32
be especially careful about using alcohol. Talk with your doctor
about the impact of alcohol use on heart disease and other health
conditions you may have. If you do decide to drink, moderation is
the key. Moderate drinking is defined as no more than one drink
per day for women, and no more than two drinks per day for men.
Heavy drinking is hazardous to your heart. More than three drinks
per day can raise blood pressure. Meanwhile, binge drinking can
contribute to stroke and doubles the risk of dying after a heart
attack. Too much alcohol also can damage the heart muscle, leading
to heart failure. Heavy drinking also raises the risk of developing
metabolic syndrome, a cluster of heart disease risk factors that is
particularly dangerous for people who already have heart disease.
Sleep Apnea
Sleep apnea is a serious disorder in which a person briefly and
repeatedly stops breathing for short periods of time during sleep.
People with untreated sleep apnea are more likely to have a heart
attack, stroke, high blood pressure, and congestive heart failure.
Sleep apnea tends to develop in middle age, and men are twice as
likely as women to have the condition. Other factors that increase
risk are overweight and obesity, smoking, use of alcohol or sleeping
pills, and a family history of sleep apnea. Symptoms include heavy
snoring and gasping or choking during sleep, along with extreme
daytime sleepiness.
If you think you might have sleep apnea,
ask your doctor for a test called
polysomnography, which is usually
performed overnight in a sleep center.
If you are overweight, even a small
weight loss—10 percent of your
current weight—can relieve mild
cases of sleep apnea.
Other self-help treatments
include quitting smoking and
avoiding alcohol and sleep-
ing pills. Sleeping on your
33
side rather than on your back also may help. Some people benefit
from a mechanical device that helps to maintain a regular breathing
pattern by increasing air pressure through the nasal passages. For
very serious cases, surgery may be needed.
Menopausal Hormone Therapy
Until recently, it was thought that menopausal hormone therapy
could lower the risks of heart attack and stroke for women with
heart disease. But research now shows that women with heart
disease should not take this medication. Menopausal hormone therapy can involve the use of an estrogen-plus-progestin medicine
or an estrogen-alone medicine. Studies on each type of medicine
show that:
■ Estrogen-plus-progestin medication increases the risk of heart
attack during the first few years of use, and also increases the
risks of stroke, blood clots, and breast cancer.
■ Estrogen-only medication increases the risks of stroke and
venous thrombosis (a blood clot that usually occurs in one of
the deep veins of the legs). Estrogen-only medicine will not
prevent heart attacks.
If you have heart disease and are currently taking or considering
taking menopausal hormone therapy, talk with your doctor about
safer medicines for controlling heart disease, for preventing osteo-
porosis, and/or for relieving menopausal symptoms.
C-Reactive Protein (CRP)
An elevated level of this blood protein is a sign of inflammation.
Studies indicate that people with low CRP levels tend to have a
slower progression of heart disease as well as fewer heart attacks
and deaths from heart disease, than those with higher levels of the
protein. Whether CRP plays a role in causing heart disease is not
known.
A high-sensitivity CRP blood test can measure the level of this
protein in your blood. Elevated levels can be lowered with the
same statin medications that lower LDL cholesterol. Getting more
physical activity, losing weight if you are overweight, eating a
healthy diet, and quitting smoking will also reduce CRP levels.
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Treatments for Heart Disease
If you have heart disease, you know by now that it’s vital to control
it. As emphasized before, making lifestyle changes that improve
your risk factors is one important part of treatment. Eating well,
getting regular physical activity, and maintaining a healthy weight
will help to lessen the severity of your condition. If you smoke,
you’ll need to quit. Reducing stress and limiting alcohol use can
also improve your heart health. And if you have diabetes, you will
need to carefully manage it. Be sure to see your doctor regularly for
followup visits.
You also may need certain medications or special procedures. This
section explains these treatments and how each can help to protect
your heart health.
Medications
Some medications may be used to treat a risk factor for heart disease
complications, such as high blood pressure or high blood choles-
terol. Others may be prescribed to prevent or relieve the symptoms
of heart disease. If you do take medicine, it’s important to keep up
your heart healthy lifestyle because healthy daily habits will keep
your dose of medicine as low as possible. Medications that are
commonly prescribed for people with heart disease include:
ACE inhibitors stop the body from producing a chemical that
narrows blood vessels. They are used to treat high blood pressure
and damaged heart muscle. ACE inhibitors may reduce the risks of
a future heart attack and heart failure. They also can prevent kidney
damage in some people with diabetes.
Anticoagulants decrease the ability of the blood to clot, and there-
fore help to prevent clots from forming in your arteries and blocking
blood flow. (These medicines are sometimes called blood thinners,
though they do not actually thin the blood.) Anticoagulants will not
35
W I L B U R
“ M A C ”
M C C O T T R Y
I was so happy to be alive. The first Christmas
“after my surgery, my family was putting up the
t r e e . Just from watching the beautiful scene,
with my newborn granddaughter, it got to me.
I got up, excused myself and cried like a baby.
They were tears of joy, r e a l l y.”
36
dissolve clots that have already formed, but they may prevent the
clots from becoming larger and causing more serious problems.
Antiplatelets are medications that stop blood particles called
platelets from clumping together to form harmful clots. These
medications may be given to people who have had a heart attack,
have angina, or who experience chest pain after an angioplasty
procedure. Aspirin is one type of antiplatelet medicine. (See
“Aspirin: Take With Caution,” on the next page.)
Beta blockers slow the heart rate and allow it to beat with less force.
They are used to treat high blood pressure and some arrhythmias
(abnormal heart rhythms), and to prevent a repeat heart attack.
They can also delay or prevent the development of angina.
Calcium-channel blockers relax blood vessels. They are used to treat high blood pressure, angina, and some arrhythmias.
C h o l e s t e rol-lowering dru g s a re usually used to decrease LDL, or
“bad” cholesterol, levels in the blood. Sometimes they are also used
to increase HDL, or “good” cholesterol, and to lower triglycerides.
Commonly used cholesterol-lowering medications include statins, bile
acid sequestrants, niacin, fibrates, and cholesterol-absorption inhibitors.
Digitalis makes the heart contract harder and is used when the heart can’t pump strongly enough on its own. It also slows down some
fast heart rhythms.
Diuretics (water pills) decrease fluid buildup in the body and are
very effective in treating high blood pressure. In addition, new
research suggests that diuretics can help to prevent stroke, heart
attack, and heart failure. For those who already have heart failure,
diuretics can help to reduce fluid buildup in the lungs and swelling
in the feet and ankles.
N i t r a t e s relax blood vessels and are used to treat chest pain. N i t r a t e s in diff e rent forms can be used to relieve the pain of an angina attack,
to prevent an expected episode, or to reduce the number of attacks
that occur by using the medicine regularly on a long-term basis.
The most commonly used nitrate for angina is nitro g l y c e r i n . ( S e e
“New Guidelines for Nitroglycerin Use” on page 41.)
