Coronary heart disease: a non-communicable disease: Students should be able to evaluate the advantages and disadvantages of treating cardiovascular diseases by drugs, mechanical devices or transplant.

The idea

Coronary heart disease occurs when fatty deposits narrow the coronary arteries, reducing blood flow to heart muscle. Treatments include drugs such as statins, which lower blood cholesterol, and anticoagulants, which reduce clotting; mechanical devices such as stents, which hold arteries open, and artificial pacemakers, which correct irregular heartbeats; and heart transplants. Evaluating means weighing benefits against drawbacks. Stents restore blood flow quickly but carry risks of infection or thrombosis. Statins reduce heart attack risk but may cause muscle pain and must be taken long term. Transplants can restore heart function but donor hearts are scarce and immunosuppressant drugs are needed. A judgement should compare options for a named patient, considering effectiveness, risk, cost, availability and quality of life.

What earns the marks

• Stents are inserted into narrowed coronary arteries to keep them open, improving blood flow and reducing angina, but surgery carries risks such as infection or blood clots.
• Statins reduce cholesterol production in the liver, lowering the risk of fatty deposits forming, but can cause side effects such as muscle pain and need long-term use.
• Anticoagulants reduce blood clotting, lowering the risk of heart attack or stroke, but can cause excessive bleeding if a wound occurs.
• Artificial pacemakers correct irregular heart rhythms by sending electrical impulses, but require surgery and battery replacement.
• Heart transplants can restore heart function when other treatments fail, but donor hearts are scarce and immunosuppressant drugs must be taken for life.
• Evaluation should compare treatments using criteria such as effectiveness, risk, cost, availability and impact on daily life, then reach a justified conclusion.

Common mistakes and how to put them right

• Listing advantages and disadvantages without a conclusion.

  Put it right: Finish with a justified judgement comparing the options.

• Treating all drugs as having the same effect.

  Put it right: Distinguish statins, which lower cholesterol, from anticoagulants, which reduce clotting.

• Ignoring non-medical factors such as cost, waiting lists or lifestyle.

  Put it right: Include these when evaluating treatments.

Exam tips

• Use a table or clear paragraphs to separate advantages and disadvantages before writing your evaluation.
• Refer to a specific treatment and a specific patient context, such as an elderly patient with narrowed arteries, to make the evaluation relevant.
• Use comparative language such as 'more effective than' or 'carries a greater risk than' to show evaluation rather than description.