Overcoming Cardiovascular Disease

If you've been diagnosed with stroke, heart attack, angina or PAD, you may be in shock. But the right medical care can prevent future problems.

From the WebMD Archives

If you just recovered from a heart attack or a stroke, or you were just diagnosed with cardiovascular disease, you might still be in shock. You might feel fearful and uncertain of the future.

"This can be a traumatic time," says Hunter Champion, MD, PhD, a cardiologist at Johns Hopkins Hospital. "Before, everything seemed fine. Now all of a sudden, you're sick. You get a scary diagnosis and prescriptions for six different medications. It can be very tough to cope."

But there's no reason to despair, says Elizabeth Ross, MD, a cardiologist and spokeswoman for the American Heart Association.

"We now have so many wonderful ways to treat people who have just been diagnosed with cardiovascular disease," she tells WebMD. "We have treatments that will not only help you recover from a heart attack or stroke, but that will also prevent future problems."

So now is the time to take action. With good medical care -- which usually means medications and sometimes surgery -- and changes to your lifestyle, you can have a huge positive effect on your health. You may even be able to reverse some of the effects of the disease. Champion urges people to see this moment as an opportunity.

"When I first see patients who have been diagnosed with cardiovascular disease, I tell them to think of it as an alarm clock going off," says Champion. "It's a sign that they need to make some changes in their lives. What they can't do is hit the snooze button."

The first step is to learn more about your condition. The next is to discover ways that you can overcome it.

Understanding Arteriosclerosis

Heart attacks, strokes, peripheral artery disease (PAD), and angina can result from the same basic cause: blockages in the arteries. These blockages often occur because of arteriosclerosis, or "hardening of the arteries." You may have heard the words before. But do you really know what's really going on?

"It's a slow and gradual process," Champion tells WebMD. "People sometimes imagine that if they could look into their arteries, they'd see cheeseburgers floating there." But it's not quite like that. "If you have cardiovascular disease, it's been something that's been developing for a while," Champion says. "You didn't get it suddenly."

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Your arteries are flexible tubes that carry blood from your heart to the rest of your body. Blood brings oxygen and nutrients to all of your organs and muscles.

Arteriosclerosis develops when fats, cholesterol, calcium, and other substances in the blood begin to stick to the inner walls of the arteries. These deposits are called plaques. They build up and narrow your blood vessels. They also make your arteries more brittle and rigid than healthy arteries.

As the arteries narrow, it's harder for the blood to get to the cells that need it. "The artery becomes like a clogged supply line," says Ross.

The problem gets worse if the plaque tears or breaks. Your body's natural response is to form blood clots. But these clots narrow the artery even further. They might block it off entirely. Clots can also detach and travel through your bloodstream, causing a blockage elsewhere in your body.

Genes can play a role in the development of arteriosclerosis. But treatable conditions -- such as high cholesterol, high blood pressure, and diabetes -- are common causes.

A Systemic Disease, Affecting the Entire Body

Arteriosclerosis sets the stage for many grave medical problems.

  • Angina develops if there is a partial blockage of the arteries that supply the heart and muscle. Like any organ, the heart needs a good supply of blood to work. If it doesn't get that blood, you'll feel squeezing pain in the chest and other symptoms. If your symptoms are predictable -- occurring only when you're under emotional or physical stress -- it's considered stable angina. Unstable angina is more dangerous. It is more severe and occurs even when you are resting. Also, some people may not even feel their angina, such as those with diabetes.
  • Heart attacks (or myocardial infarctions) occur if the artery supplying the heart is partially or completely blocked. The heart might start to pump erratically because it isn't getting the blood it needs. This can be life threatening. If the blood supply to the heart is cut off for more than a few minutes, the tissue can be permanently damaged.
  • Strokes and transient ischemic attacks (TIAs or "mini strokes") can result from blockages in the arteries that supply blood to the brain. They can also occur when a blood clot from elsewhere in the body -- like the heart -- moves through the bloodstream and lodges in an artery that feeds the brain. In a TIA, the blockage only lasts just a few minutes at most. In a stroke, the brain cells are starved of oxygen for a longer time. This can cause more permanent damage or death.
  • Peripheral arterial disease (PAD) occurs if the plaque, narrows or clot blocks the arteries that supply blood to the extremities, especially the legs. This causes painful cramping, especially after you've been walking or exercising.

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Understand that arteriosclerosis and blood clots aren't the only causes of these conditions. For instance, about 17% of strokes are caused by ruptured instead of blocked arteries. Some heart attacks result from arterial spasms. But in most people who have had PAD, angina, stroke, or a heart attack, arteriosclerosis and blood clots are the underlying problem.

"You have to know that this is a systemic disease," says Ross. "It affects your whole body. While one plaque may have caused your heart attack or stroke, that isn't the only plaque you have." So besides treating the plaque that caused your immediate problem, you also have to focus on stopping any other plaques from getting worse.

Treatments for Cardiovascular Disease

The good news is that there are many ways to stop cardiovascular disease from worsening. In some cases, you may be able to reverse the damage.

"We really encourage people to see that there are lots of good options for treatment," says Ross. "The key is to choose the one that's best for the individual."

