Heart Association nags to save lives

July 04, 1995|By Theresa Tamkins | Theresa Tamkins,Medical Tribune News Service

About 11 million people in the United States have heart disease. But new guidelines published by the American Heart Association are aimed at helping them live longer, have a better quality of life and avoid procedures such as angioplasty or bypass surgery.

The guidelines, based on the most recent studies of heart-attack patients as well as a decade's worth of research, cover all aspects of lifestyle changes and treatment for heart disease, including diet, exercise, smoking and drugs to lower cholesterol and blood pressure.

The guidelines are important, because more than half the people who have a heart attack or bypass surgery slip back into bad habits or stop taking their medication within six months, according to Dr. Sidney Smith, president of the heart association.

And some doctors may need to be reminded of the best treatment for patients after a heart attack, he said.

"More than $30 billion is spent annually on the management of heart attack, bypass surgery and coronary angioplasty," Dr. Smith wrote in a letter published Saturday in the journal Circulation.

Yet only a third of patients receive the appropriate treatment after a heart attack, he said -- treatment that could increase lifespans, reduce the risk of readmission to the hospital and cut medical costs.

"The big problem is that even when people are put on a regimen to reduce their risk of another heart attack, they don't follow it for long," said Dr. James Willerson, chief of cardiology at the Texas Heart Institute in Houston.

"Physicians need to not only start heart-disease patients on the guidelines, but to insist and persuade people to follow them."

According to the American Heart Association, if you have heart disease:

* You should be on its Step II diet. The diet restricts total fat intake to less than 30 percent of total calories, saturated fat to less than 7 percent of calories and cholesterol to less than 200 milligrams per day.

The Step I diet, which is recommended for everyone over age 2, restricts saturated fat to less than 10 percent of calories and cholesterol to less than 300 milligrams per day.

* Your level of LDL or "bad" cholesterol should be below 100 milligrams per deciliter of blood. If diet and exercise doesn't keep your LDL under this level, you probably should be taking cholesterol-lowering drugs.

A recent study found that cholesterol-lowering drugs are safe, and can reduce the risk of heart attack by 30 percent.

* You should exercise 30 to 60 minutes, three to four times per week if you have your doctor's approval.

* You should lose weight if you are at 120 percent of the ideal weight for your height. Pay attention to weight if you have high blood pressure, high blood sugar or high cholesterol.

* You should take 80 to 325 milligrams of aspirin every day. If aspirin upsets your stomach, your doctor may prescribe warfarin, another blood-thinning drug.

* Your doctor should prescribe drugs called ACE inhibitors right away if you have had a heart attack. The drugs may be continued indefinitely. Within five to 28 days of the attack, your doctor should prescribe beta blockers, which must be taken for at least six months.

* Your doctor may discuss estrogen-replacement therapy with you if you're a postmenopausal woman. Some studies have shown that the hormone can cut the risk of heart attack in half, but there may be side effects that make it unsuitable for some people.

* You should restrict alcohol and salt intake and pay careful attention to diet and weight if your blood pressure is over 140/90. If within three months your blood pressure doesn't go down, your doctor may put you on blood pressure-lowering drugs.

* You should quit smoking.

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