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Health habits key to recovery from heart disease

Thursday November 3, 2011
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Those who are at high risk for myocardial infarction or stroke, or who have already had such an event, can live longer, experience a better quality of life and lower the chance of a repeat attack or the need for artery-opening procedures through healthy habits and medication.

That statement was the crux of joint guidelines released Thursday from the American College of Cardiology Foundation and the American Heart Association. The Preventive Cardiovascular Nurses Association endorsed the guidelines.

"Unless improvements are made in your behavior and medical therapy, the same blood vessel problem that caused your first heart attack or stroke can occur again — and may result in death — so long-term changes need to be initiated to get the vascular disease under control," said Sidney C. Smith Jr., MD, chairman of the guideline writing group and professor of medicine at the University of North Carolina-Chapel Hill.

Smith said the guidelines are important because increasing numbers of older adults are living with cardiovascular disease, and in clinical practice many patients are not getting indicated therapies.

The guidelines are the first to recommend that all patients be referred to a comprehensive cardiac rehabilitation program after myocardial infarction, stroke, bypass surgery or the diagnosis of heart-related chest pain or blockages in leg arteries. In addition, the guidelines note the usefulness of screening heart disease patients for depression, a common occurrence after myocardial infarction or bypass surgery that can interfere with quality of life and the ability to initiate positive changes in health behaviors.

The guidelines recommend that patients with coronary heart disease and other vascular disease such as stroke and peripheral artery disease stop smoking and avoid exposure to tobacco smoke; get at least 30 minutes of exercise five to seven days a week; reduce fat if they are overweight, obese or have a large waist; get an annual flu shot; and take low-dose aspirin unless their doctor prescribes a higher dose or recommends against it because of medical contraindications.

In response to evidence from recent clinical trials, the guidelines make several changes for health professionals in the recommended use of antiplatelet agents and anticoagulants. New drugs such as prasugrel or ticagrelor, which may be used instead of clopidogrel in combination with aspirin for patients receiving coronary stents, are now included.

The guidelines emphasize the importance of adequate dosages for statin therapy for all patients with known atherosclerotic vascular disease. Low-dose aspirin therapy (75-162 mg) continues to be recommended for patients with known heart disease.

The writing group deferred modifying recommendations on hypertension and hyperlipidemia in anticipation of the release of new guidelines in 2012 from panels of the National Heart, Lung and Blood Institute that work specifically on these issues.

The new secondary prevention and risk reduction therapy guidelines also are endorsed by the World Heart Federation. They will be published in Circulation: Journal of the American Heart Association and the Journal of the American College of Cardiology. To download a PDF, visit http://bit.ly/t7yd4w.

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