Prevention aims to modify the risk factors through diet and life style advice. It is estimated about 40 % of the risk of developing coronary artery disease is controlled by genetic factor and 60% by environmental factors. Individuals with family history of hypertension, hyperlipidaemia, and diabetes mellitus should strictly follow the preventive measures.
- Diet should contain fresh fruits and vegetables, mainly green leafy vegetables, pulses, excess fat should be avoided. Diet rich in vitamin C, E and antioxidants may prevent the production of oxidized LDL which is the important independent risk factor of coronary artery disease.
- Hypertensive patient should maintain the normal blood pressure with the anti-hypertensive drugs like beta blockers, ACE inhibitors. Diet should be salt restricted.
- Patients with familial hyperlipidaemia have a high incidence of premature coronary artery disease. They should keep the cholesterol levels under control by cutting down the excess fat, some milk products like butter; cheese etc. Large scale randomized trials have shown that lowering high cholesterol concentration mainly by drugs reduces the risk of many cardiac events like myocardial infarction and also the need for revascular procedures.
- Patient with diabetes mellitus or prone to it should get the blood sugar levels checked routinely and maintain the normal blood sugar by regular medications like insulin therapy or anti-diabetic drugs.
- Physical inactivity is also one of the causes of diabetes mellitus, hyperlipidaemia, hypertension which leads to coronary artery disease. Regular exercise like brisk walking, swimming, cycling may be able to increase HDL cholesterol, lower blood pressure, reduce blood clotting, promote collateral vessel development.
- Smoking and tobacco chewing is one of the most avoidable cause of coronary artery disease. Alcohol should be avoided, heavy drinking leads to hypertension, diabetes mellitus, a cause of cardiac events.
Secondary Prevention of Coronary Artery disease
- There is strong and compelling evidence that the correction of risk factors like smoking, hypercholesterolemia will improve the outlook for most patients with established coronary artery disease. Individuals with documented coronary artery disease have a high absolute risk of subsequent cardiac events, therefore have most to gain from preventive measures.
- Patient with Coronary Artery disease should have regular oral administration of aspirin (75-300 mg) daily. It enhances the effect of thrombolytic therapy and improves the survival.
- Beta blocker: Continuous treatment with oral beta blockers has been shown to reduce long term mortality by 25 % among the survivors of Coronary Artery disease.
- Statins (HMG CoA reductase inhibitors): Is the most effective form of lipid lowering therapy, the largest absolute benefit is seen in those who have the highest absolute risk.
- Many clinical events offer an unrivalled opportunity to introduce effective secondary preventive measures. For example patient who have just survived the myocardial infarction or undergone the major procedure such as coronary artery bypass grafting are usually keen to help themselves and may be particularly receptive to appropriate lifestyle advice.