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After MI and surgery, lifestyle modification crucial for successful recovery
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Cardiac surgery is often a lifesaving intervention for patients with MI. Bypass surgery and percutaneous intervention can play a crucial role in repairing blocked or damaged arteries and preventing a fatal MI. However, the patient also plays a very important role in secondary prevention after cardiac surgery or PCI. Patients must make lifestyle changes to prevent additional MI.
Cardiology Today and Healio.com/Cardiology spoke with Robert A. Vogel, MD, clinical professor of medicine at University of Colorado at Denver and advising cardiologist to the Pritikin Intensive Cardiac Rehab program, about the importance of patient awareness and lifestyle modification during recovery and for secondary prevention of MI.
Q
: How do you talk to your patients about the risks they continue to face after MI and cardiac surgery/angioplasty?
There is a common misconception in patients who have had bypass surgery: They tend to believe the surgery is “fixing” them. Nothing is further from the truth. Rather, surgery is bypassing a problem, ie, clearing a blocked artery. But in reality, the process is still going on. MI is a loss of heart muscle and function, and the loss of heart function can also lead to HF.
In our patients, we use an MI or surgery or angioplasty as teaching moments. We explain that these problems — blockages in the coronary artery — are largely under our control today, with medications and lifestyle changes. Between lifestyle changes and medications like PCSK9 inhibitors, for example, we can decrease cholesterol by 75%. We can do our part with surgery and prescribing medication, but it is also the responsibility of the patient to do their part, too — from eating healthy to smoking cessation to regular physical activity.
Q: What are the recommended lifestyle modifications after cardiac surgery /angioplasty ?
A: No. 1 is smoking cessation. Unfortunately, I’ve met patients who have had multiple MIs, bypass surgery or HF who continue to smoke.
No. 2 is a healthy diet. There are 1 billion obese people worldwide today. This is a serious issue. A Mediterranean or plant-based diet is recommended. The goal is to reduce the consumption of saturated fat, red meat, whole milk products and so on.
No. 3 is regular physical activity. It is important for patients who have had an MI or cardiac surgery/angioplasty to add exercise to their lifestyle modification program.
Q: Patients who have had a
n MI often have a fear about participating in more exercise. How do you advise these patients?
A: During the cardiac rehabilitation process, which happens after a patient has had an MI, bypass surgery or angioplasty, patients start to participate in supervised exercise. At the start, the doctor does an exercise prescription, where the patient exercises on a treadmill and the doctor can monitor them to determine the right amount and intensity of exercise that patient can do safely. Another option is intensive cardiac rehab, which combines exercise, diet and lifestyle education. The Pritikin program and the Ornish program have been approved for this series of exercise teaching events.
Q: How important is patient education and compliance in preventing heart disease?
A: Data from WHO has shown that 90% of heart disease is preventable by diet, exercise, smoking cessation and stress reduction. When you have an MI, you don’t just have surgery; you take further steps do something about the problem. – by Jennifer Byrne
Reference:
Eckel RH, et al. J Am Coll Cardiol. 2014;doi:10.1016/j.jacc.2013.11.003.
Disclosure: Vogel reports consulting for Pritikin.