Heart Disease: An introduction to Coronary Artery Disease
Heart disease prevention is important before and after someone is diagnosed with the condition:
- Primary prevention refers to measures that everyone should take to reduce their risk of heart disease.
- Secondary prevention refers to measures a patient already diagnosed with heart disease should take to reduce the risk of having additional heart damage. Many of these measures are similar or the same as those recommended for primary prevention.
Key prevention measures include:
- All patients should stop smoking and avoid exposure to secondhand smoke.
- Maintain cholesterol levels at appropriate levels using a heart healthy diet, exercise, and medications
- Maintain an appropriate low blood pressure level
- Maintain an active lifestyle
- Use an antiplatelet drug, such as aspirin, if appropriate (see Medications section of this report)
- Manage diabetes and kidney disease when present
Your doctor should ask about your smoking habits at every visit. Smoking is a chronic condition and often requires repeat therapy using more than one technique.
Cholesterol and Other Lipid Disorders
All patients should start following a heart-healthy diet and exercise regularly, after talking to their doctors. [For more information on diet, see In-Depth Report #43: Heart-healthy diet.]Healthy diet, regular exercise, and quitting smoking (if you smoke) may prevent heart disease. Follow your health care provider's recommendations for treatment and prevention of heart disease.
Statin drugs are the primary medications used for lowering LDL (“bad”) cholesterol levels. For patients without heart disease, the doctor will start or consider medication, increase dosage of medication, or add new medication when:
- LDL cholesterol is 190 mg/dL or higher
- LDL cholesterol is 160 mg/dL or higher AND patient has one risk factor for heart disease
- LDL cholesterol is 130 mg/dL or higher AND patient has either diabetes or two other risk factors for heart disease
- LDL cholesterol is 100 mg/dL or higher AND patient has diabetes. Even without heart disease, medication may be considered for an LDL cholesterol of 100 mg/dL.
There are many different brands of statin drugs. One statin, rosuvastatin (Crestor), is also approved for prevention of heart attack and stroke in patients with normal LDL cholesterol levels but a combination of other risk factors that put them at increased risk for heart disease.
For patients with heart disease, the doctor will start or consider medication, increase dosage of medication, or add new medication when:
- LDL cholesterol is 100 mg/dL or higher
- LDL cholesterol is greater than 70 mg/dL. According to national guidelines, treating a patient with LDL cholesterol levels between 70 - 100 mg/dL is not required but is considered desirable. This would be true particularly for patients who have had a recent heart attack or have known heart disease along with diabetes, current cigarette smoking, poorly controlled high blood pressure, or metabolic syndrome (high triglycerides, low HDL, and obesity).
[For more information, see In-Depth Report #23: Cholesterol.]
Click the icon to see an image of cholesterol.
Manage High Blood Pressure
Keep Blood Pressure Low. People in normal health should have a blood pressure reading of 120/80 mm Hg or less. Blood pressure readings of 120/80 are considered normal, readings of 140/90 or higher indicate hypertension, and readings in between the two are called pre-hypertension. Patients with diabetes chronic kidney disease, or atherosclerosis should maintain blood pressure readings of 130/80 mm Hg or less, while others should be no higher than 140/90 mm Hg.
Depending on blood pressure levels and presence of either risk factors for heart disease or known coronary artery disease, patients may be recommended to try lifestyle changes first or to immediately begin medications. Several of the medications used to treat coronary artery disease also reduce blood pressure. [For more information, see In-Depth Report #14: High blood pressure.]
All patients with diabetes should have their blood sugar (glucose) levels well managed. For most patients, a goal would be to bring HbA1c levels down to around 7%. [For more information, see In-Depth Report #09: Diabetes - type 1 and In-Depth Report #60: Diabetes - type 2.]
Current American Heart Association (AHA) guidelines recommend:
- Balance calorie intake and physical activity to achieve or maintain a healthy body weight.
- Consume a diet rich in a variety of vegetables and fruits.
- Choose whole-grain, high-fiber foods. These include fruits, vegetables, and legumes (beans). Good whole grain choices include whole wheat, oats/oatmeal, rye, barley, brown rice, buckwheat, bulgur, millet, and quinoa.
- Consume fish, especially oily fish, at least twice a week (about 8 ounces/week). Oily fish such as salmon, mackerel, and sardines are rich in the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Consumption of these fatty acids is linked to reduced risk of sudden death and death from coronary artery disease. People with existing heart disease should consider taking daily fish oil supplements of 850 - 1,000 mg eicosapentaenoic acid (EPA) and docosahexaenoic acid (DPA).
- Limit daily intake of saturated fat (found mostly in animal products) to less than 7% of total calories, trans fat (found in hydrogenated fats, commercially baked products, and many fast foods) to less than 1% of total calories, and cholesterol (found in eggs, dairy products, meat, poultry, fish, and shellfish) to fewer than 300 mg per day. Choose lean meats and vegetable alternatives (such as soy). Select fat-free and low-fat dairy products. Grill, bake, or broil fish, meat, and skinless poultry.
- Use little or no sodium (salt) in your foods. Reducing sodium can lower blood pressure and decrease the risk of heart disease and heart failure.
- Cut down on beverages and foods that contain added sugars (corn syrups, sucrose, glucose, fructose, maltrose, dextrose, concentrated fruit juice, and honey.)
- If you drink alcohol, do so in moderation. The AHA recommends limiting alcohol to no more than 2 drinks per day for men and 1 drink per day for women.
[For more information on diet, see In-Depth Report #43: Heart-healthy diet.]
People should aim for a BMI index of 18.5 - 24.9. Weight reduction is recommended for obese patients who have high blood pressure, high cholesterol levels, metabolic syndrome, or diabetes.
Some obese patients with coronary artery disease may consider having bariatric surgery (stomach bypass) to lose excess weight. The weight lost after surgery can help improve blood pressure, cholesterol, blood sugar and other factors associated with CAD.
Exercise and Cardiac Rehabilitation
Everyone in normal health should do at least moderate physical activity for a minimum of 30 - 60 minutes on most, if not all, days of the week
Even low amounts of moderate or high intensity exercise (walking or jogging 12 miles a week) can help produce beneficial changes in cholesterol and lipid levels. However, more prolonged exercise is required to significantly change cholesterol levels, notably by increasing HDL ("good cholesterol"). Resistance (weight) training has also been associated with heart protection.
Click the icon to see an image about angina.
Sudden strenuous exercise (especially snow shoveling) puts many people at risk for angina and heart attack. Patients with angina should never exercise shortly after eating. People with risk factors for heart disease should seek medical clearance and a detailed exercise prescription. And all people, including healthy individuals, should listen carefully to their bodies for signs of distress as they exercise. [For more information, see In-Depth Report #29: Exercise.]
Influenza Vaccination (Flu Shot)
Patients with CAD are considered at high risk for complications from influenza. People with CAD should get an annual flu shot.