Lifestyle Management

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Lifestyle interventions for patients with acute coronary syndromeImage

Introduction

A healthy lifestyle can go a long way in preventing heart diseases. Simple interventions can significantly contribute to improvement of long-term heart health. A few simple steps that can aid in prevention of acute coronary syndrome (ACS) are mentioned below.


1. Quit smoking

imageSmoking is the biggest cause of premature death and many preventable diseases in the developed countries. Smoking can adversely affect the heart and blood vessels. Smoking is an independent risk factor for the development of heart disease. Smoking damages the function of the heart and blood vessels and accelerates the progression of atherosclerosis (a condition where a deposit called plaque blocks the arteries and causes narrowing of the cavity of the arteries). Passive or second-hand smoking can also be detrimental for the health of the arteries and the heart and can increase the risk of heart attack substantially.
The image below depicts the effect of smoking on the heart and blood vesselsimage





















Quitting smoking at any age has huge health benefits. People who quit before the age of 50 or after 60 have decreased risk of heart-related events. Individuals should be periodically encouraged and counselled to give up smoking. After consulting a physician, people who desire to quit smoking can adopt the following measures

  • Nicotine replacement therapy: Nicotine can be replaced with formulations available in the form of:
    • Gum
    • Patches
    • Nasal spray
    • Mouth spray
    • Inhalation cartridges
    • Lozenges and
    • Sublingual tablets
  • Medical treatment with drugs such as bupropion and varencline
  • Use of other drugs such as nortriptyline and clonidine.Alternative therapies such as acupuncture, acupressure, laser therapy, hypnotherapy and electrostimulation can also be adopted.
image2. Maintain a healthy weight

Body weight is a cumulative result of environmental, familial, behavioural and genetic factors. Obesity or being overweight can predispose an individual to developing heart diseases due to narrowing or blockage or arteries supplying blood to the heart (coronary heart disease), raised blood pressure, diabetes, gallstones, breathing difficulties and certain cancers.

Body weight can be assessed using

  • Body mass index (BMI)
    BMI uses height and weight to calculate the body fat in both men and women. The number is usually arrived at by dividing the weight in kilograms by the height in metres squared (m2).
    BMI = Weight (KG)/Height (m2)

    The following table gives us an understanding of BMI.
    < 18.5
    Underweight
    18.5 - 25
    Ideal Weight
    25 - 30
    Overweight
    30 - 40
    Obese
    > 40
    Very Obese











  • Waist measurement
    Central obesity (fat around the waist) is an indicator of increased risk of heart-related events. It is considered to be more accurate than BMI as a predictor of heart disease.

     
    Waist Measurement
    Category
    Men
    37 - 40 inches
    92.5 - 100 cms
    Overweight
     
    > 40 inches
    > 100 cms
    Obese
    Women
    32 - 35 inches
    80 - 87.5 cms
    Overweight
     
    > 35 inches
    > 87.5 cms
    Obese


    In order to lose weight, it is important to maintain the right energy balance. The amount of calories or energy consumed should balance the energy spent. A healthy diet and physical activity help in promoting weight loss.
image3. Exercise regularly

Being physically active not only improves the heart health but also helps in weight loss, controlling blood pressure and cholesterol, and improving the mental health of an individual. Any kind of physical activity such as aerobics, walking, swimming, gardening, etc., can be beneficial for health. However, it is very essential to consult a physician before starting any kind of exercise programme, especially if there is any history of heart disease or an increased risk of having a heart disease. Ideally,moderate physical activity for 150 minutes per week is recommended. This can be built up gradually. It is never too late to start exercising. However, exercising should be stopped in case of any pain or discomfort.







image4. Take action to control stress

Although stress is not a direct contributor of heart diseases, the risky solutions that individuals adopt to combat stress, such as smoking, drinking and excessive eating, can increase the risk of developing heart diseases. Stress can also precipitate a heart attack. Developing a positive attitude and adopting a healthy lifestyle can help in coping better with stress. Identifying the stressors at work or home, and learning relaxation techniques such as yoga and meditation can help in managing stress.






5. Control blood pressure and cholesterol levels

image Blood pressure should be checked every 2 years and more frequently in case of history of hypertension (high blood pressure) and heart disease. The normal blood pressure is less than 120/80 (systolic/diastolic) millimetres of mercury (mm Hg). High blood pressure can be reduced either with the help of lifestyle changes such as increasing physical activity, reducing salt and alcohol intake, and eating a balanced diet, or with medications in people not responding to lifestyle interventions.
Excess of cholesterol in the body, especially low-density lipoprotein cholesterol (LDL-C), can increase the risk of heart disease. Cholesterol levels need to be checked at frequent intervals. The recommended lipid levels are:

  • Total cholesterol <200 mg/dL
  • Low-density lipoprotein cholesterol <130 mg/dL for individuals at low risk, <100 mg/dL in people at moderate risk, and <70 mg/dL for those at high risk
  • High-density lipoprotein (HDL) cholesterol levels >40 mg/dL for men and above 50 mg/dL for women

Increasing the consumption of unsaturated fatty acids and restricting saturated fats from the diet can help in lowering cholesterol levels. Omega 3 fatty acids, a high-fibre diet and regular physical activity can help in cutting down the cholesterol levels.


6. Cut down on alcohol consumption

imageAlcohol is rich in calories, and apart from causing weight gain, it is also harmful for the heart if consumed more than the recommended limits.
The guidelines permit not more than 3 to 4 units of alcohol a day for men and 2 to 3 units per day for women (one unit corresponds to 100 mL of wine, 300 mL of 3.5% of normal-strength lager, cider or beer, and 25 mL of spirits).

Source: AstraZeneca (www.myacslive.com)