Heart attack prevention:
the first or second time
Medical disclaimer: While these heart attack prevention guidelines will reduce risk of heart disease events whether you have diagnosed heart disease already or not, they are intended to be followed in addition to your usual medical care. If you are already on medications for diabetes, hypertension or heart disease, please continue these and follow your doctor’s advice on treatment. If you have been told you are in need of diagnostic testing such as a stress test, please get it done. The guidelines presented here are not meant to substitute for your medical care.
For this page, I will hit the major categories for heart attack prevention, but out of necessity and brevity, the details in each of these categories will be filled in on another page. Please follow the links as they become available, and bookmark this page and come back frequently for more information as it is posted.
The first important strategy for heart attack prevention is nutrition . We have the most evidence for heart disease reduction for people following a Mediterranean diet. The Lyon heart study showed a 70% reduction in cardiovascular events for people following this eating pattern. There is no medication available that reduces heart disease risk by that much. What is it? In short, it is a diet hight in fresh vegetables and fruit, getting carbohydrates from whole grains and legumes rather than starches and sugars, avoiding processed foods, enjoying healthy oils daily, such as extra-virgin olive oil and fish oils, low to moderate amounts of dairy and poultry, and eating a fish meal twice weekly. It also means rare intake of red-meat; and a glass of wine with dinner (though if you do not already drink, I do not recommend that you start). OK, that’s the Mediterranean diet, now a few other food recommendations for heart attack prevention. Strictly avoid trans fats by staying away from margarine, deep-fried foods at restaurants, and any foods baked with hydrogenated oils. Watch the glycemic index of your foods (keeps insulin levels down, reduces chance of metabolic syndrome), especially if you are overweight or have a family history of diabetes. How do you make the switch from high glycemic index to low glycemic index? Decrease potatoes (sweet potatoes are fine and have a naturally low GI), decrease breads, and choose breakfast cereals made from oats, barley, and other whole grains. Keep your plate full of fresh fruits and vegetables; choose brown rice or basmati rice. Pasta generally is a low GI food and can be eaten in small to moderate quantities.
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Of course you already know that regular physical activity is one of the most important heart attack prevention strategies. Pursue enjoyable exercise routines that are appropriate for your age. Make time for a 30 minute walk daily as a minimum. Adding some high intensity exercise to that is also recommended. If overweight, 60 minutes of daily physical activity is recommended to achieve weight reduction. See your Doctor to be cleared if this would be a new pattern for you. If you already have heart disease, diabetes, angina, or feel at risk, ask your doctor if starting an exercise program in a cardiac rehab program would be advisable.
There are some supplements from botanical medicine which have a role in heart attack prevention. This includes one of my favorites: Garlic (allium sativum). Garlic has a long history of use in botanical medicine for heart health. It can help to normalize blood pressure and lipids. It also makes the blood less likely to clot. Decreased clotting is generally good for heart health, but you do need to stop any garlic or garlic supplements one week before surgery.
There has been some good research lately showing that Olive leaf capsules can significantly lower high blood pressure and modestly lower elevated triglcyerides and LDL cholesterol at the same time. It may be a good herbal medication to consider as a first line treatment.
Also a daily dose of psyllium fiber can help to lower LDL cholesterol. Soluble fiber is best obtained through healthy eating of legumes, whole grains and vegetables, but a fiber supplement in addition can help. An antioxidant called Coenzyme Q-10 has a specific benefit for heart muscle, and should be taken especially by persons taking statin medications for high cholesterol. Shitake mushrooms have a cholesterol lowering effect. Take fish oil (1 to 2 grams) every day that you don’t eat fish. Fish oil has been shown to decrease risk of sudden death from rhythm problems, even in men without a prior history of heart disease. I also recommend enteric coated aspirin 81 mg daily unless you have a history of ulcers or intestinal bleeding. (this is controversial over the age of 70…)
So while you may not have been surprised at my diet, exercise and supplement recommendations, the area of mind-body medicine is less familiar territory for many of us thinking about heart attack prevention. But research has demonstrated that a daily meditation or relaxation practice such as mindful breathing can help to normalize blood pressure, and some studies have even shown improved survival after heart attacks in people who meditate regularly. In our current high stress fast paced world, I recommend a few moments of mindful breathing, meditation, or a daily yoga or Qigong (chee-gung) practice for everyone. The benefits of this extend far beyond heart health alone. (see Dr. Herbert Benson’s book The Relaxation Response).
What does spirituality and relationships have to do with heart attack prevention? Quite a lot in my view. These questions are at the “heart” of who we are, and that’s more than metaphor. What gives you meaning and purpose? Who are you? Who is important to you? How are you doing with forgiveness? Mental health is connected to better medical outcome with heart disease: people who are depressed after a heart attack have a second heart attack sooner than people who are not depressed. Find a way to experience love and gratitude every day, and remember the Hebrew scripture, “A cheerful heart is good medicine.”
And finally, wearing my conventional medical hat in addition to my holistic approach in medicine: maintain healthy lipid values (cholesterol and triglycerides). National preventive services guidelines suggest that all adults have lipid screening once every 5 years. If we know you have a problem and are working on it, more frequent follow-up is required to monitor progress. And I recommend looking at some advanced heart and stroke risk markers including: Lipoprotein (a), sometimes called Lp(a); CRP, LDL particle size distribution, homocysteine and others. Know your blood pressure. Elevated fasting lipids and elevated blood pressure are both strong predictors of cardiovascular disease, and these need to be monitored and kept in the normal range. Many times conventional prescription medications are appropriate, and sometimes more natural approaches also work well. And of course, don’t smoke.
I know that’s a really quick overview, but in a nutshell, following this advice will make a huge difference for heart attack prevention. Please join me in these practices, since this is what I do personally already.
To your health and wellness,
Robert Pendergrast, M.D.
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