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."

If you have coronary artery disease, the main ways to prevent a heart attack are:

•Don't smoke.

•Exercise if your heart can tolerate it (30 to 60 minutes at least five days a week).

•Try to maintain a healthy weight.

•Keep your blood pressure in check.

•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 your doctor recommends it and 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:

Quit smoking. The guidelines urge your doctor to help you and your family members to quit through any means necessary, including counseling, pharmacological therapy, such as nicotine patches and bupropion (Zyban), and formal smoking cessation programs, as 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. 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.

•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. Discuss with your physician what kind of physical activity would work best for you.

•Treat 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.

•Lower high triglycerides. For all patients, the guidelines recommend that doctors emphasize weight management, physical activity, and dietary therapy (including increased consumption of omega-3 or n-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. In addition to monitoring your LDL levels, your doctor may also want to check the amount of apolipoprotein B, or apoB, in your blood. High levels of apoB indicate an increased risk of coronary artery disease and are associated with a higher incidence of fatal heart attacks.

•Increase 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.

•Keep 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 (less than 7 percent).

•Aside from these lifestyle changes, the AHA/ACC guidelines recommend the following medications:

•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 low-dose aspirin therapy. If you cannot take aspirin, the guidelines suggest your doctor consider prescribing 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

Last updated March 13, 2009
Copyright © 2004 Consumer Health Interactive

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