Heart disease remains the number one killer in America. Every year over 800,000 people suffer a heart attack. Of these, 605,000 are a first heart attack, and 200,000 happen to people who have already had at least one heart attack. Having a heart attack not only puts you at risk of having another heart attack but also increases your chance of having other heart problems like atrial fibrillation or heart failure.  

This article will highlight 5 very important things to focus on post-heart attack, such as preventive measures to help prevent future heart attacks and specialty labs commonly used in Functional Medicine to assess heart health.

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What Causes Heart Attacks?

The most common way that heart attacks occur is when there is a blockage in one or more of the coronary arteries. The coronary arteries are the arteries that feed the heart muscle itself. The arteries can become filled with plaque, a sticky substance that lines the walls of the arteries and becomes blocked up.

The blockage can develop over time due to aging, poor diet, poor lifestyle, and other factors like genetics. Over time and most often due to stress, this plaque can rupture or break open and cause a blood clot to occur at the rupture site, which completely blocks blood flow through the artery to feed the heart muscle. This type of heart attack often needs to be treated with a coronary stent to open the blockage or, in severe cases, coronary artery bypass surgery.

It is also possible to have a heart attack without significant blockage in the artery. This is rare but can occur any time there is significant demand on the heart. It can result from severe spasms of the coronary arteries, prolonged rapid heart arrhythmias, heart failure, or even the stress of surgery can cause a temporary decrease in blood flow to the heart muscle, resulting in ischemia or heart attack. This type of heart attack is most often treated with medications and does not require surgery or coronary stents.

Preventable Risk Factors Associated With Heart Attacks

• Tobacco use, in any amount
• Obesity
• High blood pressure
• Diabetes or prediabetes
• Insulin resistance
• High cholesterol
• Sedentary lifestyle
• A diet full of processed foods
• Excessive alcohol

Functional Medicine Labs to Test for Heart Health

Heart health-specific Functional Medicine labs can help determine a person's risk of developing cardiovascular disease.

APoB

APO-B and LP(a) are associated with increased cardiovascular risk. There is a growing consensus that the number of ApoB-containing lipoproteins (ApoB) is the most reliable blood marker of lipid burden and cardiovascular risk. In a very recent study, ApoB levels were the most predictive of a heart attack when compared to all other lipid metrics.

Lp(a)

Lp(a) is a subtype of an LDL molecule with a unique lipoprotein, known as apolipoprotein(a), attached to its surface. There is increasing recognition that the number of Lp(a) particles is an independent risk factor for cardiovascular disease.

Inflammatory Markers

High sensitivity C reactive protein (hs-CRP) and homocysteine have been shown to correlate specifically with heart inflammation and increased risk of heart attacks. These will be elevated initially after a heart attack but should normalize with healing and a healthy lifestyle.

Omega-3 Index

Omega-3 Index is a 3 month average of omega-3 levels in the body. A higher omega-3 index level is associated with a decreased risk of heart disease. Studies have shown that in places with a high Omega 3 Index (>8%), like in Japan, people have a lower incidence of heart disease and increased longevity. A low Omega 3 index (<4%) is associated with an increased risk of heart disease.

HbA1c

Research shows that higher HbA1c levels are generally linked with a higher risk of heart disease. High blood glucose damages your blood vessels and the nerves that control your heart and blood vessels. Over time, this damage can lead to heart disease.

Common Heart Health Risk Panels

• Heart Health Panel
• hs-CRP
• Homocysteine
• Advanced lipid panel
• Omega-3 Index
• HbA1c

Other Lab Tests to Check  

Sleep apnea is a very common condition in people who have heart disease. Sleep apnea causes temporary decreases in oxygenation levels in the body during sleep due to periodic episodes of not breathing fully. Over time, this can strain the heart and lead to heart arrhythmias, heart failure, and high blood pressure. If you wake up tired or have morning headaches, snore, or have been told that you stop breathing in your sleep, it is a good idea to get tested. Home sleep apnea tests are available.

Liver function tests are especially important if you take statins or blood thinner medications. Like most medications, statins are processed through the liver and, in rare cases, can cause liver dysfunction. The liver is also responsible for producing blood clotting factors for the body. If liver function is abnormal, it could increase bleeding risk with antiplatelet or aspirin use. This should be checked at least annually.

5 Things to Do After a Heart Attack

A preventive lifestyle is vital to implement after a heart attack in order to prevent another heart attack from occurring. Key areas to focus on are nutrition, activity, stress management, and optimizing inflammatory biomarkers such as hs-CRP, homocysteine, and omega-3 index status.

1. Focus on Nutrition

Good nutrition is a cornerstone to optimal heart health. The Mediterranean diet is the best-studied diet and is well-researched in cardiovascular health. In clinical trials, it has demonstrated the ability to lower cholesterol and reduce cardiovascular risk by decreasing the inflammation burden in the body. The Mediterranean diet focuses on foods that reduce inflammation in the body by incorporating whole foods that help strengthen the body's ability to be resilient to stress. It differs from the standard American diet (SAD), which is full of processed, empty calorie-rich, and pro-inflammatory processed oils. The SAD diet increases the cycle of inflammation in the body, which ultimately contributes to cardiovascular disease.

One often overlooked component of the Mediterranean diet is the lifestyle associated with the food eaten. It is eaten slowly and purposefully in a relaxed setting over conversation. In comparison, at least 20% of Americans eat at least one meal per day in the car. Stressed and mindless eating leads to excess calorie consumption and drives cortisol levels up. Mindful eating habits improve digestion and lower cortisol levels. High cortisol levels are associated with obesity and cardiovascular disease.  

2. Lifestyle Changes

Your everyday lifestyle is the most important component to achieving optimal heart health after a heart attack.  

