- First Aid
Tips for Recovering from a Heart Attack
If you are recovering from a heart attack, you will also have heard, if not from your doctors, from other patients who have travelled the same road, about the various ways in which your risk of future infarctions can be lowered still further.
The first to be publicized was the use of betablocker drugs. Betablockers reduce the heart rate and the force of the beat, reducing the demand for oxygen. Trials first in Norway, then in other parts of Europe and North America, showed that if heart attack survivors took a small betablocker dose every day, routinely, there was less long-term risk of early death from another heart attack.
This led, for a while, to their routine prescription to virtually all patients recovering from heart attacks. Those who had asthma, heart failure, or who found the side-effects of the drug too much, did without. Until recently, most doctors gave betablocker agents to heart attack survivors unless there was a good reason not to do so. Many still give them, and on the evidence it is with good reason.
The second series of major trials to show that a drug would reduce the risk of death after a heart attack involved aspirin. Aspirin was tested because it prevents the formation of clots in small arteries. Several of the trials involved a combination of aspirin with another drug, dipyridamole, which also lowers the chance of bloot clotting. Aspirin, with or without dipyridamole, did lower the death rate after heart attacks.
The news of the aspirin results led to its almost universal adoption for the long-term prevention of heart attacks, especially in patients who had already had one attack. At half a tablet a day, now the recommended dose for its anticlotting activity, it is very cheap and almost free of side-effects, two considerable advantages over betablockers.
Some doctors have switched from betablockers to aspirin; others have decided, on the 'belt and braces' principle, to prescribe both. The combination should do no harm, although there is no proof that the extra treatment will give extra benefit. Should you worry if you are not given a prescription for either? On balance I would say yes, if only because the evidence that they prevent second and further attacks is now so good. Aspirin, in the current low dose of 75 mg a day, is probably a reasonable self-help medicine.
The oily fish diet
In the latter half of 1989, the cardiac news was all about oily fish. In 1983, the British Medical Research Council (MRC) set up a study to find out if men who had had heart attacks could reduce their risk of death or a second attack by changing their diet. Three diets were chosen:
- a reduced fat intake, increasing the ratio of polyunsaturated to saturated fat.
- an increase in oily fish consumption such as mackerel, herrings, kippers, trout, salmon, sardines and pilchards.
- an increase in cereal fiber, such as wholemeal bread, and bran.
More than 2,000 men under 70 recovering from heart attacks were allocated to advice on one, two, or all three diets or to no advice at all, making eight groups. They were then followed for five years, the researchers doing their best to confirm at intervals that they were sticking to the advice given.
Interestingly the men found it easier to cooperate with the 'oily-fish' and the 'increased fibre' advice than with the change in food fats.
The report of the trial, published in the Lancet in 1989 (Burr, M. L. et al., 298, 920), was astonishing. Within two years of their heart attacks, the half of the men given the oily fish advice had many fewer deaths (94) than the half who did not (130). When all the calculations were made, the oily fish appeared to have reduced the numbers of deaths by as much as 29 per cent. Increasing cereal fibre did not confer benefit, and the advice on fats was not taken, so that its effect could not be measured.
These results have caused a considerable stir among the columns of the Lancet. The trial and its results have been criticized, and speculations on how oily fish could have been so beneficial have been rife. There has been considerable argument about the possible connections between the oily fish diet and the lack of heart attacks in fishing communities such as the Japanese and the Greenland Inuit (Eskimo).
It is too early to be sure whether this reduction in deaths was a real effect, or was a quirk of that particular trial. However, survivors of heart attacks will do themselves no harm if they try the fish diet themselves. All it needs, apparently, is for them to eat a helping of oily fish three times a week in place of their usual meals.
What all this boils down to is that survivors of heart attacks can do much to help themselves to an active, satisfying life. The cornerstones of that life are exercise, sensible eating, perhaps a betablocker and/or an aspirin a day, and possibly an oily fish meal three times a week. Most of all, however, it needs belief in themselves, so that they feel whole again, and not some sort of cripple, waiting for the next catastrophe. Spouses can help greatly by encouraging them with kindness to comply with their doctors' advice - without appearing to nag.
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