Secondary prevention of a heart attack

Steps you can take to help prevent another heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction. include the following:[1]

Sometimes, cardiac rehabilitation programmes are available that can combine these steps in a structured manner. These programmes are discussed in more detail below.

Stopping smoking

If you have coronaryRelating to the arteries supplying the heart itself. arteryA blood vessel that carries blood away from the heart. Apart from the pulmonary artery and umbilical artery, all arteries carry oxygenated blood. disease and you smoke, stopping smoking is the single most effective thing you can do to improve your health.

Stopping smoking helps to slow the progression of atherosclerosisDisease leading to fatty deposits in the inner walls of the arteries, which reduce and may eventually obstruct blood flow., and significantly lowers the risk of a repeat heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction..[1]

You don't need to go it alone when you try to quit smoking; your doctor is there for advice and support, and many people find that they have more success by joining a group. Nicotine replacement therapy also helps to increase success rates.[1]

Learn more about quitting smoking and how best to go about it.

Dietary changes

Dietary modification is an important aspect of risk reduction after a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction..

Diets low in saturated fatOne of the three main food constituents (with carbohydrate and protein), and the main form in which energy is stored in the body. and cholesterolA substance present in many tissues and an important constituent of cell membranes although high concentrations of a certain type of cholesterol in the blood are unhealthy. and high in fibre and fish are associated with a lower incidenceThe number of new episodes of a condition arising in a certain group of people over a specified period of time. of heart attacks.

A diet that is high in saturated fatOne of the three main food constituents (with carbohydrate and protein), and the main form in which energy is stored in the body. increases cholesterolA substance present in many tissues and an important constituent of cell membranes although high concentrations of a certain type of cholesterol in the blood are unhealthy. levels in the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid., and also increases the activity of a clotting factorA substance that can undergo a cascade of reactions in certain conditions, leading to the clotting of blood. Also known as coagulation factor. (VII), which causes the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. to clot more easily. This can lead to a higher risk of heart attacks.[1]

Lowering cholesterol

Lowering your cholesterolA substance present in many tissues and an important constituent of cell membranes although high concentrations of a certain type of cholesterol in the blood are unhealthy. levels reduces your risk of a repeat heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction., and also slows the progression of coronaryRelating to the arteries supplying the heart itself. arteryA blood vessel that carries blood away from the heart. Apart from the pulmonary artery and umbilical artery, all arteries carry oxygenated blood. disease as seen on angiographyX-ray imaging of the blood vessels following the injection of a dye to improve visibility.. Even if your cholesterolA substance present in many tissues and an important constituent of cell membranes although high concentrations of a certain type of cholesterol in the blood are unhealthy. levels are not higher than normal, lowering them further may be helpful.[1]

You can lower your cholesterolA substance present in many tissues and an important constituent of cell membranes although high concentrations of a certain type of cholesterol in the blood are unhealthy. levels by modifying your diet. Sometimes, your doctor may recommend that you take medication to lower your cholesterolA substance present in many tissues and an important constituent of cell membranes although high concentrations of a certain type of cholesterol in the blood are unhealthy. - such as a statinOne of a class of drugs that inhibit cholesterol formation in the liver., for example.

Read more about cholesterol in your blood.

Learn more about statins and who may benefit from taking them.[1]

Physical activity

Increasing physical activity levels improves the overall health of your heart and lungs, known as cardiorespiratoryRelating to the heart and lungs. fitness. This in turn has been shown to improve survival rates in people who have coronaryRelating to the arteries supplying the heart itself. arteryA blood vessel that carries blood away from the heart. Apart from the pulmonary artery and umbilical artery, all arteries carry oxygenated blood. disease. Exercise also improves cholesterolA substance present in many tissues and an important constituent of cell membranes although high concentrations of a certain type of cholesterol in the blood are unhealthy. levels, carbohydrate metabolismThe chemical reactions necessary to sustain life., and body weight, as well as having an antidepressant effect.[1]

