Further Management
Lifestyle Changes
Patients with angina should adopt a low-fat diet, establish an appropriate exercise regimen, and lose weight, if necessary. The supervision of a physician is critical when making these fundamental lifestyle changes.
A 1% reduction in LDL ("bad") cholesterol results in a 2% reduction of cardiovascular events. The National Cholesterol Education Program (NCEP) suggests that, to lower LDL cholesterol, the diet should contain:
- 20–25% calories from fat
- < 7% of calories from saturated fat
- < 200 mg of cholesterol per day
People who are inactive and sedentary are more likely to develop coronary artery disease than those who exercise regularly. Regular exercise can improve levels of "good" (HDL) cholesterol in the blood. A 1% elevation in HDL cholesterol results in a 2–3% reduction of cardiovascular events.
Similarly, regular exercise can modestly reduce high blood pressure. A 1% reduction in blood pressure results in a 4% reduction of cardiovascular events, including heart attack. Anyone with heart disease should discuss appropriate exercise programs with their physician before increasing their physical activity. Exercise also helps control diabetes, a significant risk factor for the development of heart disease.
Patients who stop smoking can dramatically decrease the risk for heart disease and angina. Within 1 year of quitting, the chances of having a heart attack decrease by about 50%; within 5 to 10 years of quitting, the risk becomes the same as that of a nonsmoker the same age.
There is no easy way to stop smoking. Some people quit "cold turkey." Others get help from support groups, behavior modification, relaxation techniques, hypnosis, or acupuncture. One recent study suggests that the combination of bupropion (Zyban®), an oral medication, plus a nicotine replacement system helps some people.
In 2009, the U.S. Food and Drug Administration (FDA) issued a black box warning for the smoking cessation drugs bupropion (Zyban®) and varenicline (Chatix®). According to the FDA, these medications carry an increased risk for mental health side effects, such as depression, behavioral changes (e.g., hostility, irritability), and suicidal thoughts. Patients who use these drugs to stop smoking should be closely monitored while taking them and after the medication is discontinued.
Physician-developed and -monitored.
Original Date of Publication: 02 Jul 2000
Reviewed by: Stanley J. Swierzewski, III, M.D.
Last Reviewed: 01 Dec 2007
Angina, Further Management reprinted with permission from cardiologychannel.com
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