Coronary Artery Disease: How Patients Can Take Back Their Lives

Coronary artery disease (CAD) can sneak up on you. You may learn you have it after months of experiencing symptoms such as chest pain, jaw pain, fatigue, or even heartburn. Or you may find out you have CAD after surviving a heart attack. Either way, once you've got it, you have to learn how to live with it, because while CAD is treatable, there is no cure. And that can shake anyone's confidence, says Paul Kligfield, MD, medical director of the Cardiac Health Center at New York–Presbyterian Hospital and the author of The Cardiac Recovery Handbook. "Even the executives who say, 'I don't get ulcers, I give ulcers' sit up and take notice where their hearts are concerned. It's scary and it's mortality-confronting," he says.

Karen Sanson, 60, of Cleveland, struggled with fear and anxiety after her heart attack and diagnosis of coronary artery disease. "I had to come to terms with trying to have a relationship with my heart where I don't panic," she says.

"You think you're never going to be the same and you have to tiptoe around everything," says Jim Hayes, 77, of Solon, Iowa, who found solace by volunteering with other people living with heart disease.

Advances in surgery and medications, along with risk reduction, which includes quitting smoking, a healthy diet, regular exercise, and stress management, have made it possible to live a long and full life with CAD. The key is to get on a program, stay on it, and continue to monitor your physical and mental health.

Taking control of your heart health
Even if you have a family history of CAD, there's a lot you can do to prevent a heart attack. "If you control risk factors and try to be as fit as possible, you have the ability to improve not only your rate of survival but also your quality of life," says Paula Johnson, MD, chief of the Division of Women's Health at Brigham and Women's Hospital in Boston.

Among the most important risk factors for CAD is smoking. "I have told some of my patients, 'Stop smoking or you're going to die.' People have heart attacks that are triggered by one cigarette or one cigar," says Dr. Kligfield.

The best way for heart patients to quit smoking, change their diet and lifestyle, increase their fitness level, and get back to daily life is to enroll in cardiac rehabilitation as soon as possible.

“If it was a drug, it would be required,” says Dr. Kligfield, who estimates that the risk of a second heart attack or premature death is reduced by up to 30% for heart attack survivors who complete a cardiac rehab program. But unfortunately, less than 30% of people who are eligible for cardiac rehab take advantage of it, despite the fact that Medicare and most insurance plans cover it for about two to four months. And women with CAD are less likely to be referred to cardiac rehab and more likely to drop out, in part because of their sense of responsibility to their families.

Your doctor or nurse should be able to refer you to the nearest program, where you'll learn how to quit smoking, eat right, reduce stress, take your medications, and exercise safely as you build strength and endurance. You'll also learn how to get your confidence back and how to cope with the anxiety and depression that often sets in.

Getting your confidence back
“Maybe your doctors are telling you four weeks after surgery that your stress test looks good, or your stents are doing their job, but you're still not confident about going back to work or managing things at home,” says Leo Pozuelo, MD, associate director of the Bakken Heart-Brain Institute at the Cleveland Clinic. “This is where I think group therapy and hearing from other patients really helps,” says Dr. Pozuelo, who encourages patients to take advantage of the psychological counseling services offered at cardiac rehab.

“The main thing for coronary artery disease is that right now there is no cure or procedure to get rid of it, so it's all up to you. The only thing you can do is prevent it from getting worse,” says Sanson, who tries to exercise every day, takes her medications, and, more than two years after her heart attack caused by CAD, continues to go to cardiac rehab once a week. She also carries nitroglycerin pills with her wherever she goes. And she has made it her mission to educate other women about the risks of CAD.

“You have fears about everything from walking too far to having sex,” says Hayes, who has been living with CAD for more than 10 years. He regained his confidence by helping patients with similar experiences through Mended Hearts, a national volunteer organization affiliated with the American Heart Association. “It's like being in the military with a bunch of guys—you went through an unspoken thing, but you all know what you went through.”

And as for sex, there's no rule, but Dr. Kligfield suggests that if you can walk up two flights of stairs without stopping, you can probably do the deed.