Posts Tagged ‘heart attack’

ED or Impotence May Be Sending A Message To Your Heart and Brain

October 22, 2014

Having trouble with your erections? You are not alone as nearly 30 million American men suffer from this problem. That’s the bad news. The good news is that erectile dysfunction or ED may be harbinger of something more ominous that may affect your health and well-being. This blog will discuss the connection between ED and heart disease.

No man wants to be diagnosed with erectile dysfunction (ED), but believe it or not, it could save your life. In many cases, ED is a precursor to cardiovascular disease and when diagnosed properly could reduce the chance of having a heart attack or stroke.

ED is the inability to obtain or sustain an erection. It is extremely common, affecting more than half of men over 60. Given our rising rates of obesity and sedentary lifestyles, there is a good chance that performance in the bedroom is not about emotional issues or the male anatomy itself. It may sound strange but the penis is the barometer of a man’s overall health.

You can imagine how a heart artery gets clogged in a person with high blood pressure, high cholesterol or diabetes. When that coronary artery, which measures around 1\8 inch, gets obstructed that little to no blood flows through it, that man is going to experience chest pain (angina) or a heart attack. The same holds true for the carotid arteries, which measure 1\2 inch and take blood up to the brain. When the carotid artery gets blocked, that man will experience symptoms of a stroke. Now imagine the tiny penile artery, measuring only 1\16 inch. Its smaller diameter makes it ultra-sensitive to blockages, resulting in erectile dysfunction the penile artery becomes blocked.

Our entire vascular system is connected and the same things that harm our big blood vessels to our heart and brain will affect our smallest ones as well. The common cause of all this is what’s called atherosclerosis. As the same systemic process takes place throughout our vascular system, it’s these small arteries in the penis that will feel the effects earlier and manifest the symptoms of ED before other organs such as a man’s heart or brain start to suffer.

A lack of erections or difficulty holding an erection may be one of the earliest signs of impending heart disease or a stroke. When a man experiences ED this should an alarm should for men, their partners and their doctors. It’s important to realize that ED and cardiovascular disease have the same risk factors. These include high blood pressure, diabetes, high cholesterol, smoking and excess weight. Realize, too, that all these risk factors are modifiable, meaning you can actually improve them to reverse or halt the damage that is being done.

The message is: the recognition of ED as a warning sign of silent vascular disease has led to the concept that a man with ED and no cardiac symptoms is a cardiac (or vascular) patient until proven otherwise. Studies show that men presenting with only mild ED have a significant amount of undiagnosed high blood pressure, high blood sugar and high cholesterol, among other things. This is why men with mild ED, particularly if they are younger than 50, need to be screened for cardiovascular risk factors and have those risks treated aggressively. This means a visit to a doctor, having an EKG, and a stress test to see if there any decrease in blood supply to the heart.

We’ve come a long way since the days when ED was something men kept to themselves, too embarrassed to discuss with their friends or doctor. The introduction of pills (Viagra, Cialis, Levitra) to treat ED over 15 years ago opened the door for conversations about the condition.

The good news that lifestyle changes to modify risk factors, such as high blood pressure, elevated cholesterol level, obesity, and diabetes, that will provide the greatest benefit to a man’s overall health, not just his penis.

Bottom Line: ED can be a harbinger of impending heart disease or stroke. Don’t dismiss difficulty getting or holding an erection as this may indicate a future heart attack or stroke. See you doctor or urologist.

