About Coronary Artery Disease (CAD)

What is CAD?

Coronary artery disease, or CAD, is a progressive heart disease that is the result of plaque buildup in the arteries that supply blood to the heart. It is also common for people with CAD to have peripheral artery disease, or PAD. People who have both have an even higher risk for blood clot–related events like a heart attack or stroke than people with CAD or PAD alone.

CAD and atherosclerosis

CAD is the end result of atherosclerosis, or hardening of the arteries. This is the process by which the arteries become damaged and inflamed as a result of certain health conditions or risk factors, including:

Then, like sludge on the inside of pipes, cholesterol, white blood cells, and other substances build up inside the damaged walls, forming plaque. Plaque can start forming as early as childhood and builds up slowly, over many years.

As the plaques grow larger, less blood can get through the artery to supply your heart with the oxygen it needs to function. This reduced blood flow may cause symptoms such as:

• Chest pain, or angina
• Shortness of breath

CAD treatment options

Surgical and nonsurgical procedures may be performed to restore blood flow in a blocked artery. Examples include:

• Angioplasty opens a blocked artery by inflating a tiny balloon inside the blockage
• Stent implantation permanently props open a blocked artery with a tiny wire mesh tube that is placed during an angioplasty
• Coronary artery bypass graft surgery (CABG) reroutes blood around a completely blocked artery using a blood vessel from another part of your body

While the above procedures may be life-saving, they do not fix you for good.

Prescription and nonprescription antiplatelet blood thinners may be prescribed immediately following diagnosis or an event to help prevent blood clots. Antiplatelets are one type of blood thinner that work by helping to keep platelets (which are pieces of blood cells) from sticking together. Examples include:

• Dual antiplatelet therapy (DAPT): aspirin plus one other antiplatelet medicine, such as clopidogrel, prasugrel, or ticagrelor, are typically prescribed temporarily to help prevent blood clots after stent implantation, coronary artery bypass graft surgery, or after a heart attack
• Clopidogrel (Plavix^®)
• Prasugrel (Effient^®)
• Ticagrelor (Brilinta^®)
• Aspirin

XARELTO^® plus low-dose aspirin for chronic CAD

The medicines just discussed, including aspirin, have been recommended to reduce the risk of blood clots in people with chronic CAD. Now, a new medication is available for healthcare professionals to prescribe for people with chronic CAD. XARELTO^® is an FDA^†-approved treatment that can be added to low-dose aspirin to help further reduce the risk of blood clots that may cause a serious cardiovascular event like a heart attack, stroke, or cardiovascular death.

^†US Food and Drug Administration.

Aspirin alone may not be enough

Even when you’re following your healthcare professional’s instructions to take aspirin every day and to eat right and stay active, you may still have an underlying risk for blood clots that may cause another unexpected cardiovascular event like a heart attack or stroke.

Adding XARELTO^® to your low-dose aspirin

XARELTO^® 2.5 mg twice daily in combination with low-dose aspirin (75 mg–100 mg) once daily is proven to help further reduce the risk of heart attack, stroke, and cardiovascular death in people with chronic CAD versus aspirin alone.

How XARELTO^® works with aspirin

XARELTO^® works together with aspirin to help protect you from blood clots that may cause a heart attack, a stroke, or cardiovascular death. Think of XARELTO^® and aspirin like two members of the same team whose job it is to prevent serious blood clots from forming and growing. But they each play different positions—aspirin, an antiplatelet blood thinner, helps keep platelets (which are pieces of blood cells) from sticking together, and XARELTO^®, an anticoagulant blood thinner, helps slow down the blood's clotting process.

Until recently, aspirin had to play defense on its own, but a study showed that adding XARELTO^® to the team helps further reduce the risk of a heart attack, stroke, and cardiovascular death compared to aspirin alone.

Bleeding risk with XARELTO^® plus low-dose aspirin

While all blood thinners come with a risk of bleeding, around 3% of people taking XARELTO^® 2.5 mg with their low-dose aspirin experienced a major bleeding event, such as bleeding into the brain. That represents about a 1% increase in bleeding versus people taking only low-dose aspirin.

But remember, if you and your doctor chose to add XARELTO^® to your low-dose aspirin, it’s likely because your doctor believes the benefit of helping to protect you from life-threatening blood clots outweighs your risk of bleeding.

Managing your overall health

It’s important to quit smoking, keep trying to eat right and stay active, and take any other medicines your doctor has prescribed, like medicines for high blood pressure or high cholesterol. Because while no drug or procedure can completely rid your arteries of plaque, managing your overall health can help slow the progression of your CAD.