Prevention
It's never too late to take steps to prevent a heart attack - even if one have already had one.
Taking medications can reduce the risk of a second heart attack and help the damaged heart
function better. Lifestyle factors also play a critical role in heart attack prevention and recovery.
Medications
Doctors typically prescribe drug therapy for people who've had a heart attack or who are at high
risk of having one. Medications that help the heart function more effectively or reduce heart
attack risk may include:
Blood-thinning medications. Aspirin makes the blood less "sticky" and likely to clot.
Doctors recommend a daily aspirin for most people who've had a heart attack. The
doctor may, in some cases, prescribe a stronger blood thinner than aspirin.Doctors may
prescribe aspirin and an anti-clotting drug, such as clopidogrel (Plavix), for people
undergoing an angioplasty or stent procedure to open narrowed coronary arteries, both
before and after the procedure.If one are taking aspirin to help prevent a heart attack, be
aware that taking the painkiller ibuprofen (Advil, Motrin, others) at the same time may
increase the risk of gastrointestinal problems and may interfere with the heart benefits of
aspirin.
Beta blockers. These drugs lower the heart rate and blood pressure, reducing demand
on the heart and helping to prevent further heart attacks. Many people will need to take
beta blockers for the rest of their lives following a heart attack. Beta therapy such
as metoprolol or carvedilol should be commenced. These have been particularly
beneficial in high-risk patients such as those with left ventricular dysfunction and/or
continuing cardiac ischaemia-Blockers decrease mortality and morbidity. They also
improve symptoms of cardiac ischemia in NSTEMI.
Angiotensin-converting enzyme (ACE) inhibitors. Doctors prescribe ACE inhibitors
for most people after heart attacks, especially for those who have had a moderate to
severe heart attack that has reduced the heart's pumping capacity. These drugs allow
blood to flow from the heart more easily, prevent some of the complications of heart
attacks and make a second heart attack less likely. ACE inhibitor therapy should be
commenced 24–48 hours post-MI in hemodynamically-stable patients, particularly in
patients with a history of MI, diabetes mellitus, hypertension, anterior location of infarct
(as assessed by ECG), and/or evidence of left ventricular dysfunction. ACE inhibitors
reduce mortality, the development of heart, and decrease ventricular remodelling post-
MI
Cholesterol-lowering medications. A variety of medications, including statins, niacin,
fibrates and bile acid sequestrants, can help lower the levels of unwanted blood
cholesterol. The majority of people who've had a heart attack take cholesterol-lowering
medications — drugs that help lower the risk of a second heart attack. These
medications can help prevent future heart attacks even if the cholesterol was not very
high at the time of the heart attack.
Statin therapy has been shown to reduce mortality and morbidity post-MI. The
effects of statins may be more than their LDL lowering effects. The general
consensus is that statins have plaque stabilization and multiple other
("pleiotropic") effects that may prevent myocardial infarction in addition to their
effects on blood lipids.
The aldosterone antagonist agent eplerenone has been shown to further reduce
risk of cardiovascular death post-MI in patients with heart failure and left
ventricular dysfunction, when used in conjunction with standard therapies above.
Spironolactone is another option that is sometimes preferable to eplerenone due
to cost.
Omega-3 fatty acids, commonly found in fish, have been shown to reduce
mortality post-MI.]While the mechanism by which these fatty acids decrease
mortality is unknown, it has been postulated that the survival benefit is due to
electrical stabilization and the prevention of ventricular fibrillation. However,
further studies in a high-risk subset have not shown a clear-cut decrease in
potentially fatal arrhythmias due to omega-3 fatty acids.
Lifestyle changes
In addition to medications, the same lifestyle changes that can help people recover from
a heart attack can also help prevent future heart attacks. These include:
Normally sedentary people who try something strenuous like shoveling snow, sprinting
to catch a bus, playing tennis or pushing a car out of a snowdrift, may be especially at
risk.
Among the cardiovascular benefits of regular exercise are a diminished tendency of
blood to form clots, an improved cholesterol profile, more efficient use of oxygen by the
muscles, a larger volume of blood pumped with each heartbeat, and during periods of
exertion, greater dilation of the arteries, a lower heart rate and lower blood pressure.
Reasonable advice includes the following:
Start slow and easy - For the first week or two, exercise at an easy pace for no more
than 10 to 20 minutes at a time.
Build up gradually – As a general rule, do not increase either the intensity, frequency
or duration of your exercise sessions by more than 10 percent each week.
Exercise often – It is safer to get modest amounts of exercise several times a week
than to try making up for days or weeks of inactivity with a single, prolonged workout.
Do not overexert – Beginners should avoid pushing their heart rate higher than 70
percent of its maximum. (Your maximum rate equals roughly 220 minus your age).
Warm up – Begin every workout with a gentle warm-up to boost circulation to the heart
muscle. Jog in place, ride a stationary bicycle or do calisthenic exercise for a few
minutes. Then stretch to reduce the risk of injury.
Cool down – Rapid muscle movement helps pump blood back to the heart. If you stop
exercising abruptly, the heart's blood supply may drop abruptly.
Do not eat and run – During and after a meal, the body sends extra blood to the
digestive organs, leaving less blood for the heart and muscles. Try to wait at least two
hours after a heavy meal before exercising.
Watch the weather – Blood vessels in the skin and the limbs constrict when it is cold
outside, making it more difficult for the heart to pump blood throughout the body. If you
exercise outdoors in frigid weather, dress in warm layers and do not push yourself too
hard. Working out in hot weather can also threaten the heart, since heavy sweating
decreases the total volume of blood, and in turn, the amount flowing to the heart muscle.
Take pollution to heart - Exercising in polluted air increases blood levels of carbon
monoxide, which raises the risk of heart attack by replacing oxygen in the blood
No tobacco - Smoking increases the risk of high blood pressure, heart disease, and
stroke. Never smoking is one of the best things a person can do to lower their risk. And,
quitting smoking will also help lower a person’s risk of heart disease. A person's risk of
heart attack decreases soon after quitting.
Moderate alcohol use - Excessive alcohol use increases the risk of high blood
pressure, heart attack, and stroke. People who drink should do so only in moderation
and always responsibly.
Maintain a healthy weight - Healthy weight status in adults is usually assessed by
using weight and height to compute a number called the "body mass index" (BMI). BMI
usually indicates the amount of body fat. An adult who has a BMI of 30 or higher is
considered obese. Overweight is a BMI between 25 and 29.9. Normal weight is a BMI
of 18 to 24.9. Proper diet and regular physical activity can help to maintain a healthy
weight.
Regular physical activity - Adults should engage in moderate level physical activities
for at least 30 minutes on most days of the week.
Diet and nutrition - Along with healthy weight and regular physical activity, an overall
healthy diet can help to lower blood pressure and cholesterol levels and prevent
obesity, diabetes, heart disease, and stroke. This includes eating lots of fresh fruits and
vegetables, lowering or cutting out added salt or sodium, and eating less saturated fat
and cholesterol to lower these risks.