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10 Reasons That Sex Contributes to Good Health

June 1, 2014

On so many occasions many of my male and female patients have indicated that as they reach middle age, that sexual intimacy has taken a back seat and is less important than it was years ago. For this blog, I would like to illuminate 10 reasons to take the sex drive off the back shelf and put it on the front burner. Both you and your partner will be glad you did.
Sex not only feels good. It can also be good for you. Here’s what a healthy sex life can do for you.
1. Revs Up Your Immune System Humming
Sexually active people miss fewer days of work and make fewer visits to the doctor.
People who have sex have higher levels of what defends your body against germs, viruses, and other foreign substances. Researchers found that those men and women who had sex once or twice a week had higher levels of the a certain antibody compared to those who had sex less often.
You should still do all the other things that make your immune system happy, such as:
Eat right.
Stay active.
Get enough sleep.
Keep up with your vaccinations.
Use a condom if you don’t know you and your partner’s STD status.
2. Boosts Your Libido
Having sex will make sex better and will improve your libido.
For women, having sex increases vaginal lubrication, blood flow to the pelvis, and elasticity of the vagina, all of which make sex feel better and help you crave more of it.
3. Improves Women’s Bladder Control
A strong pelvic floor is important for avoiding incontinence, involuntary loss of urine, something that will affect about 30% of women at some point in their lives.
Good sex is like a workout for your pelvic floor muscles. When you have an orgasm, it causes contractions in those muscles, which strengthens them.
4. Lowers Your Blood Pressure
Research suggests a link between sex and lower blood pressure. Numerous studies have reported that sexual intercourse lowered systolic blood pressure, the first or top number on your blood pressure test.
5. Counts as Exercise
Sex is a really great form of aerobic exercise. It won’t replace the treadmill, but it counts for a short cardio workout.
Sex uses about five calories per minute, four more calories than watching TV! It bumps up your heart rate.
So get busy! You may even want to clear your schedule to make time for it on a regular basis. Consistency or regular sex helps maximize the benefits.
6. Lowers Heart Attack Risk
A good sex life is good for your heart. Besides being a great way to raise your heart rate and provide you with a cardio workout more fun than spinning, sex helps keep your estrogen levels in women and testosterone levels in men in balance.
When either one of those is low you begin to get lots of problems, like osteoporosis and even heart disease.
Having sex more often may help. During one study, men who had sex at least twice a week were half as likely to die of heart disease than the less sexually active men who had sex rarely.
7. Lessens Pain
Before you reach for an aspirin, ibuprofen or a pain pill, try an orgasm.
An orgasm can block pain by releasing endorphins which are much more powerful than morphine. Orgasm releases endorphins that helps raise your pain threshold.
Stimulation without orgasm can also be effective. Vaginal stimulation can block chronic back and leg pain, and many women report that genital self-stimulation can reduce menstrual cramps, arthritic pain, and in some cases even headache.
8. Send Big “C” Out To Sea
Going for the sexual homerun or orgasm may help ward off prostate cancer.
The prestigious the Journal of the American Medical Association reported that men who ejaculated frequently (at least 21 times a month) were less likely to get prostate cancer.
You don’t need a partner to reap this benefit: Sexual intercourse, nocturnal emission, and masturbation were all part of the equation.
9. Improves Sleep
You may nod off more quickly after sex, and for good reason.
After orgasm, the hormone prolactin is released, which is responsible for the feelings of relaxation and sleepiness after sex.
10. Eases Stress
Being close to your partner can soothe stress and anxiety.
Even touching and hugging can release your body’s natural feel-good hormones. Sexual arousal releases a brain chemical that revs up your brain’s pleasure and reward system.
Sex and intimacy can boost your self-esteem and happiness, too,
Bottom Line: Who would have “thunk” that sex is good for you and can help keep you healthy and well. As my wise Jewish mother, St. Sara, would say, “It may not help but it voidn’t hoit!” Rest in peace St. Sara.

What You Need To Know About Low T (Testosterone) and Heart Disease

March 27, 2014

I have received dozens of calls from men who are concerned about the recent study that reports that testosterone replacement therapy increases the risk of heart attacks and strokes. This blog is intended to clarify some of the misinformation that is attracting so much media attention. The Androgen Study Group, a large group of physicians and researchers of which I am a member, is calling for the retraction of the paper that appeared in the Journal of American Medical Association linking testosterone and cardiovascular risks — data that its authors of the paper in the journal are standing firmly behind.

