From the Guidelines
Maintaining heart health and managing heart disease requires a comprehensive approach that prioritizes lifestyle modifications, including a heart-healthy diet, regular physical activity, weight management, smoking cessation, and stress management, as outlined in the American Heart Association's guidelines 1. To achieve this, several key recommendations can be made:
- A heart-healthy diet should emphasize fruits, vegetables, whole grains, lean proteins, and healthy fats, while limiting sodium, saturated fats, and processed foods, as recommended by the American Heart Association 1.
- Regular physical activity of at least 30 minutes per day is essential, with a goal of 150 minutes of moderate-intensity exercise per week, as suggested by the AHA/ACC guidelines 1.
- Weight management is crucial, with a goal of achieving and maintaining a healthy body weight, as defined by a BMI between 18.5-24.9, through a balance of caloric intake and physical activity 1.
- Smoking cessation is imperative, as tobacco use damages blood vessels and reduces oxygen to the heart, and avoiding secondhand smoke is also crucial, as emphasized in the cardiology patient page by the American Heart Association 1.
- Stress management through techniques like meditation, deep breathing, or yoga can help reduce strain on the cardiovascular system. For those with established heart disease, medication adherence is vital, with common prescriptions including:
- Statins to lower cholesterol
- Antihypertensives to control blood pressure
- Antiplatelet agents to prevent clots
- Beta-blockers to reduce heart workload Regular monitoring of blood pressure, cholesterol levels, and blood glucose is also essential to manage heart disease effectively, with targets including blood pressure below 130/80 mmHg and LDL cholesterol below 70 mg/dL for high-risk patients.
From the FDA Drug Label
Atorvastatin calcium tablets are used: • to reduce the risk of: o heart attack, stroke, certain types of heart surgery and chest pain in adults who do not have heart disease but have other multiple risk factors for heart disease. o heart attack and stroke in adults with type 2 diabetes mellitus who do not have heart disease but have other multiple risk factors o heart attack that does not cause death, stroke, certain types of heart surgery, hospitalization for congestive heart failure, and chest pain in adults with heart disease.
Spironolactone tablets are indicated in the management of: Primary hyperaldosteronism for: Establishing the diagnosis of primary hyperaldosteronism by therapeutic trial. ... Edematous conditions for patients with: Congestive heart failure: For the management of edema and sodium retention when the patient is only partially responsive to, or is intolerant of, other therapeutic measures. ... Essential hypertension Spironolactone tablets are indicated for the treatment of hypertension, to lower blood pressure Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions.
Amlodipine has been compared to placebo in four 8 to 12 week studies of patients with NYHA Class II/III heart failure, involving a total of 697 patients. In these studies, there was no evidence of worsened heart failure based on measures of exercise tolerance, NYHA classification, symptoms, or left ventricular ejection fraction.
The recommendations for maintaining overall heart health and managing heart disease include:
- Reducing the risk of heart attack and stroke through the use of medications such as atorvastatin 2 in adults with multiple risk factors for heart disease.
- Managing edematous conditions such as congestive heart failure with medications like spironolactone 3.
- Lowering blood pressure to reduce the risk of fatal and nonfatal cardiovascular events using medications like spironolactone 3 for the treatment of essential hypertension.
- Using amlodipine 4 to prevent hospitalizations for angina and coronary revascularization in patients with heart failure.
From the Research
Recommendations for Maintaining Overall Heart Health
- Eat a diet rich in fruits, vegetables, legumes, whole grains, and lean protein sources, with minimization/avoidance of processed foods, trans-fats, and sugar sweetened beverages 5, 6
- Substitute nonhydrogenated unsaturated fats for saturated and trans-fats 7, 8
- Increase consumption of omega-3 fatty acids from fish, fish oil supplements, or plant sources 7, 8
- Consume a diet high in fruits, vegetables, nuts, and whole grains and low in refined grain products 7
Managing Heart Disease
- Lower intake of saturated fat and replace it with unsaturated fats, especially polyunsaturated fats 8
- Avoid replacing saturated fat with mostly refined carbohydrates and sugars, as this is not associated with lower rates of cardiovascular disease 9, 8
- Follow a heart-healthy diet such as the Dietary Approaches to Stop Hypertension (DASH), Mediterranean, or plant-based diet, which have been shown to be effective in preventing cardiovascular disease 7, 8, 5, 6
Additional Considerations
- Be aware of the barriers to adopting a heart-healthy diet, such as food insecurity, poor access, and socioeconomic burden 5, 6
- Consider a multidisciplinary team-based approach, including the role of a nutrition specialist, in implementing culturally-tailored dietary recommendations 6
- Stay up-to-date with the latest research on the relationship between diet and cardiovascular health, as new evidence emerges 6