The changing face of angina and CAD   Initial treatment   Aspirin   Anti-anginal therapy   Beta-blockers   Blood pressure	Cigarette smoking   Cholesterol   Diet   Diabetes   Exercise   Education

If you're 55 or older, the bad news is that coronary artery disease (CAD) and angina show up more in your age group. But "old age" is not the cause of these conditions, which means that angina is not inevitable. The good news is that some people may be able to prevent CAD. And, even if your doctor has already told you that you have CAD, you can help keep your condition from getting worse.

Unfortunately, many older people think that they have little power over angina and heart disease. A large group of patients, average age 63, waiting to have open heart surgery, filled out a survey. Many of the over-63 patients in the group said they believed CAD was the result of "old age." They also said they believed they could not control the disease themselves, and that it would be gone after surgery. However, patients younger than 63 were more likely to believe that family history, health-damaging behaviors, and emotions were big causes of CAD. They also believed changing these behaviors after surgery was important.¹ If you were asked to take the same survey, how would you respond?

The following information on LifeHeart.com details changes you can start making in your life to reduce the number and severity of angina attacks, and your risk for possible complications down the road.

The changing face of angina and CAD

America is aging. People are living longer than ever before and the 55-plus age group is expected to increase by 80% over the next 30 years.² But even though the number of people dying today from CAD is one-quarter of the number in 1963, it is still the leading cause of death and the number-one health problem in the United States. Almost 12.6 million people have a history of heart attack, chronic angina, or both.³

Even though people are living longer, are they living better? If you have angina, you may not answer, "Yes." Painful or uncomfortable angina attacks may be curtailing your ability to enjoy your usual activities. You may not be able to work in the garden or take your favorite hike anymore. You may feel anxious each day about whether angina will strike. You may purposely avoid activities that you know might trigger an attack. Can you do anything to fight angina and CAD to help you live longer and better? Yes—prevention is your key.

Initial treatment

First, get to know your doctor's basic guidelines for treating chronic angina and coronary artery disease with this easy-to-remember key:⁴

Your plan should include at least an evaluation of each item. Of course, people are different, so treatment plans won't be the same for everyone. A younger patient, for example, who is still interested in vigorous physical pursuits won't have the same plan as an older patient who wants to be able to enjoy daily activities. But the same factors enter the equation for both. The following examines each in detail.

A = Aspirin

Aspirin won't have any effect on your angina attacks. But it is an important weapon against heart attacks and death. Aspirin reduces the sticky, adhesive quality of platelets, which can decrease the chance of a dangerous blood clot forming in the coronary arteries.

Keep in mind that aspirin may not be right for everyone. Some people are allergic to it. Other people might have a history of stomach ulcers that aspirin might make worse. Before taking aspirin, be sure to check with your doctor first.

A = Anti-anginal therapy

Getting back to your normal routine may be the most important goal if you've already reduced your daily activities to avoid angina pain. Prescribing anti-anginal drugs is one of the first steps your doctor may take. Taken daily, these medications may reduce the frequency of your attacks. Unfortunately, angina attacks may continue. The current medication choices (beta-blockers, calcium channel blockers, and nitrates) sometimes are limited by the severity of your CAD, the possibility of bothersome side effects, and other illnesses you may have. See Angina Medications for more information.

All medications have the best chance of working when they are taken just as your doctor has prescribed. Steady drug levels in your system are needed for the drugs to work. If you are having difficulty taking your medicines for any reason, or if you find your medications aren't working even though you're taking them as directed, let your doctor know right away.

In addition, all patients should receive a prescription for short-acting nitroglycerin, either as tablets to be placed under the tongue or as an oral spray for quick control of angina attacks. Be sure to ask your doctor how to use it correctly.

B = Beta-blockers

Beta-blockers are included under anti-anginal therapy in the previous section. So why are they included separately here? Research shows that beta-blockers may lower your chance of dying from a heart attack if they are started immediately after the heart attack. Beta-blockers also may lower your chance of dying from a type of high blood pressure called isolated systolic hypertension. To learn more about beta-blockers and other drugs used to treat angina, see Angina Medications.

