Preventing a Second Heart Attack

According to the American Heart Association (AHA), one out of 4 men and one out of 3 women who survive a heart attack will die within the following year, most often of cardiac arrest or another heart attack. Therefore, if you are one of those survivors, protecting your heart should be your top priority. By making some healthy lifestyle changes and working closely with your doctor, you can remain a survivor– not a victim.

What can I do to prevent a second heart attack?

Your risk for a second heart attack depends largely on your lifestyle. In other words, prevention is in your hands. Here’s a look at the lifestyle changes that can help keep your heart in working order:

If you smoke, stop. Think of your first heart attack as a very serious wake-up call. Cigarettes damage your arteries, disrupt your heart’s rhythm, and lower your HDL “good” cholesterol. You can cut your risk of another heart attack in half by giving up the habit. You should also avoid secondhand smoke at work and at home.

Eat a heart-healthy diet. Watching your diet, especially your fat intake, has never been more important. By cutting back on fats — particularly saturated fat — you can lower your LDL cholesterol, the artery-clogging substance that sets the stage for a heart attack.

According to the American Heart Association, heart attack survivors should get less than 30 percent of their calories from fat, and less than 7 percent from saturated fat (which is found in animal products). For a typical 2,000-calorie diet, this translates to less than 67 grams of fat (with less than 16 grams of that being saturated fat) every day.

Avoid trans fatty acids. These are found in some margarines, cookies, crackers, fries, donuts, and other snack foods. Some studies suggest that trans fats may actually increase cholesterol levels more than saturated fat! Check labels and avoid foods containing “partially hydrogenated oils” — i.e., trans fat. You should also aim for less than 200 milligrams of cholesterol each day. To reach that goal, have no more than two egg yolks in your diet each week.

While you cut back on fatty foods, you can fill the void with fruits, vegetables, and whole grains. These foods will lower your blood pressure, control your cholesterol, and protect your arteries. Some researchers have found that an extremely low-fat vegetarian diet has actually reversed heart disease by reducing the amount of blockage in the arteries.

Other researchers have found that taking “good fats” such as fish oil supplements containing omega-3 fatty acids — which can help lower cholesterol — is beneficial for the heart. You can also give your heart a boost by adding two fish meals to your diet each week. Cold water fish such as salmon and mackerel are especially rich in omega-3 fatty acids. Finally, substituting olive oil or canola oil for butter, margarine, and corn oil seems to have heart-protective effects as well.

Get regular exercise. Regular workouts strengthen your heart, lower your levels of LDL cholesterol, and boost levels of HDL cholesterol, the “good” cholesterol that helps keep your arteries clear. Exercise also helps ward off depression, a major threat to heart patients. All of this adds up to potent protection. A study published in the journal Circulation found that survivors who increased their activity levels were nearly twice as likely as inactive patients to still be alive seven years after the attack.

The American Heart Association recommends a minimum of 30 minutes of walking or other moderately vigorous exercise at least five times each week, or 20 minutes of vigorous exercise at least three times each week, supplemented by extra activity such as gardening and housework. Any activity is better than nothing. You can give your heart a boost simply by taking the stairs instead of the elevator or doing errands on foot instead of the car.

Not every heart can handle the rigors of exercise. You should have a thorough checkup before starting an exercise program. Your doctor may want to give you a stress test, an exam that monitors your heart while you walk on a treadmill or ride a stationary bicycle. Many patients will be advised to participate in a cardiac rehabilitation program after their first heart attack. This program monitors your heart during exercise training to make sure it’s safe to exercise.

Control your cholesterol. Current guidelines recommend keeping your LDL (“bad”) cholesterol under 2 mmol per deciliter if you have heart disease or diabetes. (You are considered very high risk if you have heart disease plus other risk factors like smoking or diabetes, or if you have been hospitalized for a heart attack.)

After lowering your LDL, your next most important goals are to keep your “good” HDL cholesterol above 1.0 mmol/dL and your overall cholesterol under 5.2 mmol/L, according to the latest guidelines. (Women should actually keep their HDL cholesterol above 1.3 mmol/dL, according to the American Heart Association).      An additional fat in the blood, triglycerides, ideally should be less than 1.8 mmol/dL.

Watch your weight. Overweight people are especially vulnerable to heart trouble, including heart attacks. Ideally, your body mass index (BMI) should be between 18.5 and 24.9. A simpler alternative to the BMI, according to the American Heart Association, is to take your waist measurement. Men should keep theirs to 40 inches or less, women to 35 inches or less. If you’re carrying some extra pounds, your doctor can help you set up an exercise and diet program. And even if you don’t lose much weight, regular workouts and a low-fat diet will go a long way toward preventing another attack.

