One month after their attacks, more than 90 percent of the participants said they were taking all of the medications on the discharge list. In contrast, less than 50 percent were exercising as instructed, had stopped smoking, or were losing weight. Just one-third had enrolled in a cardiac rehabilitation program, one of the best things you can do to prevent a second heart attack.

Ask survivors to describe the impact of their heart attacks, and a common theme is that it was a "wake-up call." Unfortunately, many people seem to hit the snooze alarm once the danger has passed. Some ignore advice that can protect the heart; others gradually let it fall by the wayside.

In a study of nearly 2,500 heart attack survivors across the country, researchers looked at the so-called discharge instructions given to these men and women when they left the hospital. These instructions should cover everything from who to call in case of an emergency to what long-term steps to take to prevent another heart attack.

One month after their attacks, more than 90 percent of the participants said they were taking all of the medications on the discharge list. In contrast, less than 50 percent were exercising as instructed, had stopped smoking, or were losing weight. Just one-third had enrolled in a cardiac rehabilitation program, one of the best things you can do to prevent a second heart attack.

Does following discharge instructions make a difference? Participants who followed fewer than half of their discharge instructions were 68 percent more likely to have chest pain with activity or stress (angina) a year after their heart attacks than people who followed all or most of the instructions (American Heart Journal, March 2009). Angina is a sign of active coronary artery disease.

PREVENTING THE NEXT HEART ATTACK

On a personal level, a heart attack is an all-too-real sign that you aren't going to live forever. Healthwise, it is an outward sign that you're living with atherosclerosis. This disease stiffens and narrows arteries throughout the body. In addition to setting off a heart attack, it can cause a stroke, damage the kidneys, and lead to problems in the legs.

Stiff, cholesterol-clogged arteries make your heart work harder. So does the scar tissue that forms in the part of the heart damaged by a heart attack. Keeping atherosclerosis at bay and strengthening the heart muscle will help you feel better, ward off a future heart attack or stroke, and lessen the chances that the damage will evolve into heart failure.

There's no magic wand you, or your doctor, can wave to make atherosclerosis go away. But you can stop it from getting worse, and maybe even reverse it, by exercising more, shifting to a healthier diet, losing weight if needed, quitting smoking, reducing stress, and taking medications as needed.

POWER OF PREVENTION

Simple steps started before middle age could demote heart disease, stroke, and other cardiovascular diseases from the leading cause of death in America to a distant runner-up. Two long-term studies suggest that most cases of high blood pressure and heart failure could be avoided if people made better choices.

In a 14-year study of female nurses, six factors emerged as important ways to keep blood pressure in check: a healthy diet, daily exercise, a healthy body weight, moderate alcohol intake (no more than one drink a day), sparing use of over-the-counter painkillers, and taking folic acid every day. The researchers estimated that if all women adopted these six practices, almost 80 percent of cases of high blood pressure would be avoided.

A 22-year study of male physicians found an equally large reduction in heart failure, a common consequence of high blood pressure or heart attack, with maintaining a healthy body weight, not smoking, regular exercise, moderate alcohol intake (one to two drinks a day), having cereal for breakfast, and eating plenty of fruits and vegetables.

GETTING HELP

For some people, a heart attack is a true wake-up call. Take Jim Lehrer, the host of PBS's "NewsHour." In a cover story in the American Heart Association's Heart Insight magazine, Lehrer credits his 1983 heart attack with changing the way he lived. He stopped smoking, started exercising and eating better, and took time to relax.

Many people head the other direction. Let's face it, a heart attack can be a frightening life changer. It affects your work, your play, your relationships with family and friends. A twinge of chest pain can rev up worries that you're having another heart attack. And it can be extremely difficult trying to make major changes in diet, exercise, weight, smoking, and other choices that are meant to protect you against another heart attack. It's no wonder that some heart attack survivors slide into the fog of depression.

One reason why cardiac rehabilitation is such a good undertaking is that it helps you cope with all the aspects of life after a heart attack. It offers support, education, encouragement, connections with others who are going through the same thing you are, and help with exercise and diet. Think of it as one-stop shopping for healing the heart. - Harvard Heart Letter

(c) 2009 Harvard Heart Letter