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  TREATMENT OPTIONS
  HOW TO MANAGE CARDIOVASCULAR DISEASE
Overview
Eating Correctly
Steps to Eating for a Healthy Heart
Drug Treatment
Medication Tips
Overview
Regardless of which type of therapy is used initially, it is very important to control those factors which lead to its development in the first place:
  • DO NOT SMOKE.
  • Monitor and control blood pressure.
  • Eat a prudent low fat, low salt diet.
  • Exercise regularly, even if your program is only modest.
  • Have your cholesterol monitored by a physician. Take medicines if prescribed.
  • If you have diabetes, you and your physician should work to control it well.
  • Attain ideal body weight.
  • Follow up with your doctor as recommended.

Lifestyle information should be given to every person with CHD. A healthy lifestyle remains the cornerstone of all the risk factors of CHD, including the management of hypertension, cholesterol and diabetes. A healthy lifestyle decreases total cardiovascular risk.

Eating Correctly

Although great advances have been made in treating coronary artery disease, a healthy diet is still the single most effective way to stop the disease from progressing.

Research has shown that a heart healthy diet can actually help slow the progress of coronary artery disease. Dietary changes should include reducing total fat intake, particularly saturated fat. Saturated fatty acids are the chief culprit in raising blood cholesterol, which then increases your risk of heart disease. Foods that are high in saturated fat are typically high in cholesterol as well, so avoiding them is particularly helpful.

Since saturated fat and cholesterol are found in all foods from animal sources, be careful to eat no more than six ounces of lean meat or skinless poultry per day, and to use fat-free and low-fat dairy products. Fish that contains heart healthy omega-3 fatty acids should be consumed at least twice a week. High-quality protein from vegetable sources such as beans are also good substitutes for animal sources of protein.

Substitute fried foods for grilled or broiled foods whenever possible. If you do decide to fry, avoid oils that are high in saturated fat like coconut and palm oils. Alternatives include oils made from polyunsaturated fats like sunflower, safflower and soybean oils or monounsaturated fats like canola, olive and peanut oils. These, when consumed in moderation, may even have beneficial effects on your blood cholesterol levels.

Whenever possible, be sure to read the label on the foods that you buy. Look for the terms “hydrogenated” or “partially hydrogenated vegetable oils” and try your best to avoid these.

 

Steps to Eating for a Healthy Heart
  • Substitute saturated fat with polyunsaturated and mono-unsaturated fats
  • Limit your intake of foods high in cholesterol to a maximum of 300mg per day
  • Eat more complex carbohydrates, especially those rich in fibre
  • Use fresh, unrefined foods to maintain a daily intake of 30-40g fibre
  • Include at least five helpings of fruit and vegetables a day
  • Control your weight through regular exercise and controlled food intake
  • Use less salt (sodium). Salt intake should be limited to 5g (1 teaspoon) a day. Remember, processed foods may contain sodium.
  • If you use alcohol, do so in moderation, two to three drinks maximum per day
  • Try to eat fish at least twice a week.

 

Strategy for a healthy lifestyle includes the following elements that will improve, blood pressure in particular:

  • Achieve and maintain ideal weight
  • Limit total sodium intake to less than 2400mg per day by consuming less than 1 teaspoon of salt per day. Besides table salt, high sodium levels are found in packet soups, stock cubes, gravies, processed cheese, many breakfast cereals, bread, salty snacks and tinned food. Reduce the intake of those foods, remove the salt cellar from the table, and gradually reduce added salt in food preparation. Food may taste bland originally and the use of lemon juice, herbs and spices are encouraged as alternative seasoning. Taste adaptation to reduce sodium intake occurs with time. Food labels list salt content as sodium. Sodium-free means less than 5mg per 100g serving, very low sodium means up to 40mg per 100g serving and low sodium means up to 120mg per 100g serving. To calculate the salt content, multiply sodium content by 2.5.
  • Limit alcohol intake to 2 standard drinks per day for men and 1 standard drink per day for women and small men. A standard drink contains about 10g of ethanol (e.g. 25ml spirits, 125ml wine, 340ml beer, 60ml sherry, 25ml liqueur).
  • Follow nutrition guidelines reported in the global strategy on diet, physical activity and health published by the World Health Organisation. These guidelines emphasise a diet low in total fat with high intake of fruit and vegetables (5 portions per day), regular use of low-fat dairy products, a high intake of high-fibre wholegrain foods, fish rather than red meat, the use of products low in saturated fat, low salt, and sparing use of sugar and sugar-containing foods. Intake of beverages with high caffeine levels should be avoided, but the modest use (1-2 cups per day) of coffee will not increase blood pressure.
  • Regular moderate-intensity exercise for at least 30 minutes on most or preferably all days of the week. Moderate levels of exercise can be achieved by brisk walking. Exercise bouts can either be continuous or accumulated in shorter time periods throughout the day. The benefit of exercise is dose-response related, and the early adaptations from a sedentary lifestyle to becoming moderately active have the greatest effect. Patients with uncontrolled hypertension should embark on exercise training only after evaluation and initiation of therapy.
  • Stop the use of all tobacco products. The use of snuff is common among South African women who traditionally do not smoke tobacco. Nicotine replacement therapy should be used for patients with hypertension while under medical supervision.

Drug Treatment
Drug treatment should be commenced in the following cases:

  • Low added risk despite a period of 6-12 months of lifestyle modification and observation
  • Moderate added risk despite a period of 3-6 months of lifestyle modification and observation
  • High or very high added risk

Drug treatment should be commenced in the following cases:

  • Low added risk despite a period of 6-12 months of lifestyle modification and observation
  • Moderate added risk despite a period of 3-6 months of lifestyle modification and observation
  • High or very high added risk

Medication Tips

  1. Take your medications exactly as instructed by your provider.
  2. Do NOT skip doses. If you miss a dose of your medication, call your provider. Do not take an extra dose to make-up for the missed dose.
  3. Even if you feel well, do NOT stop taking your medications unless ordered by your provider. Make an appointment to see your provider to discuss prescription continuation.
  4. Keep all medications in the original container, or if you use a pill case, hold onto the original prescription labels
  5. Before you leave your provider’s office, make sure you understand what each medication is for, what it looks like, and what side effects you can expect.
  6. Ask your provider or pharmacist if there are any special instructions when taking this prescription, for example to take with food or on an empty stomach. Most pharmacies will include a leaflet or print the instructions on the bottle.
  7. Bring all medications with you when you come to your appointment with your provider. Keep a list of all your medications with dosage schedules and times of administration in your wallet or purse.
  8. Take your medications at the same time every day. Try to get into a routine that makes it easy to remember when to take your prescription. It may be helpful to use a special medicine dispenser to keep track.
  9. Never take a medication that has been prescribed for someone else and never share your medication with anyone else.
  10. If you have any side effects, call your provider. Make a note of what happened, when it occurred, and how severe it was.
  11. Do NOT take over-the-counter medications unless you check with your provider first.
  12. Do NOT take herbal or “natural” medications unless you’ve checked with your provider.
  13. Be sure that your provider, pharmacist and dentist know what other medications you are taking, including over-the-counter medications, vitamins and herbal products.
  14. Be sure that your provider knows if you are pregnant or breast feeding, if you have any health problems/conditions and/or if you are allergic to anything.
  15. Don’t hesitate to contact your provider if you experience chest pain, difficulty breathing, fainting, severe weakness or severe sweating. If you cannot contact your health care provider, call an ambulance.
  16. Always check your medication labels for expiration dates. Most prescriptions lose their potency after a period of time. Safely discard any unused drugs after their expiration date.

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