Reduce your stress. If you’re feeling stressed, depressed, anxious, or angry, your emotional state may be damaging your heart. Many heart programs have shown that incorporating meditation or yoga to reduce stress helps damaged arteries.

Follow a consistent care program. Taking your heart medications on schedule and booking regular doctor visits are also crucial, as is keeping your blood pressure under control. Your goal should be to keep your blood pressure under 140/90 (under 130/80 if you have kidney disease or are diabetic). Regular exercise and eating foods rich in potassium, especially bananas, has been shown to help keep blood pressure in check. If lifestyle changes fail to control your blood pressure, your doctor will likely recommend blood pressure medication.

What can my doctor do to help?

Preventing a second heart attack isn’t just a one-person job. No matter how healthy your lifestyle, you’ll need to work closely with your doctor to give your heart the best possible protection. In addition to providing valuable advice on diet and exercise, your doctor can prescribe medications to ward off another attack.

Here’s a sampling of drugs that may be of help:

Beta blockers. Many heart attack survivors can benefit from these drugs (which include atenolol and metoprolol, among others). Beta blockers lower blood pressure, slow down the heart rate, and increase the heart’s pumping power. In addition, beta blockers may prevent a sudden cardiac arrest. Ideally, patients should start taking the drugs within 24 hours of an attack and stay on them indefinitely. However, you shouldn’t take beta blockers if you have uncontrolled heart failure, a dangerously slow heart beat, dangerously low blood pressure, or active reactive airway disease (asthma).

Beta-blockers work by easing the workload of the heart by blocking the beta receptors on heart muscle cells. A receptor is a tiny part on the wall of certain cells. There are different types of receptors throughout the body. The beta receptors on heart muscle cells are stimulated by the hormones adrenaline (epinephrine) and noradrenaline (norepinephrine). When the beta receptors are stimulated, they make the heart muscle cells work harder which increases the heart rate and blood pressure.
Beta-blocker medicines block beta receptors from being stimulated. This prevents the heart rate from going too fast, reduces blood pressure and helps to stabilise the electrical activity of the heart. Beta-blockers are also used to treat angina and high blood pressure. There are a few different beta-blockers for your doctor to chose from.

Cholesterol-lowering drugs. If regular exercise and a healthy diet aren’t enough to bring your cholesterol levels under control, your doctor can prescribe medications to finish the job. As a general rule, any heart attack survivor with an LDL cholesterol level over 2.6 mmol/L will need drug treatment.

If you are at very high risk for a heart attack (which means you have heart disease plus other risk factors like smoking or diabetes, or have been hospitalized for a heart attack), doctors may recommend that you use drug therapy to bring your LDL readings below 1.89 mmol/L.

The most effective cholesterol medications available today belong to a class called “statins.” These drugs (including atorvastatin, simvastatin, pravastatin, and lovastatin) can dramatically lower cholesterol levels and come with few side effects, although some patients complain of constipation, stomach pains, and muscle cramps. Recent studies of heart patients have found that statins can lower the risk of fatal heart complications by 20 to 42 percent.

ACE inhibitors:One of the actions of an angiotensin-converting enzyme (ACE) inhibitor is to interfere with a chemical (enzyme) found in the bloodstream, called angiotensin. Blocking this enzyme widens blood vessels and lowers the blood pressure. This eases the burden on the heart. ACE inhibitors also appear to have a direct action on the heart, which has a protective effect. There are a few ACE inhibitors for your doctor to choose from.

Angiotensin-II receptor antagonists (also called angiotensin receptor blockers) have a similar effect as ACE inhibitors and are sometimes used as an alternative. If you have side-effects with an ACE inhibitor your doctor may suggest trying them instead.

Aspirin. By thinning the blood and preventing blood clots, this humble pain-reliever can make a big difference. In a study of nearly 20,000 heart attack survivors, a daily dose of aspirin cut the risk of a second heart attack by more than 30 percent.  If you cannot take aspirin (for example, if you are allergic to it) then another antiplatelet medicine (such as clopidogrel or ticagrelor) may be used instead.


Source: Health Day (modified).


About Dr. Hassan Gargoum

Clinical Professor of Medicine, University of Saskatchewan Consultant, Cardiovascular Diseases

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