Preventing a Second Heart Attack

Most Americans survive a first heart attack, but are at increased risk for another one. By taking action you can significantly reduce your chance for a second heart attack.

Risk factors

These factors increase your risk for another heart attack, according to experts:

• Inactive lifestyle

• Being overweight or obese

• High cholesterol

• High blood sugar, if you have diabetes

• High blood pressure

• Smoking

• Too much stress

• Heavy alcohol use or use of illegal drugs

What you should do

The American Heart Association (AHA) recommends the following actions to reduce your risk for a second heart attack:

• Quit smoking. You can cut your risk for another heart attack in half by not smoking. Talk with your healthcare provider about a smoking cessation program, nicotine replacement products, or medicines to help you quit. This is the biggest preventable risk factor for heart disease. 

• Eat a heart-healthy diet. By cutting back on saturated fat and trans fat, you can lower your LDL ("bad") cholesterol and triglyceride levels. LDL is one of the primary substances that causes heart attacks. Manufacturers are reducing or eliminating trans fats from their products. You can stay away from most trans fatty acids by eating less margarine and fewer cookies, crackers, fries, doughnuts, and other snack foods that contain partially hydrogenated oils. It's important to do this even when you eat out. 

• Control your cholesterol. Besides eating a heart-healthy diet, such as the DASH (Dietary Approaches to Stop Hypertension) diet, you can help keep your cholesterol under control by exercising regularly. Your healthcare provider may also prescribe a cholesterol-lowering medicine such as a statin. It's important to take this medicine as prescribed. Your provider may prescribe other medicines such as ezetimibe or PCSK9 inhibitors if you are at a higher risk and your cholesterol has been hard to control. Talk with your healthcare provider if you have any concerns. 

• Exercise regularly. Exercise is important because it strengthens your heart muscle. It also boosts your energy level and helps with weight management, cholesterol, and blood pressure. The AHA recommends a minimum of 30 to 60 minutes of walking or other moderately vigorous exercise at least 3 to 5 times each week. If you've had a heart attack, you must get your healthcare provider's OK before starting an exercise program. If you have any of these symptoms during exercise, call your healthcare provider immediately:

  • Shortness of breath that lasts for more than 10 minutes

  • Chest pain or pain in your arms, neck, jaw, or stomach

  • Dizzy spells

  • Pale or splotchy skin

  • Very fast heartbeat or irregular heartbeat

  • Cold sweats

  • Nausea and vomiting

  • Weakness, swelling, or pain in your legs

• Stay at a healthy weight. Being overweight greatly increases your risk for a second heart attack. If you need to lose weight, ask your healthcare provider for help. Your BMI (body mass index) should be between 18.5 and 24.9. This is the healthiest range.

• Control high blood pressure. Follow your healthcare provider's suggestions.

• Assess your mental health. Depression, stress, anxiety, and anger can damage your heart and overall health. Talk with your healthcare provider about seeing a therapist if you need help with your emotions.

• Take your medicines as directed. Your heart, cholesterol, and blood pressure medicines are an important part of your heart health. If you have any questions about them, talk with your healthcare provider or your pharmacist.

• Control blood sugars. You are at higher risk for a second heart attack if you have diabetes or are developing a resistance to insulin and have high blood sugar levels. Lowering blood sugars can decrease the inflammation and damage to the coronary arteries. It can prevent scarring or narrowing of these blood vessels.

• Limit alcohol and illegal drugs. Alcohol and illegal drugs such as cocaine and amphetamines can raise blood pressure and stress on the heart. Alcohol can also raise blood sugar and triglyceride levels. Ask your provider for help in limiting your alcohol or quitting drugs.