Heart Attack and Unstable Angina

Life After a Heart Attack

Coming home after a heart attack may be unsettling. Your hospital stay may have seemed too short. You may be nervous about being home without medical oversight after being so closely attended to in the hospital. But you have undergone tests that tell your doctor that it is safe for you to return home. Also, to reduce your risk of having another heart attack, your doctor may recommend that you:

• Quit smoking and avoid second-hand smoke. Quitting smoking may be the most important step you can take to reduce your risk. Evidence suggests that people with coronary artery disease who stop smoking rapidly reduce their risk of recurrent heart attack or death. Check with your doctor about using nicotine replacement therapy. Nicotine replacement therapy, use of the medicine bupropion (such as Zyban or Wellbutrin), and supportive therapy significantly increase long-term success in quitting.¹⁰ For more information, see the topic Quitting Tobacco Use.
• Be physically active. Talk with your doctor about exercising safely and about enrolling in a cardiac rehabilitation program. Regular exercise can help reduce your risk of another heart attack by helping you control cholesterol and blood pressure, regulate blood sugar (important for people with diabetes), and lose weight. See the Cardiac Rehabilitation topic.
• Take an ASA every day. If you have a stent, you may also take an antiplatelet medicine, such as clopidogrel (Plavix).
• Lower your cholesterol by taking medicines such as statins or other lipid-lowering medicines.¹⁶ Several studies have shown that lowering cholesterol can reduce the risk for another heart attack.
• Control your blood pressure by taking medicines as directed by your health professional. Some nutrients in the diet can affect blood pressure. See nutrition for hypertension (including the DASH diet) for more information about this eating plan, which has been proven to lower blood pressure.
• Keep your blood sugar under control if you have diabetes. Studies have found that having high blood sugar over a long period of time is linked with developing heart disease.¹⁷ One way to check whether your blood sugar is under control is to have a simple blood test (called a hemoglobin A1c test) every 2 to 3 months. The Canadian Diabetes Association recommends that people with diabetes have an HbA1c level of less than 7%.¹⁸
• Follow a heart-healthy diet. A heart-healthy diet includes eating more fish. You may also follow the Mediterranean diet. A heart-healthy diet may help you lose weight, lower your blood pressure, and reduce your cholesterol. Studies show that people who follow these dietary practises may live longer.¹⁶ For more information, see:

  Eating a heart-healthy diet.

• Reduce stress. Some evidence suggests that stress management may decrease rates of heart attack or death in people with coronary artery disease.¹⁶
• Participate in a cardiac rehabilitation program. You will learn how to exercise safely, change habits that put you at risk for another heart attack, and deal with stress and emotional issues. Studies have found that cardiac rehab reduces your risk of having another heart attack.¹⁶ Try to do activities that raise your heart rate. Exercise for at least 30 minutes on most, preferably all, days of the week.
• Avoid getting sick from the flu. Get a flu shot every year.
• If you drink alcohol, drink moderately (1 alcoholic drink per day for women or 2 drinks per day for men). Drinking alcohol moderately may lower your risk of complications after a heart attack.¹⁹ Drinking alcohol moderately, along with living a healthy lifestyle, may lower your risk for a heart attack.²⁰ Although studies show that wine may be beneficial, the American Heart Association (AHA) states that the link between wine and reduced coronary artery disease has not been proven. The AHA urges individuals to talk to their doctors about the benefits and risks of drinking alcoholic beverages.²¹
• Confide in loved ones. Having a heart attack is scary, and depression afterward is common. Asking for and receiving support from friends and relatives can help you avoid depression. If you continue to have the "blues" after your heart attack, talk to your doctor about counselling and medicine for depression. A study showed that people who received treatment for depression recovered better after a heart attack than those who did not. (However, long-term survival was not affected.)²²

Before you start an exercise program or do any strenuous exercise, your doctor can do pre-exercise testing to determine your risk for heart attack. For more information, see the following:

Exercising for a healthy heart

One common myth is that resuming sex after a heart attack can cause another heart attack, stroke, or sudden death. According to the American Heart Association, people who have had heart attacks can resume sexual activity after a heart attack as soon as they feel ready for it. Talk with your doctor if you have any concerns.

Most often the underlying cause of a heart attack is coronary artery disease (CAD). Understanding what CAD is and how to treat it may help prevent a future heart attack. For more information, see the topic Coronary Artery Disease.

More information Tips for following the DASH diet

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Author:	Robin Parks, MS	Last Updated: February 26, 2008
Medical Review:	Caroline S. Rhoads, MD - Internal Medicine Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
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