Because coronary artery disease tends to develop gradually, effective strategies exist to help prevent or control it. Individuals should become well informed about how changes in lifestyle and behaviors can reduce the speed at which atherosclerosis or other heart-related problems develop. Some of the most common strategies for preventing CAD, or slowing its progression, include:
* Learning your family medical history. A patient’s family medical history can greatly increase (or decrease) the risk of the patient developing certain medical conditions, including coronary artery disease. Some patients prefer to develop their own medical family tree and bring it with them to their doctor appointment. A complete family tree traces the medical history of an individual (and his or her spouse, if applicable), through at least several generations.
* Eating a heart-healthy diet. Research has consistently supported the idea that the health of people’s bodies is largely determined by what they choose to eat. Certain vitamins and minerals have been shown to be helpful to heart health, in addition to whole grains, fruits and vegetables, and soluble fiber (the American Heart Association recently recommended that dietary fiber intake should be between 25 and 30 grams daily). In contrast, certain fats and oils such as saturated fat, trans fat and hydrogenated oils are particularly harmful because they can accelerate coronary artery disease, atherosclerosis and contribute to obesity. As of Jan. 1, 2006, the U.S. Food and Drug Administration (FDA) has mandated that all food companies publish the amount of trans fat in their nutritional information, in addition to the levels of saturated fat and overall fat. This will hopefully help consumers make more informed dietary choices. Conversely, monounsaturated fats, such as olive oil and the oils found in cold-water fish such as salmon, are good for the heart when eaten in moderation.
* Improving your cholesterol ratio. A person’s total cholesterol level (which includes LDL cholesterol, HDL cholesterol and triglycerides) should be no more than 200 milligrams per deciliter and no more than five times the HDL level. Key strategies for reducing levels of total cholesterol, LDL cholesterol and triglycerides are to eat a heart-healthy diet and exercise regularly. If these strategies do not reduce total cholesterol levels, a physician may prescribe cholesterol-reducing drugs. Strategies for increasing levels of HDL cholesterol include eating monounsaturated fats in moderation, decreasing the amount of saturated fat, limiting alcohol use and starting an exercise program.
* Controlling homocysteine levels. There is considerable debate over the role of homocysteine in heart disease. Homocysteine is an amino acid that is produced as a byproduct of other chemical reactions in the body. Numerous studies have shown that people with elevated homocysteine are at greater risk for heart attack, stroke and other cardiovascular problems. However, researchers have been unable to determine if elevated homocysteine levels are caused by heart disease, or if they cause heart disease. Also, two large, well-designed studies have recently shown that moderately lowering homocysteine among people with diabetes and existing heart disease had no effect on lowering risk for cardiovascular events. At this point, the American Heart Association has not identified elevated homocysteine as a major risk factor for heart disease and does not recommend widespread use of folic acid and vitamin B supplements to lower homocysteine. However, because of the association between homocysteine and heart disease, people are advised to obtain these important nutrients through a healthy diet that includes fruits, vegetables, whole grain and fortified grain products. Additionally, people who have a family history or personal history of heart disease but lack other well-defined risk factors, such as smoking or obesity, should consider monitoring their homocysteine levels. In the event of elevated homocysteine (above 15 mmol/L), supplementation to lower homocysteine should only be done under the supervision of a physician to ensure the patient's safety. Folate supplements that are used to lower homocysteine, for example, may mask a true vitamin B-12 deficiency. In addition, studies find that these supplements may increase the risk of artery re-narrowing (restenosis) following revascularization procedures such as balloon angioplasty and stenting.
* Exercising regularly. Exercise is an excellent tool for both preventing heart disease and improving quality of life for heart patients. Physically, it can slow or even reverse the process of atherosclerosis, as well as lower blood pressure, reduce cholesterol levels and help prevent obesity. Emotionally, it can reduce levels of stress and depression. Individuals should consult with their physician before starting any exercise program.
* Controlling diabetes. People with diabetes are more likely to develop heart-related diseases, and elevated blood glucose levels are known to accelerate the atherosclerotic process. It is essential that diabetics maintain strict glucose control, through diet, exercise and medications, in conjunction with careful blood glucose monitoring.
* Controlling high blood pressure (hypertension). Individuals with high blood Hypertension is the medical term for high blood pressure (the force of blood against artery walls).pressure are at greater risk of cardiovascular problems resulting from CAD, including heart attack. Hypertension can be controlled through taking medications, self-monitoring, eating a heart-healthy diet that is low in sodium, and engaging in regular exercise. People are also encouraged to have regular check-ups with their physician.
* Controlling weight. Obesity and being overweight are major risk factors for a host of serious health conditions, including coronary artery disease, high blood pressure, diabetes, heart attack and stroke. Some weight control methods include limiting fat in the diet, increasing activity levels, counseling, medication and surgical interventions.
* Managing stress. Some people react to stress in unhealthy ways, such as overeating and smoking. Chronic stress (and hostility) by itself may be a direct contributor to poor heart health because it produces increases in blood pressure that could become permanent, as well as other physiological changes that affect the health of arteries.
* Quitting smoking (or not starting to smoke). Tobacco smoking is a major cause of coronary artery disease and cardiac arrest. The latest statement by the U.S. Centers for Disease Control and Prevention (CDC) shows heart disease as the leading smoking-related cause of death in the United States among men and women, with tobacco use the leading preventable cause of death. The CDC also states that both middle-aged males and female smokers triple their risk of death to heart disease.
* Controlling chronic depression. Depression has been linked with a higher risk of developing high blood pressure, heart disease and having a heart attack.
These strategies may help to preserve health and prolong life, and are particularly important for those of advanced age and those with a family history of heart disease. Even someone who has suffered a cardiac event (e.g., heart attack) can reduce the risk of having another one by changing unhealthy behaviors and stopping all high-risk activities.
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