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Managing your risk factors after ACS

It is quite wrong to think that having had acute coronary syndrome (either unstable angina or a heart attack) means it is already too late and that the damage is done. It is much better to think about this as a new start and another chance – a chance to take responsibility for the things you can change, and to work together with doctors and nurses to control the things you can’t.

Things you can’t change

Unfortunately there are some people who are at risk because of things they may not be aware of.

A history of heart disease and strokes in the family may be an indicator that there is a risk of heart disease in their genetic make up.
This might mean they have a tendency to have high cholesterol levels increasing the likelihood of atheroma forming in the blood vessels.
There may be an inherited tendency towards diabetes, which would increase the likelihood of having damaged blood vessels.
A person may have an undiagnosed high blood pressure which in the long term could cause damage to the heart and blood vessels.

However monitoring and controlling these things will reduce the risk they pose. There are also a number of people who none of this applies to, who still have heart attacks. Hopefully, research in the future will find other explanations.

Things that you can change

The best way to prevent another episode of acute coronary syndrome is to understand what caused the first one and take steps to reduce your risk. Risk factors are not the cause of unstable angina or a heart attack but they have contributed to it happening. In other words by reducing these risk factors you can reduce your overall risk.

These risk factors also apply to heart disease and strokes. Many risk factors are habits and habits can be broken. Identify, honestly, any of the things in your life that you can do something about to improve things:

Do you smoke?
Do you know your blood pressure?
Do you know your cholesterol level?
Do you eat a healthy varied diet?

Do you take enough exercise?
Are you overweight?
Do you drink too much alcohol?
Do you control your stress levels?

Stop smoking

By far the most important thing you can do for your heart is to stop smoking:

Smoking narrows and blocks your blood vessels causing coronary heart disease.
Smoking makes your blood stickier. This increases the chance of clots forming that can cause heart attacks and strokes.
Smoking increases blood pressure and speeds up your heart.
From the moment you stop smoking the risks of heart disease start to decline.
You also significantly reduce the chances of developing a range of cancers.

To find out more about stopping smoking, visit "Smoking and ACS".

Try to control high blood pressure

Uncontrolled high blood pressure is an important risk factor for coronary heart disease, heart attacks and strokes.

Over the years high blood pressure slowly damages the blood vessels making them narrower and less flexible, so that the heart has to work harder to push blood through them. If blood pressure remains high the heart is put under unnecessary strain and in time this will cause damage.

Damage to the blood vessels makes it easier for clots to form and for fatty debris to build up and block blood vessels. You can help to control your blood pressure by:

Making sure you take your blood pressure lowering tablets as prescribed.
Stopping smoking.
Getting your blood pressure monitored regularly.
Reducing your intake of salt.

Keeping your weight down.
Taking plenty of exercise.
Limiting your alcohol intake.
Eating a healthy varied diet.

Try to control your cholesterol level

High cholesterol levels are associated with heart attacks and it is saturated fat that raises your cholesterol.

Cholesterol levels fall after a heart attack and an accurate reading will not be available again for 2-3 months. So if it is found to be high in the first 24 hours you will probably be started on medication to reduce it straight away. It is generally accepted that a total cholesterol of <5 is low/ normal risk. Many doctors would like to see heart patients’ cholesterol to be nearer 3, as research has shown that a low level can be preventative even in people who don’t have particularly high cholesterol. However, for many people this would be difficult to achieve.

For more information on cholesterol and how to reduce your cholesterol levels go to "Cholesterol and ACS".

Eat a healthy varied diet

The general healthy eating message is to eat a variety of high fibre, low fat foods, with saturated fat replaced by unsaturated oils and five portions of fruit and vegetables per day. To do this, you should:

Eat more:	Eat less:
Fibre (wholemeal bread/pasta/rice) Fruit /vegetables /fruit juice /salad /beans Fish (especially oily fish) Low fat alternatives for spreading and cooking Replacing with oils such as olive, rapeseed and sunflower oil Healthy options in take-away food and ready-made meals i.e. low fat and low salt	Saturated fat (animal fat/ fatty meat products e.g. sausages and burgers) Full fat dairy products (butter/ cheese/ lard) Salt Processed foods

For more information on healthy eating, visit "Healthy Eating and ACS".

Keep physically active

Keep fit class You will already be aware that exercise is good for you. By exercising regularly you can bring down your blood pressure by as much as 10mmHg which is as much as many blood pressure lowering drugs. The aim is to do some form of aerobic exercise such as brisk walking for 30 minutes most days of the week.

For further information on how physical activity can help reduce your risk of ACS, visit "Physical Activity and ACS".

Watching your weight

Being over weight: Person on scales

increases the work the heart has to do
causes high blood pressure
leads to abnormal blood fats
is associated with diabetes, gall bladder disease and some cancers.

Losing weight is not always easy and needs support and encouragement from health professionals and family alike. Better eating habits in the family may prevent problems for them in later life. For more information on ways to lose weight visit "Weight Control and ACS".

Moderate alcohol intake

Different types of alcohol Drinking large quantities of alcohol is a common cause of sustained high blood pressure in young males.

Alcohol in excess of the amount your body can easily tolerate can cause high blood pressure. If you find you are drinking heavily on a regular basis this will put up your blood pressure and increase your weight. Binge drinking (drinking to get drunk) at any age can cause a temporary but significant rise in blood pressure and an increased risk of stroke.

For further information on alcohol and ACS, visit "Alcohol and ACS".

Reducing and controlling stress

Man thinking Stress has not been proven to cause heart disease. To a certain extent we need stress to make us perform well. However when it gives us tension pains in the neck and back, makes us nervous and even afraid and disturbs our sleep it can become a trigger for behaviour that involves risk factors for heart disease.

Keeping a diary of when you feel most stressed or upset can be a start to understanding how you personally cope with stress.
Recognising a pattern to the way we behave can help us to look for other ways of coping with stress that are less harmful e.g. exercise, relaxation tapes and music.
Learning to relax is a skill that has to be learned and does not mean simply watching the television or just doing nothing.
Finding other, better ways of coping will not only reduce your risk but will help you to take control of these situations rather than them taking control of you.
Once you recognise your stress ‘triggers’ you can consciously try to relax in these situations: stretching tense muscles, breathing slowly, putting things into perspective.
At work, take jobs in order of importance and try to plan ahead. However, it may also mean making difficult decisions about your future e.g. changing to a less stressful job.

The information in this page has been adapted from the CHSS leaflet Living with High Blood Pressure and Heart attack: A guide to your recovery.