8 rules for preventing a first heart attack

Here are some things you already know:

• Heart disease is the #1 killer in the United States.
• A heart-healthy diet can significantly lower your risk for a heart attack or stroke.
• Smoking is bad for your heart.
• Exercise makes your heart stronger.

So, if you’ve never had a heart attack, and don’t have a family history of heart disease, it should be simple enough to prevent one, right?

Eat the right foods, don’t smoke, and exercise regularly.

At their 2019 annual meeting, the American College of Cardiology (ACC), along with the American Heart Association (AHA), issued a new set of guidelines for preventing a first heart attack or stroke.

Much of the advice will not be at all surprising to you. But there has been a definite shift. The guidelines, which I’ll outline below, place less emphasis on doctors and what they can do for you, and much more on what YOU can do to lower your own risk.

Let’s take a look…

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8 recommendations for heart health

1. Aspirin: don’t depend on it too much. Until now, the ACC and AHA have recommended a daily low-dose aspirin for people at higher risk of having a first heart attack.

But based on recent research, the guidelines do not recommend a daily aspirin for healthy, low-risk adults. Only after other risk factors, such as cholesterol, blood pressure, and exercise, have been factored in, should aspirin be recommended.

The guidelines also state that aspirin “therapy” should not be recommended to people over 70 since the risk of intestinal bleeding and ulcers outweighs the anti-inflammatory benefits that a daily aspirin could provide.

2. Control Type 2 diabetes. As another way to prevent a heart attack, the new guidelines emphasize doing everything possible to control Type 2 diabetes.

If left uncontrolled, high glucose damages blood vessels, as well as nerves that control the heart. According to the National Institute of Diabetes and Digestive and Kidney Diseases, the most common cause of death among adults with diabetes are heart disease and stroke.

3. Don’t use e-cigarettes to help you quit smoking. E-cigarettes should be a last resort to help you quit. Start by seeking out a proven cessation program, including nicotine replacement patches.

This recommendation is based on research showing that the cells lining the blood vessels of e-cigarette users produce less nitric oxide than the cells of non-users. (Nitric oxide is responsible for relaxing blood vessels and improving blood flow).

4. Keep blood pressure low. The guidelines still recommend that most people who have not yet had heart problems try and keep their pressure below 130/80 mmHg.

5. Watch your weight. Avoiding extreme weight gain or obesity is still a recommendation, and will help keep that blood pressure in check. Of course, a Mediterranean-style diet rich in fruits, vegetables, and whole grains, and low in sugars and refined carbs, is a great choice for heart health.

6. Lower cholesterol. The 2019 guidelines still recommend addressing diet, exercise, and smoking first before looking to treat high cholesterol.

The guidelines do mention talking to your doctor about statins to control cholesterol, but if you know the risks tied to statins, well, let’s just say it may provide you with extra motivation to do everything in your power first to lower your LDL yourself…

We know there are a host of reasons to be concerned about their side effects. We also know that doctors tend to prescribe statins indiscriminately and that there are so many natural alternatives that can help keep cholesterol in check.

7. Keep moving. The new guidelines recommend 150 minutes of moderate-intensity physical exercise each week. But they also note that some exercise is always better than none. Even walking stairs and doing housework count!

8. Doctors should look at the “whole person.” This one is a definite shift away from pulling out the prescription pad as a reflex action. The new guidelines re-emphasize non-medical, social factors that influence heart health.

These include whether a person has stable housing and can afford good food, whether they have transportation to get to a health facility as needed, and what sort of social support network they have.

Dr. Vera Bittner, professor of medicine at the University of Alabama, puts it this way: “If you want to change the risk for a patient, you cannot do that without the patient being front and center.”

She urges doctors to take their patients’ life circumstances, values and goals into account when designing a strategy to prevent a heart attack.

Sources:

1. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease — Journal of the American College of Cardiology
2. Do Not Take Daily Aspirin if You Haven’t Had a Heart Attack, Says FDA — Time
3. Effect of Aspirin on All-Cause Mortality in the Healthy Elderly — The New England Journal of Medicine
4. E-Cigs Should Be Last Resort for Quitters, Heart Group Says — Time
5. Why daily aspirin therapy for heart disease might not be safe for everyone — The University of Texas Southwestern Medical Center