Medical Care |

Medical Care




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As Bupa's Chief Medical Officer i'm delighted to introduce Bupa's ° the information in this program is Living with Coronary not intended to be medical advice, a heart Disease Shared diagnosis of your condition, or a treatment Decision guide.
recommendation. it is intended to help you learn about your symptoms, Making decisions about conditions, and various options so that the steps needed to improve your health you can participate more effectively in and make more informed choices can be making decisions about your health with complicated. this guide offers practical your doctor.
advice to help you better understand your ° not all of the options discussed may be condition and treatment choices, and approporiate for your individual medical support your discussion with your treating situation. talk with your doctor about how the information presented relates to your By keeping better informed you can be specific condition.
more confident that the care you receive is ° Bupa health Dialog does not approve or appropriate to your personal circumstances, authorise care or treatment. if you have priorities and preferences. questions about whether a particular treatment is covered by your private we are grateful to Dr Leo Mahar,1 Director health insurance, please contact your of cardiology at the Royal Adelaide hospital private health insurer. and Professor Mark harris2 and his team3 from the University of nSw who have reviewed For more information
this valuable tool. they have confirmed that it is based upon high quality, evidence based resources, and aligns with current Australian practice and guidelines. we hope this Shared Decision guide will be useful to you and your health professional when you are needing to make decisions together about yours or your family's health and health care. 1 Leo Mahar has been practising cardiology for 30 years. he is currently the Clinical Director of the Cardiovascular Service at the Royal Adelaide hospital and is a former president of the Cardiac Society of Australia and new Zealand.
2 Mark harris is foundation Professor of general Practice and Executive Director of the Centre for Primary health Care and 3 Dr nighat Faruqi, Centre for Primary health Care and Equity at UnSw

AbOut tHIS PROGRAM CREAtING A WRIttEN what is Shared Decision-MakingtM? 6 Communicate openly with your what is a written action plan? healthcare provider Signs of a serious problem or what to do when your how can this program help you? Are the options discussed in this SHARED DECISION-MAKING program appropriate for you? lIvING A HEARt-HEAltHy who made this program? who are the people in Resources that can help you succeed 19 Don't give up, even if you have how can you know if the information in this program QuIttING SMOKING Your doctor can help you quit Be sure this information is right Combining approaches is the most effective way to quit nicotine replacement therapy Prescription medicines what causes a heart attack Keep your doctor in the loop Surgery and angioplasty don't prevent heart attacks Support is just a click away what can help prevent heart attacks 11 tyPES Of HEARt MEDICINE WORKING WItH yOuR DOCtOR Medicines that lower your risk of heart attack and help you live longer 22 talk openly to your doctor Medicines that help manage angina 23 Even small changes can help uSING HEARt MEDICINES Aim for 30 minutes of activity a day Make a medicine list Start with a cardiac rehab program 30 Stick to your medicines Find activities you like Medicines are prescribed for Don't exercise when you have specific reasons Before you stop taking a medicine getting back on track after a Dealing with side effects HEARt MEDICINES: bENEfItS Problems with sexual activity and Medicines are grouped by class Erectile dysfunction medicines are not safe if you take nitrates Classes of medicines and active ingredients EAtING A HEARt-HEAltHy DIEt Angiotensin receptor blockers (ARBs) 27 Fat facts for heart health Anti-clotting medicines include good fats in your diet (including aspirin) Avoid or reduce bad fats Find alternatives to butter Bile acid binding resins Calcium channel blockers Make changes gradually Ezetimibe (Zetia®) Choose foods high in fibre Fibric acid derivatives (fibrates) Alcohol in moderation can benefit nicotinic acid (niacin) GEttING OMEGA-3 fAtty ACIDS Fish that contain omega-3 fatty acids 36 Other food sources of omega-3 bEING MORE ACtIvE health benefits of being active Fish oil supplements Physical activity strengthens Avoid fish oil supplements if you take anti-clotting medicines lOWERING yOuR CHOlEStEROl the "bad" cholesterol—LDL the "good" cholesterol—hDL high levels of triglycerides also Statins lower the risk of Other cholesterol-lowering medicines 39how often should you have a cholesterol test? MANAGING yOuR blOOD PRESSuREUnderstanding blood pressure Medicines that lower Exercise and weight loss lower Avoid sodium in processed foods tips for reducing sodium in your diet WAtCH fOR SIGNS Of DEPRESSION AND StRESSDepression and heart disease Stress and heart disease MEDICAl tERMSfOR MORE INfORMAtION RESEARCH PublICAtIONS ABOUt thiS PROgR AM whAt iS ShARED DECiSiOn-MAKing™? ABOUt ShARED DECiSiOn-MAKing™ PROgRAMS Shared Decision-Making™ is working with your doctors and other healthcare professionals this Shared Decision-Making™ program is to make decisions about your care. in Shared provided through Bupa health Dialog for Decision-Making™, your doctor is the expert in your individual use. the program is designed medicine, but you are the expert on how you to support your participation in an informed feel and what's important to you. together dialogue with your healthcare provider as you you make up a decision-making team. Family, work together to make important decisions friends, and other healthcare providers may about your health. Shared Decision-Making™ also be part of this team. programs are based on medical evidence researched and evaluated by the informed Participating in healthcare decisions helps Medical Decisions Foundation.
ensure that you are getting the care that best meets your needs. to do this, you'll need to the informed Medical Decisions be informed about your condition and the Foundation has been working for over different ways to manage it. You'll also need to two decades to advance evidence-based think about how each management approach shared decision making through research, can affect you so that you can choose what policy, clinical models and patient decision makes the most sense for you.
for more information.
COMMUniCAtE OPEnLY with YOUR hEALthCARE PROviDER hOw CAn thiS PROgRAM hELP YOU? getting good care also requires good the information in this program can help you communication between you and your prepare to talk with your doctor so you are healthcare team. to get the right care, ready to ask questions and discuss how you you and your doctor or other healthcare feel about your healthcare options. then you professional, need to talk about your health and your doctor can talk about which option goals and what you're able to do to protect may be best for you and make a decision or improve your health.
together — a shared decision. You might be wondering, is this information right for me? where did it come from? how can i use it? in this program, you'll find answers to these and other questions you may have.
ARE thE OPtiOnS DiSCUSSED in thiS whO ARE thE PEOPLE in thiS BOOKLEt? PROgRAM APPROPRiAtE FOR YOU? the people interviewed in this program are Some of the options in this booklet may not real people with coronary heart disease who be appropriate for your individual medical agreed to share their stories and were paid situation. talk with your doctor about how the a small fee for their time. the people in this information in this program relates to your program and the program developers do specific health condition. note that neither not stand to profit from recommending any Bupa health Dialog or any of its related particular treatment or self-care strategy. A entities approve or authorise care, treatments range of comments is included to show how or tests. the care, treatments or tests people used different self-care strategies and described in this program may not be covered how those strategies affected them. by your private health insurance. if you have questions about whether your private health hOw CAn YOU KnOw iF thE inFORMAtiOn insurance provides cover in respect of a in thiS PROgRAM iS UP-tO-DAtE? particular treatment or test, speak with your private health insurer or your doctor.
All booklets are reviewed regularly and updated. if you received this program some whO MADE thiS PROgRAM? time ago, or if someone passed it along to you, do not use it. the information may be Bupa health Dialog and the informed Medical out of date. to make sure you have the most Decisions Foundation produced this program recent program, please visi.
booklet. in accordance with the relevant Please use the product number located on requirements of the licence provided to the back of the booklet to determine if you Bupa health Dialog, it has been adapted have the most recent copy. from the original version produced for use in the United States. information regarding Note: italics are used in this program to
suitability for publication in Australia was emphasise key words or to identify medical provided by the University of new South terms. See the Definitions of medical terms wales Centre for Primary health Care and section for a description of medical terms Equity. to ensure the content is appropriate that are in italics.
and acceptable for Australian consumers and health professionals, Australian clinical practice guidelines have been reviewed and the Australian healthcare system, language and culture taken into account.
