Many heart attack, stroke patients revert to bad habits, experts say
1 of 5 | “Most people don’t realize that so much of heart disease is preventable,” said Dr. Roger Blumenthal, director of the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease in Baltimore. Photo courtesy of Johns Hopkins University
Many heart attack and stroke survivors revert to bad habits, even though their bodies gave them a stern warning about the need to take risk-reduction measures, cardiologists and other medical professionals say.
Too many of them eat the wrong foods, fail to exercise, drink too much alcohol, don’t take prescribed medications, pay little heed to blood pressure, and fail to regularly monitor and understand cholesterol levels, the experts say.
“Most people don’t realize that so much of heart disease is preventable. If they could do a better job with their lifestyle habits and use proven medication when appropriate, they could prevent more than three-quarters of all heart attacks and strokes,” Dr. Roger Blumenthal told UPI in a telephone interview.
Blumenthal, a spokesperson for the American Heart Association, is director of The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease in Baltimore.
Paying attention to the numbers generated by test results — and understanding them — is a major issue when treating patients who have heart disease, doctors say.
For example, 70% of heart attack and stroke survivors are unaware that LDL cholesterol is commonly known as “bad cholesterol,” according to a new survey by the American Heart Association.
LDL cholesterol (low-density lipoprotein cholesterol) greatly contributes to the development of cardiovascular disease, raising the risk of heart attacks and strokes, according to the heart association.
Three-fourths of heart attack and stroke survivors reported having high cholesterol, but only 49% recognized the need to prioritize lowering their cholesterol, the survey found.
“This is indeed an eye-opening survey. LDL cholesterol is one of the major determinants of cardiovascular risk and is an especially important target in patients who have had a prior heart attack,” Dr. Grant Reed, who was not involved with the survey, told UPI via email.
Reed, an interventional cardiologist at Cleveland Clinic in Ohio, serves as quality improvement officer and program director of the interventional cardiology fellowship.
“The goal LDL should be less than 70 mg./dl., ideally less than 55 mg./dl. or as low as possible, in patients who have coronary artery disease, including those with a prior heart attack,” Reed said.
But LDL cholesterol isn’t the only risk factor that heart attack and stroke survivors often ignore. It’s common for people to neglect what they have been told they should do.
Beyond the survey’s focus, experts offered other suggestions. For one, managing high blood pressure is a vital component of good health that many heart attack and stroke survivors should do.
“Blood pressure is probably an even stronger risk factor for strokes and congestive heart failure,” cardiologist Blumenthal said, noting that readings consistently higher than 140/90 are a strong risk factor for cardiovascular disease.
“If lifestyle modification does not significantly lower blood pressure to the desired less than 130/80, we have many types of effective medications that can help.”
Experts emphasize that undergoing angioplasty and stent placement isn’t a magic solution.
“Patients sometimes don’t recognize that just because they had a stent put in their heart, that won’t necessarily prevent a future heart attack,” Dr. Eric Brandt told UPI in a telephone interview.
Brandt, a cardiologist and expert in cholesterol management, at the University of Michigan Medical School in Ann Arbor, studies the effects of nutrition policy on population outcomes.
He recommends that patients participate in a cardiac rehabilitation program in which an exercise physiologist guides them in working out safely after a heart attack.
“It’s extremely underutilized,” Brandt said. “People aren’t going as often as they should.”
The type of exercise isn’t as important as maintaining a routine. “It doesn’t really matter what you do, but it does matter that you do it consistently,” registered dietitian Kerry Strom told UPI via email.
Strom is a certified diabetes care and education specialist at MedStar Franklin Square Medical Center in Baltimore.
Diet matters, too. Health professionals often recommend a Mediterranean diet for heart health because of its positive effects on cardiovascular disease, according to the Cleveland and Mayo clinics.
Strom advises patients to reduce intake of highly processed meats, such as sausage, salami and hot dogs. “Those meats are typically higher in sodium and saturated fat, which should be limited in a heart healthy diet,” she said.
But such recommendations often fall by the wayside.
“You find a lot of patients are still eating the standard American diet, which is high in processed foods,” cardiologist Brandt said.
For example, “patients continue to eat hamburgers, pizza and french fries on a routine basis, despite having recently had a heart attack.”
In addition to poor food choices, many patients continue to smoke. Among those who quit, high relapse rates occur, Dr. Aryan Aiyer told UPI via email.
Alyer is an assistant professor of medicine at the University of Pittsburgh School of Medicine and medical director of UPMC Heart and Vascular Institute Lipid Clinic.
“That is not to say that some patients don’t embrace a complete change in their life,” Aiyer said. “But I suspect patients feel it is easier to take a medication than change their lifestyle habits.”
Excess alcohol also has bad effects on heart function. The issue is: How much is too much?
“Increasingly, many experts feel that even moderate drinking — up to two drinks per day — is not completely benign,” Aiyer said. “For example, alcohol can lead to dementia, fatty liver, weight gain and high blood pressure, as well as heart failure.
“Limiting alcohol consumption to a few drinks per week may help mitigate against developing these issues. If you already have these health issues, the best way forward is abstinence from alcohol.”
If heart attack and stroke survivors need help making good lifestyle choices, registered dietitians can be an integral part of their support team.
“We can work together with the heart attack or stroke survivor to develop tailored meal plans that will help keep their lab values well within acceptable parameters and stress the importance of regular exercise,” Kimberly Snodgrass, spokeswoman for the Academy of Nutrition and Dietetics, told UPI via email.
“Also, we can also get other disciplines on board using interprofessional collaboration,” she said. “For example, a social worker may be able to help us make sure the patient’s insurance will cover their prescribed medications.”
Last but not least, “look for ways to limit stress,” registered dietitian Strom said. “Pick up a hobby. Join a support group. Go outside and enjoy nature. Spend time with friends. Factor in time in your busy schedule for things that bring you happiness. Get enough sleep.”
Several years ago, one of Strom’s patients dramatically changed his lifestyle after a few counseling sessions.
“He was a truck driver who ate fried food and fast food every day,” she said. But then, “he put a little fridge in his truck and started packing fruits and veggies instead of eating fried food.” He also began exercising regularly and reversed his risk factors for heart attack, stroke and diabetes.
“I told him to call me when he completed his 5K,” Strom said. “He couldn’t imagine walking to the end of the street without being out of breath when we first started working together.”
A year or two later, he called to say that he had crossed the finish line of his first half-marathon. “It was actually an emotional conversation because he realized he had saved his own life.”