Prevention of heart disease is much more important than treatment if your goal is to live longer and be healthier.  Diet, and exercise are the most important.  Some vitamins, minerals, and supplements appear very helpful.  The very cautious use of alcohol appears beneficial, but should not be tried by anyone with a past history of alcohol problems.  Making fish, fish oil, or some other source of omega-3 fatty acids is beneficial as well.  For lowering cholesterol, see my page on policosanol.  Of course, high blood pressure increases heart disease and has its own section.  Fortunately, the some health habits good for the heart are good for high blood pressure and virtually all other parts of the body.  A healthy diet and exercise are the best ways of loosing weight and avoiding diabetes, two other heart disease risk factors.

Aspirin with Statins and Beta-Blockers Appear Best in English Study: In a study of 13 029 patients with a first diagnosis of ischaemic heart disease, 2266 cases were matched to 9064 controls. Drug combinations associated with the greatest reduction in all cause mortality were statins, aspirin, and blockers (83% reduction); statins, aspirin, blockers, and angiotensin converting enzyme inhibitors (75% reduction); and statins, aspirin, and angiotensin converting enzyme inhibitors (71% reduction). Treatments associated with the smallest reduction in all cause mortality were blockers alone (19% reduction), angiotensin converting enzyme inhibitors alone (20% reduction), and combined statins and angiotensin converting enzyme inhibitors (31% reduction). BMJ  2005;330:1059-1063 (7 May)

Aspirin Better than Aspirin Plus Clopidogrel in CHARISMA: The CHARISMA ("Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance") trial compared clopidogrel plus aspirin to aspirin alone (75-162 mg/day) on the incidence of cardiovascular events in 15,603 patients at high risk for atherothrombotic events followed for a median of 28 months. A composite of myocardial infarction, stroke, or death from cardiovascular causes, was not significantly different between the two treatment arms. The secondary principal efficacy endpoint, which included all hospitalizations for ischaemic events, was slightly reduced in the group with clopidogrel-aspirin as compared to the group with placebo-aspirin. In a subgroup analysis, among so-called "symptomatico" patients (79 % of the studied population), the dual antiplatelet therapy was associated with a significantly lower incidence of events than aspirin alone, including the primary efficacy end point. On the contrary, in "asymptomatic" patients, such a favourable effect was not observed. Unexpectedly, in this subgroup, a paradoxical increase in the mortality rate was observed with the clopidogrel-aspirin combination. The risk of severe (not significant) and moderate (significant) bleeding was higher in patients with the clopidogrel-aspirin combination. Aspirin is the first choice drug and the only antiplatelet agent to be used in prvention of cardiovascular disease. In secondary prevention, the addition of clopidogrel may reinforce the cardiovascular protection given by aspirin in "symptomatic" patients, but at the expense of a slightly higher bleeding rate.

Aspirin No Overall Help in Women's Health Study: In the Women's Health Study, 39,876 female health professionals over 10 years were randomized to receive either 100 mg of aspirin or a placebo tablet every other day; they were also randomized to take 600 IU of vitamin E or a placebo capsule on the intervening days. No statistically significant differences were seen between the aspirin and placebo groups in the combined number of nonfatal MIs, nonfatal strokes, and cardiovascular deaths. Analysis of secondary cardiovascular end points revealed that aspirin use was associated with no significant effect on the number of total MIs, fatal MIs, and nonfatal MIs, and a nonsignificant decrease in cardiovascular mortality. However, aspirin users did experience significantly fewer strokes, in particular ischemic strokes. Vitamin E had very little impact on the primary prevention of both cardiovascular events and cancer. Aspirin prevents stroke but not MI in women; vitamin E has no effect on CV disease or cancer. Buring JE. Harvard. . Cleve Clin J Med 2006 Sep;73(9):863-70.

Aspirin Meta-Analysis of Primary Prevention: Bad Idea for Health Adults: Six randomized trials have evaluated the benefits of aspirin for the primary prevention: the British Doctors' Trial, the Physicians' Health Study, the Thrombosis Prevention Trial, the Hypertension Optimal Treatment study, the Primary Prevention Project, and the Women's Health Study. The combined sample consists of 47,293 subjects on aspirin and 45,580 not with an average follow-up of 6.4 years. Meta-analysis suggested superiority of aspirin for total CHD, nonfatal MI, and total CV events (p < or =0.001 in each case), with a nonsignificant trend (0.07 < p <0.34) for decreased risk of stroke, CV mortality, and all-cause mortality. Meta-analysis of data from the six primary prevention trials of cardiovascular events using aspirin. Bartolucci AA, et al. University of Alabama at Birmingham. . Am J Cardiol 2006 Sep 15;98(6):746-50. Ed: The Medical Letter notes that three of the above trials accepted patients who were at moderate to high risk for cardiovascular events and that tow studies were no double-blinded and used no placebo. In men, there was a 69% higher risk of hemorrhagic stroke and a 68% higher risk of major bleeding. It concludes, "For healthy patients, asporin prophylaxis might do more harm than good." 7/3/06