Bupa health Dialog does not profit from any of the treatments discussed in the program.

BE SURE thiS inFORMAtiOn iS Right FOR YOU! this booklet is intended for people diagnosed with coronary heart disease. this includes people who have had any of the following: ° a heart attack, or more than one heart attack ° episodes of angina (heart-related chest pain) ° coronary artery bypass surgery ° angioplasty (with or without stenting) ° any procedure to restore blood flow to This information is not for …
° pregnant women ° people at high risk of coronary heart disease who have not been diagnosed with the disease; in other words, this program is not for primary prevention of heart disease in those at high risk ° people who have one or more of the following problems, but do not have
coronary heart disease: – heart disorders present since birth (congenital heart defects) – diseases that affect the heart valves– heart failure – a history of stroke – peripheral vascular disease. ABOUt COROnARY hEARt DiSEASE Information in this chapter includes:
° what causes a heart attack? ° Surgery and angioplasty don't prevent ° what can help prevent heart attacks the heart gets its blood supply from blood vessels called coronary arteries. in people with coronary heart disease, cholesterol deposits called plaques form within the walls of these arteries. the medical term for buildup of plaque inside blood vessels is atherosclerosis. Six months ago i was in hospital having heart surgery. now i feel that i've come the coronary arteries supply blood to the heart muscle, a long way. But i feel that every day is allowing the heart to function.
a new beginning. i have to stick to the things that i'm doing because i don't What causes a heart attack?
want to end up in that same situation.
A heart attack happens when the blood flow through a coronary artery is completely blocked. this prevents blood from reaching if plaques get bigger, they narrow the part of the heart muscle. As a result, a arteries and interfere with the blood supply portion of the heart muscle can be damaged. to the heart. this can cause symptoms Scientists used to think that most heart including pressure, pain, or discomfort in attacks happened when a plaque got so big the chest, arm, shoulder, or neck. these that it completely blocked blood flow. it now symptoms are called angina. appears that big plaques cause only about 15 out of 100 heart attacks. Most heart attacks involve smaller plaques that do not completely block an artery. these unstable or vulnerable plaques can break open or rupture. when they do, it can trigger a blood clot that completely blocks the artery, causing a heart attack. this explains why most heart attacks occur in coronary arteries that are only partly what i tell my patients is, ‘i can't predict what will happen tomorrow. blocked by plaque. it also helps explain why But i can certainly reduce the odds that bypass surgery and angioplasty, which only treat large plaques, do not prevent most something bad is happening to your heart.' that's what all of our medicines and all of our recommendations Coronary plaques build up in artery walls
are trying to do—reduce the risk of something happening. Dr Karol Watson, Cardiologist
What can help prevent heart attacks
the best way to prevent future heart attacks
is to:
° quit smoking (if you smoke)° take your medicines° get regular physical activity° eat a heart-healthy diet. Depending on your situation, your doctor may recommend other things you can do, such as losing weight. if a plaque ruptures, it can cause a blood clot to form. if this these measures can help you reduce your clot blocks the flow of blood through a coronary artery it causes a heart attack.
heart attack risk, feel better, and manage other health problems, such as arthritis or diabetes. Surgery and angioplasty don't prevent
Living with heart disease changes your Bypass surgery and angioplasty are used to life. You learn to live life as much as you treat arteries that have large plaques. these can, and not worry about what's going to happen to you. ° help reduce angina in people who have Esther P.
chest pain that is not relieved by medicines ° help people who have severe heart disease in general, bypass surgery and angioplasty do not prevent heart attacks. this is because these procedures are not used to treat arteries with small plaques—the plaques most likely to cause heart attacks.

wORKing with YOUR DOCtOR Information in this chapter includes:
Your doctor is there to work with you, not ° talk openly with your doctor simply tell you what to do. that's why it's important to be clear about what you can ° Even small changes can help and can't do. if you are open with your when doctors treat people with coronary doctor, together you can make a plan that heart disease, they usually recommend that you can follow, rather than an unrealistic plan that will set you up to fail. ° quit smoking (if they smoke) Even small changes can help
° take several medicines You don't have to do everything perfectly–even ° get regular physical activity small changes will help your heart. Focus on what you can do. Don't worry or feel guilty if ° eat a heart-healthy diet. you can't do everything at once, or if things Each of these lifestyle changes can lower a don't go well the first few times you try. person's risk of future heart problems.
if you've been diagnosed recently, it may take some time before you figure out how to i can tell you medically what are the best fit all the changes into your life. You'll have recommendations to reduce your risk many chances to find ways to make healthy of heart attack and to make you live the lifestyle changes that work for you. longest. But only you can tell me what are the best recommendations that work with your lifestyle. As a patient, i need to participate in my own healthcare. i absolutely believe Dr Karol Watson, Cardiologist
that the practitioners and the doctors and the nurses can't do it for me. they can just show me the way, provide the Talk openly to your doctor
prescriptions, do the surgery, but i have Some people have an easy time following to basically take care of me these recommendations. Others have trouble making the changes. Either way, let your doctor know how you're doing. Your doctor can follow your progress and offer suggestions when things aren't going well.

CREAting A wRittEn ACtiOn PLAn CREAtING A WRIttE Information in this chapter includes:
in addition, the plan should include instructions
for what to do if you develop other symptoms
° what is a written action plan? that may indicate a heart attack: ° Signs of a serious problem or heart attack ° what to do when your symptoms change What is a written action plan?
° shortness of breath heart-related chest pain, known as angina, is a common symptom of heart disease. it can also signal a change in your heart disease. ° lightheadedness that's why it's useful for you to monitor your ° discomfort in any part of the upper body. symptoms and have a written action plan. these symptoms can occur instead of, or in A written action plan is a set of written addition to, chest pain. instructions on what to do if you notice a change in your symptoms or develop signs of a What to do when your symptoms change
heart attack. Depending on the symptoms, how severe they
if you don't have a written action plan, work are, and how long they last, your plan might tell
with your doctor to create one. Revisit the plan regularly to make sure it's up to date. ° write down your symptoms and tell your having a plan for dealing with heart symptoms doctor about them during your next visit can help you feel more confident and in ° take extra medicine control. Your family will feel better too, ° call your doctor right away knowing that they can help you follow the plan's instructions. ° call triple zero (000) to ask for an ambulance or seek emergency care. if Signs of a serious problem or heart attack
calling 000 does not work on your mobile phone, try calling 112. Angina that is new, different, or does not
respond to rest and your medicines can signal
if the plan tells you to seek emergency care, a serious problem. the written action plan it might include other steps, such as an should tell you what to do if: instruction to chew an aspirin after you've called for an ambulance. ° you develop angina for the first time talk with your doctor to be sure that your plan ° you start to have angina at a time you never used to have it, such as when you are at rest includes all the information that is right for you. ° your angina is worse or lasts longer than usual ° your angina does not respond to your regular treatment. ShARED DECiSiOn-MAKing Information in this chapter includes:
Shared effort
Shared decision-making also includes shared effort. Part of your doctor's job is
to explain your condition and treatment working with your healthcare providers to choices, and listen carefully to your make decisions about your care that take concerns. Your job is to prepare your your preferences into consideration is called questions, make sure you understand the shared decision-making.
answers, and help your doctor understand there are many reasons for getting involved what is important to you. in your healthcare. Shared decision-making Shared decision-making means that you: ° Educate yourself about the medical
° get more out of conversations with condition(s) you have, as well as any health problems you may be at risk for ° feel more satisfied with your healthcare ° get the type of medical care you want ° Talk clearly and openly with your doctor
about your health and habits. ° avoid treatments or side effects you don't ° Ask questions until you understand
° gain a feeling of control over your life. ° Use your time with your doctor wisely.
