Heart Attack Prevention Gets New Lease of Life

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Heart Attack and Having Sex

For the first time, known triggers for heart attacks - including sexual activity, cocaine use, pollution, heavy meals, and stressful major events like September 11 - have been analysed to develop a whole new approach to prevention.

Traditional long term approaches to heart attack prevention - diet and exercise regimes and medication - are important but often ignore brief external triggers, according to Dr Geoffrey Tofler, Professor of Preventive Cardiology at the University of Sydney and Royal North Shore Hospital, and Lecturer in Medicine at Harvard University.

External triggers - such as sudden severe stress or physical exertion - can be a factor in up to 40% of heart attacks, said Professor Tofler. "We know, for example, that the incidence of heart attacks rises sharply in the days after people are exposed to major events such as an earthquake or a September 11. That knowledge can be used to ensure aid teams have the equipment and knowledge to treat heart attacks and not just traumatic injuries."

Along with Dr James Muller, Professor of Cardiology at Harvard University in Boston, Professor Tofler has proposed a new 5-pronged approach for prevention of triggered heart attack and stroke called Triggered Acute Risk Prevention (TARP).

"The TARP approach includes the role of common sense measures, such as a person at high risk for heart disease getting someone else to mow the lawn or limiting time outdoors on hot days or when pollution levels are high," Professor Tofler said.

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Having sex causes little increased risk of heart attack, while in contrast cocaine use can result in a 20-fold increase in heart attack risk during use: if individuals know what the relative risks are they will be better able to manage their own health accordingly, Professor Tofler said.

The TARP approach also includes social policy initiatives, such as implementing tighter controls on pollution, a known trigger for heart attack, and using vaccinations to protect against the increased cardiac risk posed by influenza and pneumonia.

Professor Tofler likens TARP, recently published in the prestigious USA cardiology journalCirculation, to "a protective tarpaulin that keeps off the rain."

Professor Tofler cautions, however, that concern about heart attack triggers must be kept in perspective. "It would be a concern if focus on very small risks associated with the stress of daily living led to excessive caution."

The next steps for Tofler and his colleagues are to further evaluate specific stressors, including bereavement, infection and heavy physical exertion.

"Further research is also needed to address questions such as whether, during a highly stressful event such as the last minutes of a close football final, people at risk would benefit from added medicine to prevent blood clots, fast heart rate and raised blood pressure that could increase the risk of a heart attack."

Development of the TARP approach will hopefully add to current recommendations for long term risk reduction, said Professor Tofler.

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