Preventing Coronary Artery Disease

"Prevention" has two meanings when dealing with coronary artery disease. Primary prevention aims at preventing heart and blood vessel disease in individuals who haven't had a heart attack or symptoms of coronary artery disease and have no known clinical evidence of CAD. Secondary prevention is aimed at individuals with known CAD.

The single most essential element in primary prevention centers on a set of measures collectively termed therapeutic lifestyle changes (aptly termed TLC in the latest treatment guidelines from the government-sponsored National Cholesterol Education Program). Heeding all the TLC recommendations all the time is not easy. But research shows that making even the smallest lifestyle changes can reduce the risk of coronary artery disease, heart attack, stroke, and other serious cardiovascular conditions.

Stop smoking. Smoking is the biggest risk factor for sudden cardiac death. Smoking even one to two cigarettes a day greatly increases the risk of heart attack, stroke, and other cardiovascular conditions or events. Cigarette, pipe, and cigar smokers all have more than double the risk of a heart attack than nonsmokers.

Goal: Stop smoking.

Lower your blood level of total cholesterol, LDL cholesterol, and triglycerides. Fatty substances in your blood such as LDL cholesterol and triglycerides cause fatty deposits to build up in your arteries. The deposits can reduce or block the flow of blood and oxygen to your heart. If your total cholesterol levels are above 240 milligrams per deciliter (mg/dL), your risk of CAD is high, but your risk begins rising when your total cholesterol is above 200 mg/dL. Without a family history of cardiovascular disease or high cholesterol, women should have a cholesterol profile done annually starting at age 40, men at age 30. If there is a family history of cardiovascular disease or hyperlipidemias, you should have your lipid profile checked at age 20 or even in childhood.

Goal: LDL cholesterol should be less than 70 mg/dl for those with heart or blood vessel disease and other patients at very high risk of cardiovascular disease, such as those with metabolic syndrome. LDL cholesterol should be less than 100 mg/dl for those who have a high risk of cardiovascular disease, such as some patients with diabetes or those who have multiple heart disease risk factors. For all others, LDL cholesterol should be less than 130 mg/dl.

Triglycerides are also linked to heart and blood vessel disease. Triglyceride levels should be less than 150 mg/dl.

Raise your level of HDL or "good" cholesterol. HDL cholesterol carries LDL, or "bad," cholesterol away from the arteries back to the liver, which removes it from the bloodstream. High levels of HDL apparently protect against cardiovascular disease.

Goal: The higher the HDL, the better. An HDL level below 40 mg/dL is considered a risk factor.

Bring down high blood pressure. Blood pressure is an indication of the force applied in your arteries as your heart beats. High blood pressure (or hypertension) increases the workload of the heart and kidneys, increasing your risk of a heart attack, heart failure, stroke, and kidney disease. It is the biggest risk factor for stroke.

Goal: The latest standards say that normal blood pressure is below 120/80 and that high blood pressure is 140/90 (blood pressure of 120-139/80-89 is considered pre-hypertension). Diet, exercise, bringing your weight to normal levels, and, if needed, medications can control high blood pressure. Since alcohol can increase your blood pressure, it's best to limit alcohol to the recommended equivalent of one glass of wine daily.

Control diabetes. Diabetes occurs when your body can't produce insulin, the hormone that breaks down digested sugars, or utilize the insulin it does produce. That allows blood sugar to escalate to a harmful level. Controlling diabetes is essential for reducing your risk of CAD, because diabetes is a major independent risk factor for cardiovascular disease and raises the level of LDL and triglycerides, lowers HDL, and elevates blood pressure. In fact, in terms of heart attack risk, someone with diabetes, whether male or female, is put in the same category as someone with proven heart disease and is a candidate for secondary prevention. Diabetes increases the risk of heart disease in women more than in men.

Goal: Keep the condition under control with diet, exercise, faithful monitoring of blood glucose, and other measures recommended by the doctor monitoring you. The hemoglobin A1c test, often called the "diabetic report," provides an average blood sugar level over a 2 to 3 period. It should be less than 7 percent if you have diabetes and less than 6 percent if you do not.

Maintain a healthy body weight. The more you weigh, the harder your heart has to work. Overweight individuals are much more subject to cardiovascular disease than are their trim counterparts. Excess weight raises blood cholesterol, triglycerides, and blood pressure, and lowers HDL cholesterol. It also increases your risk of diabetes. How excess weight is distributed is important. Fat concentrated in your midsection puts you at greater cardiovascular risk than extra pounds in the arms and legs. To identify the way your fat is distributed, measure your waist. Waist measurements for women should be less than 35 inches. Men should aim for a waist less than 40 inches.

Your body mass index (BMI), a figure that combines height and weight, is recommended by the National Institutes of Health to check whether you are overweight or obese. The BMI is calculated by dividing your weight in kilograms by your height in meters, squared. (Divide pounds by 2.2 to get your weight in kilograms and multiply your height in inches by 0.0254 to get your height in meters.) You can do the calculation yourself or go to our BMI calculator that will do it for you. A normal BMI ranges from 18.5 to 24.9. Overweight is defined as higher than 25 and obesity as higher than 30.

Goal: If your BMI puts you in the obese or overweight categories, work to drop down to the normal range.

For more information on exercise and losing weight, see our section on weight control.

Move your body. Your heart, like any other muscle, needs a workout to stay strong. Activity and exercise, coupled with a healthy body weight, interact with many other risk factors and help you prevent heart disease.

Goal: Moderate exercise 30 minutes a day on most days of the week. More vigorous activities are associated with more benefits. But be sure to consult your doctor before starting any exercise program. To achieve cardiovascular benefits, exercise should be aerobic, involving the large muscle groups. Aerobic activities include brisk walking, cycling, swimming, jumping rope, and jogging. If walking is your exercise of choice, use a pedometer and aim at least 10,000 steps a day.

Follow a heart-healthy diet. The old saying, "You are what you eat," is true especially when you want to prevent cardiovascular disease. Four cardiac risk factors result from dietary mismanagement: high blood pressure, high blood cholesterol, diabetes, and obesity.

Goals: Eat foods low in sodium, cholesterol, and saturated fats, and shun trans fats—partially hydrogenated fats used in butter substitutes and processed foods. Stay away from foods containing refined sugar such as pies, cakes, cookies, and ice cream. Try to eat foods containing omega-3 fatty acids, good fats found in tuna, salmon, flaxseed, almonds, and walnuts. Mono-unsaturated fats, found in olive and peanut oils, are also good for you. According to the latest 2005 U.S. dietary recommendations, you should strive every day to eat at least nine plant-based foods, which are fruit, vegetables, nuts, and whole grains.

Reduce stress. Several researchers have noted a relationship between cardiovascular disease risk and stressful responses, including free-floating hostility, to everyday events, intimate relationships, and particularly to their socioeconomic status.

Goal: Manage stress by practicing relaxation techniques, learning how to manage your time, and setting realistic goals.

Limit alcohol consumption. Heavy drinking can raise your blood pressure, increase your risk of heart failure and stroke, as well as cause heart palpitations. It is also linked to obesity and cancer.

Goal: Moderation is the key. If you already drink, it's best to limit alcohol to the recommended equivalent of one glass of wine daily. If you don't drink the American Heart Association cautions you not to start because it's impossible to predict whether you might develop a drinking problem.

Know your risk factors. If you have a family history of cardiovascular disease or high cholesterol, it is important for you to try to lower your risk on other fronts. It is also vital have your cholesterol levels tested yearly and see your health care provider yearly for a checkup.