Heart Attack Prevention From a Doctor's Perspective

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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 high blood pressure
• controlling diabetes
• stopping cigarette smoking
• losing excess weight
• exercising regularly
• lowering LDL cholesterol
• increasing HDL cholesterol

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:

1. 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.

2. 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.

3. 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.

4. Non-pharmacologic supplements such as green tea that contains flavonoids and Policosanol may lower LDL cholesterol to a lesser extent than the statins.

5. Non-pharmacologic supplements such as natural plant phytosterols that block cholesterol absorption can also lower LDL cholesterol.

Natural supplements such as green tea and phytosterols are safe but not as potent as the statins in lowering LDL cholesterol. Only your doctor can determine the degree of LDL cholesterol lowering that is necessary for you, and he/she can then decide which of these different options is appropriate.

Increasing HDL cholesterol

Measures to increase HDL, like measures to lower LDL, involve therapeutic lifestyle changes and medications if therapeutic lifestyle changes are not sufficient.

For more on cholesterol, please read the Cholesterol article.

For more information about other measures to prevent heart attacks that do not involve cholesterol, please read the following articles:

• Aspirin and Antiplatelet Medications
• Aspirin, Beta Blockers, and Ace Inhibitors
• Heart Attack Prevention Overview
• Screening Tests for Coronary Artery Disease
• Omega-3-Fatty Acids
• Vitamins and Exercise
• Smoking Cessation