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Reducing Risks When You Have Heart Disease


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 (CAD). Taking steps like lowering your 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 jointly released guidelines on secondary prevention for people 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

There are many options to help you quit smoking. Strategies that may work for you include:

  • Counseling
  • A nicotine patch, gum, spray, or inhaler
  • A formal smoking cessation program
  • Drug therapy, such as varenicline (Chantix) or antidepressants, such as bupropion

A combination of therapies is generally more effective in helping people quit.

Blood Pressure
Goals
  • Aim for a blood pressure less than 140/90.
  • If you have chronic kidney disease or diabetes, keep blood pressure less than 130/80.
Advice
  • If you have high blood pressure, your doctor may have you take medication.
  • In addition to medication, make healthy lifestyle changes, such as:

Remember that high blood pressure does not have symptoms, so you will not know you have it or if it changes. Consider buying a reliable home monitoring device so you can check your blood pressure on a regular basis.

Cholesterol
Goals

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

  • LDL (bad) cholesterol less than 100 milligrams per deciliter (mg/dL).
  • Non-HDL cholesterol (combination of bad cholesterol) less than 130 mg/dL if triglycerides are greater than 200 mg/dL.

Your doctor will evaluate your lipid levels and help you determine what is desirable for you.

Advice
  • Follow a low-fat diet.
  • Reduce intake of saturated fat, trans fat, and cholesterol.
  • Increase consumption of omega-3 fatty acids, found in fatty fish, like salmon. You may also want to talk to your doctor about taking omega-3 supplements.
  • If you are overweight, lose weight. Aim to maintain a healthy weight.
  • If you smoke, quit.
  • Exercise regularly—Check with your doctor for guidelines on starting an exercise program.
  • Talk with your doctor about whether you need to take cholesterol-lowering medication.
Physical Inactivity
Goal

Physical activity includes both aerobics and weight training:

Advice
  • Your doctor should approve the type and amount of exercise you do.
  • Try to perform at least 30 minutes of moderate intensity activity, such as brisk walking, on most days of the week
  • Incorporate more physical activity by increasing daily activities, like walking, cycling, gardening, or household work.
  • Include two days per week of strength training.
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 (89 centimeters) for women.
Advice

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

Diabetes
Goals

If you have diabetes:

  • Have your HbA1c tested regularly. The HbA1c test provides information about your diabetes management over the past few months.
  • Aim for HbA1c below 7%.
Advice
  • If blood sugar is too high, intensify therapy to control blood sugar.
  • Address other risks, such as weight, activity level, blood pressure, and cholesterol.
Drug Therapy
Goal

Ask your doctor to evaluate your need for preventive drugs.

Advice
  • Aspirin is recommended for most people with CAD. If you cannot take aspirin, your doctor may recommend another type of blood thinner.
  • If you are at high risk or have had a heart attack, your doctor may recommend other medications, such as ACE inhibitors, beta-blockers, and cholesterol-lowering medication.
Other Recommendations
Advice

It is important that you take steps to stay healthy, like getting a yearly flu shot.

You should also talk to your doctor about your mental health, which can impact your overall health. Tell your doctor if are feeling depressed or anxious or if you are having problems sleeping.

RESOURCES:

American Heart Association
http://www.heart.org

National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov

CANADIAN RESOURCES:

Canadian Cardiovascular Society
http://www.ccs.ca

Heart and Stroke Foundation of Canada
http://www.heartandstroke.com

References:

American College of Cardiology/American Heart Association (ACC/AHA) guidelines for secondary prevention of coronary artery disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 3, 2013. Accessed January 31, 2014.

Antman EM, Hand M, Armstrong PW, et al. 2007 Focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2008;117(2):296-329.

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;285:2486-2497.

Glycemic goals in patients with type 2 diabetes. EBSCO DynaMed website. Available at: http://www.ebscohost.com. Updated January 22, 2014. Accessed January 31, 2014.

Smith S, Allen J, Blair S, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic cardiovascular disease: 2006 update. J Am Coll Cardiol. 2006;47;2130-2139.

Smith S, Blair S, Bonow R et al. AHA/ACC guidelines for preventing heart attack and death in patients with atherosclerotic cardiovascular disease: 2001 update. American Heart Association website. Available at: http://www.circ.ahajournals.org/cgi/content/full/104/13/1577. Published 2001. Accessed January 31. 2014.

Tobacco use disorder. EBSCO DynaMed website. Available at: http://www.ebscohost.com. Updated December 16, 2013. Accessed January 31, 2014.



Last reviewed January 2014 by Michael Woods, MD

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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