Heart Attack Prevention From a Doctor's Perspective
Medical Author: Dennis Lee, MD
Medical Editor: Melissa Conrad Stoppler, MD
Heart
attacks are the major cause of sudden unexpected
death among otherwise healthy adults in the prime of their lives. Heart attacks
are also a significant cause of heart failure (due to weakening of the heart muscle) in the United States. Heart failure considerably decreases a
person's longevity and quality of life. In dollar terms, coronary heart disease
(coronary artery disease) is costly. The total cost of coronary artery bypass surgery
, coronary
angioplasty
and stenting, medications, and hospitalizations exceeds 50 billion dollars
annually.
The major cause of heart attacks is coronary atherosclerosis
(cholesterol plaque-induced hardening and narrowing of the arteries that supply
blood to the
heart). Coronary atherosclerosis, and hence heart attacks, are preventable
conditions. Heart attack prevention involves first identifying one's risk
factors for developing atherosclerosis and heart attacks, and then taking
measures to change those risk factors. Even though one cannot change risk
factors such as genetic makeup, a person can significantly lower his/her risk of
heart attacks by improving modifiable risk factors such as:
Lowering LDL cholesterol
Lowering LDL ("bad") cholesterol can be accomplished through diets, weight
loss, exercise, medications, and sometimes dietary supplements. These measures
can have side effects, and all
cholesterol-lowering treatments should be prescribed and monitored by a doctor. Numerous large-scale placebo-controlled
clinical trials have
consistently shown that lowering LDL cholesterol (using diets and the class of
drugs known as statins) can prevent heart attacks and strokes. Lowering LDL
cholesterol is currently the primary focus in preventing atherosclerosis and
heart attacks. Studies are also demonstrating the heart attack prevention
benefits of increasing HDL, the so-called "good" cholesterol.
Measures to lower LDL cholesterol include:
- Therapeutic lifestyle changes (TLC) (such as modification of diet and exercise programs) are important
treatments for high blood levels of cholesterol. When TLC are not sufficient,
then medications are prescribed. For more, please read the TLC
article.
- Statin medications to lower LDL cholesterol. Currently statins are the most widely used and the most
potent (and reliable) medications to lower LDL cholesterol. For more, please
read the Statins
article.
- Bile acid sequestrants,
ezetimibe (Zetia),
and ezetimibe/simvastatin
(Vytorin) are other drugs that can lower LDL cholesterol. For more,
please read the Bile Acid
Sequestrants
article.
- Non-pharmacologic supplements such as green tea that contains
flavonoids and Policosanol may lower LDL cholesterol to a lesser extent than
the statins.
- Non-pharmacologic supplements such as natural plant phytosterols that block cholesterol absorption can also lower LDL cholesterol.