B = Blood pressure

High blood pressure, also known as hypertension, is often called the silent killer. Many people don't even know they have it, because obvious symptoms rarely show up. If you have high blood pressure, you are at increased risk for getting CAD and angina. And the more severe your high blood pressure is, the greater your risk. Untreated, high blood pressure can lead to permanent damage of the vessels and also of the heart muscle. People with CAD should always have their blood pressure checked regularly. If your doctor says you have high blood pressure, you'll most likely need to make some changes in diet and exercise habits. If you still have high blood pressure several months after these changes are made, then drug therapy may be needed. Medications may help reduce your blood pressure to more normal levels and lower your risk of worsening CAD and angina. Read more in Blood Pressure and Heart Rate.

C = Cigarette smoking

Smoking cigarettes or other tobacco products is one of the most preventable risk factors for angina and CAD. Smoking increases your chance of dying from heart disease by as much as 50%. Plus, smoking magnifies the worst effects of other risk factors. Deadly blood clots in the coronary arteries are more likely to develop. Fatty plaques in the arteries are more likely to break apart as well. Both can lead to a heart attack. And if you have a heart attack, smoking increases your chance of developing a possibly life-threatening, abnormal heart rhythm (arrhythmia).

Once you stop smoking, the positive effects begin almost right away. Your risk of having a heart attack can be nearly halved. The arteries in your heart relax more and allow more oxygen-rich blood to reach the heart. Your blood is able to carry more oxygen, and your "good cholesterol" (HDL) levels should begin to rise.

Smoking is a powerful physical and psychological addiction. Kicking the habit isn't easy. You'll need support from your family, friends, and coworkers. Some stop-smoking programs may also have a pharmacist or nurse on staff who can help guide you. Ask your doctor or other healthcare professional how you can get started and stay with a program. See the Five-Day Stop Smoking Plan for more.

C = Cholesterol

High levels of LDL cholesterol—low-density lipoprotein: the "bad cholesterol"—are the main reason fatty plaques are deposited along artery walls. As more plaques build up, arteries become more narrow and the heart may not get the oxygen-rich blood it needs for energy. Moreover, the higher your LDL cholesterol rises, the greater your chances for a heart attack.

High-density lipoprotein (HDL) is "good cholesterol." HDL is good because it carries cholesterol away from the coronary arteries and other parts of the body back to the liver for removal. The more HDL you have, the less cholesterol is available to attach to artery walls.

Prescription drugs called statins may help decrease levels of bad cholesterol, but they aren't the only answer for controlling fat levels in your blood. Lifelong changes to your diet, emphasizing low-fat foods, are equally important and necessary. This can be true whether your LDL levels are seriously high or only slightly increased. If you don't exercise, eat healthier foods, stop smoking, or take your medications, CAD and painful angina attacks may continue.

Always remember: "LDL is bad—keep it low! HDL is good—keep it high!" Learn more about how to manage cholesterol in your diet in Nutrition Matters.

D = Diet

The Food Pyramid, USDA and DHHS. Click to enlarge picture.

Unfortunately, you really are what you eat. A diet rich in high-fat foods leads to weight gain and possibly serious medical conditions over time. Obesity is defined as being 30% over your ideal body weight.⁵ Frankly, obesity in America has reached epidemic proportions. Almost two-thirds of Americans are overweight or obese. And experts believe the problem may be even worse by the year 2010. Lack of exercise and eating too many high-fat foods and not enough grains, fresh fruit, and vegetables are the main causes of obesity.

Obesity increases your chances of having high blood pressure and diabetes (high levels of glucose in the blood). Both may increase your risk for heart disease. Obesity also lowers levels of "good cholesterol" (HDL) and increases your triglyceride levels, which also can lead to heart disease. Being seriously overweight increases the work your heart must do to keep the oxygen pumping and your body functioning. By dropping your weight to a healthy level, you can lower your risk of developing other medical conditions. In the long run, you're also decreasing your chance for heart disease.

