How to prevent the progression of heart disease

Getting diagnosed with coronary heart disease can be overwhelming but there’s a lot you can do to prevent your condition from progressing. This is clinically called secondary prevention and focuses on managing your risk factors.

Who needs secondary prevention?

You will need secondary prevention if you have been diagnosed with coronary heart disease, have had a heart attack, developed angina or developed other heart conditions, such as atrial fibrillation.  

What does secondary prevention of heart disease involve?

Preventing the progression of coronary heart disease focuses on seven main approaches. 

1. Regular exercise

A sedentary lifestyle can worsen your condition. It is, therefore, important to engage in regular exercise. 

The NHS recommends around 150 minutes of moderate-intensity exercise spread across the week. Moderate-intensity exercise will raise your heart rate and make you sweat. A sign that you’re exercising at this level is the inability to sing but the ability to talk while exercising. 

2. A heart-healthy diet

This means reducing the amount of food you eat that is high in salt, sugar, starch and highly processed carbohydrates (eg refined white flour, white rice, white pasta). This includes reducing how much ultra-processed foods you eat (eg ham, ice cream, instant soups, sausages, crisps, ready meals). 

Instead, replace these unhealthy foods with fresh fruits and vegetables, whole grains and oily fish (eg salmon, sardines), and use olive oil instead of butter. 

You can still eat red meat and cheese, which are high-calorie, high-fat foods but do so in moderation. 

3. Quit smoking

Smoking increases your risk of a variety of serious health conditions and worsens heart disease. There is no level of smoking that is safe for your heart. To help you quit, you can speak to your GP about local stop smoking services. 

4. Maintain a healthy weight

Being overweight puts extra strain on your heart. It is, therefore, important to make the necessary lifestyle changes (ie changes to your diet and regular exercise) to ensure your body mass index (BMI) is below 25, or if you’re of Asian descent, below 23.5. 

5. Reduce high blood pressure

High blood pressure is a major risk factor for heart disease and its progression. 

Diet has an important role to play in your blood pressure — a low-salt diet can help bring high blood pressure down. Regular exercise is also important as it strengthens your heart so it can pump a greater volume of blood with less effort and also helps you maintain a healthy weight. 

If you’re overweight, for every kilogram of excess weight you lose, your systolic blood pressure (the pressure when your heart pumps out blood) can reduce by one unit (mmHg). 

If lifestyle changes aren’t enough to bring your blood pressure down to within a healthy range, your doctor can prescribe you antihypertensive medication. 

In a minority of cases, high blood pressure doesn’t respond to medication (resistant hypertension) and your doctor may recommend a minimally invasive procedure called renal denervation. This involves destroying the nerves in your renal artery, which reduces nerve activity to your kidneys and consequently reduces your blood pressure. 

6. Reduce high cholesterol 

Most people with high cholesterol will need to take medication, in addition to making dietary changes to reduce the amount of saturated and trans fats they consume. 

The most common medication for treating high cholesterol is statins. Statins significantly reduce your risk of heart attack and stroke. 

If you can’t tolerate statins due to the side effects, or they are unable to lower your cholesterol enough, then there are a variety of alternative treatments including cholesterol absorption inhibitor tablets and PCSK9 inhibitor injections. It is now increasingly common to be on a combination of different treatments as is often the case for other conditions, such as diabetes or high blood pressure. 

It is particularly important that your levels of LDL cholesterol, colloquially known as bad cholesterol, are kept low, ideally below 1.4 mmol/L if you have had a previous heart attack — for context, the LDL levels of a newborn baby are around 0.8–1 mmol/L.

7. Effectively manage diabetes 

If you have diabetes it is important to take your medication as prescribed to control your blood sugar levels. 

Recent research has shown that certain diabetes medications not only help control blood sugar levels but also have a separate and beneficial effect on the heart, reducing the risk of heart attack and stroke. 

The future of secondary prevention of heart disease

Research continues into new medications and approaches to reduce the risk of heart disease and limit its progression. 

For example, siRNA (small interfering RNA) prevents certain proteins implicated in heart disease, high cholesterol and/or high blood pressure from being produced by silencing their genes. These new medications appear to be highly effective and have minimal side effects. 

Research into diabetes treatments have also shown promise due to the effects they have beyond controlling blood sugar levels. For example, medications which activate a protein called GLP-1, treat diabetes but also causes significant weight loss. 

There are several other new developments in weight loss medications, which appear to have results almost as significant as weight loss surgery. As being overweight is a major risk factor for heart disease and its progression, these medications will likely play an important role in secondary prevention in the future.