A coronary event is any medical situation that involves the arteries or blood vessels of the heart such as a heart attack. This event is life-changing, and as you recover and move forward, it’s crucial to have a solid grasp on your cholesterol management. Lowering your cholesterol can reduce your risk of future cardiac events and improve your overall cardiovascular health.
Your doctor will go over your goals and lifestyle changes that are best for you based on your health history and cardiac function.
Goal Cholesterol Levels
In general, doctors recommend a total cholesterol level of about 150 mg/dL, with LDL, or “bad,” cholesterol at or below 100 mg/dL. These levels can lower your risk of heart disease and stroke.
But after a coronary event, you’re at a higher risk of having another cardiovascular event and should aim for lower cholesterol numbers than you did before the event.
Your doctor may tell you to lower your LDL, or “bad,” cholesterol levels by at least 50%. Or your doctor may tell you to aim for an LDL cholesterol of 70 mg/dL or below. But some doctors may target your “bad,” or LDL, cholesterol level below 55 mg/dL. This level is ideal for people with a history of heart issues because LDL levels below 55 mg/dL lowers the risk of another coronary event.
Prescription Medications
Once you’ve had a coronary event, medications often become an important tool in your cholesterol-lowering toolbox. If high cholesterol runs in your family, lifestyle changes may not be enough to lower your cholesterol and your risk of a coronary event can be higher. You may need to take one or more medications to lower your levels.
Statins, which are medications you take once a day by mouth, work by reducing the cholesterol your liver makes and by helping your liver get rid of extra cholesterol already present in your bloodstream.
Doctors often prescribe statins for people who haven’t had a coronary event but who live with high levels of “bad” cholesterol or high blood pressure, even after trying lifestyle changes. Taking a statin can reduce your risk of having another coronary event in the future but once you start taking a statin, you typically take it for life.
Statins don’t work for everyone, and just like any medication, they can come with some risks. If you’ve already tried statins at the highest dose and still deal with high cholesterol, your doctor may prescribe another cholesterol-lowering medication.
Ezetimibe (Zetia). This medication can help lower cholesterol by another 13% to 20%. Ezetimibe is taken in addition to your statin medication.
PCSK9 inhibitors. Added to statins, alirocumab (Praluent) and evolocumab (Repatha) are two PCSK9 inhibitors that can help lower cholesterol levels by another 54% to 74%.
Bile acid sequestrants. These medicines block bile acid in your stomach. Your liver then uses cholesterol to make more bile acid, and this lowers your LDL cholesterol.
ACL inhibitors. These medications slow down the production of cholesterol in your liver. ACL inhibitors can lower cholesterol up to 50% in combination with ezetimibe.
Fibrates. Fibrates lower fats in the blood, especially triglycerides. But these medicines can also help raise your “good,” or HDL, cholesterol levels.
Inclisiran (Leqvio). Inclisiran is a small interfering RNA (siRNA) medication that works to “interfere” or turn off PCSK9 in the liver, removing higher amounts of “bad” LDL cholesterol from your bloodstream. You can take inclisiran as an injection under your skin along with your other cholesterol-lowering medications.
These medications work in different ways to lower cholesterol by aiding the liver in getting rid of extra cholesterol. If you’ve had a coronary event and still have high cholesterol after trying cholesterol-lowering medicines, your doctor may talk to you about other options.
Cardiac Rehab: Strengthen Your Circulatory System
Cardiac rehabilitation, sometimes called “cardiac rehab,” is a recovery and strength-building program for people who’ve had a coronary event or a heart issue like a heart attack. A team of experts help you learn new ways to eat, how to safely exercise, and even offer emotional support. You’ll also learn more about heart health and how to make healthy changes that work for you.
You may start cardiac rehab while you’re still in the hospital after your coronary event. But once you’re discharged, you’ll move to outpatient cardiac rehab. And when you’ve made enough progress, you’ll be able to do exercises at home.
Most insurance companies, including Medicare, cover 12 weeks or three sessions a week for a total of 36 sessions of cardiac rehab. Cardiac rehab can lower your risk for heart attack by 30%, for stroke by 60%, and cardiovascular death by 58%.
Gentle and Consistent Exercise
Cardiac rehab is an important step toward getting back to physical activity, which is a crucial part of cholesterol management and overall heart health. Regular exercise helps you return to normal activities sooner and lowers your chance of having another coronary event. Doctors recommend you get 30 minutes of exercise five times a week.
