Coronary Artery Disease
Prevention
From 1979 to 2003, the death rate from coronary artery disease (CAD) declined by about 50% in Canada.14 This decline is attributed to the steps people are taking to prevent coronary artery disease, including lowering blood pressure and cholesterol, changing diet and exercise habits, quitting smoking, and getting improved medical care.
Coronary artery disease is caused by the buildup of plaque on the inside of the coronary arteries, the blood vessels that supply oxygen-rich blood to heart muscle. You too can take measures to delay the progression and even reverse coronary artery disease.
Quitting smoking may be the most important step you can take to prevent coronary artery disease. According to the World Health Organization, after 1 year of not smoking, a person's risk of coronary artery disease decreases by 50%. After 15 years of not smoking, the risk of death due to coronary artery disease is equal to that of someone who has never smoked at all.3
Exercising regularly and eating a balanced diet that is low in saturated fats and rich in fruits and vegetables are also advised.
Lifestyle changes
- Quit smoking. Quitting smoking may be the most important step you can take to prevent coronary artery disease. Avoid second-hand smoke too.
- Control your cholesterol. This can be accomplished with diet, exercise, and medicines, if needed.
- Control your blood pressure. Follow the Dietary Approaches to Stop Hypertension (DASH) diet—which is designed to reduce high blood pressure with foods rich in potassium, calcium, and phosphorous—increase exercise, decrease alcohol intake, and take medicines, if needed, to control your blood pressure. For more information, see:
- Exercise. Exercise has many positive effects: weight management, cholesterol reduction, blood pressure control, blood sugar levelling in diabetes, triglyceride reduction, mood elevation, and increasing strength. Try to do activities that raise your heart rate. Exercise for at least 30 minutes on most, preferably all, days of the week. Talk to your doctor before starting an exercise program. For more information, see:
- Relax and reduce stress. Stress can negatively affect your heart in many ways, but you can lower your stress level through talking about your problems and your feelings, exercising, and doing deep breathing, meditation, or yoga.
- Manage depression and anger. Treating depression and managing anger are important steps in improving your overall health.
- Avoid getting sick from the flu. Get a flu shot every year.
General dietary considerations
- Therapeutic Lifestyle Changes (TLC) diet is recommended by the National Cholesterol Education Program of the National Institutes of Health. The diet's main focus is to reduce the amount of saturated fat you eat because it elevates your cholesterol.15
- American Heart Association healthy diet guidelines, which are similar to those of Canada's Food Guide
, recommend limiting saturated fat and cholesterol intake, increasing fruits and vegetables, and limiting salt and alcohol.
Specific dietary considerations
- Antioxidants and heart disease. Some experts believe antioxidants may be helpful in treating coronary artery disease. But there is not enough proof that antioxidants reduce the risk of coronary artery disease. Most doctors recommend that you get antioxidants from food, and they do not recommend taking antioxidant supplements. Fruits, red wine, and some teas contain flavonoids which may have especially potent antioxidant effects.
- Fish oil and heart disease. The Heart and Stroke Foundation of Canada and the American Heart Association recommend that healthy adults eat at least two servings of fish a week, particularly oily fish such as albacore tuna, salmon, mackerel, lake trout, herring, and sardines, all of which contain omega-3 fatty acids. In people with heart problems, omega-3 fatty acids may help reduce their risk of death.16
- Fibre to lower cholesterol. Eat foods that are high in soluble and insoluble fibre.
- Soy protein. Eating soy protein does not significantly reduce LDL cholesterol. Soy protein does not affect HDL cholesterol, triglycerides, or blood pressure. But substituting soy protein for animal protein should be beneficial to your overall health because of the fibre, vitamins, minerals, and low saturated fat in soy.17
- Mediterranean diet. This diet is similar to the Therapeutic Lifestyle Changes (TLC) diet, except that more fat is allowed, mainly from unsaturated oils, such as fish oils, olive oil, and certain nut or seed oils.
- Alcohol and heart disease. If you drink alcohol, drink moderately (1 alcoholic drink
Lowering cholesterol
If diet and exercise are not effective in lowering your cholesterol to a safe level, your doctor will probably prescribe a cholesterol-lowering drug. These medicines have been proven effective in treating high cholesterol, and now doctors are beginning to prescribe them for people with only mildly elevated cholesterol levels. In these people, cholesterol-lowering drugs combined with lifestyle changes may slow the development of atherosclerosis and may lower the risk of heart attack or death.15
Cholesterol-lowering medicines appear to be the best protection against heart attack in post-menopausal women with moderate to high cholesterol levels. In the HERS study, women who took cholesterol-lowering medicines had significantly lower rates of heart attacks and death from CAD than the women who did not take cholesterol-lowering medicines.18
ASA
ASA may reduce the risk of stroke and heart attack in people with increased risk of coronary artery disease. ASA also is known to reduce the risk of developing blood clots, which can lead to a heart attack in people with known CAD or in people with multiple risk factors for CAD, such as diabetes, high blood pressure, and high cholesterol. There are some risks associated with ASA therapy that you should discuss with your doctor before you begin this type of treatment.
Managing other diseases or conditions
Many diseases and conditions that increase your risk of developing CAD can be successfully managed with medicines and lifestyle changes.
Strategies that are not recommended to prevent coronary artery disease
- Hormone therapy. Taking estrogen with or without progestin does not prevent coronary artery disease. In fact, if you are 10 or more years past menopause, taking hormone therapy may raise your risk of coronary artery disease.19 Talk to your doctor about your risks with hormone therapy. And carefully weigh the benefits against the risks of taking it. If you need relief for symptoms of menopause, hormone therapy is one choice you can think about. But there are other types of treatment for problems like hot flashes and sleep problems. For more information, see the topic Menopause and Perimenopause.
- Low-carbohydrate diets. The American Dietetic Association and American Heart Association do not recommend low-carbohydrate diets, because they cause abnormal functioning of the metabolism that could have serious medical consequences for some people, especially those who have heart disease, type 2 diabetes, high cholesterol, or high blood pressure.20
- High-protein diets. The American Heart Association does not recommend high-protein diets, because they restrict healthful foods, such as fruits and vegetables, and do not provide essential vitamins, minerals, and fibre.
- Vitamin B supplements. Vitamin B and folic acid supplements do not appear to lower the risk of heart disease or stroke.21 Most doctors recommend that you get B vitamins from a balanced diet, and they do not advise taking vitamin B supplements.
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| Author: | Douglas Dana Robin Parks, MS | Last Updated: September 21, 2007 |
| Medical Review: | Anne C. Poinier, MD - Internal Medicine Caroline S. Rhoads, MD - Internal Medicine Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology Robert A. Kloner, MD, PhD - Cardiology Ruth Schneider, MPH, RD - Diet and Nutrition | |
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