Prevention of Heart Attack
Block formation in the coronary
arteries is the biggest killer in the world. Coronary artery disease (angina
and heart attack) remains the leading cause of death in men over 45 years
through out the world now. The underlying atherosclerosis (block) develops
insidiously, and is generally advanced and difficult to reverse once symptoms
occur. Thus, development of heart attack is strongly related to lifestyle
characteristics and associated risk factors, and there is now clear evidence
that lifestyle modification and risk factor reduction can retard the
development of angina or heart attack. Major advances in the diagnosis and
treatment of coronary heart disease have not been paralleled by similar
enthusiasm for measures aimed at its prevention.
Life style and characteristics associated with increased risk of future coronary artery disease (angina and heart attack) :
1. Life style
a. Diet high in saturated
fat, cholesterol and calories.
b. Tobacco smoking
c. Excess alcohol
consumption.
d. Physical inactivity.
2. Biochemical and
physiological factors:
a. High blood cholesterol
b. Elevated blood pressure
c. Low plasma HDL
d. High blood triglyceride
level
e. Diabetes
f. Obesity
3. Personal
characteristics
a. Age
b. Sex
c. Family history of heart
attack
Who are the persons require attention
(according to priority)
a. Priority-1 (very high
risk). Patients with established angina or prior history of heart attack.
b. Priority-2 (high risk).
No symptom but has diabetes or hypertension or high blood cholesterol. Smokers
are also included in this group.
c. Priority-3 (moderate
risk). Close relatives of patients with early-onset angina or heart attack.
d. Priority-3 (Low risk).
Any adult patient not included above.
Preventive approach
Prevention of coronary artery disease
is of two types’ primary prevention and secondary prevention. Primary
prevention means, prevention before the disease manifests. So, they do not have
angina and do not have any past history of heart disease. They are asymptomatic
high risk persons. Secondary preventive approach is applied in those who are
established to have coronary artery disease in the form of angina or heart
attack. In this group preventive approaches are important to halt the further
progression of disease or to reverse the process if at all possible. So,
primary prevention is before the development of disease and secondary
prevention is after the development of disease.
How to prevent heart attack?
Secondary prevention:
1. To modify lifestyle
a. Avoidance of all
tobacco
b. Modify food choices to
reduce fat intake to 30% or less of total energy and the intake of cholesterol
to less than 300 mg/day. Vegetables, fruit and cereals intake should be
emphasized. Calorie intake should be reduced be reduced in the overweight.
c. To improve physical
fitness through regular leisure exercise.
2. To modify risk factors:
a. Again, lifestyle
modification to control weight, high cholesterol and hypertension (high blood
pressure) are appropriate. Drug therapy is needed for the control of high
cholesterol and hypertension if lifestyle modification fails to produce a
satisfactory response.
b. Optimum control of
blood sugar and meticulous attention to other risk factors along with diabetes.
c. Reduction in thrombotic
tendency (solidification of blood) through avoidance of tobacco, changes in fat
consumption as above and in women of fertile age avoidance of the oral
contraceptive pills.
3. To consider preventive
medications :
a. Aspirin for most
b. Beta-blockers
(tenormin, tenoren, tenoloc, betaloc, batanol, cardipro, betasec etc) after
heart attack to reduce the incidence of sudden death.
c. Angiotensin converting
enzyme inhibitor medicines (zestril, acepril, neopril, capoten, vasopril,
vasotec lipril, topril, ramipril, Cardace, Inhibase, Coverrsyl etc) to prevent
heart dysfunction after heart attack.
Primary prevention:
The principle here remains the same.
There is, as yet, no established place for universal preventive drug treatment
with, for example, aspirin.
Control your Hypertension (high blood pressure) :
High blood pressure is an important
risk factor for development of coronary heart disease or heart attack. Regular
treatment of high blood pressure can reduce the incidence of heart attack. Even
treatment of mild hypertension brings about 35% to 40% reduction in strokes and
20% to 25% reduction in heart attack. If your blood pressure is not well
controlled the chance of formation of block in your coronary artery increases.
Persistent rise of blood pressure also increase the thickness of the muscle of
heart which then demand more oxygen than normal. This increase in thickness of
heart muscle is called left ventricular hypertrophy. This type of increase in
thickness of heart muscle is found in up to 50% of hypertensive patients and is
associated with a five fold increase in sudden death. Between 20% and 30% of
the adult population in developed countries is found to have raised blood
pressure; about two thirds have mild blood pressure. The separation between
normotension (normal blood pressure) and hypertension (high blood pressure) is
arbitrary. About 20% of the adult population aged 18-74 has high blood
pressure, defined as >/= 140/90 mm of Hg. Blood pressure rises with advancing
age and affects approximately :
10% of patients aged 50
20% of patients aged 60
30% of patients aged 70
It is recommended that if blood
pressure is persistently higher than 140/90 mm of Hg patient requires
treatment. Single measurement of high blood pressure does not indicate that the
patient is hypertensive; the decision should be based on the average of two or more
readings taken at each of two or more visits after an initial screening. Optimal
blood pressure in respect of cardiovascular risk is about 120 mm of Hg systolic
and about 80 mm Hg diastolic. It is rational to bring down blood pressure less than
140/90 by anti hypertensive medicines.
We can bring down blood pressure by
using many antihypertensive drugs. This important drugs are beta blockers, ACE inhibitors,
calcium channel blocker, diuretics etc. Beta blockers are very popular in the
treatment of blood pressure. Atenolol in dose 25 mg to 100 mg daily, metoprolo
(betaloc) 50 mg twice daily to 100 mg twice daily and propranolol (Indevar,
inderal, propranol, adloc, etc) 20 mg three times daily to 80 mg three times
daily can effectively control blood pressure. But these drugs can not be used
in patients with bronchial asthma, heart block and heart failure. ACE
inhibitors such as lisinopril, captopril, ramipril enalpril, are also used in
the treatment of hypertension. Lisinopri (Acepril, zestril, neopril, lipril) 5
mg to 40mg once daily, Captopril (caprten) 12.5 mg to 50 mg three times daily
or enalapril in does 5 mg to 40 mg once or in two divided doses or cilazapril 1
mg to 2.5 mg once a day can be used in the treatment of hypertension. Calcium
channel blockers like nifedipine, diltiazem, verapamil, amlodipine etc are also
excellent drugs in the control of blood pressure. Nifedipine in dose 10 mg
three times daily to total mximum 120 mg/day, diltiazem 30 mg three times daily
to maximum 360 mg/day, verapamil 40 mg three times daily to maximum 480 mg/day
or amlodipine 5 mg once daily to 10 mg once daily may be used to control blood
pressure.
If your heart muscle has already been
thickened even then it can be reversed by some drugs. It has been proved that
the medicines like ACE inhibitors, diuretics like indapamide 2.5 mg once daily
may reverse heart muscle thickening.
Control high Blood sugar
Diabetic patients are more prone to
develop hear attack. They may develop heart attack with out pain because pain
perception may be impaired in many diabetics due to prior damage of pain
carrying nerves. If you are diabetic you may have painless heart attack. So if
any patient with diabetes suddenly develops shortness of breath or marked
sweating or if blood pressure drops suddenly the possibility of myocardial
infarction (heart attack) to be excludes by proper investigations.
