details’ buttons below for a more scientific explanation.
Three years after treatment, more diabetic patients are alive after coronary artery bypass grafting (CABG) surgery compared to percutaneous coronary intervention (PCI).
More Details...
Researchers analyzed information from 4,386 diabetic patients with stable coronary artery disease in 11 randomized studies.* An average of 3.8 years later, 15.5% of diabetic patients died after PCI compared to 10% who had CABG surgery for treatment of coronary artery disease narrowing/blocking multiple blood vessels supplying the heart.
Research article: https://doi.org/10.1016/S0140-6736(18)30423-9
Three years after treatment, less diabetic patients had a heart attack following coronary artery bypass grafting (CABG) surgery compared to percutaneous coronary intervention (PCI). More patients had a stroke after CABG compared to PCI. More patients required another coronary revascularization treatment (PCI or CABG) following PCI compared to CABG.
More Details...
More than 1900 diabetic patients from around the world were randomly* assigned to have PCI or CABG treatment. These patients had stable coronary artery disease that affected multiple vessels supplying blood to their heart. The researchers followed up patients a median of 3.8 years later to see the results of the treatment. Close 14% of patients had a heart attack after PCI compared to 6% after CABG. 5.2% of patients had a stroke after CABG compared to 2.4% after PCI. One year after treatment, close to 13% of patients who had PCI needed another coronary revascularization treatment, compared to 5% of patients who had CABG. This study is known at the FREEDOM (Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multi-vessel Disease trial) and has changed the way that doctors treat coronary artery disease in patients with diabetes in B.C.
Research article: http://www.nejm.org/doi/full/10.1056/NEJMoa1211585
Here in B.C., three years after treatment; less diabetic patients died, had a heart attack or required more coronary revascularization treatment (PCI or CABG) after they had coronary artery bypass grafting (CABG) surgery compared to percutaneous coronary intervention (PCI). More patients had a stroke after CABG compared to PCI in the first 30 days after treatment.
More Details...
This study was not a randomized study so it is considered less strong research compared to studies where patients are randomly assigned to get a type of heart treatment.* There is a chance that the sickest people had PCI because they were not healthy enough for surgery. A good thing about this study was it was closer to the ‘real world’ in B.C. The treatment was decided by the BC doctors with the patients and their families. The study included 2,947 diabetic patients who needed fast treatment for certain types of acute coronary syndrome. These types of patients were not included in the other randomized studies.
Research article: https://www.ncbi.nlm.nih.gov/pubmed/29241487
Percutaneous coronary intervention (PCI) or angioplasty is an important treatment for:
More Details...
- Certain types of coronary artery disease: Your blood vessels can be affected by coronary artery disease in different ways and the anatomy of each heart is unique. The results of your angiogram will help to determine if PCI is the better choice for treatment.
- Times when blood flow to the heart muscle needs to be restored right away: Like when you are having a heart attack.
- Patients who are more likely to have a stroke: There is a bigger chance that that you could have a stroke following CABG, particularly in the first 30 days of recovery after surgery.
- Elderly patients and patients with other health conditions that would make surgery a riskier treatment option. There is a shorter recovery time and less risk of some problems, like infection and bleeding, with PCI.
Research article: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30424-0/fulltext
How is coronary artery disease different in diabetes?
If you have diabetes, you are more likely to develop coronary artery disease, and more of the blood vessels supplying your heart may become narrow or blocked. This increases your risk of having a heart attack or dying.
Treatments for coronary artery disease
Coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) are used with medication to treat coronary artery disease in diabetes. They are coronary revascularization treatments. They are used to increase blood flow to your heart muscle.
*What is a randomized study?
Randomized studies use a chance process (like flipping a coin) or computer number system that cannot be changed by the researchers to determine which heart treatment a patient gets. This means there is an equal chance that patients get PCI or CABG. Studies randomly assign patients to reduce the possibility that the patients receiving one treatment are different in some way (say, their age) from patients receiving the other treatment.
- General information about living well with heart disease
- General information to help you control stress
- Information on managing high cholesterol
- Information on managing high blood pressure
- Learn about heart healthy eating
- Get help to make healthy food choices (translation services available in 130 languages)
- Get advice about exercise (translation services available in 130 languages)
- Guidelines for angina and physical activity
- Guidelines for previous heart attack and physical activity
- Connect with a community of survivors
- Information about healthy lifestyle for people with diabetes
- Wellness information from the First Nations Health Authority
- Financial support for medical transportation is available to help you get to/from your medical appointments and treatments
