ST AGNES CARDIOVASCULAR PROGRAM

People with established cardiovascular disease are at high risk of having further episodes of related illnesses, such as heart attack or stroke, and developing complications of their existing illness e.g. heart failure.

There is overwhelming evidence that aggressive treatment of risk factors in such people will greatly reduce  the progression of their disease and the likelihood of further episodes or complications. Indeed, vigorous treatment may result in the reduction of existing vascular disease. Some factors such as age, gender and family history cannot be altered - however the following factors can, and should be treated :

SMOKING is the worst thing that you can do - no-one with cardiovascular disease should smoke.

CHOLESTEROL. Regardless of pre-existing cholesterol levels, reducing your cholesterol will reduce the risk of disease progression. Patients with coronary artery disease who lower their LDL cholesterol, reduce their risk of another cardiovascular event by 25% to 30% over the next 5 years.

Recent studies show that patients who commence a statin cholesterol lowering medication at the time of an acute "heart attack" have a 16% reduction in coronary events and a 50% reduction in stroke over the next 16 weeks.

CHOLESTEROL GOALS

Total Cholesterol                 Less than 4 mm

LDL (low density,"bad") Cholesterol     Less than 2 mm - ideally 1.8 mm or less

HDL (high density, "good") Cholesterol         More than 1.0 mm

Triglycerides                       Less than 1.5  mm

LDL cholesterol can be lowered by diet and medication - particularly "statins".

HDL may be improved by exercise.

Consideration should be given to all patients being on a statin from the time of diagnosis.

BLOOD PRESSURE. Lowering blood pressure reduces the risk of cardiovascular events - the greater the reduction the greater the benefit. Lower blood pressure goals are particularly important for patients with coronary artery disease, diabetes, heart failure, left ventricular enlargement or kidney or eye damage ( nephropathy or retinopathy) - "high risk" patients.

    Blood Pressure Goals

        BP                    140/90 or less

        High Risk group    135/85 or less

WEIGHT CONTROL - maintaining an ideal body weight.

   Weight Goal      Body Mass Index (BMI) of less than 27 - ideal 25

EXERCISE  Regular, moderate exercise improves outcomes. Walking for 20 minutes at least 4 or 5 times per week is recommended.

ALCOHOL  No more than 2 standard alcohol drinks per day should be consumed.

DIABETES should be checked for annually.

OTHER MEASURES TO CONSIDER

ANTI-PLATELET MEDICATION. Low dose aspirin or other anti-platelet medication to "thin the blood" should be considered in most patients.

ACE INHIBITORS (a group of medications used to treat blood pressure and heart failure) have been shown to reduce the risk of heart attack in patients with cardiovascular disease by at least 20% - this is independent of their blood pressure lowering effect. Consideration should be given to patients taking an ACE medication if they have cardiovascular disease - this is particularly the case if they have diabetes, hypertension or left ventricular enlargement.