Features June 2007 Issue

How to Live Longer With CAD

The diagnosis of coronary artery disease (CAD) and the increased heart attack risk accompanying it can be a shocking reminder of our mortality. It motivates many people to change their lifestyle and begin taking medications to prevent a heart attack. But when the shock wears off, compliance with treatment begins to wane and we easily slip back into old habits.

So what’s the secret to implementing long-term lifestyle changes?

"The key is to set realistic goals, determine what needs to be done to lower your risk, and find the options for achieving these goals that are right for you," says Cleveland Clinic cardiologist Michael Rocco, M.D.

What determines your risk?

A landmark study of 27,000 men and women in 52 countries found that eight risk factors accounted for more than 90 percent of heart attacks in men and 94 percent in women worldwide: smoking, abnormal lipid levels, type 2 diabetes, abdominal obesity (high waist-hip ratio), high blood pressure, psychosocial factors (such as stress), too little exercise and low consumption of fruits and vegetables.

Because these risk factors are additive, chances of having a heart attack increase if you have more than one, or if you have type 2 diabetes, peripheral arterial disease (PAD) or have already had a heart attack or stroke.

Health Risks of Smoking

Health Risks of Smoking

The good news is that many of these risk factors are manageable with behavioral changes. "This means lowering your risk of heart attack or recurrent heart attack is partially under your control," says Dr. Rocco.

Improving your odds

If you have cardiovascular disease or multiple risk factors, following these steps can help lower your risk:

Eat heart-healthy foods

. To lower your cholesterol and blood pressure, and reduce or eliminate type 2 diabetes or metabolic syndrome, reduce sources of saturated fat, such as red meat and full-fat dairy products. Eliminate processed food with trans fats. Instead, the USDA recommends eating five to nine daily servings of fruits and vegetables, while sodium should be limited to 2,300 mg—less if you have hypertension.


Do 30 minutes of aerobic activity a day.

Exercise your large muscles by walking, jogging, swimming, bicycling, or using the treadmill or elliptical machine. Do whatever is enjoyable so you’re more likely to stick with it.


Stop smoking.

This is the single-most-important step you can take, since stopping (not just cutting back) reduces your heart attack risk by 50 percent after just one year. The most effective approach is a combination of aids for short-term nicotine addiction, such as a nicotine replacement patch or gum, a prescription medication such as Wellbutrin or Chantix, and counseling.


Take a statin.

Statin therapy is recommended for high-risk patients to bring "bad" LDL cholesterol under 100 mg/dL, and very high-risk patients under 70 mg/dL.


Take daily aspirin.

If you have had a heart attack or have any type of cardiovascular disease, a daily low-dose aspirin is recommended. The need for other drugs that affect clotting and platelets should be discussed with your doctor.