In a letter to Howard Bauchner, MD, editor-in-chief of the Journal of the American Medical Association, members of the group — formed in response to the paper and comprised of more than 125 doctors — said the study’s credibility was compromised by at least two corrections and should be pulled from the journal.
A close friend and colleague, Dr. Abraham Morgentalker pointed out the there’s no misconduct, no one faked any data, it’s just sloppy. The group called it “gross data mismanagement.”

The paper, published in JAMA in November by Michael Ho, MD, PhD, of the Eastern Colorado VA, and colleagues, found that testosterone therapy was associated with a greater risk of death, heart attack, and stroke in male veterans who’d had coronary angiography. (If the men were having coronary angiography, it stands to reason that they already had some heart disease or they wouldn’t have been subjected to this invasive procedure)

But two corrections have since been published. The first, in the Jan. 15 issue, was a clarification that the results were based on “estimates” and not raw data.

The second, which Morgentaler and colleagues focus on in their letter to the editor of the journal, involved reclassivication of patient who were excluded from the study. More than 1,000 excluded patients were assigned to different categories of exclusion, including 100 who were women!

The authors included almost 10% women in an all-male study, so why should we believe any of the other data? The Androgen Study Group points out that the data were so off that it’s hard to believe the data for the entire study are accurate.

However, Ho and colleagues said they “stand firmly by the results of our study,” noting that the overall number of excluded patients remains the same, as does the total number of included patients, and the main results of the study were not changed.

The study group said that these claims run contrary to 40 years’ worth of research on testosterone, which suggests that the hormone has some beneficial effects in certain heart patients.

But the testosterone therapy field has garnered much media attention for its financial relationships with industry. Several articles in the New York Times, including one on the marketing of “Low T”, another on the selling of testosterone gels, and an editorial, have questioned the potential overselling of the therapy.

It is true that several members of the Androgen Study Group, myself included, have relationships with testosterone drug makers, such as AbbVie, Watson, and Endo Pharmaceuticals.

It is my opinion that men who are symptomatic for low testosterone and have complaints such as lethargy, decreased libido, loss of muscle mass, and decrease in erections or potency AND who have a documented decrease in the blood level of testosterone, are good candidates for hormone replacement therapy. These men who are going to receive testosterone should have a normal digital rectal exam and a normal PSA test if they are less than 75 years of age.

Bottom Line: Low testosterone has effects that impact a man’s quality of life. If a man has symptoms of low T and a documented decrease in the blood testosterone level, he should speak to his physician about testosterone replacement therapy.

Good News For the Bedroom-Sex Is Heart Healthy

February 28, 2014

Certainly there are some men who worry that having sexual intercourse may cause a heart attack. Or men who have had a heart attack are at risk for another attack if they have sexual intercourse. Well, there’s good news for men. A recent study from England shows men who indulge in regular lovemaking are up to 45 per cent less likely to develop life-threatening heart conditions than men who have sex once a month or less.

The study, of over 1,000 men, shows sex appears to have a protective effect on the male heart but did not examine whether women benefit too.

Now the American researchers who carried out the investigation are calling for doctors to screen men for sexual activity when assessing their risk of heart disease.

Every year, around 270,000 people in Britain suffer a heart attack, and coronary disease remains Britain’s biggest killer.

Although sex has long been regarded as good for physical and mental health, there has been little scientific evidence to show the full benefits that frequent intercourse can have on major illnesses such as heart disease.

In the latest study, scientists at the New England Research Institute in Massachusetts, tracked the sexual activity of men aged between 40 and 70 who were taking part in a long-term project called the Massachusetts Male Ageing Study, which began back in 1987.
At regular points over a 16-year period, each man was questioned on how often they had sex and then checked for signs of heart disease.
Researchers took into account other risk factors, such as their age, weight, blood pressure and cholesterol levels.