Once your doctor clears you for exercise and you know what’s safe to do and what to avoid.
Stop if you have pain. If the activity you’re doing causes any pain, dizziness, or shortness of breath, stop.
Carry your phone. Carry your phone with you so you can contact someone in case you don’t feel OK.
Set aside time. Time your exercise well so you have enough energy. Avoid exercise right after eating.
Get plenty of fluids. Drink plenty of water before and after you exercise.
Walking is an ideal exercise. It gives you an aerobic workout and you can go at the pace that works for you. Even a 10-minute walk three times a day can make a big difference in lowering cholesterol and helping your heart.
Diet Dos and Don’ts
Your liver makes cholesterol, but you also get it from your diet. Your eating patterns can play a major role in your cholesterol levels. Adopt these habits for lowering cholesterol and maintaining healthy levels.
Be choosy about fats. The best way to lower your cholesterol is to eat less saturated fat and limit it to less than 6% of your daily calories. Try to avoid trans fat completely.
Foods high in saturated and trans fats include red meat and dairy products made with whole milk. For more heart-healthy choices, go for skim milk, low-fat or fat-free dairy products, and healthy cooking oils such as vegetable oil. Limit the fried foods you eat, too.
Pick heart-health proteins. There are many non-meat sources of protein like beans, nuts, and seeds. Plant- and dairy-based protein can lower both “bad,” or LDL, and total cholesterol.
If you do include animal protein in your diet, stick to these heart-healthy eating habits:
- Choose white meat or fish and poultry.
- Avoid red meat.
- If you eat red meat, choose only lean pieces like round, loin, or sirloin instead of prime cuts.
- Pick cuts with very little visible fat.
- Remove any fat before cooking.
- Avoid processed meats like bacon, ham, sausage, or hot dogs.
Up your fiber content. Soluble fiber can slow down the absorption of cholesterol into your bloodstream. You can get it from whole grains, beans, and fruits and veggies, such as oatmeal, kidney beans, Brussels sprouts, apples, and pears.
Limit alcohol. Drinking too much alcohol can raise the triglyceride levels in your blood. Triglycerides are fats in your blood that at high levels can combine with high levels of cholesterol and lead to fatty buildup in your artery walls.
Cap your drinking to one a day, or better yet, skip the booze completely.
Other Risk Reduction Tips
Don’t smoke. Smoking raises “bad” LDL cholesterol and triglycerides. It also lowers levels of “good” HDL cholesterol. The good news is that your doctor can help you find programs to help you quit smoking. Your doctor also has tools to help ease you through the process of quitting.
Reduce your stress. High levels of stress over time can tax your heart, triggering hormonal changes that raise cholesterol levels and your risk for another coronary event. Pinpoint causes of stress in your life and work to change those patterns. Relaxation techniques can help you lower your stress. Try yoga, deep breathing exercises, tai chi, or meditation.
Be strict about your treatment schedule. Follow your doctor’s plan when it comes to medication, office appointments, tests, and lifestyle changes. Be an active participant in your health and engage with your doctor. Ask questions about your cholesterol targets and levels. Taking control of your cholesterol numbers is a great way to self-advocate and live a heart-healthy lifestyle.
Show Sources
Photo Credit: Westend61/Getty Images
SOURCES:
American Heart Association: “What Your Cholesterol Levels Mean,” “Prevention and Treatment of High Cholesterol (Hyperlipidemia),” “Is Drinking Alcohol Part of a Healthy Lifestyle?”
Yale Medicine: “9 Things You May Not Know About Cholesterol.”
MillionHearts: “The Scoop on Statins: What Do You Need to Know?”
British Heart Foundation: “Statins—Your Questions Answered.”
Medical Clinics of North America: “Atherosclerotic disease: pathogenesis & approaches to management.”
Cleveland Clinic: “Antihyperlipidemic,” “Cardiac Rehab,” “High Cholesterol.”
Mayo Clinic: “Top 5 Lifestyle Changes to Improve Your Cholesterol.”
Heart Foundation: “Physical Activity After a Heart Attack.”
American Lung Association: “8 Ways Your Health Improves When You Quit Smoking.”
Journal of Cardiovascular Pharmacology and Therapeutics: “A comprehensive review of PCSK9 inhibitors.”
Genomic Education Programme, National Health Services (NHS): “RNAi: A New Approach to Combat Cholesterol.”
MedlinePlus: “Inclisiran Injection,” "Bile Acid Sequestrants for Cholesterol."
