Best lifestyle advice for patients after a heart attack

When treating a patient who presents with a myocardial infarction, the clinician’s responsibilities also include prevention of a secondary event. In addition to an appropriate long-term treatment regimen, this typically also involves lifestyle advice in terms of exercise, nutrition, tobacco cessation and blood pressure control.

Diet

Dietary changes are one of the key components of lifestyle advice for patients who have had a myocardial infarction. This includes maximizing the patient’s intake of quality nutrients from the calories they consume. Study results have indicated that adhering to a Mediterranean-style diet improves outcomes from atherosclerotic cardiovascular disease, in conjunction with appropriate pharmacologic treatment. Such a diet, which emphasizes extra-virgin olive oil, fish, whole grains, fruits, vegetables and legumes, has been found to improve lipid profiles with or without weight loss. A DASH eating plan, which is based on foods low in sodium and rich in potassium, magnesium and calcium, may also be appropriate for decreasing BP. A DASH diet prioritizes vegetables, fruits, and low-fat dairy and whole grains, fish, poultry and nuts. Both the Mediterranean-style diet and the DASH diet favor plant-based nutrition and whole grains, and minimize the intake of red meat. Minimizing saturated fats can also be valuable for lowering cholesterol in combination with lipid-lowering treatment.

Exercise

Exercise is also a valuable aspect of secondary prevention in MI patients. The American Heart Association recommends that physically capable adults perform moderate-intensity activity for 30 to 60 minutes a day at least five days a week. This could entail a walk, the pace of which might cause the patient to feel slightly out of breath but still be able to carry on a conversation.

For patients who have not exercised in a while, physicians should recommend that they gradually work up to at least 30 minutes of physical activity per day at a comfortable pace. Patients who feel unable to complete a sustained 30 minutes of exercise should be encouraged to do smaller amounts of exercise of the course of the day, in 10-to 15-minute segments. Resistance training 2 days per week is also considered beneficial and should be advised.

The physician should evaluate the patient’s BMI at each follow up visit, and encourage the patient to reach and maintain a healthy BMI target through a combination of reduced calorie intake and increased exercise.

Other risk factors

Patients who are current smokers should be strongly encouraged to stop smoking at each follow-up visit. Physicians should ask the patient about their smoking status, and suggest smoking cessation tools that may be useful to them. The physician should also encourage the patient to take measures to avoid exposure to secondhand tobacco smoke in the home and in public places.

Minimizing alcohol intake can also be valuable for reducing the risk of a secondary cardiovascular event. Because alcohol can increase blood pressure, patients with existing atherosclerotic cardiovascular disease should not consume more than one drink per day (for women) or two drinks per day (for men).

Patients who are taking calcium for osteoporosis prevention should be encouraged to take this supplement in combination with vitamin D, at a daily dose no higher than 1,200 mg. Some evidence has suggested that calcium supplementation may be linked to increased risk for myocardial infarction and other cardiovascular events; the concomitant use of vitamin D may mitigate this risk.

Patients who are recovering from a myocardial infarction should be screened for depression, and re-evaluated for depression at each visit. Depression is common after experiencing a cardiovascular event, and depressed patients should receive appropriate pharmacologic treatment and therapy.

Additional information can be found at these websites:

http://circ.ahajournals.org/content/124/10/e258.full

https://www.ghc.org/all-sites/guidelines/ascvd-secondary.pdf