Controlling Contributing Disorders and Improving Lifestyle

A motivated person who consistently makes healthy choices can not only help prevent a heart attack and improve the overall quality of life, but may even halt the progression of already established atherosclerosis. For smokers, the first step is to quit. Lowering cholesterol levels using diet and exercise alone or in combination with drug therapy can be heart saving. A study shows that stress management along with exercise can reduce coronary disease. After consulting a physician, most people should exercise a minimum of 30 minutes 3 or 4 times a week. Hypertension drops with changes in lifestyle alone or with various drug therapies, and when blood pressure returns to normal, the risk of developing coronary disease falls significantly. Diabetics should do their best to maintain normal blood sugar levels and engage in healthy lifestyles.

Keeping Arteries Open

Aspirin inhibits blood platelets (major clotting factors); it is usually the first choice for people with stable angina or those with risk factors for a first heart attack. Recent aspirin use may also reduce the severity of a heart attack. For those who have had a heart attack or are at severe risk for one, other anti-clotting drugs may be needed.

Cholesterol Lowering Drugs

Cholesterol-lowering drugs commonly known as the statins may improve blood flow through the arteries, even after being taken for only a few months. They are proving to reduce the risk for heart attacks even in people with normal or below-normal cholesterol.

Vitamins and Diet

Protective and Dangerous Foods. Although there is much controversy on the effects of fat on health, virtually all experts strongly advise limiting intake of saturated fats (found in animal products) and trans-fatty acids (found in commercial baked goods and fast foods). Other fatty acids, however, may offer benefits. How much one should eat of even beneficial fatty acid, however, is under intense debate. Some experts recommend maintaining a relatively high intake of monounsaturated and polyunsaturated fats (about 32% of calorie intake), with saturated fats representing no more than 8%. Others believe that a very trim diet, 20% fat with as little as 4% saturated fat, is ideal. Still others recommend fat intake somewhere in between these extremes. Meals rich in carbohydrates tend to set off angina attacks, possibly because they raise insulin levels. One study suggested, in fact, that in women, sugar may pose an even higher risk for heart disease than fats do.

Whole grains and fresh fruits and vegetables that are rich in fiber, vitamins, and other important nutrients are heart-protective. Natural chemicals in cooked tomatoes, garlic, nuts, apples, onions, wine, and tea also appear to offer some protection for the heart. Drinking as little as a cup of tea a day appeared to help protect against heart disease. Much evidence suggests that eating fish, particularly oily fish (such as salmon, halibut, swordfish, and tuna) is protective, although some studies indicated that eating fish every day may be dangerous to the heart. Taking capsules of fish oil has not been found to be protective and may be toxic in high doses or increase the risk of bleeding. Soy is an excellent food. It is rich in both soluble and insoluble fiber, omega-3 fatty acids, and provides all essential proteins. It has estrogen-like compounds that might be as effective as estrogen therapy itself in slowing progression of heart disease without increasing triglycerides or the risk for breast cancer (as estrogen therapy does).

Vitamins. Sufficient amounts of folic acid, B6, and B12 are certainly important to prevent high levels of homocysteine. Researchers have also focused on the antioxidant vitamins E and C. A number of studies have indicated protection against coronary artery disease with doses of vitamin E between 100 and 400 IU, but their value is still unsubstantiated. (Lower doses do not offer any benefits.) Also, if people are taking medications to prevent clotting, such as aspirin or heparin, adding vitamin E could theoretically increase the risk for bleeding. Little evidence has emerged to prove any protective effects from taking vitamin C. Of interest, however, is a study suggesting that long term administration of vitamin C may improve endothelial function, a factor affecting blood flow known to be important in connection with coronary artery disease. Studies have reported that a high intake of beta-carotene and other carotenoids from fruits and vegetables (but not from supplements) may reduce the risk of heart attack. It should be stressed, however, that studies are continuing to indicate that high doses of supplements of any of these antioxidants have pro-oxidant effects that can harm the arteries and incur other damage.

Alcohol. The effects of alcohol on heart disease vary depending on consumption. Evidence strongly suggests that light to moderate alcohol consumption (one or two drinks a day) protects the heart. The benefits are strongest in people at high risk for heart disease and may be fairly small in those at low risk. Light to moderate alcohol intake may also reduce the risk of sudden cardiac death and even protect against coronary heart disease in people with adult-onset diabetes. Large amounts of alcohol, however, can raise blood pressure, trigger irregular heartbeats, and damage the heart muscle. Binge drinkers have a significantly higher risk for a cardiac emergency

Hormones

Hormone replacement therapy for postmenopausal women may benefit the heart in many ways, including increasing HDL levels and helping to heal damaged blood vessels. Although a number of observational studies have found a lower incidence of heart disease in women taking HRT, one clinical trial reported that it failed to protect women who already had heart disease before they started treatment. Results of other major studies are still pending. Use of oral contraception in older women may increase the risk for heart disease later in life, perhaps because it elevates blood pressure slightly. Studies on newer so-called designer estrogens, including raloxifene and tamoxifen, are showing some protective qualities. (Tamoxifen, but not raloxifene, significantly increases the risk for endometrial cancer.) Testosterone seems to lower the risk for heart disease in men.