Shared goal
° Work with your doctor to make your
Shared decision-making starts with a healthcare decisions. shared goal: keeping you healthy with care
that's right for your needs. to get the right ° Follow through on the care plan you
care, you and your doctor need to talk choose together. if you have trouble about your personal health goals and what following through, be sure to let your you're able to do to protect or improve your doctor know so that you and your doctor health. getting good care requires good can figure out an approach that works communication between you and your doctor.
ED DECISION-MAKING Living A hEARt-hEALthY LiFEStYLE lIvING A HEARt-HE Information in this chapter includes:
these are changes that [people] have ° Resources that can help you succeed to try to put in place for the rest of their ° Don't give up, even if you have a setback lives. You can't expect to be perfect for the next 30 years. we want people this booklet describes the most important to do the best that they can, each day things you can do to protect your heart and that they can, and that's better than not your health. You can reduce your risk of future heart problems if you: Dr Karol Watson, Cardiologist
° quit smoking (if you smoke) ° take your medicines Don't give up, even if you have a setback
° get regular physical activity You can't control everything about coronary heart disease, even if you make all the changes ° eat a heart-healthy diet. described in this booklet. Even people who do when you make big changes in your lifestyle, all the right things may have symptoms worsen, take it slow. You don't have to do everything at have heart attacks, or need heart procedures.
once. instead, make changes gradually.
if this happens to you, it doesn't mean you Resources that can help you succeed
have failed. it simply shows that other factors, such as your age and family history, also play You're not alone in trying to stay as healthy as a role in your heart disease. it's important that possible. if you have trouble making changes you don't give up on living a heart-healthy life. that will help your heart, ask your doctor for Making healthy choices is still the best way support. You can work together to find ways you can help yourself live as well as possible. around the problems. As you start making changes, resources that can help you succeed include: ° your doctor and other healthcare professionals, including cardiac rehabilitation specialists, who can recommend tools and techniques to help you get started and stay on track ° reputable web sites (see the For more information section in the back of this booklet).
Information in this chapter includes:
Your doctor can help you quit
° Your doctor can help you quit if you want to quit smoking, ask your doctor ° Combining approaches is the most effective for advice. he or she can tell you about the different prescription and nonprescription treatments that can help. ° nicotine replacement therapy ° Prescription medicines Your doctor can also help you find support groups or local programs for people who are ° Keep your doctor in the loop ° Support is just a click away Ask for support from your family and friends, if you smoke, the most important thing you too. if your family and friends know that you can do to reduce your risk of heart attack is to want to quit smoking, they can help you stay on track with your treatments. within about a year of quitting smoking, your Combining approaches is the most
risk of heart attack drops by about half. if you effective way to quit
keep smoking, you face much higher risks of heart attacks and other health problems. Up to 30 out of 100 people who use nicotine replacement therapy or prescription medicines while going to counselling or a support group Almost immediately [after quitting] your succeed in quitting. this is the most effective risk is lower of having a heart attack. within two to five years, your risk of a heart attack is back down to that of if you don't use these approaches, or you use someone who never smoked at all. So only one, it may be harder for you to quit it's a very, very important thing to do. if you smoke, quit. Nicotine replacement therapy
Dr Karol Watson, Cardiologist
nicotine replacement therapy comes in several forms that are available over-the-counter including: ° lozenges.
Prescription medicines
Support is just a click away
Other products that can help you quit smoking to learn more about how to quit smoking, visit: include two prescription medicines: or call quitline (13 qUit) (13 7848) this web site and hot line run by the Australian You can use these medicines alone or together government provide information and support with nicotine replacement therapy. for people interested in quitting smoking. Many states also offer local programs or resources to these medicines are safe for people with help people quit smoking. coronary heart disease. however, they're not suitable for everyone and can cause side effects in a small number of people. talk to your doctor to find out if they're right for you. Keep your doctor in the loop
Let your doctor know how your efforts to
quit smoking are going. Knowing that you'll
need to report back to your doctor can be
one more tool you can use to help you stay
on track.
t YPES OF hEARt MEDiCinES Information in this chapter includes:
Medicines that lower your risk of heart
° Medicines that lower your risk of heart attack attack and help you live longer
and help you live longer Medicines that lower your risk of heart attack ° Medicines that help manage angina and help you live longer include: there are two types of medicines used to treat ° statins coronary heart disease: ° angiotensin-converting enzyme (ACE) inhibitors ° medicines that lower your risk of heart attack and help you live longer ° angiotensin receptor blockers (ARBs), if you cannot tolerate ACE inhibitors ° medicines that help manage angina which help prevent and relieve symptoms and help ° beta blockers you feel better. ° anti-clotting medicines, including aspirin (also called anti-platelet medicines). Some medicines lower your risk of heart
attack and help you live longer as well as help
You can lower your risk of heart attack and relieve symptoms. death related to coronary heart disease by: ° 25% to 30% if you take a statin ° 25% or more if you take an ACE inhibitor, a beta blocker, or an anti-clotting medicine. if you take both a statin and another one of the medicines listed, you'll reduce your risks by some amount more, but it won't be by another 25%. You probably won't feel any different when taking these medicines. this doesn't mean they aren't working. instead, these medicines have effects you can't feel. tyPES Of HEARt MEDICINES Medicines that help manage angina
Angina can be treated with a lot of For people with coronary heart disease different medicines. Some things work who have angina (chest pressure, pain, or better for some patients, and other discomfort), especially during physical activity, things work better for other patients. doctors prescribe medicines to prevent and [the doctor has] to adjust the medicine treat these symptoms. so that the individual patient gets the Medicines that help manage angina include: best response.
Dr Adolph Hutter, Cardiologist
° nitrates ° calcium channel blockers. these medicines reduce chest discomfort, and can keep you from being limited by angina. Although studies have not shown that these medicines will prevent heart attacks or help you live longer, they are likely to make you feel better because they reduce your angina. Beta blockers can help your angina symptoms and lower your risk of heart attack and help
you live longer.
USing hEARt MEDiCinES Information in this chapter includes:
Stick to your medicines
° Make a medicines list Many people don't like taking medicines. ° Stick to your medicines Some people find medicines expensive or ° Medicines are prescribed for specific reasons inconvenient, and others don't like to think of ° Before you stop taking a medicine themselves as sick. in addition, medicines can sometimes cause bothersome side effects. ° Dealing with side effects when your doctor prescribes a new medicine, Make a medicines list
be sure you understand the answers to three if you take several medicines, it's a good important questions: idea to make a list to help you keep track of them. Share the list with all your healthcare ° what is the medicine for? professionals so that your doctors can avoid ° how will this medicine help me? giving you medicines that might interact. ° what could happen if i don't take Keep a copy of your medicines list in your purse or wallet, and be sure to keep the list Understanding what's at stake may help current with new and updated prescriptions. convince you that a medicine is worth taking. At a minimum, your medicines list should include: Medicines are prescribed for
specific reasons
° the name of each medicine you take,
Each of the medicines your doctor prescribes including over-the-counter and plays a different role in keeping you as healthy ° the strength (or dose) of the medicine, and
the number of times a day you take it For example, statins lower your cholesterol and reduce your chance of a heart attack in ° a list of your allergies or problems you've
experienced with medicines in the past. if you have recently had a stent placed in a You can obtain a medicines list from the coronary artery, it is important to take an national Prescribing Service.
