Preventing a repeat heart attack

Almost a third of patients who have a heart attack or myocardial infarction (MI) don’t reach the hospital alive. They can die on the spot, or on the way to the hospital, and are pronounced as DOA (dead on arrival) when they reach the hospital emergency room.

So heart attack victims who survive their heart attack should not squander such a big blessing by going back to their wanton ways once they feel better. A second or repeat heart attack usually has worse consequences than the first one, and the risk of dying from a repeat heart attack is higher.

Cardiovascular disease (CVD) which may lead to heart attacks is the world’s number one killer, according to Prof. Massimo F. Piepoli, the lead author of a consensus paper published this week in the European Journal of Preventive Cardiology.

“The biggest consequence of CVD is myocardial infarction (heart attack),” stresses Professor Piepoli. He warns that a heart attack victim has a 20-percent risk of having another serious “cardiovascular event in the first year.” This level of risk remains even if one is receiving optimal treatment and care. For those who are not optimally treated, or are not compliant with their treatment, the risk is even higher.

Preventive measures

The consensus document authored by Professor Piepoli and his colleagues in the European Society of Cardiology (ESC) details the preventive measures patients and their doctors and other healthcare professionals can take to prevent repeat heart attacks.

If a heart patient thinks that taking a palmful of medicines or having a stent inserted in his heart arteries are assurances to prevent a second heart attack, he’/she is in for a disappointing surprise. A heart-healthy lifestyle is still the most effective way to avoid another heart attack, according to ESC prevention spokesperson Prof. Joep Perk. This, supported with good medical treatment and regular followup, markedly reduces the risk.

According to the paper, the following are the simple but effective measures to prevent a repeat heart attack:

Smoking cessation (totally!);

Regular physical activity;

Eating a heart-healthy diet (high fiber, low animal fats);

Taking prescribed medications to protect heart arteries to prevent atherosclerosis (slow gradual blockage of the arteries), and to control risk factors such as high blood pressure and high bad cholesterol (low density lipoprotein type of cholesterol).

Usual drug regimen

A usual drug regimen for heart attack victims would consist of blood thinners like aspirin, statins—drugs for cholesterol which should be taken even if cholesterol levels are normal due to their other non-cholesterol-related effects, heart-protective drugs like an angiotensin converting enzyme (ACE) inhibitor and a beta-blocker.

These used to be expensive drugs, but with a lot of generic brands in the market, they are now well within the reach of the ordinary patient. Hopefully, our local drug manufacturers can duplicate what India has done by manufacturing a “polypill,” a single capsule or tablet containing all these essential drugs in patients at risk for a heart attack. The polypill is usually cheaper than the total cost of the individual components, and patient compliance is also enhanced since they only have to take one pill instead of several.

Need for healthy lifestyle

Of course, the effectiveness of these heart pills may be nullified if one continues to smoke. “Stopping smoking beats everything for preventing heart attacks,” explains Professor Perk. “Combine that with exercise and a healthy diet and we could avoid 80 percent of all myocardial infarctions.” That translates to four out of five being spared from a repeat heart attack.

According to a previous survey done in Europe, despite all counseling after a heart attack, 16 percent of patients still smoke, 38 percent remain obese and 60 percent are sedentary with little or no physical activity.

I’m not aware of any similar survey among Filipinos but I suspect it’s worse here. The attending physicians must make more intensive and consistent efforts to motivate their patients to do some lifestyle changes to minimize their risk for another heart attack.

“Having a heart attack is an upsetting experience but it does not seem to motivate patients to adopt a healthy lifestyle to avoid having another one,” Professor Piepoli laments. “We also know that more than half of heart attack patients stop taking their preventive medications.”

Professor Piepoli sums it up well: “We have scientifically proven ways to prevent second heart attacks. But we need to empower patients to better understand their risk factors after myocardial infarction and take a central role in their recovery. Cardiologists, nurses and allied professionals all have a role to play in prevention, starting in the acute phase through to follow-up care after hospital discharge.”

In a way, preventing a repeat heart attack is a personal decision and commitment one makes. The doctor can only prescribe, educate, support and motivate, but making that life-changing decision to change one’s lifestyle, and be fully adherent or compliant to one’s doctor’s prescriptions and instructions rests on the patient.