Ten steps for keeping heart disease in check

Published: October, 2006

New guidelines from the American Heart Association for people who already have heart disease.

Every so often, new research prompts the American Heart Association and American College of Cardiology to revise their guidelines for diagnosing and treating heart disease. The latest update covers secondary prevention "" preventing a heart attack in people who have heart disease or who have already had a heart attack.

One of the biggest changes since the last iteration, published in 2001, is the recommendation for some people to lower their LDL (bad) cholesterol to less than 70 mg/dL. That's well below the previous target of 100. The new version also ups the ante for physical activity with its call for daily exercise. And for the first time it advises getting a yearly vaccination against influenza. These are on top of other aggressive lifestyle and drug strategies that are indicated for preventing a first or repeat heart attack.

The clinicians who wrote the recommendations acknowledged the "discouraging conclusion" that many people who could benefit from following the guidelines aren't doing so, partly because following the steps takes some work and partly because too many doctors aren't getting with the guidelines.

Why bother? These steps are good for your heart, lungs, and blood vessels. They can give you a better, longer life.

You can get the full guideline for free at health.harvard.edu/102. If you don't have heart disease and want to stay that way, the American Heart Association's diet and lifestyle guidelines are available at health.harvard.edu/103.

Covering the goal line

These guidelines are for people diagnosed with heart disease or significant atherosclerosis. This includes those with narrowed coronary or carotid arteries, those with chest pain (angina) or peripheral artery disease, those who have had a heart attack or episode of unstable angina, and those with heart failure.


Getting there

Blood pressure:Aim for a blood pressure below 140/90 mm Hg. If you have diabetes or chronic kidney disease, aim for under 130/80.

A healthful lifestyle (weight control, physical activity, alcohol in moderation, and a healthful diet) is the first and best strategy for blood pressure control, followed by medications if needed.

Cholesterol:Reduce LDL (bad) cholesterol to 100 mg/dL or below. If you have had a heart attack or are at very high risk for having one (or another one), an LDL of 70 or lower offers even more protection.

Healthy eating and exercise often aren't enough to drive LDL below 100, not to mention 70. A cholesterol-lowering statin is currently the best way to do this. If your starting LDL is very high, a 50% or greater reduction is a good alternative to a target of 100 or 70.

Smoking:If you smoke, try to quit. Avoid secondhand smoke whenever possible.

The most effective quitting strategy seems to be talk therapy combined with nicotine replacement and possibly the antidepressant bupropion.

Physical activity:Be active for at least 30 minutes every day if possible, or at least five days a week.

If you aren't physically active, brisk walking is a great way to start exercising. An "exercise buddy" makes it more fun to exercise and harder to skip your daily workout.

Weight:Try to keep your body mass between 18.5 and 24.9, and taper down your waistline so it is 40 inches or below if you are a man, 35 or below if you are a woman.

If you are overweight, losing even 5%""10% of your current weight can take a big bite out of high blood pressure or high cholesterol, and can dramatically improve blood sugar control.

Diabetes management:Keep your hemoglobin A1c under 7%.

Diet and exercise are essential to keeping your blood sugar under control, whether or not you are taking diabetes medication.

Antiplatelet agent/anticoagulant

Take low-dose aspirin (75""162 milligrams) every day unless your doctor tells you not to. In addition to aspirin, some people need to take clopidogrel (Plavix) or warfarin.

Blocking the renin-angiotensin-aldosterone system

If you have heart failure, high blood pressure, diabetes, or kidney disease, you probably should be taking an ACE inhibitor every day. An angiotensin-receptor blocker is an alternative if you can't tolerate ACE inhibitors. Some people also need an aldosterone blocker such as spironolactone.

Beta blocker

Take a beta blocker if you have had a heart attack or unstable angina, or if you have left ventricular dysfunction. It may also be a good idea for others with heart disease, peripheral vascular disease, or diabetes.

Influenza vaccination

Get one every fall.

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