anti-clotting medicine for the full length of time recommended by your doctor to reduce your chance of blood clots that can form even months after the procedure. Learn about the medicines you are taking and how they work. Knowing what your medicines are for and how they can help will make it easier for you to take them. uSING HEARt MEDICINES Before you stop taking a medicine
Dealing with side effects
Before you stop taking a medicine, tell your Although doctors often have solutions to doctor why. he or she may be able to help. reduce or avoid side effects, it's not always possible to find a medicine that has no side effects. talking with your doctor may help you ° if you can't afford your medicines, there understand and deal with the side effects you may be less expensive versions of the medicines you need. Discuss this with your doctor or pharmacist. You may find that side effects bother you less ° if you can't remember to take three pills a over time, or that you learn to cope with them. day, your doctor might be able to prescribe a Even if a side effect is bothersome, you may long-acting pill you take just once a day. decide to live with it if the medicine can help you live longer. ° if one of the medicines you take causes bothersome side effects, your doctor may be able to lower your dose or prescribe the ACE inhibitor medicine was causing another medicine. a little cough. After talking with a doctor, i recognised that the side effect it's important to look for a solution and talk was not that severe, and i've decided to with your doctor before you stop taking a continue taking the medicine without medicine. there may also be instructions that are important to follow when you stop taking a medicine. hEARt MEDiCinES: BEnEFitS AnD SiDE EFFECtS hEARt MEDiCinES: Information in this chapter includes:
easier to tolerate. if medicine costs are an issue, you might be able to switch from one ° Medicines are grouped by class ACE inhibitor to less expensive version. ° Classes of medicines and active ingredients For each class of medicines, this chapter ° Angiotensin-converting enzyme lists a few common side effects that have (ACE) inhibitors been shown in studies to be clearly related ° Angiotensin receptor blockers (ARBs) to medicines in the class. it also lists some ° Anti-clotting medicines (including aspirin) rare but serious side effects. it is not a complete list of all possible side effects. More ° Beta blockers information about side effects is available in ° Bile acid binding resins the Consumer Medicines information leaflet ° Calcium channel blockers that comes with your medicine. You may experience side effects that are ° Fibric acid derivatives (fibrates) not included in this list. it can be hard to ° nicotinic acid (niacin) know if your symptoms are related to a specific medicine, especially if you are taking several medicines. talk to your doctor if you are concerned.
° Other medicines for angina if you are bothered by a side effect that's this chapter lists common heart medicines not listed in this chapter, it is recommended and discusses some of their benefits and you seek advice from your doctor. he or she may be able to lower your dose or switch you to another medicine. Keep in mind that this is not a complete list
of heart medicines. You may be taking one Classes of medicines and active ingredients
or more medicines that are not listed in this chapter. Most medicines have two names: the active ingredient and the brand name. the active Medicines are grouped by class
ingredient is the name of the chemical Medicines that contain similar chemicals in the medicine that makes it work. the and have similar effects are grouped into a manufacturer of the medicine also gives class. Medicines in the same class may cause it another name — the brand name. there slightly different side effects. are often many brand names given to a single medicine; however, medicines with For example, one class of medicines is the same active ingredient are usually ACE inhibitors. if the side effects of one ACE interchangeable. the medicines in this inhibitor are too bothersome, another in the chapter are organised alphabetically by same class may have side effects that are class names and active ingredient. All and reduce the risk of heart attack and the medicines listed here are approved in heart-related death in people with coronary Australia for managing angina symptoms heart disease, heart failure, or diabetes.
or for lowering the risk of heart attacks and helping you live longer. Possible side effects of ARBs the order does not reflect their importance Common side effects of ARBs include dizziness and headache. ARBs can also cause cough and in treating heart disease. As each medicine may be available under several brand names, angioedema (swelling of the face, tongue, or throat), although they are much less likely to only the active ingredients are listed. cause these symptoms than ACE inhibitors. Angiotensin-converting enzyme
(ACE) inhibitors
ACE inhibitors lower blood pressure and reduce the risk of heart attacks and heart- related deaths in people with coronary heart disease, heart failure, and diabetes. Possible side effects of ACE inhibitors Out of 100 people who take ACE inhibitors, 5 to 10 will develop a dry, hacking cough. in rare cases, ACE inhibitors can cause Anti-clotting medicines (including aspirin)
swelling in the face, tongue, or throat. Medicines like aspirin are anti-clotting this condition, called angioedema, can be medicines (also called anti-platelet serious. it is more likely to occur in people medicines). they prevent blood clots that of Black African or Caribbean heritage than can trigger heart attacks, and they reduce in people of other races. if you develop the risk of heart-related death. People who swelling or difficulty breathing at any have had angioplasty and stents will often time while taking an ACE inhibitor, seek take both aspirin and another anti-clotting immediate medical care. medicine, usually clopidogrel, for some time ACE inhibitors include: after the procedure.
Possible side effects include: ° platelet inhibitors can cause bleeding ° aspirin can also cause stomach pain. Anti-clotting medicines for coronary heart ° trandolapril.
Angiotensin receptor blockers (ARBs)
° ticagrelor.
Angiotensin receptor blockers (ARBs) are also known as angiotensin ii antagonists, angiotensin receptor antagonists, and sartans. they can be an option for people who cannot take ACE inhibitors. Similar to ACE inhibitors, ARBs lower blood pressure hEARt MEDiCinES: BEnEFitS AnD SiDE EFFECtS Beta blockers
Calcium channel blockers
Beta blockers are used for preventing and Calcium channel blockers lower blood pressure treating angina. Beta blockers also reduce the and help relieve angina. they are often prescribed risk of heart attack in people with coronary to people who cannot take beta blockers, but heart disease, lower blood pressure, and may may also be used along with beta blockers. be used to treat irregular heart rhythms. in people who have had a heart attack, beta Possible side effects of calcium blockers reduce the chance of death from channel blockers future heart attacks.
Side effects can include ankle swelling and flushing (a feeling of warmth that comes from Possible side effects of beta blockers blood rushing to the surface of the skin). Beta blockers may cause dizziness and lightheadedness, although these symptoms Calcium channel blockers include: can decrease over time. Some people find that beta blockers make them more tired or less able to participate in sexual activity. People with asthma may also have more wheezing when taking beta blockers.
Beta blockers include: ° verapamil.
Ezetimibe lowers "bad" (LDL) cholesterol, and is
sometimes combined with a statin. it is not known whether it reduces the risk of heart attacks. Possible side effects of ezetimibe Side effects can include stomach upset and diarrhoea.
° propranolol.
Ezetimibe is the only medicine in this class. Bile acid binding resins
Bile acid binding resins help lower "bad"
Fibric acid derivatives (fibrates)
cholesterol (LDL) levels. they are usually Fibrates lower triglycerides and raise "good" used with statins and/or other cholesterol- (hDL) cholesterol. they may also lower "bad" lowering medicines. (LDL) cholesterol. they are usually used for people with very high triglycerides, but Possible side effects of bile acid sometimes they are used with statins and/or other cholesterol-lowering medicines. Side effects can include stomach upset, nausea, bloating, and constipation.
Possible side effects of fibrates Side effects can include nausea, diarrhoea, Bile acid binding resins include: stomach pain, gas, and heartburn.
° cholestyramine Fibrates include: ° colestipol.
° fenofibrate° gemfibrozil.
Nicotinic acid (niacin)
Possible side effects of statins nicotinic acid raises "good" (hDL) cholesterol Side effects can include muscle pain and and lowers "bad" (LDL) cholesterol. it liver damage (rare).
is usually used with statins and/or other cholesterol-lowering medicines. Statins include: Possible side effects of nicotinic acid Side effects can include flushing and Nitrates
° simvastatin.
nitrates improve blood flow to the heart and relieve angina. People can take nitrates Other medicines for angina
regularly or as needed to help relieve chest if you are not able to take the medicines for pain. nitrates can be short acting (sprays or angina described earlier, or if they cause tablets under the tongue) used to relieve or bothersome side effects or do not work well prevent angina immediately before an activity. enough to control your angina, one of the nitrates may also be long acting (patches following medicines may be an option.
or tablets) used to prevent angina in people with more frequent symptoms. if you use a long-acting nitrate, work with your doctor on ivabradine reduces the heart rate and helps a schedule for using it. manage angina symptoms. Side effects can include mild problems with vision, such as Possible side effects of nitrates seeing bright spots (which usually goes away Side effects can include headache, dizziness over time) and dizziness.
or light-headedness, and flushing of the face and neck.
if you take nitrates, do not take medicines to nicorandil improves blood flow to the heart, treat erectile dysfunction. Combining these which helps prevent angina. Side effects two types of medicines can be fatal. can include headache (especially when first starting to take the medicine) and flushing. nitrates include: ° glyceryl-trinitrate (nitroglycerine) Perhexiline helps manage angina symptoms. ° isosorbide dinitrate Due to serious possible side effects, regular ° isosorbide mononitrate.
blood tests are necessary. Serious side effects can include muscle weakness, numbness, and loss of appetite. Other side effects can include Statins lower "bad" (LDL) cholesterol, raise dizziness and unsteadiness when walking.
