The percentage of Americans who have a heart attack, as well as the number of resulting deaths, has continued to decrease since the 1970s. This decline is mainly attributed to the steps people are taking to prevent coronary artery disease (CAD) and heart attack, including lowering blood pressure and cholesterol and changing diet and exercise habits.¹²

The most important lifestyle changes that you can make are to quit smoking and to exercise on most, preferably all, days of the week. Eating a balanced diet that is low in saturated fats and rich in fruits and vegetables is also advised.

Lifestyle changes may include:

• Quitting smoking and avoiding secondhand smoke.
• Controlling your cholesterol.
• Controlling your blood pressure.
• Exercising.
• Relaxing and reducing stress.
• Managing depression and anger.
• Getting a flu shot every year.

General dietary guidelines for heart-healthy eating may be recommended, such as the:

• Therapeutic Lifestyle Changes (TLC) diet.¹³ For more information on this diet, see:
  • The nutrient composition of the TLC diet.
  • Tips for success with the TLC diet.
  • Sample menu for the TLC diet.
• American Heart Association healthy diet guidelines.
• Mediterranean diet.

Specific dietary considerations involve:

• Antioxidants and heart disease.
• Fish and heart disease.
• Fiber's effect on cholesterol.
• Soy's effect on cholesterol.
• Alcohol and heart disease.
• B vitamins. Doctors recommend eating a balanced diet that includes plenty of vitamins B6, B12, and folic acid. These vitamins can reduce homocysteine levels. (People with high homocysteine levels can be at increased risk for heart attack.) But vitamin B and folic acid supplements have not been shown to reduce the risk of a heart attack.^{14, 15}
• Cholesterol-lowering margarines.
• Trans fat and heart disease.

Cholesterol

Having high cholesterol increases your risk of coronary artery disease. If diet and exercise are not effective in lowering your cholesterol to a safe level, your doctor will probably prescribe a statin, a cholesterol-lowering medicine. These medicines have been proven effective in treating high cholesterol, and now doctors are beginning to prescribe them for people with lower cholesterol levels. Recent studies show that the use of cholesterol-lowering drugs can also help people with normal to moderately high levels of cholesterol. In these people, cholesterol-lowering drugs combined with lifestyle changes may slow the development of atherosclerosis and lower the risk of heart attack or death.

Aspirin

Aspirin may reduce the risk of developing blood clots that can lead to a heart attack in people with known CAD and in people with multiple risk factors for CAD, such as diabetes, high blood pressure, and high cholesterol. There are some risks associated with aspirin therapy that you should discuss with your doctor before you begin this type of treatment. If you cannot take aspirin, your doctor may prescribe another antiplatelet medicine, such as clopidogrel (Plavix).

Hormone therapy

Taking estrogen with or without progestin does not prevent coronary artery disease. In fact, if you are 10 or more years past menopause, taking hormone therapy may raise your risk of coronary artery disease.¹⁶

Talk to your doctor about your risks with hormone therapy. And carefully weigh the benefits against the risks of taking it. If you need relief for symptoms of menopause, hormone therapy is one choice you can think about. But there are other types of treatment for problems like hot flashes and sleep problems. For more information, see the topic Menopause and Perimenopause.