For many people who survive a heart attack, a long road to recovery is before them, as well as the need to change their lifestyle.
“A heart attack is really a cold glass of water in the face for most individuals. It can really depress them. Most people should be able to look at it as an opportunity to reassess,” says Dr. Gervasio A. Lamas, chairman of medicine and chief of Columbia University’s division of cardiology at Mount Sinai Medical Center in Miami Beach.
Fortunately, there are many steps to be taken and plenty of support available to facilitate a full recovery and vastly reduce the risk of a second heart attack — and possible death.
The first thing anyone should do after a heart attack is step back and conduct a self-assessment, Lamas says.
What you’re essentially asking is this: How can I lower my cardiovascular risk?
Priorities include quitting smoking, losing weight, working to become fit, decreasing stress and establishing a healthy diet. Above all, follow your doctor’s instructions.
Causes of a heart attack, like high cholesterol and obesity, often can be identified. Sometimes, however, it’s not so easy to see the patterns.
“There are some heart attacks we cannot predict, and they are based on family history and genetics. They might, in fact, be based on risk factors that we are only beginning to identify. ... As many heart attacks as there are, there’s still a lot of mystery about them. Why did this person have a heart attack? And why did it occur today? That’s a very deep one. Why today?”
Anyone who’s had a heart attack will typically be prescribed a minimum of three different kinds of pills, says Lamas: baby aspirin, a beta blocker to decrease the effect of adrenaline on the heart and a medicine to reduce cholesterol, typically a statin, like Crestor or Lipitor.
If you’ve had an angioplasty or a stent, you will also be prescribed a medication like Plavix, which is “like aspirin, but more powerful,” Lamas adds.
If the heart has been weakened by a heart attack, you will also be prescribed an ACE inhibitor or an ARB.
In addition to medication, your doctor should prescribe a cardiac rehabilitation program, which has been proven to decrease the risk of cardiovascular mortality and further hospitalization, according to the American Heart Association. Cardiac rehab is a medically supervised program that consists of both exercise and secondary prevention. It’s typically administered over 12 weeks, three days per week for 36 sessions.
“The patient comes in and gets thoroughly evaluated and they’re instructed in terms of exercise, as well as diet, weight management and smoking cessation. We closely monitor lipid and glucose levels,” says Dr. Sharon Andrade-Bucknor, director of UHealth’s Cardiac Rehabilitation Center.
A baseline is initially established through a six-minute walk test and a stress test. In addition to a nurse practitioner and physical therapist, the patient also meets with a dietitian to create a healthier diet.
“We also have the means to refer patients who need more in-depth psycho-social intervention because depression comes hand in hand with coronary disease after an event or heart attack,” says Andrade-Bucknor.
In spite of cardiac rehab’s effectiveness in reducing the risk of future potentially fatal cardiac events, it’s still underutilized. Nationwide, only 14 to 35 percent of eligible heart attack survivors participate in cardiac rehab programs, according to the American Heart Association.
“We have them as a captive audience. That’s where the benefit comes in,” says Andrade-Bucknor. “A patient has an event and they’re given recommendations by their physician, but saying it and having them just go home without this constant monitoring and feedback makes it difficult for the patient to really adhere to it.’’
After a heart attack, it’s important to adjust your diet and nutrition. According to the American Heart Association, an overall heart healthy dietary pattern emphasizes fruits and vegetables, whole grains, skinless poultry and fish, low-fat dairy, nuts and legumes. You’ll want to limit saturated fat, trans fat, sodium, red meat and sugar.
Weight loss is often a significant concern after a heart attack. “One of the big offenders, as far as weight is concerned, is carbohydrate consumption,” says Andrade-Bucknor. “That means refined sugar, as well as more complex starches, like rice and pasta.”
Psycho-Social & Stress Management
The shock of a heart attack also has psycho-social repercussions, including depression, which cardiac rehab and counseling can address. Patients fill out questionnaires to see where they are, and will work with counselors and others going through similar issues.
“It’s almost like a little family because everything is done in a group setting, so patients talk to each other,’’ Andrade-Bucknor said. “They meet people who have similar problems. They see people getting on top of these problems and it acts as motivation to work on their own.”
For the past five years, Dr. Claudia A. Martinez-Bermudez, an expert in integrative cardiovascular medicine at UM, has taken a holistic approach to managing emotions when treating heart attack patients.
“Personally, I witnessed it with my father when I got him a book by Deepak Chopra, and he got into meditation. He began manifesting changes in blood pressure, cortisol levels and the way he would react to stress,” she says. “There is evidence that meditation changes cardiovascular outcomes and we should all incorporate it in our routine as cardiologists. Meditation helps with blood pressure management and heart rate management.”
For patients interested in incorporating meditation into their lives, she recommends starting with the computer and free apps, like Oprah & Deepak’s 21-day Meditation Experience. Within the past year, the Osher Center for Integrative Medicine was established at the University of Miami Health System offering a wide range of evidence-based therapies, including acupuncture, massage and yoga.
“When one is trained with meditation, the body reacts differently to stress,” says Martinez-Bermudez. “The heart rate doesn’t go that fast, the blood pressure doesn’t go up, the breathing doesn’t get that fast. The frontal part of the brain, you have trained it to react in a different way.”
Are you eligible to join the TACT2 Study?
Starting in 2002, Dr. Gervasio Lamas, chairman of medicine and chief of Columbia University’s division of cardiology at Mount Sinai Medical Center in Miami Beach, conducted a 10-year clinical Trial to Assess Chelation Therapy (TACT). Chelation therapy was initially used in the early 20th century to treat metal poisoning and has long since been considered an alternative medicine frowned upon by the medical community. However, the results of his study have some medical professionals taking a second look.
Lamas noted that chelation practitioners always gave high volumes of oral multi-vitamins and multi-minerals, so he created a subgroup of individuals to compare the effects of vitamins to placebos.
The study was conducted with 1,708 participants over the age of 50 who had survived a heart attack. Of these, 460 participants were not taking statins and were treated either with a daily high dose oral multi-vitamin or placebo. The patients who were given the multi-vitamin reduced their relative risk of future cardiovascular events and mortality by almost 40 percent.
“There was no one more surprised by the results than I,” says Lamas, who published the study in the American Heart Journal in January. “What that leaves us with is a hypothesis. It doesn’t really leave us with a conclusion. … We need another study to show that this is real. … There may be more to this vitamin thing than meets the eye.”
Lamas is now conducting a five-year TACT2 study identical to the original study’s design in order to reach a definitive conclusion. He’s working with diabetic patients who have survived a heart attack because they have the greatest potential benefit.
“Patients who have had a heart attack and are captivated by this idea, they might be eligible for TACT2. It’s an active study and we want patients,” Lamas said. “Give us a call.”
Potential patients for TACT2 can call 305-674-2162.