Stress modification and relaxation

Emotional stressRelating to injury or concern. has been linked to heart attacks, although the underlying mechanisms for this are not yet properly understood. Certainly, stressRelating to injury or concern. can affect the heart rate, blood pressure and heart rhythms, as well as clotting factorsA group of substances that can undergo a cascade of reactions in certain conditions, leading to the clotting of blood. Also known as coagulation factors., platelets, and levels of stressRelating to injury or concern. hormones in the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid..[1]

Learning relaxation techniques is not difficult and may improve your quality of life, ease any depression and improve cardiovascular risk factors. Some people find that support from various forms of psychosocialRelating to psychological and social factors. counselling is helpful. [1]

Research has suggested that depression may be linked to coronaryRelating to the arteries supplying the heart itself. arteryA blood vessel that carries blood away from the heart. Apart from the pulmonary artery and umbilical artery, all arteries carry oxygenated blood. disease through behavioural factors; for example, someone who is depressed is less likely to lead an active lifestyle.[2]

Medication

A variety of medicines are given to people after a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction., and many of these may need to be continued long term. These may include antiplatelet agents such as aspirin and clopidogrel, and anticoagulants such as warfarin.

Warfarin may need to be continued lifelong in a few people, particularly those who have had more than one heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction. or who have persistent heart rhythm abnormalities.

Beta-blockers may also be given.[3] These drugs reduce heart rate and bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. pressure, so lowering the oxygen demand of the heart.[4]

Statins, a type of cholesterolA substance present in many tissues and an important constituent of cell membranes although high concentrations of a certain type of cholesterol in the blood are unhealthy.-lowering drug, are usually given to patients who have had a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction., even if their cholesterolA substance present in many tissues and an important constituent of cell membranes although high concentrations of a certain type of cholesterol in the blood are unhealthy. levels are not raised, as they have benefits beyond their cholesterolA substance present in many tissues and an important constituent of cell membranes although high concentrations of a certain type of cholesterol in the blood are unhealthy.-lowering effect.

These medications are thought to stabilise atheromatous plaques (in other words, make them less prone to rupture; learn more about atheromatous plaques) and reduce the risk of a repeat heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction..

Omega-3 fatty acid supplements may also be recommended.[3]

Another class of drugs, called angiotensin converting enzyme inhibitorsA group of drugs used to treat high blood pressure and heart failure. (abbreviated to ACE inhibitors), may also be given. This type of medication is thought to be more useful in people in whom the left side of the heart is not pumping as efficiently as it could be, known as left ventricularRelating to a ventricle (either in the brain or the heart) dysfunction.[3,4]

Amiodarone may help those who are at high risk of abnormal heart rhythms after a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction.. Some research has suggested that omega-3 fatty acids [5] and antioxidants [4] may also be of some value.

References: 
  1. Cardiac rehabilitationThe treatment of a person with an illness or disability to improve their function and health.. Gohlke H and Gohlke-Bärwolf C. European Heart Journal 1998;19:1004-10.
  2. Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronaryRelating to the arteries supplying the heart itself. heart disease. Whooley MA, de Jonge P, Vittinghoff E et al. JAMA 2008;300:2379-88.
  3. Myocardial infarction in young adults. Egred M, Viswanathan G, Davis GK. Postgrad Med J 2005;81:741-5.
  4. Drugs used in secondary prevention after myocardial infarctionDeath of an area of heart muscle due to poor blood supply.: case presentation. Maxwell S and Waring WS. Br J Clin Pharmacol 2000;50:405-17.
  5. Link. AHA Scientific Statement. Fish Consumption, Fish Oil, Omega-3 Fatty Acids, and Cardiovascular Disease. Penny M. Kris-Etherton, PhD, RD; William S. Harris, PhD; Lawrence J. Appel, MD, MPH, for the Nutrition Committee. Circulation. 2002;106:2747.