Even if you have heart disease, there is a lot you can do to improve the health of your heart. Making changes can prevent a heart attack.

• Do not smoke
• Treat high blood pressure if you have it
• Eat a diet that is low in fatm cholesterol and salt
• Eat lots of fresh fruits and vegetables
• Exercise
• Keep your weight in the normal range
• Follow your doctor's orders for taking medicine
• See your doctor for regular checkups
• Control your blood sugar if you have diabetes

Atherosclerosis is the underlying process that causes most heart disease. It begins in young adulthood, but it may be decades before clinical disease shows up. That is why more effort should be focused on prevention. We do not fully understand all the causes of heart disease, but large epidemiological studies have identified risk factors and strategies to reduce the risk. The risk factors we can change, treat or modify include:

• cigarette and tobacco smoke
• high fat, high cholesterol diet
• obesity and overweight
• physical inactivity
• high blood cholesterol
• high blood pressure
• diabetes mellitus

Do not smoke tobacco/minimize exposure to second-hand smoke. Smoking limits the amount of oxygen going to the body tissues, increases heart rate and blood pressure, increases the risk of developing blood clots, and damages arteries throughout the body, especially in the heart and brain. In addition, smoking increases the risk for various lung diseases, of extra concern for persons with heart disease.

• Second-hand smoke exposure (environmental tobacco smoke) is also a serious health hazard. It increases a non-smoker's risk of death from heart disease and lung cancer
  
• The addictive effects of nicotine often make it very difficult to quit smoking once one starts; therefore, every effort should be made not to start smoking. If persons with coronary artery disease already smoke, the most important thing they can do to improve their health is to quit. A variety of resources are available from health care professionals, the American Heart Association (AHA), and the American Cancer Society to help with this undertaking

Strategies to stop smoking:

• Make an agreement with yourself to quit
• Ask your health care professional for information and programs that may help
• Fight the urge by going where smoking is not allowed and staying areound people who do not smoke
• Reward yourself when you quit
• Keep busy doing things that make it hard to smoke, like working in the yard, washing dishes and being more active
• Remind yourself that smoking causes many diseases, can harm others and is deadly
• Ask your family and friends to support you
• Visit the AHA smoking cessation website for more information

Eat a healthy diet that is low in fat and cholesterol and high in fiber. This type of diet is recommended by the AHA and other groups to help prevent heart disease and stroke as well as some cancers. For the American public in general, the AHA recommends a diet that limits fat intake to about 30% of total calories (called the AHA Step I Diet). (The average American currently consumes about 40% of its total calories from fat.)

• Read food labels to find the fat content of food products and go easy on those high in saturated fat or cholesterol
  
• Limit salt intake. This is of special concern if one has high blood pressure or heart failure

Strategies for a healthy diet:

• Ask your doctor, nurse or licensed nutrionist for help
• Avoid foods like egg yolks, fatty meats, skin-on chicken, butter and cream
• Cut down on saturated fat, sugar and salt
• Substitute skin or low-fat milk for whole milk
• Bake, broil, roast and boil - do not fry foods
• Eat fruit, vegetables, cereals, dried peas and beans, pasta, fish, skinless poultry and lean meats
• Limit alcohol to one drink a day, and if you do not drink, do not start

Exercise regularly. A regular exercise program is encouraged for everyone. While exercise can improve the way one looks and feels, it also has other benefits:

• Helps lower blood pressure and resting heart rate and improves blood flow to the heart
  
• Allows the heart to do work with less energy
  
• Helps increase HDL or the "good" cholesterol level in the blood
  
• Improves flexibility of the muscles and joints, building muscle strength and tone
  
• Along with a proper diet, aids in weight loss

Strategies for exercising:

• Check with your doctor before you start
• Start slow and build up to 30 minutes daily
• Physical activity reduces your risk of heart attack and makes your heart stronger
• It helps control your weight and blood pressure, helps you relax, and can improve your mood!
• Look for chances to be more active. Take 10 to 15 minute walking breaks during the day and after meals

Strategies to control blood pressure:

• Promote lifestyle modification: weight control, physical activity, moderation in alcohol intake, moderate sodium restriction
• If blood pressure 140/90 mm HG or greater after 3 months of life habith modification or if initial blood pressure is greater than 160/100 mm Hg, you may need blood pressure medication. Check with your doctor for individualized care.

If high blood pressure is or has been a problem, focus on lifestyle measures to ensure that it stays within the normal range. High blood pressure puts extra work on the heart. It is important that individuals follow their physician's advice on losing weight, cutting down on salt, exercising, taking needed medicines, quitting smoking, and reducing stress. Since high blood pressure often goes undetected, it is important to have it checked periodically.

Strategies to manage stress:

• Be more active every day
• Limit caffeine (coffee, tea and cola drinks) and alcohol
• Try to avoid things that upset you, such as rush-hour traffic
• Learn to work through your anger
• Sign up for a stress management course

Strategies to remember to take your medicine:

• Take it at the same time every day
• Try a day-of-the-week divided pill box (at all drugatores)
• Put a reminder note on your medicine cabinet
• Ask a family member to help you remember to take your pills

These strategies are key to the prevention of another heart attack, Remember:

• Stop smoking
• Lower your blood pressure
• Eat a healthy diet
• Be physically active
• Get regular medical checkups
• Know the warning signs