When you have a coronary event like a heart attack or stroke, it’s really important to take care of your heart health. Because your risk of having another coronary event is higher than for other people, the best way to lower your chances of having another cardiac event is to control your cholesterol levels.
Getting your cholesterol to a healthy level can help you feel better, live longer, and stay out of the hospital. Treating your cholesterol works to lower your chance of heart attack, stroke, and death. That’s why it’s key to stay on top of your cholesterol and follow your treatment plan.
Your Cholesterol Goals
Normally, it’s a good idea for your cholesterol levels to be kept in check.
- LDL, or “bad,” cholesterol lower than 100 mg/dL
- HDL, or “good,” cholesterol higher than 40 mg/dL for men or 50 mg/dL for women
But when you’ve had a cardiac event, your doctor will probably want to target much lower numbers. You’ll likely be aiming for an LDL, cholesterol level lower than 70 mg/dL.
The most common way to lower “bad” cholesterol is through medication called a statin, which works by lowering the amount of cholesterol your liver makes. That can help slow down the amount of cholesterol that builds up in your arteries, lowering your chance of a heart attack or stroke.
When you’ve had a cardiac event, doctors recommend high-intensity statin therapy. This therapy can lower your LDL cholesterol by 50% or more. In some cases, your doctors might add another cholesterol-lowering medication and suggest you make lifestyle changes like a heart-healthy diet and exercise more often.
Sticking to Your Treatment Plan
Cholesterol treatment isn’t like taking medicine to help your headache get better. It’s not easy to tell that it’s working until you get your cholesterol checked. But don’t be tempted to skip your medication or forgo your exercise and diet changes just because you feel fine.
Follow your treatment plan exactly as you discussed with your doctor. Never stop taking your medicine without talking to your health care team first. Don’t lower or increase the amount of medicine.
Keep Track of Side Effects
Like all drugs, statins can cause side effects. But they are usually safe with a low chance of causing problems. Keep track of how you feel when taking your medication so you can tell your doctor if you are having issues.
There’s a slight chance that statins can cause headaches, sleep problems, or stomach issues. Be sure to tell your health care team if you feel muscle aches. Your doctor will also keep an eye out for changes in blood sugar.
If side effects don’t go away or they get worse, your doctor might suggest a change in dosage or change how often you take the drug. In some cases, you may be asked to try a different medicine completely.
See Your Doctor Regularly
Your health care team will want to see you at least every year. You’ll get blood tests to check your cholesterol levels, and you’ll meet with your doctor to talk about how you’re feeling and any side effects or changes in symptoms.
To get the most out of those visits, be sure to come prepared with questions or concerns. Tell your doctor about any side effects if you have any. Also tell your doctor about any goals as far as healthy eating, exercise, or other lifestyle changes that can help keep your cholesterol at good levels.
Learn about the medications you are taking and ask how they can help. Be sure to tell your doctor about all the medicines and supplements you’re taking and ask if they’re OK to combine with your cholesterol drugs.
Ask if there are any foods you should avoid. For example, grapefruit can change how your liver breaks down some statins, so you may need to skip it.
In between visits, keep track of your weight and blood pressure. You can get a blood pressure monitor online or in many stores. These monitors are easy to use and can track changes in your blood pressure for you. And with a simple bathroom scale, any changes in weight can be tracked and written down, too.
Be sure to let your doctor know about any changes to your weight or blood pressure. Your doctor may want to see you more often, depending on your symptoms and overall health.
Signs You Might Need to Change Your Treatment Plan
Whenever you feel your symptoms changing, reach out to your doctor. They may want to see you for an exam or run tests. Your doctor might make changes to your treatment plan—maybe adding or taking away a drug or changing the dosage.
Some of the most important changes in your symptoms to look for include:
- Major changes in weight
- Any changes in side effects
- Chest pain
- Shortness of breath
After a serious coronary event like a heart attack or stroke, if your cholesterol is still high after statin therapy or if statin therapy is not working, your doctor may suggest trying another medication. Your doctor may recommend adding ezetimibe to your statin treatment because this medicine can lower your risk of having another coronary event.
Another option includes fibrates, which can raise your “good” HDL cholesterol and lower your triglycerides or blood fat. You can also try bile acid-binding drugs or bile acid sequesterants that can lower LDL cholesterol levels.
Your doctor may also suggest ACL inhibitors or bempedoic acid (Nexletol), which can be added to your statin or ezetimibe medication. If these medication options do not lower your cholesterol or help you reach your cholesterol goal, your doctor may recommend PCSK9 inhibitors like alirocumab (Praluent) or evolocumab (Repatha).
Your doctor may also recommend adding inclisiran (Lequio) after your coronary event. This small interfering RNA (siRNA) medicine blocks or “interferes” with the PCSK9 gene in your liver to remove more cholesterol from your blood. Inclisiran helps lower “bad” LDL cholesterol and can be added to other cholesterol-lowering medications.
Stick to Healthy Lifestyle Changes
Although cholesterol-lowering medication will be the main focus of your treatment plan, it’s still smart to make healthy lifestyle changes.
Eat a heart-healthy diet. Avoid saturated fats found in red meat and full-fat dairy items. Instead, opt for whole grains, fruits and vegetables, and unsaturated fats found in vegetable oils, nuts, and avocados.
Get 2 1/2 hours of weekly exercise. You don’t have to get it all at once. Stay active with a few minutes of brisk walking, swimming, or even yard work—it all adds up when you do it every day.
Reach your target weight. Work on losing extra weight so that you reach your targeted goal.
Quit smoking and avoid alcohol. If you smoke, then quit. If you drink, cut back on how much alcohol you have.
Get a good night’s rest. Try to get 7 to 9 hours of sleep every night.
Lower your stress levels. Find healthy ways like meditation or yoga to manage your stress levels.
Support From Family and Friends
Dealing with any kind of health issue can be tough when you deal with it alone. That’s why it helps to have a support system with family and friends to help you.
If you’re changing your diet or exercise routine, ask your family to eat healthy or get moving along with you. You can cook together, go walking, or find better ways to manage stress as a team. Having support can also help you manage stress and that can lower your risk of more serious heart problems.
Show Sources
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SOURCES:
Yale Medicine: “9 Things You May Not Know About Cholesterol.”
CDC: “Treat and Manage High Cholesterol.”
Journal of the American Heart Association: “Lipid testing and statin dosing after acute myocardial infarction.”
Roger S. Blumenthal, MD, FACC, the Kenneth Jay Pollin Professor of Cardiology; director, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore.
Aaron Troy, MD, MPH, cardiovascular disease fellow, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore.
National Heart, Lung, and Blood Institute: “Blood Cholesterol: Treatment,” “Therapeutic Lifestyle Changes (TLC) to Lower Cholesterol,” “Living With High Cholesterol.”
Harvard Health Publishing: “Statins: Types, Uses, Side Effects, and Alternatives,” “Understanding Statin Intensity.”
Mayo Clinic: “Statin Side Effects: Weigh the Benefits and Risks.”
American College of Cardiology: “2018 Guideline on the Management of Blood Cholesterol.”
American Heart Association: “My LDL Cholesterol Treatment Plan,” “Prevention and Treatment of High Cholesterol (Hyperlipidemia),” “Cholesterol Medications.”
University of Rochester Medical Center: “Stress Can Increase Your Risk for Heart Disease.”
