For people who are either at high risk for a heart attack or stroke, or who have already had such an event, healthy habits and medication can help you live longer, improve your quality of life, and lower your chance of a repeat attack or the need for artery-opening procedures, according to new joint guidelines developed by the American College of Cardiology Foundation and the American Heart Association. The guidelines will be published in Circulation: Journal of the American Heart Association and the Journal of the American College of Cardiology. “Unless improvements are made in your behavior and medical therapy, the same blood vessel problem that caused your first heart attack or stroke can occur again – and may result in death – so long-term changes need to be initiated to get the vascular disease under control,” said Sidney C. Smith, Jr., M.D., chair of the guideline writing group and professor of medicine at the University of North Carolina-Chapel Hill. The guidelines are important because increasing numbers of older adults are living with cardiovascular disease, and in clinical practice many patients are not getting indicated therapies, Smith said. For the first time, the guidelines recommend that all patients be referred to a comprehensive cardiac rehabilitation program after a heart attack, stroke, bypass surgery, or the diagnosis of heart-related chest pain or blockages in leg arteries. In addition, the guidelines note that it is useful to screen heart disease patients for depression, a common occurrence after heart attack or bypass surgery that can interfere with quality of life and the ability to initiate positive changes in health behaviors. The guidelines recommend that patients with coronary heart disease and other vascular disease such as stroke and peripheral artery disease:
- Stop smoking and avoid exposure to tobacco smoke;
- Get at least 30 minutes of exercise 5-7 days a week;
- Reduce weight if you are overweight, obese, or have a large waist;
- Get an annual flu shot;
- Take low-dose aspirin daily unless your doctor prescribes a higher dose or recommends against it because of medical contraindications.
In response to evidence from recent clinical trials, the guidelines make several changes for health professionals in the recommended use of medications that reduce the tendency for blood clotting (antiplatelet agents/anticoagulants). New drugs that may be used instead of clopidogrel in combination with aspirin for patients receiving coronary stents, such as prasugrel or ticagrelor, are now included. The importance of adequate dosages for statin therapy (to lower cholesterol) for all patients with known atherosclerotic vascular disease – the disease process that underlies most heart disease and strokes -- is emphasized. Low-dose aspirin therapy (75-162 mg) continues to be recommended for patients with known heart disease. The writing group deferred modifying recommendations on high blood pressure and high blood cholesterol levels because new guidelines are anticipated to be released in 2012 from panels of the National Heart, Lung and Blood Institute that work specifically on these issues. “Be sure to ask your physician about therapies that can help you live longer and stay healthier after you’ve survived a heart attack or stroke and make them part of your commitment to a healthy lifestyle,” Smith said. The new secondary prevention and risk reduction therapy guidelines are endorsed by the World Heart Federation and the Preventive Cardiovascular Nurses Association. Co-authors are Emilia J. Benjamin, M.D., Sc.M.; Robert O. Bonow, M.D.; Lynne T. Braun, Ph.D.; Mark A. Creager, M.D.; Barry A. Franklin, Ph.D.; Raymond J. Gibbons, M.D.; Scott M. Grundy, M.D., Ph.D.; Loren F. Hiratzka, M.D.; Daniel W. Jones, M.D.; Donald M. Lloyd-Jones, M.D., Sc.M.; Margo Minissian, A.C.N.P.; Lori Mosca, M.D., Ph.D.; Eric D. Peterson, M.D., M.P.H.; Ralph L. Sacco, M.D., M.S.; John Spertus, M.D., M.P.H.; James H. Stein, M.D., and Kathryn A. Taubert, Ph.D. Author and reviewer disclosures are on the manuscript.