Doctors use the terms "cardiovascular disease" and "heart disease" broadly. When they urge you to "prevent coronary heart disease," they are usually talking about coronary artery disease, or CAD. In industrialized countries, CAD is the most common heart disease. It affects 16 million Americans and is by far the leading cause of heart attacks, known in doctor-speak as "myocardial infarctions."

The main ways to prevent heart attacks from CAD are:

•Don't smoke.

•Exercise if your heart can tolerate it.

•Try to maintain a healthy weight.

•Take aspirin every day unless your doctor advises against it, in which case you might be able to use clopidogrel (Plavix).

•Take a beta-blocker and an ACE inhibitor (angiotensin-converting enzyme inhibitor) if you can tolerate it.

•Reduce your LDL cholesterol to a level below 100, something that generally requires a statin drug. If you are at very high risk for a heart attack (i.e. you have CAD and other risk factors like diabetes or continued smoking), there is an option to use drug therapy to reduce LDL to below 70.

•If you have diabetes, get that disease under control.

•See your doctor at least once or twice a year to monitor your medications.

•Make sure you know the warning signs of a heart attack so you can get to the emergency room if needed.

Yes, because coronary artery disease rarely occurs in isolation. Often, it weakens the heart, leading to other consequences, including arrhythmias (abnormal heart rhythms) and congestive heart failure (when the heart no longer pumps normally, vital organs aren't supplied with enough blood, and heart tissue is damaged, causing shortness of breath, fluid retention, and fatigue).

Adopting certain behaviors can reduce the risk of dying from CAD. Because of this, the American Heart Association and American College of Cardiology "secondary prevention" guidelines for patients with coronary and other vascular diseases recommend these measures:

•If you smoke, quit. To help you with this difficult step, the AHA/ACC guidelines encourage doctors to point you to counseling, nicotine replacement therapy, and the drug bupropion (Zyban), in whatever combination is appropriate.

The guidelines also encourage you to avoid secondhand smoke completely at work and home.

•Keep your blood pressure 120/80 mm/Hg or lower. All patients should implement weight control, physical activity, alcohol moderation, moderate salt restriction, and a healthy diet (rich in fruits, vegetables and fibers, and low-fat dairy products).

Your doctor will also urge you to control your blood sugar if you have diabetes, and to control your blood pressure if you have hypertension or diabetes (if you have diabetes or chronic kidney disease, your goal should be less than 130/80).

•Change your diet to help lower LDL ("bad") cholesterol levels to less than 100 milligrams per deciliter of blood. If your LDL cholesterol is 100 or more, your doctor should recommend drug therapy to lower your cholesterol. A program of weight management and dietary therapy, including consumption of omega-3 fatty acids, will also likely be recommended. (The goal is to get your LDL under 100, your overall cholesterol under 200, and your saturated fat intake to less than 7 percent of your daily calories.)

•If your triglycerides are 150 milligrams per deciliter or above, your doctor should talk with you about weight management, physical activity, and -- if you smoke -- quitting. Omega-3 fatty acids and certain medications, including gemfibrozil (Gemcor, Lopid), can help lower it as well. (Omega-3 fatty acids are found in, among other things, walnuts, fish oil supplements, and fatty fish such as salmon.)

•Get a minimum of 30 to 60 minutes of exercise daily, preferably every day, but at least five days each week (walking, jogging, cycling, or other aerobic activities). Supplement this with an increase in everyday physical activity, such as gardening and household work. Your doctor should assess your risk, preferably with an exercise test, and supervise your exercise program if you're in a moderate to high-risk group.

•Manage your weight. The guidelines suggest that the doctor calculate your body mass index (BMI) and measure your waist as part of your evaluation, and suggest weight management and physical activity as appropriate. The goal for your BMI is a range between 18.5 to 24.9 kilograms per square meter. Women should have a waist circumference of less than 35 inches, and men less than 40.

Aside from counseling about lifestyle changes, the AHA/ACC guidelines recommend:

•Quitting smoking. The guidelines urge your doctor to help you and your family members to quit through any means necessary, including counseling, pharmacological therapy, including nicotine patches and bupropion, and formal smoking cessation programs, as appropriate.

•Controlling blood pressure. The guidelines recommend that your doctor add blood pressure medication under certain conditions: if your blood pressure is 140/90 mm/Hg or higher; if it's 130/80 or more for people with diabetes or kidney disease. The doctor will adjust for individual differences such as age, race, and so on.

•Treating high cholesterol. If you have LDL ("bad") cholesterol of above 100 mg/dL, the guidelines recommend drug treatment. You may be able to lower your LDL through resin or statin therapy. If you have a low HDL ("good") cholesterol or high triglycerides, you can take fibrate or niacin, or a combined drug therapy (a statin drug plus fibrate or niacin).

For all patients and if your LDL is 100 mg/dL or more, the guidelines recommend altering your "lifestyle options" -- which usually means losing weight, increasing physical activity, improving your diet, and, if you smoke, quitting.

•Lowering high triglycerides. For all patients, the guidelines recommend that doctors emphasize weight management, physical activity, and dietary therapy (including increased consumption of omega-3 fatty acids).

If your triglycerides are between 200 and 499 mg/dL, your doctor should consider fibrate or niacin after therapy to lower your LDL.

If your trigylcerides are 500 mg/dL or more, your doctor is encouraged to consider fibrate or niacin before LDL-lowering therapy.

•Increasing physical activity: The guidelines recommend that your doctor give you an exercise test to help tailor your exercise "prescription." At a minimum, you should get some aerobic exercise, such as walking briskly, at least 30 minutes to an hour a day, five to seven days a week, if your heart can tolerate it.

•Managing weight. Your goal should be a BMI range of 18.5 to 24.9 kilograms per square meter. Discuss with your physician what kind of physical activity would work best for you.

The goal for your waist measurement is 40 inches or less in men and 35 inches or less in women.

•Keeping diabetes under control. If you have diabetes, the guidelines recommend appropriate therapy to achieve near-normal fasting blood glucose, as indicated by the all-important A1c test (blood glucose at less than 7 percent).

•Anticoagulants/antiplatelet agents: Anticoagulants, also known as antiplatelet agents, prevent the clotting of blood. If aspirin is safe for your particular condition, the guidelines suggest starting and indefinitely continuing daily aspirin therapy of 75 to 162 mg/d.

If you cannot take aspirin, the guidelines suggest your doctor consider prescribing 75 milligrams of clopidogrel or warfarin (Coumadin), a blood thinner. Warfarin is not generally used in routine cases of CAD; when it is clinically necessary following a heart attack, the guidelines suggest using its "international normalized ratio" of 2.0 to 3.0.

•ACE inhibitors: The guidelines suggest treating all patients with ACE inhibitors indefinitely following a heart attack, and starting early therapy in stable high-risk patients, including those who've had a previous heart attack. Doctors are asked to consider starting ACE-inhibitor therapy for all other patients with coronary or vascular disease.

•Beta-blockers: Beta-blockers cut down on the heart's need for oxygen by lowering the heart rate and blood pressure and by lessening the force of heart muscle contractions. The guidelines recommend starting beta-blockers in all patients who have had a heart attack and those with "acute coronary syndrome," or sudden inadequate blood and oxygen flow to the heart. Doctors are urged to observe warnings regarding certain contraindications, and to use as needed to manage angina, heart rhythm, or blood pressure in all other patients.

-- Diana Reiss-Koncar is a freelance writer based in Oakland, California.

References

First published June 22, 2004
Last updated January 16, 2008
Copyright © 2004 Consumer Health Interactive

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