  • Procedures and Surgery. There are many approaches available. To open up an artery that has become clogged with plaque, your doctor might perform an angioplasty. This procedure guides a tiny balloon into the artery and inflates it to open up space at the site of the blockage. Afterward, your doctor might insert a stent -- a small, mesh cylinder -- into the artery to keep it open. In some cases, your doctor may also give a dose of a medicine directly into the artery to break up the blockage. More invasive procedures are sometimes necessary, like bypass surgery.
  • Medication. Depending on your case, you might need a number of medications.
    • Antiplatelet drugs (including aspirin) can help reduce clotting in the blood.
    • Angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and vasodilators relax your blood vessels. This makes it easier for your heart to pump blood and lowers your blood pressure.
    • Blood thinners also help prevent blood clotting.
    • Beta-blockers lower blood pressure and lower the heart rate.
    • Calcium channel blockers relax blood vessels and ease the workload on the heart.
    • Diuretics help lower your blood pressure by getting rid of excess sodium and water.
    • Statins and other medicines can help control your cholesterol levels.

But of course, medicine won't help if you don't remember to take it. So make sure your health care provider tells you exactly when and how to use your medicine. If you need reminders, leave notes around the house or use timers or alarms. Also, invest a few bucks in a plastic pillbox that has slots for each day of the week.

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Lifestyle Changes Go a Long Way

But when it comes to cardiovascular disease, medicines and surgery are only a small part of your overall treatment.

"Pills are only going to do so much to treat cardiovascular disease," says Champion. "The greatest benefits to your health will come from things that you do on your own."

Medicine and surgery can't counteract any of your bad habits. "In other words, taking medication or having surgery doesn't give you permission to keep smoking and keep eating an unhealthy diet," says Ross.

According to the experts, here are some of the things you need to do.

  • Stop smoking. "Smoking promotes blood clotting and it constricts the blood vessels," says Ross. "But once you quit, the effects tend to go away quite quickly."
  • Get on a healthy diet. Good nutrition -- eating foods low in fat and high in fruits and vegetables -- is an important way of controlling cardiovascular disease. Ask your health care provider for specific recommendations. Or get a referral to a nutritionist. Depending on your condition, you may need to reduce the salt in your diet as well.
  • Get more physical activity. You should always check with your healthcare provider before starting a new exercise routine. But physical activity is key for people fighting cardiovascular disease. The American Heart Association recommends gradually working up to 30 to 60 minutes of physical activity on most days of the week.

Champion says that, after a heart attack or stroke, people are often wary of exercise. "They're afraid that something bad will happen if they push themselves," he tells WebMD. However, you're not as fragile as you think. Champion recommends working with your doctor or looking into a cardiac rehabilitation program. These programs allow you to start exercising in a safe environment watched over by health care professionals. It's a great way to ease into exercise and build up your confidence.

Sticking to It

Making big -- and permanent -- changes to your lifestyle isn't easy. Eating healthier foods and exercising may be a lot easier at first, since fear is a great motivator. The minute you checked out of the hospital, you may have rushed out for a stack of healthy cookbooks, a new tracksuit, and a gym membership. But as the memory of your heart attack or stroke fades, your health kick may lose some of its momentum.

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"Sticking to changes in your behavior is really hard," says Ross.

But don't give up. Sure, you may slip every once and a while. But the next day, you have to get back on your food and exercise plan. Don't ever lose sight of how important these lifestyle changes are for your health.

Here are some tips from the experts on how to stick to your plan.

  • Find support. It's key that you pay attention to your psychological health. "It's completely normal to become depressed after having a heart attack or stroke," says Champion. According to the American Heart Association, up to 25% of people develop major depression after a heart attack, but it often goes untreated.

Don't ignore symptoms of depression. It won't only make you feel terrible. Depression can worsen conditions like high blood pressure. It also raises the risk of dying from a heart attack or stroke.

  • Get your family involved. You can't change your way of life on your own. You need to have the support of your family.

"I really try to get the whole family involved, and will often invite a patient's partner into the clinic," says Champion. "Changing your lifestyle has got to be a team effort. Everyone may need to make some changes. For instance, you can't tell dad to quit smoking if mom is still smoking."

  • Be careful of alternative treatments. "I understand why people want to 'go natural' in their treatment," says Champion. "I think a multivitamin is perfectly reasonable. But don't go overboard. Why on earth would you turn to a 16-year-old behind the checkout counter at a health food store for advice about treating your arteries?" Instead, always check with your doctor before trying any herb or supplement. Some alternative treatments can cause risky interactions with standard medicines.

Finally, don't despair. "A lot of patients will have a strong family history of cardiovascular disease and they'll dwell on it," says Champion. "Some want to just give up. But I remind them that while they can't change their genes, there are so many other things that they can change."

He urges people to look at the positives. "This is a much better disease to have now than it was 15 or 20 years ago," Champion tells WebMD. "We have new medications and we know how to use old medications better. You now have a chance to make some changes in your life that can alter the whole course of this disease."

WebMD Feature Reviewed by Louise Chang, MD

Sources

SOURCES: Hunter Clay Champion, MD, PhD, assistant professor of medicine, division of cardiology, Johns Hopkins Hospital, Baltimore. Elizabeth Ross MD, spokeswoman, American Heart Association; cardiologist, Washington Hospital Center, Washington, D.C. American Heart Association web site. National Heart, Lung and Blood Institute web site. National Institute of Neurologic Disorders and Stroke web site.

© 2005 WebMD, Inc. All rights reserved.

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