People with heart disease are at increased risk for suffering heart attacks or sudden cardiac death. But there is evidence that risk factor modification can help people with coronary artery disease. Lowering blood pressure and cholesterol can improve survival and quality of life if you have heart disease. Here are some therapies to help protect your heart.

Guidelines

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.

Smoking

Goals

Advice

To help you stop smoking, try:

  • Counseling
  • A nicotine patch, gum, spray, or inhaler
  • A formal smoking cessation program
  • Drug therapy with varenicline (Chantix) or bupropion (Wellbutrin, Zyban)

Blood Pressure

Goals

  • Aim for a blood pressure (BP) less than 140/90.
  • If you have chronic kidney disease or diabetes, keep BP less than 130/80.

Advice

  • 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:

    However, persons with significant heart disease may need 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.

Cholesterol

Goals

All patients should have a blood test called a fasting lipid profile. Desirable ranges of lipid levels are:

  • LDL (bad) cholesterol less than 100 mg/dL
  • non-HDL cholesterol (combination of bad cholesterols) < 130 mg/dl
  • Triglycerides less than 200 mg/dl

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:

Advice

  • Follow a low-fat diet in which most of your fat is from vegetable sources (oils, nuts, fish).
  • Reduce intake of saturated fat, trans fat, and cholesterol.
  • 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.

Physical Inactivity

Goal

  • Target 30-60 minutes of exercise 5 days per week (minimum). 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.
  • Resistance training 2 days per week
  • Before starting physical activity, your risk for complications should be determined and it is recommended that you discuss this with your physician.

Advice

  • 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.

Weight

Goals

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.

Advice

If your weight is not in the target range, start weight management and medically supervised physical activity programs.

Diabetes

Goals

For all people with diabetes:

  • Have your blood levels of glycosylated hemoglobin (A1C) tested regularly.
  • Aim for an A1C below 7%.

Advice

  • If blood sugar is too high, intensify therapy to control blood sugar.
  • Address other risks such as weight, activity, blood pressure, and cholesterol.

Drug Therapy

Goal

Ask your doctor to evaluate your need for preventive drugs such as aspirin, ACE inhibitors, and beta-blockers.

Advice

  • Nearly every man with heart disease should take aspirin. Talk with your doctor about what dose is recommended. Aspirin in women may be less effective in preventing a first heart attack, but it does reduce the risk of stroke 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.

Vaccination

Goal and Advice

Get a flu shot.