Cardiovascular disease remains the leading cause of death in Spain, e.g. In 2021, cardiovascular disease represents 26,4% of the total (and a mortality rate of 251,8 deaths per 100.000 inhabitants). For those who have experienced a heart attack, the risk of suffering another increases significantly.
Despite advances in the treatment and care of patients who suffer a heart attack, the risk of a recurrence remains high. It is estimated that approximately 20% of people who have had a heart attack will have another within a year. Therefore, it is essential to adopt preventive measures for proper recovery of the infarcted heart and avoid a new insult, which could be fatal.
With appropriate guidance and monitoring, it is possible to reduce this risk and return to normal activities of daily living.
- Know your residual cardiac function (that is, “how is your heart after the heart attack”)
The first step is to understand in depth the consequences of this event (infarction) on the heart muscle (is the contraction capacity normal or has it deteriorated?). In addition, you should consult frequently with your cardiologist to know and modify the risk factors that led you to this event. It is also important to know the status (degree of obstruction) of the rest of the arteries (those NOT responsible for the current heart attack). With all this data it is possible to estimate the individual risk of each patient.
- Adherence to treatment
After a heart attack, it is common for medications to be prescribed to control blood pressure, reduce cholesterol or prevent the formation of blood clots (this may include aspirin and other anti-platelet agents, which should not be withdrawn under any circumstances, without prior evaluation by the cardiologist). , it is essential to take it according to the cardiologist's instructions. Medication will be essential for recovery from the heart attack and reducing the risk of a second heart attack. It is important to remember that blood pressure, “bad” cholesterol (LDL), and glucose levels should be much lower in patients who have already suffered a heart attack. The q values that are considered “normal” in the general population are unacceptable after a heart attack, if we want to avoid a new event.
- Adopt a heart-healthy diet and maintain a normal weight
A diet rich in fruits, vegetables, whole grains, fish, nuts, and olive oil can help keep your arteries clear and your heart in good shape. Avoid foods high in saturated fats of animal origin, salt and added sugars.
If you are overweight or obese, losing even a little weight can significantly reduce your risk of a second heart attack. Excess weight puts an additional burden on the heart and increases the likelihood of developing cardiovascular problems. Currently there are drugs that could be useful to control risk factors such as diabetes, which could also help lose weight.
-Exercise regularly/Cardiac rehabilitation
Exercise is essential to strengthen the heart. Consult your cardiologist before starting an exercise program (you may need a cardiac rehabilitation program). Cardiac rehabilitation programs (CRP) carried out after acute myocardial infarction have demonstrated their effectiveness in terms of increasing functional capacity, controlling coronary risk factors, reducing symptoms and improving psychological deterioration. Likewise, there is evidence of benefits in terms of cost-effectiveness.
Stop smoking
It has been shown that people who continue smoking after having suffered a heart attack have up to five times the risk of mortality from cardiovascular causes than patients who quit.
Tobacco consumption leads to the appearance of endothelial damage (damage to the walls of the arteries) that contributes to the development of atherosclerosis, it also favors the development of glucose intolerance, and in already diabetic people it makes glycemic control difficult. Tobacco decreases HDL levels and increases triglyceride levels, and although it does not directly cause hypertension, it is related to higher blood pressure levels.
Smoking is one of the most significant risk factors for cardiovascular problems.
-Control of depression
Depression is a mental disorder that affects mood, thinking and behavior. It can have various causes, including having suffered a heart attack. Depression not only affects quality of life and emotional well-being, but also physical health. It has been associated with an increased risk of suffering a second heart attack or dying from cardiovascular causes.
It is important to detect and treat this problem as soon as possible. To do this, you can use the help of a mental health professional (psychiatry). Cardiac rehabilitation has also been shown to reduce depression and anxiety after an AMI.
-Limit alcohol consumption
Excessive alcohol consumption can increase blood pressure and contribute to heart problems.
Elevated blood pressure: Excessive alcohol is one of the recognized causes of refractory (or difficult to control) high blood pressure. This increases the workload of the heart. It also causes an increase in heart rate. And it is associated with the appearance of arrhythmias such as atrial fibrillation. But it can also cause direct damage (due to toxicity) to the heart muscle, which reduces its ability to pump blood.
Close follow-up in consultation
Due to the high risk of new cardiovascular events in patients with a myocardial infarction, and given that, as we have detailed previously, there are many causes that contribute to a second infarction. It is important to have subsequent follow-up in cardiology, not only to assess recovery after the heart attack, but also to detect and treat potential risk factors.
In conclusion
Preventing a second myocardial infarction involves a comprehensive approach, which will usually be carried out in coordination with the cardiology consultation with endocrinology, cardiac rehabilitation, psychiatry, etc. It is important to adopt a healthy lifestyle, follow medical recommendations and detect what the problems are. that could have led the patient to his first heart attack. It is also important to remember to always consult your cardiologist before making significant changes to your medical treatment.
By Dr. Frank Sliwinski.