Rx for Heart Patients: Healthier Living, Medication

New guidelines on managing heart disease also call for cardiac rehab

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THURSDAY, Nov. 3 (HealthDay News) -- A healthy lifestyle and appropriate medications can help people with heart disease live longer and avoid a heart attack or stroke, according to new guidelines from the American College of Cardiology Foundation and the American Heart Association.

Following the updated recommendations can also improve quality of life, reduce the need for surgical procedures to open blocked arteries and lower the likelihood of a repeat heart attack or stroke if you've suffered one already, the authors said.

"The full implementation of these cardiovascular protective therapies into clinical practice can markedly reduce the risk of death, disability and health care expenditures due to cardiovascular disease," said Dr. Gregg Fonarow, professor of cardiology at the University of California, Los Angeles and a spokesman for the American Heart Association.

For the first time, the guidelines also recommend a comprehensive cardiac rehabilitation program after a heart attack, stroke, bypass surgery, or the diagnosis of heart-related chest pain or blockages in leg arteries.

Doctors should also screen patients with known heart disease for depression, the authors said. Depression, which is common after heart attack or bypass surgery, can reduce quality of life and make it difficult to alter harmful health behaviors, they noted.

"Every effort should be made to apply these evidence-based, guideline-recommended therapies to routine clinical practice," added Fonarow, who was not involved in writing the guidelines.

Once people develop coronary artery disease or other vascular disease, such as peripheral artery disease, they are at high risk for recurrent events and death. "Cardiovascular disease remains the leading cause of death and disability for men and women in the United States," Fonarow said. "Fortunately, there are a number of therapies proven to reduce the risk of mortality, recurrent events, need for revascularization procedures, cardiovascular hospitalizations and impairment of health status in patients with established cardiovascular disease."

The guidelines are published online Nov. 3 in Circulation and in the Journal of the American College of Cardiology.

Both patients and their doctors play a part in preventing heart attack and stroke, said the experts, who also recommend the following for anyone with heart disease:

Quit smoking and avoid secondhand smoke.
Exercise at least 30 minutes a day five to seven days a week.
Take off those extra pounds.
Get a flu shot every year.
Take low-dose aspirin daily unless your doctor recommends otherwise.

"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," Dr. Sidney C. Smith, Jr., chair of the guideline writing group and professor of medicine at the University of North Carolina, Chapel Hill, said in a news release from the associations.

"Be sure to ask your physician about therapies that can help you live longer and stay healthier after you've survived a heart attack or stroke and make them part of your commitment to a healthy lifestyle," Smith said.
For doctors prescribing drugs to prevent blood clotting, the authors offer new options. As alternatives to Plavix (clopidogrel) plus aspirin for patients who have received heart artery stents to help blood flow, they suggested Effient (prasugrel) and Brilinta (ticagrelor).

The guidelines also stress the importance of statin drugs, such as Lipitor and Crestor, to lower cholesterol in patients with atherosclerosis, a condition involving plaque buildup in the arteries.

The authors did not provide new recommendations for lowering blood pressure and cholesterol as these are expected next year from the U.S. National Heart, Lung, and Blood Institute.

SOURCES: Gregg Fonarow, M.D., professor of cardiology, University of California, Los Angeles, and spokesman, American Heart Association; Nov. 3, 2011, Circulation, online, and Journal of the American College of Cardiology

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