The results, published in the American Journal of Cardiology, showed men who made love at least twice a week were much less likely to have heart disease than those whose sexual encounters were limited to once a month or less.

In a report on their findings, researchers said the benefits of sex could be due to both the physical and emotional effects on the body.
Men with the desire for frequent sexual activity and who are able to engage in it are likely to be healthier.

But sex in some forms has a physical activity component that might directly serve to protect cardiovascular health.

Also, men who have frequent sex might be more likely to be in a supportive intimate relationship and this might improve health through stress reduction and social support.

And there’s a benefit for the women in your life as well: Regular sex can even boost a woman’s sense of smell by triggering the release of a hormone called prolactin, according to scientists at Calgary University in Canada. This may be a mechanism to help mums bond with their new babies.

Bottom Line: No one disagrees that sex is good and sex might just be good for your health as well. So men, if you are looking for a reason to have regular sex, tell your partner to do it for your health and her health as well. It’s a twofer!

http://www.telegraph.co.uk/health/healthnews/6950548/Having-sex-twice-a-week-reduces-chance-of-heart-attack-by-half.html

Take Two (Aspirins) “At Night” And You Won’t Need To Call Me In the Morning

November 22, 2013

Take Two “At Night” And You Won’t Need To Call Me In the Morning

For several decades doctors have been prescribing low dose aspirin as means to protect against heart disease. Most men, including myself, take the aspirin in the morning. The researchers wanted to see if taking aspirin at night could better thin a person’s blood and potentially lower their heart attack risks.
Since the 1980s, it’s been known that cardiovascular events happen more often in the morning. Morning hours are a peak period of activity for platelets, blood cells that aid in clotting, he said. Doctors suspect that might have a hand in the increased risk of heart attacks and strokes in the morning.
Aspirin reduces the activity of platelets, and thus reduces the chance that those platelets will clot in the bloodstream and cause a heart attack or stroke, according to the findings.

Until now most doctors didn’t feel that timing of the dose, morning or evening, would matter. That’s because aspirin has a long-lasting effect on platelets, helping thin the blood for days after it is taken.
That’s why, prior to surgery, patients are told to hold off on aspirin for five to seven days, and why it continues to thin your blood even when you miss a dose.

But the Dutch researchers found that taking aspirin at bedtime reduced platelet activity more than taking it in the morning, apparently because it headed off the body’s normal morning surge in platelet activity.
The team also found that people who took aspirin at bedtime did not suffer any more stomach upset or other side effects than people who took it in the morning,.

Cardiologists who have reviewed this report suggest that until larger follow-up studies take place, people prescribed aspirin for heart problems should continue to take it whenever in the day they like.

Bottom Line: Taking baby aspirin has an affect on blood clotting mechanism and prevents heart attacks and strokes. Since there is no disadvantage to taking the medicine at night, I plan to use this medication before going to bed. If you have any questions about this recommendation, ask your doctor

Testosterone And Heart Disease – Facts and Caveats

November 6, 2013

Like most urologists, endocrinologists, and cardiologists, I have received numerous calls from men who have symptoms of low testosterone, documented decrease in their blood testosterone level, and who are receiving testosterone replacement therapy about a study that appeared in a reputable medical journal that treatment with testosterone increases the risk of heart disease. (JAMA. 2013;310(17):1829-1836. doi:10.1001/jama.2013.280386).

Let’s look at some facts. The human body is always trying to achieve homeostasis which is defined as “The ability or tendency of an organism or cell to maintain internal equilibrium by adjusting its physiological processes.” What does this mean? It means that the body is always trying to stay normal without deviations from normal. For example, if a man drinks too much water, the kidneys will increase the excretion of water. If a man is dehydrated, the kidneys will try and conserve water to prevent the problems associated with dehydration. If a man has diabetes, the doctor will recommend a treatment to lower the blood sugar. If a man has high blood pressure, the doctor will recommend dietary changes, exercise, and perhaps medication to lower the blood pressure. If a man has anemia or a low blood count because of iron deficiency, the doctor will prescribe iron supplements. If a man has a deficiency in vitamin D, then the doctor will recommend increase the consumption of this necessary vitamin. These actions are what doctors do every day; they attempt to achieve a normal equilibrium in the body as this is the best way to restore and maintain health.

