How can I prevent a heart attack?

This is a question I am asked frequently, not only from patients, but also from friends and family. Cardiovascular disease mortality has dropped dramatically in the past 25 years, but still remains the leading cause of death in the U.S. What many people may not realize is that over 80% of heart attacks are PREVENTABLE! Yep, that’s right. Our diet and lifestyle choices dramatically affect our chances of developing heart disease. While genetics certainly play a role in our susceptibility to heart disease (and we still are in the infancy of understanding these genetics), this is felt to play a minor role in causality. You can play a MAJOR part in prevention.

Let’s list what you can do:

1. If you smoke, stop. Smoking increases your risk of having a heart attack by about 30%, and stopping smoking is the main preventive thing you can do. There are medications and counseling available that may help you quit.

2. Diet is important. In the the 1950’s, Japan had a low incidence of heart disease. But starting in the 1960’s, this started to change significantly. What happened? McDonalds and other fast food outlets moved in, and the typical Japanese diet of fish, rice and vegetables started to change to a high fat, high calorie Western diet. Coincidence? Unlikely. What has been shown is that a Mediterranean type diet of fresh fruit and vegetables, fish, and nuts does lower risk. The South Beach Diet was written by a cardiologist and is a good resource for healthy eating that I frequently recommend. Does that mean you have to completely give up mac and cheese or fried chicken? No, but when given a choice, maybe go with the healthier alternative on a regular basis, and save those for weekends or holidays.

3. Maintain a reasonable weight. I know, it’s hard. But being overweight is tied to increased risk of high blood pressure, higher cholesterol and diabetes, which are all risk factors for heart attacks.

4. Regular exercise. I’m not asking you to run the Mercedes Marathon. Simply walking for 30 minutes five days a week lowers risk by 25-30%. If you want to do more, that’s great!

5. “Hey, Doc…I take an aspirin every day. I should be good”. Not so fast. Aspirin is certainly good for those with a history of cardiovascular disease (heart attack, stroke, etc.), but several large recent studies show that it has little benefit for primary prevention, and actually may be harmful, since it increases bleeding risk.

6. How about statins (cholesterol lowering drugs) like Lipitor? Should we just put them in the drinking water? Absolutely not. The benefits really depend on your baseline risk, such as diabetes, high blood pressure, and your cholesterol levels. Doctors now even have computer programs that can quickly give us the risk/benefit levels of starting these medications that can be discussed during your office visit.

To sum things up, an ounce of prevention is at least worth a pound of cure when it comes to heart disease. Get off the couch, eat better, and quit smoking. It can make a difference!

Steven E. Jones MD, FACC