"good" (hDL) cholesterol, and reduce the risk of heart attack and heart-related death in people with coronary heart disease or diabetes.
BEing MORE ACtivE Information in this chapter includes:
Aim for 30 minutes of activity a day
° health benefits of being active the goal for most people with heart disease is to be active for at least 30 minutes each day. ° Physical activity strengthens the heart ° Aim for 30 minutes of activity a day it's not necessary to be active for 30 minutes at one time. You can divide your activity time into ° Start with a cardiac rehab program shorter periods—for example, three 10-minute
° Find activities you like periods each day. Over time, you can build up
° Don't exercise when you have chest pain to longer periods of continuous activity. ° getting back on track after a heart attack Health benefits of being active
Exercise can be hard if you're not used Physical activity offers many health benefits. to it. it's a matter of fitting it in your life, and making it work for you. My husband Being physically active can: and i talked it over and we bought a treadmill and an exercise bike. And i ° lower your blood pressure now do my exercising at home.
° improve your cholesterol levels Esther P.
° help keep your weight within a healthy range ° relieve stress Start with a cardiac rehab program
° ward off depression. Cardiac rehabilitation is a program of Physical activity strengthens the heart
exercise, education, and support for people Your heart is a muscle—anything that makes with heart problems. the heart pump faster and more forcefully Experts recommend that people attend a will strengthen it, just as lifting weights cardiac rehabilitation program if they've strengthens your arms. having a stronger had a heart attack or a procedure such as heart lowers your risk of heart attack and may angioplasty or bypass surgery. help protect your heart from damage if you do have a heart attack. A great help for me was at the suggestion of my doctor to join the
cardiac rehab program at my local
hospital. And there i learned the proper
way to exercise.
Esther P.
Cardiac rehab programs usually last a few Don't exercise when you have chest pain
weeks or months. During this time, nurses and Avoid activity when you have chest pain. if other healthcare professionals: your angina gets worse during an activity, ° help you choose an activity plan that works slow down. if your angina doesn't get better when you slow down, stop what you are doing and rest. ° monitor your heart to make sure the activities you're doing are safe for you if the symptoms don't get better even after ° help you overcome fears you may have you stop, or if your angina becomes severe, about being active. you may need to go to the emergency room. Most hospitals that care for people with For more information on dealing with a change heart problems also offer cardiac rehab in symptoms or a possible heart attack, see the programs. they are available in many Creating a Written Action Plan chapter.
public and private hospitals and through community health services in all Australian Getting back on track after a heart attack
States and territories. the costs of these After a heart attack or an invasive procedure programs can vary. Contact the cardiac to treat coronary artery disease, you may rehab program for more information.
feel a little uncertain. You might be fearful of another heart attack or of needing more Find activities you like
surgery. Or, you might be coping with if you choose an activity you find boring discomfort. these concerns can prevent you or unpleasant, you'll probably have trouble from doing everyday activities. sticking with it. the key to getting enough to get back to your normal activities, it's physical activity is finding something you like important to follow the advice of your doctor and other healthcare professionals. this can be anything that gets your body it is also helpful to interact with other people moving—walking, gardening, dancing, or and do things that are meaningful to you. something else that's fun and gets you going back to work or volunteering are ways moving. You don't need to go to the gym or to stay involved with others and do things that break a sweat to benefit from activity. are important to you. whatever activity you choose, start with a if this is hard for you to do, talk to your doctor few minutes at a time and gradually build or other healthcare professional. he or she up to more time as your body gets used to will likely have some ideas and suggestions to the activity. Spend a few minutes to gently help you become active and engaged in your warm up before you start, and a few minutes life or work again. to cool down afterwards. this will give your heart a chance to adjust to your body's changing demands.
Information in this chapter includes:
if you are having problems with sexual ° Problems with sexual activity and sex drive activity, talk with your doctor about ° Erectile dysfunction medicines are not safe if it. Sexual activity is a very important you take nitrates activity for most people. You should be able to talk to your doctor about sexual Sexual activity is safe for most people with activity or sexual problems. You and heart disease, even if it's not as easy as it once your husband, or you and your wife, was. You need to start slow and give your should be able to talk about it. heart time to adjust. Dr Adolph Hutter, Cardiologist
when it comes to your heart, sexual activity isn't much different from any other physical Erectile dysfunction medicines are not safe
activity. Don't have sex if you feel ill or have if you take nitrates
chest pain. if you've recently had a heart attack or heart procedure, wait until your doctor Some people with coronary heart disease has given you the go-ahead before resuming use prescription medicines to treat erection sexual activity. problems. these medicines include: Problems with sexual activity and sex drive
People with heart disease sometimes have a decreased sex drive, problems with erections, ° vardenafil.
or difficulty with orgasm. if you take nitrates, these medicines are Atherosclerosis, or the buildup of plaque inside not safe for you. Combining nitrates with blood vessels, can affect arteries and blood medicines to treat erection problems can be flow in other parts of the body besides the dangerous or even fatal. heart. when the blood vessels in the pelvic area are affected, it can cause erection problems. worry or fear about heart problems can also reduce a person's sex drive or make it difficult to have an erection. Some of the medicines used to treat coronary heart disease may also cause sexual problems. For example, some men say they have problems with erections when they start taking beta blockers. it's not always clear whether these problems are related to the medicine or to the disease itself. EAting A hEARt–hEALthY DiEt Information in this chapter includes:
i've learned about good fat and bad ° Fat facts for heart health fat. i eat a lot of salmon, nuts, grains . ° include good fats in your diet baking with substitute eggs and baking with apple sauce instead of oil. i am ° Avoid or reduce bad fats trying to incorporate the good fats into ° Find alternatives to butter and margarine ° Make changes gradually Esther P.
° Choose foods high in fibre ° Alcohol in moderation can benefit the heart Avoid or reduce bad fats
Bad fats include saturated fats and trans
Being overweight or obese increases the fats. these fats raise "bad" cholesterol, lower chance of having a heart attack in the future. "good" cholesterol, and increase the risk of Managing your weight by eating a healthy diet and limiting the amount of food you eat reduces that risk. Saturated fat has a bigger impact on cholesterol than any other part of your diet. Fat facts for heart health
Scientists used to think that all fats were bad
Avoid these sources of saturated or trans fats: for you. it turns out that some types of fat are ° high-fat dairy products such as butter, good for heart health. cheese, whole and 2% milk, sour cream and ice cream Pay attention to the kind of fats you eat. Once you learn to tell the difference between good ° fatty meats such as sausage and and bad fats, do your best to replace bad fats in your diet with good fats. Include good fats in your diet
° coconut, palm, and palm kernel oils good fats include polyunsaturated and ° fried foods such as doughnuts, french fries and deep-fried fast foods monounsaturated fats. these are found in: ° foods with partially hydrogenated oils (trans ° vegetable oils such as canola, corn, olive, fat) in their ingredients, such as crackers, peanut, safflower, soybean, and sunflower oils biscuits, pies, pastries and many snack foods. ° soft margarines that do not have trans fats how much saturated fat can you have? ° fatty fish such as salmon, trout, and herring Less than 7% of your total kilojoule intake ° nuts such as walnuts, almonds, peanuts, should come from saturated fat. For most cashew nuts, pecans and hazelnuts people, this means between 10 and 15 grams ° avocados.