This same reasoning applies to men who are deficient in testosterone. Testosterone is a necessary hormone produced in the testicles that is responsible for a man’s sex drive, muscle mass, energy level, bone strength, and even a man’s mood which may cause depression if the hormone is low and not returned to normal.

There are more than 13 million men in the United States who suffer from testosterone deficiency. For men who receive treatment, they usually report significant improvement in their symptoms. There are many conflicting reports about testosterone and heart disease. There are even studies that support that low testosterone increases the risk of heart disease and that treating the deficiency with hormone replacement therapy may be protective of heart disease.

I would like to list several comments about the study that was reported in the recent Journal of the American Medical Association (JAMA).

Of nearly 7,500 guys who did not get extra T, about 1 in 5 had bad cardiovascular outcomes, including stroke, heart attack or death. In the more than 1,200 men who got testosterone, nearly 1 in 4 had those terrible problems, an increased risk of nearly 30 percent. A truly scientific study has similar number of study patients in each group, not 7500 in the control group and 1200 in the experimental group.
The researchers concluded that taking testosterone came with an increased risk of an adverse outcome. If a statistician would add up the actual reported events in the paper for each group and divide by the numbers of men in each group. What you will find is that the absolute risk of events (death, heart attack, or a stroke) was 10% in men treated with T and 21% in men not treated. That’s right- the risk was REDUCED BY HALF in men treated with T. So a closer scrutiny needs to be done before conclusions can be made and distributed to the media.
This is obviously the opposite of what the authors reported. They come up with absolute risk rates that are not explained by any numbers in their paper. They used a complex statistical analysis to get to their conclusions without showing the numbers it was based on.

That’s not the whole story, though. Dr. Anne Cappola of the Perelman School of Medicine at the University of Pennsylvania wrote in an accompanying editorial: “The most important question is the generalizing the results of this study to the broader population of men taking testosterone ….” The take home message is not possible to generalize from this study to the entire population of men some of whom may have a low testosterone level.
That’s a very big caveat: By definition, all the men in the study were older than 60 and all had heart problems. It’s still not clear whether those same risks apply to younger, healthier guys.
“These were sick, older veterans,” Dr. Michael Ho, a cardiologist with the VA Eastern Colorado Health Care System who helped direct the study, said in an interview. Many were obese, had diabetes, and other ailments, he said. Obese men with diabetes and other co-morbid conditions are certainly at risk for heart disease, stroke, and even death.

Bottom Line: So what is a man who has low testosterone to do? I would suggest that they have a discussion with their doctor. If they have symptoms of low testosterone, and a documented level of low testosterone blood test, then the doctor and the patient have to weight the risks of testosterone replacement therapy versus the benefits. Certainly if the benefits outweigh the risks and the risks are composed of an older man with heart disease, diabetes, and other illnesses, then raising the testosterone level may not be in his best interest.

