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If you have coronary heart disease, following the recommendations of your health care provider is very important if you wish to improve your condition or prevent it from getting worse. If you notice any change in your condition, you may need further diagnosis or treatment.

The most important ways to reduce the risk of heart disease are in your control, not the control of your health care provider.

• Lifestyle changes are the most powerful way to prevent heart disease from getting worse or of reducing the risk of getting heart disease in the first place.
• The phenomenal drop in the heart disease death rate over the past 30 years has been due more to reducing risk factors than to advances in treatment.

Everyone should take the following measures to lower the risk of heart disease:

• Eat a heart-healthy diet: This is the most important step you can take in lowering your risk.
• Lower your fat intake: Calories from fat should be less than 30% of your total calorie intake every day. This translates to less than 60 grams of fat per day for an adult.
• Lower your blood cholesterol to the recommended level, especially the LDL cholesterol: This keeps plaque from building up within your coronary arteries.
• Engage in regular exercise: This can reduce your risk of heart disease. Exercise strengthens the heart, makes it more efficient, and lowers your blood pressure and bad cholesterol (LDL), yet raises you good cholesterol (HDL). Check with your health care provider before beginning an exercise program. The American Heart Association recommends at least 30 minutes of exercise 3-5 times a week.
• Quit smoking: This also provides a very striking benefit. After only 3 years of not smoking, your risk of heart disease drops to that of a nonsmoker. Your health care provider can help you quit smoking by providing guidance on changing your behavior. Certain medications have been shown to help some people quit smoking.
• Control high blood pressure and diabetes: If you have diabetes, keep your blood sugar under control every day. You should know the value of your HbA1c, a measure of how your blood sugar is controlled; it should be less than 7.0.
• Take a low-dose aspirin daily: This can reduce your risk of heart attack. With aspirin, there is some risk of bleeding, so ask your health care provider before taking aspirin daily.
• No scientific clinical trial in humans has shown a beneficial effect of vitamins on the heart.

Note that hormone replacement therapy (HRT) was used for many years to prevent coronary heart disease and heart attack in women who had gone through menopause.

• Replacing certain hormones was thought to provide a heart-protective effect enjoyed by women before menopause.
• A research study that ended in 2002 found, however, that women who took HRT actually had higher rates of heart disease and stroke than women who did not take HRT.
• HRT is no longer recommended for prevention of heart disease.

Follow these dietary guidelines.

• Soy products help reduce LDL cholesterol.
• Eat a fruit plate or low-fat yogurt for dessert. Cut sweets and sugars to a minimum.
• Cook foods in olive oil or canola oil, which are high in monounsaturated fats. These fats decrease LDL and total cholesterol levels.
• Eat 1 or 2 servings of fish or seafood each week.
• Eat nuts that are rich in monounsaturated fats, such as hazelnuts, almonds, pecans, cashews, walnuts, and macadamia nuts. These nuts are healthful but high in fats. They should be eaten in small amounts.
• Cooking foods with garlic, which may have a slight cholesterol-lowering effect.

Alcohol may be taken in moderation.

• No more than 2 drinks per day for men and 1 drink per day for women is recommended to raise the good cholesterol (HDL).
• However, some people should not use alcohol. People who have liver or kidney problems, certain other medical problems, problems with alcohol abuse, or who are taking certain medications should not use alcohol.
• If you do not use alcohol, most medical professionals would recommend that you not start just for the benefits to your heart.
• If you have any questions about alcohol's positive and negative effects on your health, ask your health care provider.

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