The goals of long-term treatment are to facilitate healing within the heart, to make it easier for the heart to function effectively, and to decrease the risk for future heart attacks. Medications may include aspirin and beta-blockers, and ACE inhibitors.
Patients who have had a heart attack should not smoke. Smoking cessation substantially reduces the risk for heart attack. Within one year of quitting, heart attack risk decreases by about 50 percent; and within 5 to 10 years of quitting, the risk is about the same as for anyone who is the same age and has never smoked.
Support groups, behavior modification, relaxation techniques, hypnosis, acupuncture, and drug therapy (e.g., bupropion [Zyban]) may be helpful while quitting. A recent study suggests that a combination of bupropion and a nicotine patch may also be helpful.
In 2009, the U.S. Food and Drug Administration (FDA) issued a black box warning for the smoking cessation drugs bupropion (Zyban) and varenicline (Chatix). According to the FDA, these medications carry an increased risk for mental health side effects, such as depression, behavioral changes (e.g., hostility, irritability), and suicidal thoughts. Zyban also may increase the risk for vision loss and angle-closure glaucoma. Patients who use these drugs to stop smoking should be closely monitored while taking them and after the medication is discontinued.
Cholesterol reduction therapy has been proven to decrease the risk for future heart attacks and strokes and to decrease the need for coronary angioplasty or bypass surgery. The primary goal of treatment is to reduce the level of "bad" (LDL) cholesterol to less than 100 mg/dL.
Medications called statins often are used to lower cholesterol. They include atorvastatin (Lipitor), cerivastatin (Baycol), fluvastatin (Lescol), lovastatin (Mevacor), pravastatin (Pravachol), and simvastatin (Zocor). These medications effectively lower LDL cholesterol levels and usually are well tolerated. Rare side effects include liver inflammation and muscle pain and inflammation. Patients taking these medications also must follow a low-cholesterol diet.
People who are physically active and exercise regularly have a lower risk for coronary heart disease than those who have inactive, sedentary lifestyles. Regular exercise can improve levels of "good" (HDL) cholesterol, can help control diabetes, can lead to modest reductions in blood pressure, and can reduce the risk for future heart attacks.
Heart attack patients must consult a physician for help devising an exercise program before beginning to exercise. Cardiac rehabilitation programs are available at many hospitals and community centers.