Once the weight is off, you'll want to keep it off for a lifetime. Adopting a healthy, low-fat diet is your first step. The Food Pyramid can guide you. Ask your doctor or dietitian for help devising a healthy meal plan that suits your tastes and lifestyle. Meanwhile, these tips can help get you started:⁶

• Eat a variety of foods
• Follow an eating plan with lots of fruits, grains, and vegetables
• Only eat foods low in fat, saturated fat, and cholesterol
• Keep sugar intake low
• If you drink alcoholic beverages, drink only in moderation
• Include physical activity to help lose weight and keep it off

D = Diabetes

One-quarter of heart attacks in the United States happen in people who also have diabetes. About 10.6 million Americans have been diagnosed with diabetes, and the rate is rising for both men and women, in all age and ethnic groups and among all education levels.³ Diabetes also is emerging as a stronger risk factor for heart disease in women than in men. Read more about Women and Heart Disease.

Diabetes means a person's body is unable to efficiently use glucose, the simple sugar that is converted from food. Either the body is unable to produce enough insulin to help glucose get into cells for energy (Type 1 diabetes), or the body's cells aren't able to take up the glucose they need (Type 2 diabetes). Both types increase the risk for angina and CAD, because diabetes alone can worsen the health of the body's vessels. In fact, three-quarters of deaths in people with diabetes are related to CAD.

If you have diabetes with angina and CAD, you'll want to tightly control your blood sugar levels to as close to normal as possible. A healthy diet, regular exercise, and medications can all help. Since many people with diabetes are also overweight, have high blood pressure, and high levels of "bad cholesterol," aggressively treating these risk factors is very important. Your doctor can tell you how to tackle each one effectively. See Nutrition Matters for more.

E = Exercise

One of the main reasons Americans are heavier than ever is lack of exercise. Doing just 30 minutes of a moderate-intensity activity such as walking, climbing stairs, or gardening three to four times a week meets the minimum recommendation for good health. Even though you might think it's hard at first, your body eventually becomes conditioned. You will probably start to feel better and wonder why it took you so long to start.

While you're working your muscles, your heart will start to become more fit as well. You may even be able to do some of the activities that angina prevented you from doing before—more easily, and with less fear of angina attacks.

Before starting any exercise program, check with your doctor to determine the types of exercise that are safe for you. He or she can help determine the types of exercise that are safe for you. Then, speak to a specialist in cardiac rehabilitation about heart-healthy exercise programs. Find more information in Exercise for Heart Health.

E = Education

The more you know about angina and CAD, the more empowered you are to take action. Don't be afraid to ask your doctor questions. Ask your pharmacist for information about your medications. You also can find heart-healthy education programs in your community through your local hospital or American Heart Association chapter.

	The female hormone estrogen may help protect women against heart disease by: Click here.

Sources

1. Gump, B.B., K.A. Matthews, et al. "Illness Representations According to Age and Effects on Health Behaviors Following Coronary Artery Bypass Graft Surgery." Journal of the American Geriatric Society, 2001, Vol. 49, Number 3. 284 - 289. PubMed

2. Statistical Information Staff, U.S. Census Bureau. "Projections of the Total Resident Population by 5-Year Age Groups, and Sex with Special Age Categories: Middle Series, 2001 to 2005." Jan. 13, 2000. http://www.census.gov/population/
projections/nation/summary/np-t3-b.txt and Statistical Information Staff, U.S. Census Bureau. "Projections of the Total Resident Population by 5-Year Age Groups, and Sex with Special Age Categories: Middle Series, 2025 to 2045." Jan. 13, 2000. http://www.census.gov/population/projections/nation/summary/
np-t3-f.txt

3. American Heart Association. 2002 Heart and Stroke Statistical Update. 2001.
http://www.americanheart.org/downloadable/heart
/10148328094661013190990123HS_State_02.pdf

4. "American College of Cardiology/American Heart Association/American College of Physicians/American Society of Internal Medicine Guidelines for the Management of Patients with Chronic Stable Angina." Journal of the American College of Cardiology, 1999, Vol. 33, No. 7. 2092-2197. PubMed

5. National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC). Obesity Epidemic Increases Dramatically in the United States. March 2001.

6. U.S. Department of Agriculture, U.S. Department of Health and Human Services. Dietary Guidelines for Americans. December 1995, Home and Garden Bulletin No. 232. http://www.nal.usda.gov/fnic/dga/dguide95.html