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New guidelines detailing how to care for heart patients include several warnings that are easy for patients to understand.
The chronic coronary artery disease guidelines from the American Heart Association and American College of Cardiology, published Thursday in the AHA journal Circulation, are not incremental updates, said Dr. Salim Virani, chairman of the expert panel that rewrote the guidelines. .
“This means that everything that needs to be evaluated in terms of evidence has been reviewed and all recommendations have been rewritten,” said Virani, associate research professor and professor of medicine at the Aga Khan University in Karachi, Pakistan. It’s actually a new guideline.”
Coronary artery disease includes a variety of conditions that can be traced back to the buildup of plaque within the walls of arteries that restricts blood flow to the heart. This includes care after coronary artery disease, angina, heart attack, and procedures that open blocked heart arteries.
The guidelines cover a wide range of topics, from exercise to cholesterol management to bypass surgery. “This brings everything together as a one-stop shop for health care providers treating these types of patients,” said Dr. Christine Newby, vice chair of the writing committee.
From that “one-stop shop,” here are six warnings for people with coronary artery disease and an overall message to embrace.
avoid trans fats
“Trans fats are not good for anyone,” said Newby, a professor of medicine and cardiology at Duke University in Durham, North Carolina. However, people with coronary artery disease should be especially careful.
Of all the fats and oils used in cooking, trans fats are most likely to cause plaque in the arteries, Newby says. In people with pre-existing conditions, trans fats have been linked to an increased risk of heart attack and stroke, increased mortality from those problems, and increased risk of premature death.
Artificial trans fats are solid forms of liquid oils. Margarine and shortening are common examples. The Food and Drug Administration has banned food manufacturers from using partially hydrogenated vegetable oils, a once common source of trans fat. However, in some places, trans fats may still be present, such as in restaurant deep fryers.
Trans fats are also found naturally in beef, lamb and milk fat, but the guidelines say these pose a lower risk than artificial trans fats.
Companies are allowed to claim that a food product does not contain trans fat, even if it contains 0.5 grams. To avoid trans fats, check nutrition labels and limit your intake of fried foods, processed baked goods, and refrigerated dough. And look for terms like “partially hydrogenated oil” in the ingredients list.
Be careful of passive smoking
Smoking is a well-known cause of heart disease. However, you need to be careful even if you don’t smoke.
“Every effort should be made to avoid second-hand smoke, as it contains many of the same chemicals and irritants that are thought to cause coronary artery disease,” Newby said. said.
It’s a matter of cumulative risk, Virani said. “If you have heart disease, and you add in second-hand smoke on top of other conditions, your risk really increases.” If you’ve had a heart attack before, your risk of having another one is higher.
If you work in an area where smoking is allowed, it can be difficult to avoid second-hand smoke. But if someone in your household smokes, Virani says you should “at least” ask them to smoke outside.
Be careful with common medications such as ibuprofen
“Oftentimes, we all have the misconception that if something is available over the counter, it’s safe,” Virani said. “Patients with heart disease need to be very careful with even vitamins.”
The guidelines provide special warnings about nonsteroidal anti-inflammatory drugs, also known as NSAIDs. These drugs include ibuprofen and naproxen sodium.
“We’re not talking about a one-time use just because you’re sore after a workout,” Newby says. “What we’re talking about is using them every day.”
Virani said NSAIDs pose two problems for patients with coronary artery disease. First, long-term use is thought to be associated with cardiovascular problems, including a second heart attack.
Second, NSAIDs can cause bleeding in the stomach and intestines. Virani said heart patients may be taking one or two blood-thinning drugs. Combining these with his NSAIDs “significantly increases the risk of bleeding.”
He says it’s fine for occasional use. But he and Newby recommend acetaminophen as an alternative.
Do not use erectile dysfunction drugs and nitrates together
For angina pectoris or chest pain, nitrates, including nitroglycerin, are prescribed. Phosphodiesterase type 5 inhibitors, such as sildenafil and tadalafil, are used for erectile dysfunction.
Mixing them can cause a potentially life-threatening drop in blood pressure.
“It’s not about do not have “You just have to be careful with it,” Newby said.
For example, tadalafil stays in your body for up to 48 hours, and some nitrates act for a long time as well. Experts said men should talk to their doctors about how long the drugs last in their bodies and look for alternatives if necessary.
Don’t use these weight loss drugs
Sympathomimetic weight loss drugs, such as phentermine and benzphetamine, work by suppressing appetite. They also increase heart rate and blood pressure, which can put a strain on a heart that already suffers from impaired blood flow, Virani said. The drug may also cause arrhythmia.
One drug in this class, sibutramine, was removed from the U.S. market in 2010, but it may be available or sold illegally outside the country.
Avoid them all, Virani said. “We have much better and safer weight loss drugs.”
Caution is required when using hormone therapy after menopause
Estrogen and progestin are given to women to help with postmenopausal symptoms such as hot flashes. In the context of heart disease, there is a problem.
First, the hormone has been extensively studied in hopes of proving it protects against heart disease, but intensive research has found no benefit, Newby said. However, hormone therapy increases the risk of venous thromboembolism, which is a blood clot in the deep veins or lungs.
“What we suggest to patients with chronic coronary artery disease is to actually have a conversation with their treating clinician to see what other options they have.” Virani said. Given the already heightened risks, “we need to be extremely careful.”
And good news…
Managing chronic coronary artery disease may seem like a list of limitations. Virani said this should also be seen as a rich opportunity.
“Thirty or 40 years ago, having chronic coronary artery disease was like, ‘Okay, I’m going to have another heart attack eventually, and I don’t know if I’m going to survive,'” he said. Ta. But even in the past four or five years, new treatments have made it more manageable than ever before, if people work with a medical professional and take their medications.
“So there’s a lot of hope,” he said. “This is no longer a death sentence. If you actually follow the recommendations, you can have a fairly normal lifespan and a good quality of life.”
