One heart attack is enough

Too many heart attack victims don’t exercise as instructed, stop smoking, or lose weight to prevent a second heart attack. Many patients fail to follow Doctor's orders.

Ask survivors to describe the impact of their heart attacks, and a common theme is that it was a “wake-up call.”

Unfortunately, many people seem to hit the snooze alarm once the danger has passed. Some ignore advice that can protect the heart; others gradually let it fall by the wayside.

In a study of nearly 2,500 heart attack survivors across the country, researchers looked at the so-called discharge instructions given to these men and women when they left the hospital. These instructions should cover everything from who to call in case of an emergency to what long-term steps to take to prevent another heart attack.

One month after their attacks, more than 90 percent of the participants said they were taking all of the medications on the discharge list. In contrast, less than 50 percent were exercising as instructed, had stopped smoking, or were losing weight. Just one-third had enrolled in a cardiac rehabilitation program, one of the best things you can do to prevent a second heart attack.

Does following discharge instructions make a difference? Participants who followed fewer than half of their discharge instructions were 68 percent more likely to have chest pain with activity or stress (angina) a year after their heart attacks than people who followed all or most of the instructions (American Heart Journal, March 2009). Angina is a sign of active coronary artery disease.

Preventing the next one

On a personal level, a heart attack is an all-too-real sign that you aren’t going to live forever. Healthwise, it is an outward sign that you’re living with atherosclerosis. This disease stiffens and narrows arteries throughout the body. In addition to setting off a heart attack, it can cause a stroke, damage the kidneys and lead to problems in the legs.

Stiff, cholesterol-clogged arteries make your heart work harder. So does the scar tissue that forms in the part of the heart damaged by a heart attack. Keeping atherosclerosis at bay and strengthening the heart muscle will help you feel better, ward off a future heart attack or stroke and lessen the chances that the damage will evolve into heart failure.

There’s no magic wand you, or your doctor, can wave to make atherosclerosis go away. But you can stop it from getting worse, and maybe even reverse it, by exercising more, shifting to a healthier diet, losing weight if needed, quitting smoking, reducing stress and taking medications as needed.

Power of prevention

Simple steps started before middle age could demote heart disease, stroke, and other cardiovascular diseases from the leading cause of death in America to a distant runner- up. Two long-term studies suggest that most cases of high blood pressure and heart failure could be avoided if people made better choices.

In a 14-year study of female nurses, six factors emerged as important ways to keep blood pressure in check: a healthy diet, daily exercise, a healthy body weight, moderate alcohol intake (no more than one drink a day), sparing use of over-the-counter painkillers and taking folic acid every day. The researchers estimated that if all women adopted these six practices, almost 80 percent of cases of high blood pressure would be avoided.

A 22-year study of male physicians found an equally large reduction in heart failure, a common consequence of high blood pressure or heart attack, with maintaining a healthy body weight, not smoking, regular exercise, moderate alcohol intake (one to two drinks a day), having cereal for breakfast and eating plenty of fruits and vegetables.

Getting help

For some people, a heart attack is a true wake-up call. Take Jim Lehrer, the host of PBS’ “NewsHour.” In a cover story in the American Heart Association’s Heart Insight magazine, Lehrer credits his 1983 heart attack with changing the way he lived. He stopped smoking, started exercising and eating better, and he took time to relax.

Many people head the other direction. Let’s face it, a heart attack can be a frightening life changer. It affects your work, your play, your relationships with family and friends. A twinge of chest pain can rev up worries that you’re having another heart attack. And it can be extremely difficult trying to make major changes in diet, exercise, weight, smoking and other choices that are meant to protect you against another heart attack. It’s no wonder that some heart attack survivors slide into the fog of depression.

One reason why cardiac rehabilitation is such a good undertaking is that it helps you cope with all the aspects of life after a heart attack. It offers support, education, encouragement, connections with others who are going through the same thing you are, and help with exercise and diet. Think of it as one-stop shopping for healing the heart.

P.S. protect your heart naturally by eating Vitamin C and Vitamin D rich foods and fruits.

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Rates of heart attacks increasing for middle-age women

Middle-aged men still have higher rates of heart attacks and heart disease than middle-aged women, but those gender differences appear to be narrowing, according to a study published Monday.

The findings follow earlier research, published in a 2007 issue of the journal Neurology, establishing that stroke prevalence among women ages 45 to 54 was double that of men of the same age. Together, the findings suggest "an ominous trend in cardiovascular health among midlife women," said the lead author of both studies, Dr. Amytis Towfighi, an assistant professor of neurology at the University of Southern California.