Chelation Didn’t Help: Placebo controlled study. JAMA 1/23/02;287:481

Estrogen: Epidemiology Studies Say Helps: Several observational studies have found women on estrogen with or without risk factors had lower total mortality and CAD and CVD mortality. Grodstein, NEJM 336:1769, ’97; Newtone, Am J Epidem 145:269, ’97

Estrogen-Medroxyprogesterone Increases Mortality: In one year, for every 10,000 women who take the estrogen-progestin combination Prempro there will be eight more breast cancers, eight more strokes and seven more heart attacks - and six fewer colon cancers and five fewer hip fractures - compared with 10,000 women who didn't take the pills. Prempro increased the risk of stroke by 41 percent HR 1.41, a heart attack by 29 percent and breast cancer by 26 percent HR 1.26.It decreased hip fractures 0.66, colorectal CA 0.63, and prevents osteoporosis. 5.2 year study of 16,000 women aver. age 63 HRT or placebo. NIH Study, JAMA 7/9/02 288:321

Estrogen OK, Not Prempro: Women’s Health Initiative Prempro arm stopped due to increased harm, however, estrogen by itself in another arm of the study for women with hysterectomies was continued because of no sign of harm. Medroxyprogesterone interferes with the beneficial effects of estrogen. A different progestin may cause fewer side-effects and less interference. Only medroxyprogesterone of several progestins blocked the favorable anti-dementia effect. Scientific American 10/03

Estrogen-Progesterone Combination Increases Illness: DB HERS study of 2783 with daily estrogen-progestin no effect on cardiovascular, a triple increase in thromboembolic disease and a 35% increase in gallbladder disease.(JAMA 280:605 ’98). Estrogen lowers LDL and raisies HDL and trigly. Observational studies reduce mortality (NEJM 336:1769, 1997; Am J Epidem 145:269, 1997).

Exercise: Cuts Exercise-triggered Sudden Death: A 12-year study of thousands of male physicians showed that men who exercised at least five times a week had a much lower risk of sudden death -- about sevenfold less -- than those who only exercised once a week, Christine M. Albert, Brigham and Women's Hospital. 11/9/2000 CNN. For many more studies, see Exercise.

Fiber Lower Ischemic Heart Disease in Iowa Women’s Health Study: 34,492 women ages 55-69 with 9 years of follow-up found the three highest quintiles for whole fiber intake (>1.2 servings/day) had an RR .69 for IHD death. Am J Clin Nutr ’98 Aug; 68:248-57. Reference two other studies showing whole grains decreased heart disease: 7^th day Adventist study, Arch Intern Med ’92;152:1416 and Br Med J ’90;300:771

Fiber Helps In Finnish Smokers: 21,930 smokers ages 40-59 found CHD death rate in the highest quintile of fiber intake vs. lowest had a very favorable risk ratio: RR 0.69. Circ 96’;94:2720

Fiber: Grain Fiber But Not Other Fibers Helps: In a 10 year follow-up of 75,000 nurses found a strong decrease in CHD for cereal fiber RR .63, but no benefit from other sources of fiber, i.e. fruit and vegetable fiber. Willett, W.C.; JAMA 1999, Jun 2, 281:1998-2004. Ed: Cereal fiber is primarily whole wheat and rye covered under the diet section.

Flu Shot May Help: Three studies find: 1) Heart attacks more severe in cold months, cardiac arrest most common in winter, and 3) 233 patients with heart attacks followed by Morteza Naghavi of the University of Texas were studied. Those getting flu shots had 67% reduced rate of 2^nd heart attack. 2000 meeting Am College of Cardiol. Anahiem AP 3/13/00.

Flu Shot Cuts Strokes & Heart Deaths: A study of 148,000 adults over age 64 in a health care system found that vaccination against influenza was associated with a reduction in the risk of hospitalization for cardiac disease (reduction of 19 percent during both seasons [P<0.001]), cerebrovascular disease (reduction of 20% during the two seasons, and pneumonia or influenza (reduction of 30% during the two seasons and a reduction in the risk of death from all causes (reduction of 49% during the two seasons. U Minn. Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly. N Engl J Med 2003 Apr 3;348(14):1322-32Nichol KL, Nordin J, Mullooly J, Lask R, Fillbrandt K, Iwane M.

Nap Three Times a Week Cuts Heart Disease: A six-year Greek study of 23,681 adults 20-86 without known heart disease found that those who took a 30-minute siesta at least three times a week had a 37% lower risk of heart-related death. Trichopoulos D, et al. Harvard. 2/12/07 BBC News.

Tetracyclines & Quinolones Might Help: A case control study of 3,315 patients under 76 with first heart attacks and 13,139 controls found those using tetracyclines in the previous three years had an adjusted odds ratio of 0.70 and for quinolones of 0.45. No effect was found for macrolides (primarily erythromycin), sulfonamides, penicillins, or cephalosporins. Other research in observational studies and randomized trials suggest bacteria, especially Chlamydia pneumoniae and possibly Helicobacter pylori and periodontal disease bacteria may play a role in increasing the risk of a heart attack as well as thromembolic stroke. Christoph Meier, Boston U, JAMA 281:427-31. (2/3/99). Ed: A more careful DB PC study was unable to confirm this finding.