Patients with coronary artery disease and stable angina are often confused by how to lower their risk of a future heart attack. This article addresses recently updated treatment targets along with both medical and non-medical strategies to meet your goals.
Although diet and exercise strategies are included as treatment options for several specific risk factors, everyone should adjust their diet and exercise routine to prevent heart attacks, not just those with risk factors.
The recommendations below are ones I discuss with my patients whom I see on a regular basis. In this way, I can monitor for individual reactions to a treatment plan and recommend appropriate adjustments. It’s important for you to have similar follow-up. Discuss any new or changing treatment with your doctor prior to proceeding.
Smoking
Stop smoking and avoid second-hand smoke.
Medication Approach: Nicotine gums, patches, and candy along with other medications such as BuSpar and Chantix can help.
Blood Pressure
Keep your blood pressure below 140/90, or 130/80 if you also have diabetes or chronic kidney problems.
Lose weight if you are overweight:
- BMI is a measure of weight relative to height. It is calculated by taking your weight in kilograms and dividing it by your height in meters. Ideal numbers are between 18.5 and 24.9 kg/m2. A conversion calculator is available here.
- Keep your waist circumference below 35 inches for women and 40 inches for men.
Increase your physical activity:
- 30-60 minutes at least 5 days per week.
- Moderate-intensity activity such as brisk walking is appropriate.
- An exercise stress test may be required prior to starting an exercise program.
- A supervised program (cardiac rehabilitation) may be required
- Light weight lifting 2 days per week may also help.
No more than two alcoholic drinks per day.
Limit sodium intake to less than 2.5 grams (2,500 mg).
Maintain diet high in fresh fruits, vegetables, low-fat dairy products. The Mediterranean diet incorporates many of these strategies.
Medication Approach: Beta-blockers and/or ACE inhibitors are commonly used to control blood pressure in those with coronary artery disease.
Lipids
Keep LDL less than 100mg/dl (less than 70mg/dl in some cases)
Keep HDL above 60mg/dl.
- Daily exercise and weight control (see above).
- Keep saturated fats to less than 7% of total calories.
- Keep trans-fatty acids and cholesterol to less than 200mg per day.
- Add plant stanol/sterols (2g per day) and or viscous fiber (greater than 10g per day)
- Take omega-3 fatty acids (as fish or in pill form) – 1g per day. Higher doses to further decrease risk.
Medication Approach: Statins can lower LDL. Niacin and fibrates help lower triglycerides and raise HDL.
If You Also Have Diabetes
Keep your HgBA1C below 7%.
Am excellent review of dietary control of diabetes is available here.
Medication Approach:There are many medicines used in the treatment of diabetes. Picking the right one is a decision you and your doctor should discuss together. A referral to an endocrinologist, or diabetes specialist may be appropriate.
Source:Fraker, TD and Fihn, SD. Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina. J Am Coll Cardiol, 2007; 50:2264-2274