of saturated fat per day, depending on how many kilojoules you need. Read food labels carefully ° avoid butter and margarine Food labels list the number of grams of ° eat more soluble fibre saturated fat in one serving. Serving amounts ° eat fish or other foods that contain omega-3 are often small, so it's a good idea to read the fatty acids.
label carefully. Figure out how many servings you plan to have, and multiply the amount of Choose foods high in fibre
saturated fat in one serving by the number of Foods high in fibre offer many health servings you're planning to have. benefits. they slow the rate at which food travels through the digestive system, which Find alternatives to butter and margarine
helps you feel full longer. Soluble fibre also instead of butter or margarine, use spreads helps lower cholesterol levels. that contain plant stanol or sterol esters Foods high in soluble fibre include: such as Pro-activ® and Logicol®. it's possible that these products can help lower "bad" cholesterol. ° fruits (not fruit juices, because they don't usually have the fibre content of Make changes gradually
the fruit itself) Don't try to eliminate all your favourite high-fat foods at once. instead, replace ° beans (legumes, peas, lentils) one food at a time. here are some examples. ° oatmeal and oat bran ° whole-grain cereals, breads and pastas. ° if you love cheeseburgers, try switching to grilled chicken burgers with regular cheese. Aim for 25 to 30 grams of fibre a day. Food when you've adjusted to that change, you labels show the number of grams of fibre each can try a chicken burger without cheese. serving contains. ° if you have a favourite salad dressing, replace Alcohol in moderation can benefit the heart
it with a dressing that contains a healthy oil. if you drink alcohol, you'll be happy to know ° if you normally have meat sauce with your pasta, switch to marinara sauce. that for many people, moderate amounts of alcohol benefit the heart. On the other hand, if you have heart failure or it's like getting used to drinking no-fat milk. high triglycerides, doctors usually recommend the first couple of times it's rough, but that you avoid alcohol. after a while you can't stand the real thing. So i'm still adjusting …. But i am feeling a Moderation is important—drinking too much lot of short-term immediate benefits. can contribute to other health problems. if you choose to drink alcohol, drink only a moderate amount—no more than two standard drinks per day. One standard drink contains 10 grams of tips for improving your diet alcohol and is equivalent to: the foods you eat—and the foods you don't eat—can affect your heart and your ° 285mL (one middy or pot) of full-strength beer (4.8% alcohol content) these diet changes can benefit your heart: ° 100mL of wine (13.5% alcohol content)° 30mL of spirits plus mixer ° limit saturated fat (40% alcohol content).
° reduce or eliminate trans fats ° replace bad fats with polyunsaturated and monounsaturated fats and oils gEtting OMEgA–3 FAtt Y ACiDS Information in this chapter includes:
Plant-based sources include: ° Fish that contain omega-3 fatty acids ° Other food sources of omega-3 fatty acids ° flaxseeds (and flaxseed oil) ° Fish oil supplements ° Avoid fish oil supplements if you take anti-clotting medicines these sources of omega-3 fatty acids have Omega-3 fatty acids are a type of unsaturated not been as well studied as fish and fish fat found in some fish, nuts, and oils. Diets rich oil supplements. in omega-3 fatty acids seem to reduce the risk of dying from certain types of heart attacks. Fish oil supplements
People who don't eat fish or other
Fish that contain omega-3 fatty acids
omega-3-rich foods sometimes take fish oil Eating two or three servings a week of fish that supplements. in one study of people who contain omega-3 fatty acids has been strongly took about 1,000 milligrams per day, fish linked to a lower risk of death in people who oil supplements helped prevent certain have had heart attacks. heart-related deaths. Fish that are rich in omega-3 fatty Many omega-3 fatty acid supplements are available over the counter, and one product is available by prescription. Avoid fish oil supplements if you take
anti-clotting medicines
Fish oil supplements thin the blood. taking fish oil or other omega-3 the supplements ° mackerel.
with anti-clotting medicines (such as warfarin, Other food sources of omega-3 fatty acids
clopidogrel, or aspirin) may increase the risk of if you don't want to eat fish, you may get bleeding so discuss this with your doctor first. similar benefits from including plant-based sources of omega-3 fatty acids in your diet. GEttING OMEGA–3 fAtty ACIDS LOwERing YOUR ChOLEStEROL Information in this chapter includes:
Coronary artery disease results from ° the "bad" cholesterol—LDL a buildup of plaques in the coronary ° the "good" cholesterol—hDL arteries. the plaques build up with bad cholesterol, the LDL cholesterol. there's ° high levels of triglycerides also increase risk a buildup there, and there's a little wall ° Statins lower the risk of heart attack over the buildup, and that wall becomes ° Other cholesterol-lowering medicines inflamed. the more inflamed it is, the more unstable it is, the more likely it is ° how often should you have a cholesterol test? to rupture. that can cause heart attacks. high cholesterol doesn't cause symptoms, Dr Adolph Hutter, Cardiologist
but it does increase your risk of having a heart attack. Lowering your LDL cholesterol level reduces Cholesterol levels are lowered most effectively this risk. People with heart disease who with medicine. Lifestyle changes can also have cholesterol levels in the normal range help lower cholesterol, along with their other benefit from lowering their LDL cholesterol important benefits for the heart.
Your cholesterol is measured in a blood test called a cholesterol profile or lipid profile. in general, the treatment goal for most the test measures: people is to reduce LDL cholesterol by 30% to 40%. that gives you most of the benefit, ° LDL (low-density lipoprotein) cholesterol
no matter what your LDL is to start with.
° VLDL (very low-density lipoprotein)
the goal for most people with coronary heart disease is an LDL level of <1.8 mmol/L. ° HDL (high-density lipoprotein) cholesterol
° Total cholesterol (including LDL, vLDL
The "good" cholesterol—HDL
hDL cholesterol helps remove LDL ° Triglycerides (another type of fat found in
cholesterol from the bloodstream. As a result, a high level of hDL cholesterol lowers your risk of heart problems. The "bad" cholesterol—LDL
Because LDL cholesterol contributes to the
buildup of unstable plaque, a high LDL level the goal for most people with coronary heart increases a person's risk of heart attack, stroke, disease is an hDL level of more than 1 mmol/L.
and death from heart-related causes. High levels of triglycerides also increase risk if you're experiencing side effects you can't
tolerate, your doctor can work with you to high levels of triglycerides also increase your risk of heart-related problems. A normal find a dose that's comfortable. You'll still benefit from taking the statin at a lower dose. triglyceride level is less than 2.0 mmol/L. if cost is an issue, talk to your doctor or Statins lower the risk of heart attack
pharmacist to see if cheaper versions of Statins help lower the risks related to high your medicine are available. LDL cholesterol. Finally, remember that high cholesterol if you have heart disease, your doctor has doesn't cause symptoms. Be sure to keep probably recommended a statin to lower taking your statins even if you feel well. your LDL level—even if your LDL is already in the normal range. For people with heart Other cholesterol-lowering medicines
disease, taking a statin can reduce their risk in addition to statins, several other kinds of of a heart attack by up to 30%. medicines lower cholesterol. these medicines if you've ever had a heart attack or have are sometimes prescribed along with a statin been hospitalised for heart-related chest or as an alternative for people who can't pain, your doctor will likely suggest that you take statins (because of liver disease or an take a statin to lower your cholesterol. if you inability to tolerate the side effects). were already taking a statin, your doctor Other cholesterol-lowering medicines include: might prescribe a stronger statin or a higher dose to lower your LDL even more and help ° bile acid binding resins you avoid a future heart attack. ° fibric acid derivatives (fibrates) Possible side effects of statins ° nicotinic acid (niacin) As the dose or strength of a statin increases, ° ezetimibe.
side effects become more common and these medicines don't lower LDL cholesterol more serious. You and your doctor may as well as statins, but they offer some need to weigh the benefits of higher doses other advantages. For example, fibric acid against the potential for bothersome or derivatives are better at lowering triglyceride harmful side effects. levels, and nicotinic acid is especially good at Common side effects include: increasing hDL cholesterol. ° muscle aches or tenderness How often should you have a cholesterol test?
