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A one-two punch: Beating heart disease with healthy living and medication

While healthy living and modern medicines offer effective heart benefits, it’s the combination of the two that’s lifesaving for many people. It’s well documented that even modest improvements in your habits—eating healthier, losing weight, quitting smoking, monitoring blood sugar and exercising nearly every day—can significantly reduce your heart disease risk. Similarly, patients today have an array of effective medications for controlling cholesterol, blood pressure and diabetes. Using both approaches will help you mount the best attack on heart disease.

The first defense

Ask your doctor for your personal guidelines, which he or she will base on a healthy lifestyle:

  • Improve your diet. Eat a variety of foods, including moderate amounts of lean meats and low-fat dairy products and lots of fiber, fresh fruits and vegetables. The American Heart Association (AHA) recommends eating oily fish high in omega-3 fatty acids at least twice a week and considering omega-3 supplements. Try to keep your sodium intake to no more than 1,500 milligrams daily. That’s about one teaspoon of salt. Limit saturated fat intake to less than 7 percent of calories if possible.
  • Exercise more. Check with your doctor first and start slowly, but eventually aim for at least 30 minutes of moderate to vigorous physical activity on most days of the week. Make it 60 to 90 minutes if you need to lose weight or maintain weight loss.
  • Kick the habit. There’s no way around it: Smoking puts a heavy burden on the heart, making it beat faster, constricting blood vessels, decreasing blood flow and raising blood pressure. What’s more, it inhibits your ability to exercise and makes the blood more likely to clot. Ask your doctor about resources to help you quit. Certain medications can lessen the urge to smoke, including nicotine supplements in many forms (gum, patch, inhaler and nasal spray) and a non-nicotine prescription drug.

Your second front

Sometimes these important lifestyle improvements are simply not enough to prevent or reduce heart disease or its risk factors, and your doctor may recommend one or more medications. He or she may prescribe daily aspirin therapy or another blood thinner to reduce the tendency of your blood to clot. Low-dose aspirin therapy should be considered for all women over age 65, even those with no other cardiovascular risk factors. If you have been diagnosed with heart disease, nitroglycerine and calcium channel blockers can relax blood vessels and reduce chest pain (angina). The drug digitalis may help a weak heart contract better and normalize a too-fast rhythm.

Despite improved diet and exercise, your blood pressure or cholesterol may remain dangerously high, warranting drug therapy. If you’ve been diagnosed with heart disease and your LDL (bad) cholesterol remains higher than 100 mg/dL, your doctor will likely prescribe medication as well as lifestyle changes. In the absence of diagnosed heart disease, your doctor may advise drug therapy if your LDL is greater than 130 mg/dL after lifestyle changes. What’s more, the AHA suggests that high-risk women use cholesterol-lowering drugs even if their LDL is lower than 100 mg/dL. Drugs that improve cholesterol, such as resins, fibrates, niacin and statins, work by lowering LDL or raising HDL (good) cholesterol or both.

Hypertensive drugs can treat high blood pressure. Diuretics reduce excess fluid in your body, leaving a smaller volume of blood and exerting less pressure on your blood vessels. Beta-blockers slow heart rate and reduce its force. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARB) can help relax blood vessels.

The first defense

Your second front