• Cardiovascular Disease

    Reducing Your Risk

    Reducing the risk of cardiovascular disease takes two basic forms—lifestyle modification and medications. Both are commonly used simultaneously.

    • Lifestyle Modification —Changing health behaviors is, by far, the most challenging way to reduce risk, but it is also the most effective and long-lasting. In fact, successfully modifying your lifestyle can eliminate a risk factor altogether in some cases. The greatest benefit would be gained by:

    • Not Smoking Cigarette smoking kills more Americans than any other health behavior. It won’t be easy, but if you quit smoking, you will halve your chances of developing heart disease.
    • Eating Healthfully Eating healthfully can contribute to lower cholesterol and blood pressure levels, and can reduce the risk of type 2 diabetes by helping to maintain an appropriate weight. To follow a heart-healthy diet, you should:
      • Limit intake of total fat, saturated fat, trans fats, and cholesterol
      • Eat five or more servings of a variety of fruits and vegetables per day
      heart-healthy diet
      • Choose six or more servings per day of a variety of grain products, especially whole grains; reduce your intake of refined carbohydrates
      • Limit intake of foods that are high in calories, but low in nutrition
      • Eat six grams or less of salt per day
    • Exercising Regularly Regular exercise can help you lose weight, lower cholesterol and blood pressure levels, and reduce you risk of type 2 diabetes. Aim for at least 30 minutes of moderate-intensity activity most (preferably all) days of the week.
    • Drink in Moderation Light to moderate alcohol intake has been shown to reduce the risk of heart disease. However, there is not enough evidence to suggest that you should start drinking if you do not already in order to protect your heart. Heavy drinking actually increases your risk of hypertension and heart disease. Women should limit themselves to one alcoholic drink per day and men to two.
    • Maintain a Healthy Weight Maintaining a healthy weight can help you decrease your risk of developing type 2 diabetes and hypertension. First, use the body mass index (BMI) to get a sense of your target weight, keeping in mind the BMI is an imperfect gauge. To lose weight you need to burn more calories than you take in. Maintaining your weight requires a balance between calorie consumption and expenditure. While dieting alone will help you lose weight in the short run, it is difficult to keep the weight off without a combination of diet and regular exercise.

    • Medications —While medications are convenient to take, they suffer from two major drawbacks: they cause adverse effects and they tend to compensate for, rather than solve, the underlying problem. For these reasons, medications are usually prescribed only when lifestyle modifications have proved ineffective by themselves.

      Antihypertensives —A doctor will prescribe an antihypertensive to reduce high blood pressure and to lower overall cardiovascular disease risk. Antihypertensives work in several ways: by ridding the body of excess fluids, by slowing down the pace of the heart, by dilating blood vessels or by blocking the effects of chemicals that cause them to constrict. You may have to go through a trial period with different medications to find out which work best for you. Examples include:
      • Alpha 1-selective adrenoceptor blockers, such as doxazosin and prazosin
      • Angiotensin-converting enzyme (ACE) inhibitors, such as enalapril and lisinopril
      • Angiotensin receptor blockers, such as candesartan and losartan
      • Beta blockers , such as atenolol and pindolol
      • Calcium-channel blockers, such as nicardipine and nisoldipine
      • Centrally acting sympathoplegic drugs, such as clonidine and guanfacine
      • Diuretics, such as acetazolamide and hydrochlorothiazide
      • Ganglion-blocking agents, such as mecamylamine
      • Postganglionic sympathetic nerve terminal blockers, such as guanethidine and reserpine
      • Vasodilators, such as diazoxide and hydralazine

      Antiplatelets —Antiplatelets interfere with the formation of blood clots that can lead to heart attack, stroke or gangrene.
      • Low-dose aspirin is most commonly prescribed antiplatelet agent used to reduce the risk of CVD. Other more expensive drugs (ex. clopidogrel) are often used in patients already diagnosed with CVD.

      Cholesterol-lowering Agents —Based on your overall cardiovascular risk and your success with dietary changes, your doctor may recommend drugs to lower cholesterol. Some drugs are better than others at lowering high LDL or total cholesterol, raising low levels of HDL cholesterol, or lowering triglyceride levels. Examples include:
      • Bile-acid sequestrants, such as cholestyramine and colestipol
      • Fibrates, such as gemfibrozil and fenofibrate
      • Nicotinic acid drugs, such as niacin
      • Statins (HMG-CoA Reductase Inhibitors), such as pravastatin and simvastatin
      • Drugs that reduce cholesterol absorption, such as ezetimibe.

      Hypoglycemic Agents —Many diabetics can control their blood glucose levels through a combination of healthy eating, exercise, and weight loss. If these lifestyle changes don’t work, diabetes medications may be in order. Depending on the agent, anti-diabetic medications may work by stimulating your pancreas to make more insulin, reducing the amount of glucose made by your liver, slowing the absorption of dietary carbohydrates (a major source of blood glucose), or increasing the sensitivity of cells to insulin. Examples include:
      • Sulfonylureas such as glipizide, glimepiride, glyburide
      • Biguanides such as metformin
      • Alpha-glucosidase inhibitors such as acarbose, miglitol
      • Thiazolidinediones such as pioglitazone, rosiglitazone
      • Meglitinides such as repaglinide, nateglinide
      • Dipeptidyl peptidase-4 inhibitors such as sitagliptin
      • If your pancreas no longer makes insulin at all, you will have to resort to insulin injections


    American Heart Association http://www.americanheart.org

    Texas Heart Institute Heart Information Center http://texasheart.org/HIC/his.cfm


    Health Canada http://www.hc-sc.gc.ca/index%5Fe.html

    Heart and Stroke Foundation http://ww2.heartandstroke.ca/


    American Heart Association. Risk factors and coronary heart disease. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4726 . Accessed January 8, 2003.

    American Heart Association. Taking medication for high blood pressure. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=2141 . Accessed January 8, 2003.

    Braunstein JB. Do you know your risk of cardiovascular disease? Heartinfo.org website. Available at: http://www.Heartinfo.org . Accessed January 8, 2003.

    Merck website. Available at: http://www.merck.com/ .

    National Heart, Lung, and Blood Institute. The DASH Diet .

    National Institute of Diabetes & Digestive & Kidney Disease. Medicines for people with Diabetes. National Institute of Diabetes & Digestive & Kidney Disease website. Available at: http://ww.niddk.nih.gov/health/diabetes/pubs/med/index.htm . Accessed January 10, 2003.

    Nordenberg T. An aspirin a day—just another cliché? FDA Consumer Magazine. FDA website. Available at: http://www.fda.gov/fdac/features/1999/299%5Fasp.html. Accessed January 16, 2003.

    Prevent a first stroke. JAMA . 1999;281:1146.

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