Smoking Cessation

Tobacco use continues to be one of the top risk factors in the development of heart disease worldwide. Even small amounts of tobacco cause inflammation and premature aging of the body and heart. There are many different ways to achieve smoking cessation other than going 'cold turkey' or taking a pharmaceutical medication or patch. Auricular acupuncture, hypnotherapy, transcranial stimulation, yoga, and app-based cognitive behavior therapy have all been shown to help with smoking cessation.

Movement

Daily physical activity is vital to our health and longevity. Our body requires daily movement to keep our muscles and bones strong. Exercise aids in weight, blood pressure, and blood sugar management and is also an important component in stress reduction. Physical activity has been shown to reduce mortality risk factors, including arterial hypertension, diabetes mellitus type 2, dyslipidemia, coronary heart disease, stroke, and cancer.

While it is recommended for adults to obtain 150 minutes of vigorous activity per week, movement throughout the day does add up. Try breaking the walking into 10-minute increments throughout the day if you cannot fit a full 30-minute walk in your day. Cardiac rehabilitation programs offered at most cardiovascular centers are also a great way to get into an exercise routine if you are not already in one.

Stress Reduction

There are many ways to incorporate stress reduction into a daily routine. Meditation, mindfulness, yoga, talk therapy, journaling, singing, and dancing can help lower stress in the body. The key is finding what works best for you and incorporating it into your daily routine.

3. Lower Cholesterol and Blood Pressure

Cholesterol and blood pressure control are essential physiologic markers to optimize after a heart attack.  

While there is significant data on the benefits of statin use in decreasing cardiovascular risk, there are other ways to lower cholesterol levels.

Dialing in on an anti-inflammatory diet, like the Mediterranean diet, avoiding highly processed foods and sugars, incorporating daily activity into your daily routine, and keeping blood sugars well controlled go a long way in lowering cholesterol levels.

Optimizing blood pressure makes it easier for the heart to pump. A goal blood pressure is below 120/80 at rest. Several factors can elevate blood pressure, but diet and exercise capacity strongly influence this.  

4. Manage Diabetes

Diabetes affects over 37 million Americans and is closely associated with the development of heart disease. Persistently high blood sugar levels cause damage to the lining of the artery's wall, making it more vulnerable to plaque formation leading to blocked arteries. It also can cause nerve damage, called neuropathy, which can also affect the heart. This increases the risk of someone having a "silent heart attack," a heart attack without any symptoms.

5. Aim for a Healthy Weight

Maintaining a healthy weight lowers the risk of heart disease. Studies that have examined the relationship between abdominal fat and cardiovascular outcomes confirm that people with too much visceral fat around their midsections and vital organs are at increased risk for heart disease.

Experts recommend that both waist-to-hip ratio and BMI be considered during regular health care visits due to the correlation between excess visceral fat and increased heart disease risk.

Abdominal obesity is also linked to fat accumulation around the liver. That often leads to non-alcoholic fatty liver disease, which increases cardiovascular disease risk.

Having a waist-to-hip ratio higher than 1.0 indicates an increased risk of heart disease.  

Optimal Measurements:

For women:

• Waist circumference <35 inches
• waist to hip ratio: <0.8

For men:

• waist circumference <40 inches
• waist to hip ratio: < 0.9

Conventional Treatment Post Heart Attack

After a heart attack, current cardiovascular guidelines recommend starting several medications to reduce the chance of having another heart attack and help the heart recover after the current one.

• Aspirin daily - this thins the blood to help prevent another heart attack
• Antiplatelet agents, like Plavix or Efficient. This typically continues for a year or longer. This is especially important if a coronary artery stent is placed.  
• Beta-blocker and ACE inhibitors are both added to decrease mortality risk after a heart attack and blood pressure management.
• Statins for cholesterol-lowering and anti-inflammatory benefits
• Nitroglycerin to take if needed for future episodes of chest pain.
• Diabetes medications, if diabetes is newly diagnosed.

Functional Medicine Treatment Post Heart Attack

A functional medicine approach post-heart attack emphasizes optimizing the above 5 lifestyle changes and treating underlying risk factors that lead to the development of heart disease. Following the above guideline-directed medical therapy after a heart attack is recommended under the supervision of a licensed practitioner. However, there are nutraceutical supplements that can be beneficial in aiding the heart's ability to recover after a heart attack.

Coenzyme Q 10:

CoQ 10 levels in the heart can be depleted using beta-blockers, statins, and sulfonylurea drugs like metformin. CO-Q 10 helps reduce inflammation in the heart and body.

Omega 3 Fish Oil:

heart-protective and potent anti-inflammatory and antioxidant. Lowers triglyceride levels in the blood. It should be used with caution while taking other blood thinner medications, such as aspirin and antiplatelet agents.

Red Yeast Rice

Red Yeast Rice - has cholesterol-lowering properties and is used for some statin-intolerant people.

N-Acetyl Cysteine (NAC)

has been shown to improve lipid profile, fasting blood sugar, and blood insulin levels.

Follow Up Labs

Follow-up laboratory testing should be completed at least annually. This should include blood cholesterol levels, CRP, metabolic, liver and kidney function markers, and hemoglobin A1c.

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Summary:

While heart disease remains the number one cause of death in America, there are many ways to improve your overall heart health after a heart attack. Focusing on optimizing physiologic risk factors like weight, blood pressure, and cholesterol levels and prioritizing exercise and a healthful diet can significantly reduce your risk of having a second heart attack and improve heart health.

Functional medicine laboratory testing annually can help ensure heart biomarkers are optimized, and your heart is healthy. Be sure to talk with your practitioner before starting or stopping any medication or supplement.

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