° digestive upset. Most people with heart disease should have their cholesterol levels checked once a year. Rare side effects include: if you recently started taking a medicine ° muscle inflammation (myositis) to lower your cholesterol, your doctor may check your cholesterol more often (for ° liver damage. example, every 2 to 3 months). Statins work only if you keep taking them Most people who have been in hospital Always talk with your doctor before you because of a heart-related problem should stop taking a statin. have their cholesterol level checked 4 to 6 weeks after they go home from hospital. MAnAging YOUR BLOOD PRESSURE Information in this chapter includes:
Diastolic pressure: the bottom (or second)
number reflects the pressure inside your ° Understanding blood pressure arteries when your heart is relaxed and filling with blood. ° Medicines that lower blood pressure ° Exercise and weight loss lower Medicines that lower blood pressure
Medicines that lower blood pressure include: ° Avoid sodium in processed foods ° angiotensin-converting enzyme ° tips for reducing sodium in your diet in general, the higher your blood pressure, ° alpha blockers the higher your risk of heart attack, heart ° angiotensin receptor blockers (ARBs) failure, stroke, and kidney damage. if you ° calcium antagonists also have diabetes, high blood pressure is particularly harmful. ° beta blockers.
You can reduce these risks by lowering your blood pressure to: these medicines lower your risks and your blood pressure, but they are not a cure. they Less than 130/80 mmHg if you have coronary
only work if you keep taking them. heart disease or diabetes.
this means you should continue to take your Understanding blood pressure measurements medicines even if you feel well. Like high
Your doctor will probably check your
cholesterol, high blood pressure doesn't blood pressure at every visit. You can also usually cause symptoms. check your blood pressure with equipment Some of the medicines listed here (as well designed for use at home. as calcium channel blockers and diuretics) Blood pressure measurements consist have other benefits. that's why doctors of two numbers: systolic pressure and sometimes prescribe them for people with diastolic pressure. heart disease, diabetes, or heart failure who may have normal blood pressure. Systolic pressure: the top (or first) number
reflects the pressure inside your arteries if you have heart disease, you may find when your heart is contracting to pump that one or more of the medicines you take blood out to the rest of your body. for other conditions may also lower your blood pressure. Exercise and weight loss lower
° cured meats, such as ham, bacon, or sausage blood pressure
° cold cuts or lunch meats, including hot dogs Regular exercise and weight loss are effective ways to lower blood pressure. ° soy sauce, ketchup, and other condiments thirty minutes of daily exercise can lower ° smoked, cured, or pickled foods blood pressure as much as some blood pressure medicines. But for most people with ° fast food and restaurant meals coronary heart disease, daily exercise won't completely replace blood pressure medicines. ° gravies and sauces if you're overweight, weight loss can also ° snack foods, such as crackers, popcorn or lower blood pressure. Losing about 10 kilograms can lower systolic blood pressure Tips for reducing sodium in your diet
by 5 to 20 points. it can be difficult to switch to a low-sodium Reducing alcohol can help reduce diet. Unfortunately, many high-sodium foods are more convenient and less expensive than Excessive drinking increases your risk of high lower-sodium choices. blood pressure and heart disease. Australian here are some tips to help you reduce sodium: guidelines recommend healthy men and women should avoid drinking more than two ° Buy fresh, fresh-frozen, or canned standard drinks per day and have no more vegetables labelled "no-salt-added" or than four drinks on any single occasion. "without added salt." if you have high blood pressure and you ° Use fresh poultry, fish, and lean meat rather have established ChD, you may need to than canned or processed versions. reduce your alcohol intake further. talk to ° Use herbs, spices, and salt-free seasoning in your doctor about what level of drinking is cooking and at the table. appropriate for you and strategies for how you might reach your goal.
° Buy no-salt-added, low-salt, or low-sodium versions of foods when available, including Avoid sodium in processed foods
low-sodium salad dressings, peanut butter, and condiments. to help lower blood pressure, experts recommend eating less than 2,300 ° Choose breakfast cereals that are low milligrams of sodium (salt) each day. if you have heart failure, you may be advised to eat ° Avoid frozen dinners, pizza, canned soups even less sodium. or broths, and packaged rice, pasta, and meat dishes. the average person eats about twice as much sodium as recommended. Most of the ° if you need to use canned foods, such as sodium we eat does not come from table canned tuna or beans, discard the liquid salt. it comes from processed foods that and rinse the foods to remove some of have salt in them, including: ° Remove salt from recipes whenever ° canned and dried soups possible. Rice, pasta, and hot cereals can ° canned vegetables and vegetable juices be cooked with little or no salt. ° packaged foods, such as boxed potato, pasta, and rice dishes ° microwave meals or frozen meals wAtCh FOR SignS OF DEPRESSiOn AnD StRESS Information in this chapter includes:
Stress increases the production of ° Depression and heart disease ° Stress and heart disease ° affect the heart and blood vessels ° increase blood pressure Depression and heart disease
People with coronary heart disease sometimes ° make the heart work harder get depressed, especially if they recently had ° affect cholesterol levels. a heart attack, bypass surgery, or have been in hospital with heart-related chest pain. Although studies do not show a strong if you had a heart attack or heart operation, connection between stress levels and heart it's understandable that you might feel down problems, people sometimes feel better if they for a few weeks. if these feelings last longer, take steps to reduce stress. consider seeking help. Depression can make it harder to recover from heart surgery, and may People are different in how stress affects them put you at a higher risk of future heart attacks. and in the activities that help them cope with stress. For most people, relaxation techniques Signs of depression Over the past two weeks:
i'm taking more vacations now than i ° have you felt down, depressed, or hopeless? ever have. i find that relieves a lot of the stress . i enjoy what i do and i'm going to ° have you had little interest or pleasure in continue doing it as long as i'm healthy, and i intend to continue to be healthy. if you answered yes to either of these
questions, it is important to talk with your doctor. he or she can assess you more carefully to see if you have depression and help you An easy relaxation technique decide whether to consider treatment. this is an easy technique that you can practice several times a day. treating depression 1. Sit or lie with a pillow in the small of
Depression can be treated with medicines, counselling, or a combination of the two. Many antidepressant medicines are safe for people 2. Inhale slowly into your abdomen, letting
with coronary heart disease, and most people your belly rise with your breath. with depression can be successfully treated. 3. Exhale slowly, and let your belly relax.
Stress and heart disease
4. Repeat until you've completed Stress does not cause coronary heart disease, 10 deep breaths.
but it can affect the body in ways that make heart disease harder to manage. DEFinitiOnS OF MEDiCAL tERMS Active ingredient: the name of the chemical in Beta blockers: Medicines that prevent angina
the medicine that makes it work.
and reduce the risk of heart attack in people with coronary heart disease. in people who Angina: Pain, discomfort, or pressure in the
have had a heart attack, beta blockers reduce chest, arms, shoulder, or jaw, often during the chance of death from future heart attacks. exercise or emotional stress. Angina is a they lower blood pressure and may also be symptom of coronary heart disease. it is taken to treat irregular heart rhythms.
caused by reduced blood flow to part of the heart muscle. Blood clot: A cluster of blood cells that form
a clump. Blood clots normally help stop blood Angioplasty: A procedure in which a thin tube loss due to injury. A clot that occurs inside a
called a catheter is inserted into an artery in coronary artery can block the flow of blood the arm or leg and threaded into a narrowed and cause a heart attack. coronary artery. the catheter carries a deflated balloon, which is inflated within the Blood pressure: the pressure of blood
narrowed artery to compress plaque. tiny against the walls of the arteries. Systolic blood mesh tubes called stents are often placed in pressure is the amount of pressure when the the arteries to help keep them open longer. heart pumps. Diastolic blood pressure is the Stents may be plain or coated with medicines, amount of pressure when the heart is at rest, called drug-eluting stents.
