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Coronary Heart Disease

Follow-up

Regular follow-up visits with your health care provider are essential. Coronary heart disease is a chronic (long-term, ongoing), relentlessly progressive disease.

Reducing risk factors may only slow its pace.
Even angioplasty or bypass surgery only reduces the severity of the disease. It does not cure the disease.
It often comes back and gets worse, requiring further treatment for people with previous heart attack or bypass, especially if the patient has not corrected the abnormal risk factors.

Your health care provider will usually monitor you for the following conditions:

New symptoms or signs of disease progression (periodic physical exams and ECGs or stress tests)
Silent ischemia (periodic treadmill or radionuclide stress tests or stress echocardiography)

Your health care provider will also monitor your progress in risk reduction and how well treatment is working. Keep track of your own numbers. This is your life.

Checking weight and activity levels
Checking blood lipid levels, including the bad LDL, the good HDL, and triglycerides, another fat frequently elevated in overweight patients, especially if diabetes - LDL should be less than 100
Checking blood pressure, which should be less than 130/80 mm Hg
If diabetic, checking blood sugar and A1C (should be less than 7.0%)
Checking progress with quitting smoking

He or she will monitor how well your medications , making adjustments as necessary. Side effects of medications will also be monitored and treated if necessary.

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Prevention

Risk refers to the odds that something will occur, but there are no guarantees.
  Having one or more risk factors does not mean heart disease is inevitable.
Similarly, absence of risk factors does not guarantee you will not have heart disease.
Monitoring and modifying certain risk factors is the best way to prevent coronary heart disease.
If possible, adopt a healthy lifestyle early in life.
Because risk factors are interrelated, many are present together in the same person.
Thus, moderate changes in one area of your life often reduce other risk factors at the same time.
You can't change some risk factors.
  Age: Men older than 45 years and women older than 55 years are at increased risk for coronary heart disease.
Family history: If someone in your immediate family has had coronary heart disease, angina, or heart attack by age 55 years, your risk of developing heart disease is increased. If heart disease runs in the family, seek medical attention. Your health care provider may recommend screening tests and preventive measures.

You can change the following risk factors:

High total cholesterol: Know your total cholesterol level and take measures to control it with diet and exercise if your levels are high. Your health care provider will check your levels and compare them with guidelines from the National Cholesterol Education Program (NCEP). Your total cholesterol levels are measured in your blood after a 9- to 12-hour fast. The following subtypes of cholesterol are important:
LDL cholesterol
Less than 100 - Optimal
100-129 - Near optimal/above optimal
130-159 - Borderline high
160-189 - High
190 or higher - Very high
  Total cholesterol
Less than 200 - Desirable
201-239 - Borderline high
240 or higher - High
HDL cholesterol (the good cholesterol)
Less than 40 - Low
60 or higher - High (desirable)
Diet: A balanced, low-fat diet is good not just for people with high cholesterol but for everyone.
The American Heart Association recommends that maximum calories from fat be less than 30% of total calories in any meal.
Each day, try to eat 6-8 servings of bread, cereal, or rice; 2-4 servings of fresh fruit; 3-5 servings of fresh or frozen vegetables; 2-3 servings of nonfat milk, yogurt, or cheese; and 2-3 servings of lean meat, poultry, fish, or dry beans.
Use olive or canola oils for cooking. These oils contain monounsaturated fats known to lower cholesterol.
Eat 2 servings of fish each week. Eat fish such as salmon, mackerel, lake trout, herring, sardines, and albacore tuna. All of these fish are high in omega-3 fatty acids, which lower levels of certain fats in the blood and help prevent irregular heartbeats and blood clots that cause heart attack.
Research suggests that alcohol can help protect against coronary heart disease, but limit your intake to 1-2 drinks per day. Higher amounts can increase blood pressure, cause heart rhythm disorders (arrhythmias), and damage your heart muscle and liver directly.
Avoiding fast food may not be pleasant or convenient, but it may provide significant benefit in the long run.
Smoking: Quitting smoking is the single best change you can make.
Quitting can be difficult, so seek your health care provider's help
. Passive smoking (breathing in tobacco smoke), smoking cigars, or chewing tobacco are equally dangerous to your health.
Physical inactivity: Exercise helps to lower your blood pressure, increase your level of good cholesterol (HDL), and control your weight.
Try to complete an endurance exercise of at least 30 minutes, 3-5 times a week. But just brisk walking alone will improve cardiovascular survival.
Exercise can include walking, swimming, biking, or aerobics.
Before beginning an exercise program, talk to your health care provider.

Obesity: Excess weight puts extra strain on your heart and blood vessels by increasing blood pressure , plus frequently associated with diabetes, high cholesterol and triglycerides, and low HDL.
A high-fiber, low-fat diet and regular exercise can help you lose weight and keep it off.
Fad diet programs may be unsafe. Seek your health care provider's advice before starting any weight loss program.
Don't rely on drugs to lose weight. Certain medicines used for weight loss—for example, Fen-Phen—have been associated with dangerous heart valve damage and other serious medical conditions in some users.
High blood pressure: If you have high blood pressure, your health care provider should treat it aggressively.
Proper diet, low salt intake, regular exercise, reduction in alcohol intake, and weight reduction are of paramount importance.
If your health care provider prescribes medications, take them faithfully.
Diabetes: Diabetes  causes blockage and hardening (atherosclerosis) of blood vessels everywhere in the body, including coronary arteries. Controlling diabetes significantly reduces coronary risk.
Viagra and coronary heart disease: If you intend to use sildenafil (Viagra) for erectile dysfunction, contact your doctor to make sure it is safe for you.
If you have a significant coronary blockage, angina or heart attack may occur with use of Viagra.
Also, you must avoid taking nitroglycerin in any form—pill, patch, or spray—within 48 hours of taking Viagra. Using Viagra with nitroglycerin may cause dangerously low blood pressure.

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