After a Coronary Event, Practice Healthy Behaviors for Life

A Mediterranean diet includes:

• Fruits and vegetables
• Whole grains
• Beans
• Nuts and seeds
• Healthy fats like olive oil
• Dairy products, eggs, fish, and poultry

People who eat a Mediterranean diet may be less likely to have major coronary events like heart attack or stroke. “A Mediterranean diet is rich in monounsaturated fat and omega-3 fatty acids, both of which improve cholesterol and overall heart health,” points out Oen-Hsiao. It’s also low in saturated fat, which can harm your heart.

Support a Healthy Cholesterol

If you’ve already had a coronary event and have high cholesterol, it’s very important to get your levels under control. “It’s a major risk factor for coronary events,” explains Goldberg. Luckily, medications can help support healthy cholesterol levels.

While you are still in the hospital, your doctors will likely put you on high doses of cholesterol lowering medications known as statins, says Goldberg.

Statins keep your body from making too much cholesterol. They also help your liver get rid of the cholesterol in your bloodstream. They can lower your LDL, or “bad,” cholesterol by 25% to 55%. 

Statins can also lower your triglycerides which are another type of fat in your blood that can raise your risk for another coronary event when the levels get too high. 

“We also think [statins] reduce inflammation, which can contribute to heart attack and stroke,” says Goldberg. 

Most people on statins feel fine. Occasionally though, you may notice muscle pains or aches. Most of the time, you can avoid this if you switch statins, advises Goldberg. 

A few studies suggest that taking a coenzyme Q10 supplement can help relieve these aches and pains. Always ask your doctor before starting any new medicines and see if they think it is an option for you. 

Sometimes, statins aren’t enough to lower your cholesterol levels. In these cases, your doctor may recommend that you take a second drug. One option is ezetimibe (Zetia), says Goldberg. It can lower your LDL cholesterol levels by another 20% to 25% and has few side effects. 

If you’ve had a serious coronary event like a heart attack, combining ezetimibe with a statin drug can reduce your risk for a second one. Other options include fibrates, which lower your triglycerides and raise your “good” HDL cholesterol, or bile acid sequesterants, which can lower cholesterol levels. 

Another option is an adenosine triphosphate-citrate lyase (ACL) inhibitor or bempedoic acid (Nexletol). It’s a relatively new cholesterol drug that’s given along with another cholesterol-lowering drug like a statin, or ezetimibe. 

If none of these drugs lower your cholesterol enough, your doctor may recommend that you try a type of drug called a PCSK9 inhibitor. There are two common PCSK9 inhibitors:

• Alirocumab (Praluent)
• Evolocumab (Repatha) 

They are given as an injection every two to four weeks. Inclisiran is also an option given as an injection. Inclisiran is a small interfering RNA (siRNA) medication that works by blocking or “interfering” with PCSK9 in the liver to remove more cholesterol from your blood. 

But since injections are very expensive, they are limited to people who still have high LDL cholesterol, even on other medicines like statins, says Goldberg.

Coping With Emotional Challenges After Heart Disease

Many people can experience depression or anxiety after a coronary event. “I’ve even seen patients develop symptoms of posttraumatic stress disorder,” says Master.  

After a coronary event, about 1 in 5 people can experience depression, and almost 1 in 3 get anxiety. But either condition can raise your risk for a second coronary event. And if the depression is persistent after a coronary, your risk of having a second one is almost three times higher than people without it.

One way to help buffer effects of depression and anxiety is to have strong social support, says Oen-Hsiao. While friends and family can help, one of the best places to find support is at cardiac rehabilitation, she adds. 

“You’ll be surrounded by other people who have gone through very similar experiences,” Oen-Hsiao stresses. “You can talk to them, provide each other encouragement, and offer tips to one another to find out what’s been helpful as far as lifestyle changes.”

Many cardiac rehabilitation centers offer support groups, notes Oen-Hsiao. They may also provide one-on-one counseling, if you need it. But if you feel depressed or anxious, it’s very important to also let your cardiologist or primary care provider know. 

“Both conditions raise your risk of another coronary event because they raise your stress levels,” says Master. “But they can also make you less likely to want to follow other healthy lifestyle practices, like eating the right foods and engaging in regular exercise.”

Other Heart-Healthy Strategies

Exercise can lower your risk of having another coronary event. “It’s not just good for your heart, but it also lowers stress levels, which are associated with heart disease,” says Oen-Hsiao. 

Exercise can also raise your HDL, or “good,” cholesterol. “This is important because cholesterol medications like statins only lower your LDL cholesterol,” explains Goldberg. “There’s no medication to raise HDL levels.”

If you weren’t active before your coronary event, then walking is the best place to start, advises Goldberg. Regular walking can lower your total cholesterol levels by about six points and lower your “bad” LDL cholesterol by about seven points.

Do resistance training, too. Regular strength training, at least twice a week, not only lowers your cholesterol but can also lower your risk of heart disease by about 17%. Yoga is another good option, since it helps to increase mindfulness and lower stress levels, says Master.

It’s also important to get enough sleep. “Sleep and stress are interconnected. Stress can affect sleep, and lack of sleep leads to more stress,” says Goldberg. If you’re tired, you’ll have less healthy lifestyle motivation. Try to get 7 to 8 hours of sleep a night. 

During the day, Goldberg recommends that you use an app like Calm or Smiling Mind for a few minutes anytime you feel frazzled. They have relaxation techniques such as deep breathing exercises to help calm you down.