Sex After a Heart Attack

October 3, 2013

A man has a recent heart attack. He is eager to get back in the saddle and remembers the movie, Something’s Gotta Give, when Jack Nicholson, who had a recent heart attack, asks his doctor about when “his best friend” can start getting back into action. He’s told that he has to wait until he can climb two flights of stairs without shortness of breadth or chest pain. Both the man and his partner are concerned if sex trigger could another heart attack.
It is well documented that fewer than 1% of heart attacks come from having sex. It makes sense to think of sex as a form of exercise: If your doctor clears you for physical activity, you’re also likely safe for sex. Remember the two flights of stairs test.
Most men and their partners are uncomfortable broaching the topic with their doctor. Most doctors are comfortable talking about sexual intimacy and you shouldn’t avoid the topic. Often the patient is surprised — or even relieved — that the doctor raises the subject.
Similar to any type of exercise, if you begin to feel symptoms such as chest pain, abnormal shortness of breath, fatigue, dizziness, or palpitations, it definitely makes sense to slow down what you’re doing, whether you’re a man or a woman. If you’re pretty certain it’s angina, which is temporary pain or pressure in the chest when the heart doesn’t get enough oxygen, it might help to take your nitroglycerin.
The exception to that advice is for men who use medication for erectile dysfunction such as Viagra, Levitra, and Cialis — it’s dangerous to take nitroglycerin. Your blood pressure can fall to dangerously low levels, and there’s an increased risk of heart attack and even death. If you’re on an erectile dysfunction drug and have heart-related symptoms during sex, call your doctor.
Bottom Line: Sexual intimacy is important to men at all ages and includes men who have had a recent heart attack. A candid conversation will help you get back to enjoying a sexual relationship with your significant other. Talk to your doctor

Sex After a Heart Attack: What You Need To Know

May 29, 2013
Your Average Middle Age Couple Who Are In Love And Wish To Be Sexually Active

Your Average Middle Age Couple Who Are In Love And Wish To Be Sexually Active

Every man or woman who has had a heart attack has concerns when they can begin having sexual intimacy after recovering from a heart attack. Certainly the movie, Something’s Gotta Give with Jack Nicholson and Diane Keaton, offers the protagonist advice about engaging in sexual intimacy after a heart attack until the man can climb two flights of stairs without shortness of breadth or chest pain. Every woman is concerned whether resuming sexual activity may trigger another heart attack in her partner. We know depression is extremely common after a heart attack, especially for women. This blog will attempt to answer some of those questions that men and women have after a heart attack.

First, most cardiologist believe it is helpful for men to be in a supervised exercise program. These cardiac rehab programs teach men and women that it’s OK for them to exercise after a heart attack.

However, if you begin to feel symptoms such as chest pain, abnormal shortness of breath, fatigue, dizziness, or palpitations, it definitely makes sense to slow down what you’re doing, whether you’re a man or a woman. If you’re pretty certain it’s angina, which is temporary pain or pressure in the chest when the heart doesn’t get enough oxygen, it might help to take your nitroglycerin tablet under your tongue.

Now the warning: Just like the movie, Something’s Gotta Give, men who use medication for erectile dysfunction, such as Viagra, Levitra, or Cialis, — they should not take nitroglycerin. Your blood pressure can fall to dangerously low levels, and there’s an increased risk of heart attack and even death. If you’re on an erectile dysfunction drug and have heart-related symptoms during sex, call your doctor.

Yes, and sexual intimacy is often related to the emotions that follow a diagnosis of heart disease. It influences people’s lives in many different ways, and sexual activity is one of them. A new diagnosis of heart disease — or even a surgical scar — can make people feel less attractive. Some drugs have side effects that diminish sexual interest and performance. When patients feel angry and frustrated, it affects not only their sex lives but also their “couple” relationships.

Sexual intimacy is like a stress test. Engaging in sex shows that you’re capable of doing physical activity in which your heart rate and blood pressure go up. In a sense, you’re doing a stress test on your heart. If you tolerate that well and you feel good doing it, it suggests good things about your overall level of fitness and therefore your risk of heart disease.
Sex can also be a sign of healthy relationships and social supports. It shows you have the opportunities, frankly, and that you’re interested and engaged. Sex is a barometer for overall health.

Bottom Line: Sex is a good thing and sex is okay after a heart attack if your doctor gives you permission to exercise and engage in sexual intimacy. This is a discussion every man and woman needs to have with their doctor after having a heart attack and before leaving the hospital.

A Drink A Day Keeps A Heart Attack Away

November 14, 2012

Moderate alcohol consumption may lower the risk of heart disease.