Angiotensin converting enzyme (ACE)
Brand name: the name given by a
inhibitors: Medicines that lower blood
pharmaceutical company to their medicine.
pressure and have other effects that help reduce the risk of heart attack and heart- Bypass surgery: See coronary artery
related death in people with coronary heart disease. they are also important for people Cardiac rehabilitation: A program of
with heart failure or diabetes. exercise, education, and support for people Angiotensin receptor blockers (ARBs):
with heart problems. Medicines that lower blood pressure, and may Cholesterol: A type of fat found in the
have benefits similar to ACE inhibitors. they bloodstream. high cholesterol levels can are also important for people with heart failure contribute to the buildup of plaque and increase the risk of coronary heart disease. Anti-clotting medicines: Medicines that
Cholesterol profile: A report on the levels of
help prevent blood clots and heart attacks. various types of cholesterol and triglycerides in Some anti-clotting medicines, such as the blood. Also called lipid profile. aspirin and clopidogrel, prevent clots by interfering with platelets. these medicines Coronary artery bypass surgery: An operation
are also called anti-platelet medicines. that takes healthy blood vessels from the leg they are used by some people with coronary or chest to reroute blood flow around portions heart disease, including those who have of the coronary arteries that are blocked or stents. See platelets. Other anti-clotting narrowed by plaque. medicines, such as warfarin prevent clots Diabetes: A chronic disease that causes blood
by interfering with certain proteins. these glucose levels to become too high. Diabetes medicines may be used by people with other increases the risk of coronary heart disease. conditions, such as atrial fibrillation.
Atherosclerosis: the buildup of plaque inside
HDL (high-density lipoprotein) cholesterol:
Saturated fats: A type of dietary fat the body
the type of cholesterol that helps remove LDL converts into cholesterol. (or bad) cholesterol from the bloodstream. Side effect: A secondary, usually unwanted
Also known as "good" cholesterol. effect or symptom caused by a medicine Heart attack: Damage to the heart that
happens when blood flow to a portion of the Statins: Medicines that lower LDL (bad)
heart muscle is completely blocked by plaque or a blood clot. Also known as myocardial cholesterol and raise hDL (good) cholesterol. infarction or Mi. it is one of the causes of acute Statins reduce the risk of heart attack and coronary syndrome.
heart-related death in people with coronary heart disease. Statins are also important for LDL (low-density lipoprotein) cholesterol:
people with diabetes and for some people with the type of cholesterol that contributes to the buildup of plaques and increases the risk of heart attack. Also known as "bad" cholesterol. Stent: A tiny metal tube that is used to prop
open a coronary artery. Lipids: Any of several blood fats including hDL
and LDL cholesterol, vLDL, and triglycerides. Stress: Any emotional or physical factor that
Omega-3 fatty acids: heart-healthy fats found
in certain types of fish, nuts, and vegetable oils. Trans fats: A type of dietary fat, found in
partially hydrogenated oils, that increases Plaque: A buildup of cholesterol, calcium, and
LDL cholesterol levels. Also known as other substances within the walls of an artery. trans-unsaturated fatty acids. when plaque builds up in the arteries that supply blood to the heart, it is called coronary Triglycerides: A type of fat found in the
heart disease. Plaque can also build up in other arteries, such as those in the legs, pelvis, Unsaturated fats: A type of dietary fat that can
help improve cholesterol levels. Platelets: Particles in the blood that are
Unstable plaque: A type of plaque that has a
involved in forming blood clots. Some tendency to break open or rupture, which can medicines act on platelets to help prevent trigger a blood clot and cause a heart attack. blood clots developing in coronary arteries that can cause heart attacks. FOR MORE inFORMAtiOn The Heart Foundation, Australia
the heart Foundation provides print, video, the beyondblue web site contains and web-based materials on all aspects of information on depression and related coronary heart disease, including an action conditions, including checklists to help plan for recognising and responding to a you figure out if you have the symptoms heart attack. the heart Foundation tick of depression. it also includes directories program can help you choose healthier of healthcare professionals who work with options for many foods. the Action Plan people who have depression, as well as on the web site can help you recognise the services available on the web.
warning signs of a heart attack.
American Heart Association
National Prescribing Service (NPS)
the American heart Association provides nPS provides practical tools and print, video, and web-based materials on all information about coronary heart disease, aspects of coronary heart disease. including medicines and tests. the nPS Medicine name Finder can help you learn to identify your prescription medicines National Heart, Lung, and Blood Institute
by the active ingredient and brand name. the active ingredient is the chemical in the nhLBi web site provides information on the medicine that makes it work. nPS also coronary heart disease, including high blood hosts the nPS Medicines Line for expert pressure, cholesterol, exercise, heart-healthy medicines information. eating, and weight control. Therapeutic Goods Administration (TGA)
Check with your doctor for resources other
than those listed here.
the tgA is Australia's regulatory authority for medicines and other therapeutic goods such as stents. the tgA website provides general and safety information about products used to treat coronary heart disease. Quitnow: Australian Government
Department of Health and Ageing
the quitnow website has information on
reasons to quit smoking and ways to quit
smoking. People wanting to quit smoking
can call quitline, a confidential telephone
service providing information, support, and
advice for quitting.
RESEARCh PUBLiCAtiOnS this booklet was written using the most Fiore MC, Bailey WC, Cohen SJ, et al.
up-to-date medical and scientific research. treating tobacco Use and Dependence. the research is described in the articles listed quick Reference guide for Clinicians. below. Each listing includes the authors of the Rockville, MD: U.S. Department of health and article, the article title, the journal in which it human Services, Public health Service; 2000. was published, and the publication year. if you Available online at are interested in reading any of these articles, tobacco/tobaqrg.pdf. your doctor or librarian may be able to help you get a copy.
Freemantle N, Cleland J, Young P, Mason
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Package ‘NRAIA' Title Data sets from Nonlinear Regression Analysis and Its Applications'' Maintainer Douglas Bates <[email protected]> Author R port by Douglas Bates <[email protected]> Description Datasets from Bates and Watts (1988) Nonlinear Regression Analysis and Its Applications'' with sample code. Depends lattice, stats License GPL (>= 2)


British Journal of Rheumatology 1998;37:274–281 UNCOOKED, LACTOBACILLI-RICH, VEGAN FOOD AND RHEUMATOID M. T. NENONEN, T. A. HELVE,* A.-L. RAUMA and O. O. HA ¨ NNINEN Department of Physiology, University of Kuopio and *Kivela¨ Hospital, Helsinki, Finland We tested the effects of an uncooked vegan diet, rich in lactobacilli, in rheumatoid patients randomized into diet and controlgroups. The intervention group experienced subjective relief of rheumatic symptoms during intervention. A return to anomnivorous diet aggravated symptoms. Half of the patients experienced adverse effects (nausea, diarrhoea) during the diet andstopped the experiment prematurely. Indicators of rheumatic disease activity did not differ statistically between groups. Thepositive subjective effect experienced by the patients was not discernible in the more objective measures of disease activity( Health Assessment Questionnaire, duration of morning stiffness, pain at rest and pain on movement). However, a compositeindex showed a higher number of patients with 3–5 improved disease activity measures in the intervention group. Stepwiseregression analysis associated a decrease in the disease activity (measured as change in the Disease Activity Score, DAS ) withlactobacilli-rich and chlorophyll-rich drinks, increase in fibre intake, and no need for gold, methotrexate or steroid medication(R2 = 0.48, P = 0.02). The results showed that an uncooked vegan diet, rich in lactobacilli, decreased subjective symptoms ofrheumatoid arthritis. Large amounts of living lactobacilli consumed daily may also have positive effects on objective measuresof rheumatoid arthritis.