I had an acute myocardial infarction. Now what? Not the end, but the beginning

“Tiv an acute myocardial infarction. Now what? It is not the end, but the beginning of a new journey. The goal is to prolong life and give it quality while avoiding new events. We're talking secondary prevention.

Pharmacological therapy is essential to control risk factors. To do so, we should lower LDL cholesterol to recommended levels, rigorously control blood pressure, and properly treat diabetes when it exists.

By large clinical studies we know that these interventions have concrete consequences: the reduction of LDL cholesterol to levels below 55 mg/dL is directly associated with a significant decrease in cardiovascular mortality and new serious events, such as infarcts and strokes (it is estimated that each reduction of about 40 mg/dL in LDL cholesterol is associated with 20 to 25% less major cardiovascular events); a reduction of 10 mmHg in systolic blood pressure is associated with about 20% less major cardiovascular events; quit smoking was associated with approximately 39% less cardiovascular mortality.

It is also essential to change behaviors and lifestyles. More importantly, changing to good habits and maintaining them over time: quitting tobacco, exercising, and eating healthier are interventions aimed at reducing the risk of a new cardiovascular event.

New guidelines for cardiovascular rehabilitation of the European Society of Cardiology have recently emerged. They establish that post-infarct cardiac rehabilitation is strongly recommended and should be prescribed to all patients and initiated as early as possible.

In rehabilitation programs the approach should be personalized and multidisciplinary: Physical exercise, psychological support, medication optimization, health education and nutritional control.

The essential message is simple: the first heart attack can be a turning point. Survival of the acute episode opens an opportunity to control much more closely the part of the risk that can be modified.

Taking the medication every day, achieving and maintaining objectives of LDL and blood pressure defined by the medical team, controlling diabetes, quitting smoking, practicing physical activity, adopting cardioprotective feeding and attending follow-up consultations are concrete ways to protect the heart.

Portugal has already significantly reduced mortality and morbidity associated with cardiovascular diseases. The next step is to ensure that each person who survives a heart attack can transform this survival into more years of life and more years of quality life.

Surviving a heart attack is not simply going back to the life that existed before. It is to start a new relationship with the heart based on treatment, surveillance and prevention.”