Reducing Risks When You Have Heart Disease
Heart disease patients are at increased risk for suffering heart attacks or sudden cardiac death. It's expected that the number of Americans with cardiovascular disease—currently 12.4 million—will keep rising as our population ages.
But there is evidence that risk factor modification can help people with coronary artery disease. Studies show that strategies like lowering blood pressure and cholesterol can improve survival and quality of life in heart disease patients. Here are some simple, effective, and proven preventive therapies to help protect your heart.
The American Heart Association and American College of Cardiology have jointly released guidelines on secondary prevention for patients with cardiovascular disease. Their recommendations reflect data gleaned from large scale clinical trials that have identified which preventive therapies work best.
Check to see which advice you are already using correctly, and which you may want to discuss with your doctor.
- Stop smoking
- Avoid exposure to secondhand smoke
To help you stop smoking, try:
- Drug therapy with buproprion or Chantex
- A nicotine patch, gum, spray, or inhaler
- A formal smoking cessation program
- Aim for a blood pressure (BP) less than 140/90
- If you have heart failure, strive for a BP lower than 130/85
- If you have chronic kidney disease or diabetes, keep BP less than 130/80
- Begin taking medication if BP is not below goal.
In general, patients with a BP of 120-139/80-89 or higher should try lifestyle measures. For example:
- Lose weight
- Exercise regularly; check with your doctor for guidelines on starting an exercise program
- Limit alcohol intake to one drink daily or less
- Reduce salt intake
- Increase intake of vegetables, fruits, and low-fat dairy products
However, persons with significant heart disease may wish to begin with medication and then reduce dosage (or stop medicine entirely) as these nonpharmacological treatments take effect. Surely, medication should never be a replacement for exercise, good diet, and sensible alcohol use.
All patients should have a blood test called a fasting lipid profile. Desirable ranges of lipid levels are:
- LDL (bad) cholesterol less than 100-130
- Triglycerides less than 150
- HDL (good) cholesterol greater than 40 (50 for women)
These levels are only approximations and may need to be individualized depending on other risk factors. Your doctor will evaluate your lipid levels and help you determine what is desirable for you. However, the following advice is pertinent for everyone:
- Follow a low-fat diet in which most of your fat is from vegetable sources (oils, nuts, fish).
- Increase consumption of omega-3 fatty acids, which are found in fatty fish and flax seeds.
- Discuss with your doctor whether a formal supplement with omega-3 fatty acids might be valuable for you. For persons with known coronary heart disease, the American Heart Association recommends intake of at least 1 gram daily of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). This is equivalent to eating ¼ pound or less of salmon, sardines or trout, or about ½ pound of canned tuna, halibut, or oysters. A pound of shrimp or scallops will also do. Soybeans or tofu and walnuts also provide omega-3 fatty acid benefits.
- Achieve and maintain a healthful weight.
- Quit smoking.
- Exercise regularly; check with your doctor for guidelines on starting an exercise program.
- If goals are not reached, talk to your doctor about adding a cholesterol-lowering medication.
- Target 30-60 minutes of exercise 3-4 days per week. However any exercise is beneficial and better then none at all. So if all you can fit in a particular day is 5 minutes do it!
- Daily exercise is optimal.
- Before starting physical activity, your risk for complications should be determined and it is recommended that you discuss this with your physician.
- Your doctor should approve the type and amount of exercise you do.
- Incorporate more physical activity by increasing daily activities such as walking, cycling, gardening, or household work.
Have a waist measurement and body mass index (BMI) calculation.
- The desirable BMI range is 18.5-24.9 kg/m².
- Desirable waist measurements are no more than 40 inches (102 centimeters) for men, and no more than 35 inches (88 centimeters) for women.
If your weight is not in the target range, start weight management and medically supervised physical activity programs.
For all people with diabetes:
- Have your blood levels of glycosylated hemoglobin (A1C) tested regularly
- Aim for an A1C below 7%
- If blood sugar is too high, intensify therapy to control blood sugar
- Address other risks such as weight, activity, blood pressure, and cholesterol
Ask your doctor to evaluate your need for preventive drugs such as aspirin, ACE inhibitors, and beta-blockers.
- Nearly every man with heart disease should take aspirin, 75-325 mg/day, as recommended by their doctor. Aspirin in women may be less effective in preventing a first heart attack, but it does reduce the risk of stroke. Aspirin does increase the risk of stomach and bowel bleeding, so be sure you discuss its use with your doctor to insure that it is the right drug for you. If aspirin is contraindicated for you, alternate blood thinners may be considered.
- In addition to aspirin, patients who have had a heart attack should take an ACE inhibitor, beta-blocker, and cholesterol reducing medication unless there is a contraindication.
- ACE inhibitors and cholesterol reducing medications should also be considered in other patients, especially those who are at high risk.
Taking Advantage of Prevention
The effects of many other drugs and remedies that have been used in an attempt to prevent heart disease are still uncertain or potentially harmful. Examples include estrogen, herbs, alcoholic beverages, and antioxidant vitamins.
Until future research has more definitive data, focus your attention on time-tested and proven preventive therapies such as those recommended by the American Heart Association, and those described here.
What better time than now to take full advantage of the measures known to help prevent further heart disease!
American Heart Association
Familydoctor.org, American Academy of Family Physicians
National Council on Aging
National Heart, Lung, and Blood Institute
Canadian Cardiovascular Society
Heart and Stroke Foundation of Canada
AHA/ACC guidelines for preventing heart attack and death in patients with atherosclerotic cardiovascular disease: 2001 update. Circulation. 2001 Sep 25.
Executive summary of the third report of the National Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA. 2001 May 16.
Secondary prevention of coronary heart disease: what works and what doesn't. Family Practice Recertification. 2001 Oct.
Last reviewed May 2008 by Craig Clark, DO, FACC, FAHA, FASE
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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