Women have been thought to be largely protected from heart attacks and stroke prior to menopause due to hormonal influences. But the rising rate of obesity, which is higher in middle-aged women than middle-aged men, could undermine that natural benefit.

"People didn't think that women in that age group were at high risk for heart disease and stroke," she said. "But I suspect that with growing rates of obesity, women aren't as protected as much as they have been in the past."

The new study, published in the Archives of Internal Medicine, examined national survey data from 1988 through 1994 and from 1999 through 2004. More than 4,000 men and women, ages 35 to 54, participated. Researchers looked at heart attack rates as well as scores from a measure used to predict the risk of a having a heart attack in 10 years. This risk-assessment tool includes factors such as age, cholesterol levels, blood pressure and smoking history.

In both time periods, men had more heart attacks than women. But the rates of men improved from 2.5% in the earlier period to 2.2% in the second time frame; women's rates increased from 0.7% to 1%.

Men's cardiovascular risk factors improved or remained stable over the two study periods, whereas the only risk factor that improved in women was high-density lipoprotein levels. This suggests that precursors to heart disease, such as high blood pressure and high cholesterol, are not assessed or treated as aggressively in women, said Towfighi, also chairwoman of the neurology department at Rancho Los Amigos National Rehabilitation Center.

"There have been several studies that have found women have their risk factors checked less frequently than men," she said. "When they are checked, women are less likely to receive medication than men. And when they receive medication, their symptoms are not as controlled as much as men."

However, a second paper published in the same journal reveals that some strides are being made in treating women's cardiovascular health. That study found survival rates following a heart attack improved in both men and women between 1994 and 2006, with the biggest improvements seen in women.

Researchers led by Dr. Viola Vaccarino of Emory School of Medicine, looked at in-hospital death rates following heart attacks in 916,380 patients. Women younger than 55 had a 52.9% reduction in the risk of death over the time period, whereas men of the same age had a 33.3% reduction.

The two studies looked at somewhat different risk factors and different time periods, which could account for the more positive findings of the study on death rates, Towfighi said. "The second study is encouraging. But although mortality is improving in recent years, women are having more heart attacks," she said.



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Smoking blamed for 1 in 5 heart attacks

OUT of every five cases of a heart attack in Metro Manila, one can be attributed to exposure to secondhand smoke, the Department of Health (DOH) said yesterday, citing the results of a survey conducted by antismoking advocates.

World Lung Foundation (WLF) and the Paris-based International Union Against Tuberculosis and Lung Disease (The Union) calculated that between 10 and 20 percent of heart attacks in Metro Manila could be linked to secondhand smoke depending on the number of hours of exposure per week.

The groups based their findings on a survey conducted by WLF and DOH earlier this year as well as published global medical risk estimates for acute myocardial infarction (heart attack) from exposure to secondhand smoke.

Secondhand smoke, also known as passive smoking, is defined as the smoke from the burning tip of a cigarette and the smoke inhaled by a nonsmoker from a smoker.

According to the WLF, secondhand smoke is more toxic.

Children who are exposed to tobacco smoke are at increased risk for sudden infant death syndrome, acute respiratory infections, ear problems and severe asthma.

Studies also showed that exposure to secondhand smoke for more than 21 hours per week can increase one’s risk of a heart attack by as much as 62 percent.

The WLF-DOH survey showed that 52 percent of people in Metro Manila were exposed to secondhand smoke every day in workplaces, restaurants and other public places.

While most nonsmokers reported that they get upset when they are exposed to secondhand smoke, only eight percent said they asked the smoker to put out their cigarette.

The DOH and its partner agencies—the Bloomberg Philanthropies The Union and WLF—presented the new data yesterday as the department received a grant to press its campaign for the implementation of a smoke-free policy in all public places.

“The new evidence linking secondhand smoke to heart attacks makes it even more clear that tobacco use is harming people who do not smoke,” said Health Undersecretary Alex Padilla in a press conference.

“We also know that we can stop this trend by eliminating exposure among innocent mothers, fathers, children, neighbors and colleagues,” he added.

“Tobacco is taking a devastating toll on the Philippines and people are dying every day, even those who don’t use tobacco. The way to reverse this epidemic is through proven policies such as creating 100 percent smoke-free public places and work places,” said Health Secretary Francisco Duque III.

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