Lowering your risk of further cardiovascular disease

While cardiovascular disease is not entirely preventable there are three areas to focus your attention on to reduce your risk of further problems:

Controlling your blood cholesterol and blood fats

Maintaining cardiovascular condition with exercise

Use of blood thinners

The following information is provided as a guideline to help you develop a risk factor control program and is meant as an introduction to a continuing self education and health maintenance program.

Blood cholesterol and blood fats

It has been recognized for a number of years that people with an elevated blood cholesterol have an increased risk of cardiovascular disease. It is only more recently that the benefit of reducing blood cholesterol has been more conclusively demonstrated. The value of blood cholesterol control for people over the age of 70 is still being debated. Nonetheless since further circulatory obstructions are a risk faced by all patients who undergo coronary bypass surgery I recommend taking reasonable steps to control the blood cholesterol.

There is no level of blood cholesterol at which the risk of heart disease disappears. I feel it is important to keep your cholesterol below 200 if possible. Further if you start with a so called normal cholesterol it is still in your best interest to follow a heart healthy diet.

The first step for anyone to take who is trying to control their cholesterol is to get on a low fat diet. It turns out that the main factor contributing to elevations of the blood cholesterol is the amount of fat in the diet - particularly saturated fat.

There are two guidelines to follow when it comes to dietary fat: 1) eat less than 20 - 30 grams of fat daily, and 2) Be sure no more than 25-30% of your dietary calories come from fat. Both of those rules require you to begin to go out and increase your nutritional knowledge. Read the labels on packages so you know how many grams of fat are in the food you are eating. Keep a mental running tally each day of the number of grams of fat you eat or if necessary at first keep a diary of what you eat and write down both calorie consumption and grams of fat.

There are several references that will help you with your calculations including the American Heart Association Cook Book; Good Fat Bad Fat How to lower your cholesterol & beat the odds of a heart attack by Griffin and Castelli - Fisher books 1989; Controlling Cholesterol by Cooper - Bantam 1988; The 8 - week Cholesterol Cure Kowalski - Harper & Rowe 1987; Dr. Dean Ornish's Program for Reversing Heart Disease - Random House 1990; and any of the Pritikin books. All of these sources will provide you with more background than is provided here - although they have a tendency to be too crusading and perhaps promise more than they can deliver.

It is the fat that you eat that stimulates your body to manufacture cholesterol. That is why it is the fat content rather than the cholesterol content that should concern you when it comes to dietary management. For instance there are many foods advertised as cholesterol free that are really high in fat and therefore won't be helpful in reducing blood cholesterol - peanut butter is one example. On the other hand there are foods that are relatively high in cholesterol but almost fat free - shell fish for example - which are relatively safe to consume as long as they aren't prepared with a lot of fat.

Weight loss is a big part of any cholesterol reducing program for anyone who is the least bit overweight. Fortunately a low fat diet will help with weight loss.

In order to evaluate the success of your efforts to lower your cholesterol you must have it checked periodically. Many labs are now subdividing the cholesterol into high and low density lipoproteins. You may hear high density lipoproteins referred to as good cholesterol. Fundamentally low density lipoproteins are manufactured by your liver when it is making cholesterol for transport to the bodies fat cells because dietary calories are more than needed to supply immediate needs. On the other hand high density lipoproteins are manufactured to carry cholesterol from the fat cells back to the liver where it is metabolized to supply the bodies need for calories during times when metabolic demands exceed intake - such as during exercise.

Unfortunately there are some people who are thin and follow a strict diet but will still have elevated blood cholesterol levels. Fortunately, there are now drugs available which will lower blood cholesterol for those people.

Blood cholesterol is lowered by 1)reducing the amount of cholesterol consumed; 2) reducing the amount of cholesterol manufactured (with a low fat diet and if necessary with drugs that prevent its manufacture) and; 3) increasing the amount of cholesterol lost from the body. (Certain high fiber foods such as oat bran and some drugs bind with cholesterol so that it is lost through the bowel.)

Drugs should only be used to supplement diet and exercise since they always carry risks, and no one knows for certain at this time what their effect will be over many (15-20) years.

Exercise

Regular exercise will help to maintain cardiovascular fitness. The type of exercise (i.e. walking, swimming, bicycling, etc.) isn't so important as that you do the exercise. No exercise is of any value if you don't do it. Its too hot or I'm too busy can't be allowed to become excuses for not getting out and being active.

Twenty minutes of activity once or twice daily should be a minimum goal. How vigorous that activity is in part a matter of personal preference. If you are anxious to try vigorous physical exercise have a stress electrocardiogram done and learn what is a safe maximum heart rate for you.. Then exercise to that heart rate on a regular basis. As time passes you will be able to do more before you reach that limit.

We can't tell you that the exercise will prolong your life, but that it will improve your quality of life. If you prefer to exercise indoors there is a variety of exercise equipment available. Heart rate monitors are also available to help you be sure you achieve and don't exceed your target heart rate.

Some people find cardiac rehab programs an effective way to overcome the inertia that can stand in the way of starting in on a regular exercise program.

Blood Thinners

It has long been known that there is a relationship between blood clots and heart attacks. While it is known that prevention of coagulation won't eliminate heart attacks it is also known that the frequency and severity of heart attacks can be lowered by the use of low dose aspirin therapy in those people who tolerate it. It is also known that aspirin has some significant side effects including gastric hemorrhage, and bleeding into the eyes or brain. For that reason regular aspirin use should be limited to those who are at an increased risk of heart attack.

We have also recommended the use of another drug (persantine or dipyramidole) as a blood thinner. The value of a second drug is less clear, and does increase the risk of bleeding problems. When we use it we generally restrict its use to the first two or three months following operation

Other Considerations

While red wine may raise high density lipoproteins its benefit is nebulous enough that we can't recommend it for medical reasons.

Smoking is a very strong risk factor and should be scrupulously avoided.

Avoid milk, cheese, and most dairy products.

If you have high blood pressure be sure it is well controlled.

Limit you salt intake as much as possible.