A half century ago, people who were lucky enough to survive a heart attack were told to take it easy. Very easy. For the rest of their lives.

Now: Enormous progress in our understanding of heart disease has led to a complete about-face. If you have a heart attack today, chances are that life afterward will be just as active-maybe more so-than before. With modern medicines and a healthy lifestyle, you may well avoid further trouble for decades. Here's how…

Cardiac Rehabilitation

Whether you have had a heart attack or undergone a procedure designed to prevent one, such as bypass surgery or angioplasty (inflating a tiny balloon inside the artery to open it), you will have two goals—one is staying healthy, and the other is living a full and active life. Exercise is key to both.

New findings: A meta-analysis of 22 studies that included 4,500 patients found approximately 20% fewer deaths among those in an exercise program than in a non-exercising control group, one, two and three years after their heart attacks. Another recent study found 53% fewer visits to the emergency room for people in such a program during the year after their heart attack.

For most people, the best first step is a program of cardiac rehabilitation—typically a 12week series of three sessions per week. In each one-hour session, you will warm up, stretch, then work out on a stationary bicycle, treadmill, stair climber or rowing machineall under medical supervision.

You'll wear electrocardiogram (ECG) electrodes to monitor your heart rate and rhythm while you exercise. You'll be asked to stop or slow down at the first sign that your heart is having trouble keeping up.

Advantage: You can safely work out to your fullest capacity. Because you're being monitored, you will have the confidence to increase your exercise regimen and advance quickly toward your desired physical condition.

Bonus: A cardiac rehabilitation program provides you with discipline and structure, which makes it much easier to get into the exercise habit, particularly if you've been sedentary. In some cases, insurance will provide partial or full reimbursement.

If you choose to begin an exercise program on your own after heart attack or surgery, ask your cardiologist to supervise you. He/she can give you an exercise stress test to determine your physical limits and recommend incremental increases in the intensity and duration of your workout.

Exercise is a lifetime prescription. For most people, the best long-term results are achieved with four or five 30-minute sessions per week—walking, riding a stationary bicycle or jogging.

Maximize Mental Health

Even if you're physically fit, emotional stress can strain your heart. Best self-defense...

  • Reach out to family and friends for added support.
  • Practice a relaxation technique, such as yoga or meditation.

Forty percent of people who have heart disease experience depression. This not only prevents them from living full and satisfying lives but also increases their risk for additional heart attacks-and death. The more serious the depression, the greater the risk.

If you feel sad, find little pleasure in life, withdraw from family and friends or think often about death or suicide, see your doctor or a mental health professional. Medication and/or psychotherapy can ease depression.

A Chronic Illness

If you've had a heart attack or heart surgery, you still have heart disease. This means you will probably need to take medication for the rest of your life to help prevent additional heart trouble. Medications are likely to include…

  • Anticlotting drugs. Aspirin, clopidogrel (Plavix) and riclopidine (Ticlid) keep platelets from forming clots that could block coronary arteries.
  • Cholesterol-lowering drugs. Statins, such as torvastatin (Lipitor) and simvastatin (Zocor), lower LDL ("bad") cholesterol and, in some patients, also raise HDL ("good") cholesterol.
  • Beta-blockers. Metoprolol (Toprol) and propranolol (Inderal) reduce strain on the heart by curbing the rise in blood pressure and pulse rate caused by exercise or stress.
  • Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). ACE inhibitors, such as enalapril (Vasotec) and lisinopril (Prinivil), and ARBs, such as losartan (Cozaar), work by relaxing arteries and improving the heart's pumping efficiency.

Risks You Can Control

Some heart attack risk factors such as age, sex or family medical history-can't be changed. That's why it's important to control the risks you can. These include…

  • Cholesterol. Aim for a total cholesterol level below 180 mg/dl...LDL cholesterol below 100 (ideally, below 80)...and triglycerides below 150. HDL cholesterol should be above 45. To achieve these levels, you may need to take a statin in addition to eating wisely.

Follow a diet in which fat accounts for 25% to 30% of total calories, with no more than 7% saturated fat. Just over half of your daily calories should come from complex carbohydrates in vegetables, fruits and whole grains.

  • Blood pressure. Aim for 120/80.

To lower your blood pressure: Lose weight, if necessary...limit salt intake, if recommended by your doctor...exercise regularly... and drink no more than two alcoholic drinks per day if you're a man, one if you're a woman. If your blood pressure is above 140/90, you may need medication to bring it down.

  • Blood sugar. Diabetes increases the risk for heart attack. Exercise and weight control lower your chance of developing this disease.

Taking good care of yourself physically and emotionally should be a top priority—it's a lifesaver.

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