Alcohol in moderation may help the heart

A recent study from Japan evaluated moderate alcohol consumption in in men , especially those with metabolic syndrome which consists of hypertension, diabetes and high cholesterol levels, found higher levels of HDL bandeaux in men who did not consume any alcohol. Again, there may be a medicinal advantage to moderate alcohol consumption.

Hypertension awareness
More men than women in the United States have hypertension, that men are less likely than women to be aware of their condition and to be taking medication to reduce the high blood pressure. The study appeared from the national health and nutrition examination survey.

The data from the study showed that less than 80% of the men were aware of their condition of high blood pressure compared with 85% of women. In addition, 70% of men were taking medication for hypertension compared with 80% of women with hypertension.

Bottom line: “If it may grow, don’t fix it” may apply to your car but not to your heart and blood vessels. Hypertension is a silent disease and often has no symptoms until complications occur. See your doctor at least once a year to have a blood pressure determination.

After a Heart Attack: Nine Important Steps to Follow

November 25, 2011

Heart disease is one of the most common conditions affecting middle age and older men and women. What you do after you have a heart attack (myocardial infarction) is important to your recovery and to your survival.
If you’ve just had a heart attack, how do you know whether you’re getting the best possible care? A new set of clinical performance measures can tell you whether your in-hospital treatment is on track. The measures, which were developed by the American College of Cardiology and the American Heart Association, are designed to help physicians provide optimal care for heart attack patients by outlining the key therapies that define high-quality hospital care.
• Heart Attack Step 1. You should receive aspirin when you arrive at the hospital. Studies show that aspirin reduces the risk of dying after a heart attack.
• Heart Attack Step 2. The hospital should provide clot-busting medication or angioplasty quickly. Prompt treatment is essential after a heart attack to reduce the risk of death. If you’re a candidate for clot-busting medication, you should receive it within 30 minutes of arrival at the hospital. Angioplasty with or without stenting should be done within 90 minutes of arrival.
• Heart Attack Step 3. While you’re in the hospital, you should receive a test that evaluates your heart’s pumping ability. Doctors will administer an echocardiogram, radionuclide angiogram or left ventriculogram to evaluate your heart’s left ventricular systolic function, or pumping ability.
• Heart Attack Step 4. Within 24 hours of admission, doctors should measure your total, LDL and HDL cholesterol levels as well as your triglyceride level. The results of this test will help determine your risk of a second heart attack and how aggressive your lipid-lowering therapy and dietary modifications need to be.
• Heart Attack Step 5. You should leave the hospital with prescriptions for a beta-blocker and a statin and advice to take a daily aspirin. These drugs reduce the risk of death and a second heart attack. A statin will be prescribed even if your LDL cholesterol is below 100 mg/dL.
• Heart Attack Step 6. If your heart’s pumping ability is reduced, you should also receive on discharge a prescription for an ACE inhibitor or angiotensin II receptor blocker (ARB).
• Heart Attack Step 7. If you received clot-busting medication after your heart attack, you should also receive a prescription for the antiplatelet drug clopidogrel (Plavix) when leaving the hospital. Adding Plavix to a daily aspirin further reduces the risk of heart attack in individuals treated with clot-busting medication after a heart attack.
• Heart Attack Step 8. You should receive a referral to a cardiac rehabilitation program or information about a clinical exercise program. These programs offer supervised exercise in addition to counseling on lifestyle measures, medication use and psychological issues. Make sure to follow through with your referral to cardiac rehab.
• Heart Attack Step 9. If you are a smoker, you should receive advice on smoking cessation while in the hospital. Quitting smoking is an essential part of recovering from a heart attack and has important long-term health benefits, including reducing your risk of a second heart attack.

This was excerpted from Johns Hopkins Medical Report: https://mail.google.com/mail/?hl=en&shva=1#inbox/133da74a2625336a