Before his first heart attack, he admits that he had already received several warning signs. Tomás Fajardo, 69 years old, worked as an executive in a financial institution, ate out from home, did not play sports and his daily life was very stressful. Every year he had the medical checkup offered by his company and at 34 they warned him that his cholesterol was high. “From the age of 40 I started taking medication. “I had a clear risk factor,” he admits.
Tomás maintained a sedentary lifestyle until, at age 48, everything that seemed invisible became visible. “Late one afternoon, I began to feel unwell and felt pain in my chest that radiated to my arms. I knew at all times what was happening to me,” he confesses. Tomás knew he was having a heart attack because his older brother, who died the previous year, had experienced a similar episode, although he only survived a week, and his father had also died at 62 from a heart attack.
With unusual serenity, he quickly went to the emergency room driving his car. “With the bad look on my face, they didn't understand that I was driving,” she remembers. After that scare, the recovery was slow and the sick leave lasted half a year. As a result of that episode, he realized that there was a before and after in his life, however, the transformation that he promised himself was left half-finished. “I took the medication, went to the check-ups and felt fine. But I went back to the cycle of work, stress, meetings, trips…,” he says.
After a first heart attack, patients who go to the doctor say they are aware of the disease. “They are scared and worried,” highlights Dr. Cosme García, head of the Coronary Unit of the Institut del Cor Germans Trias i Pujol. During the first months, these patients improve their diet, some stop smoking, try to exercise and walk. But this improvement in lifestyle habits is more difficult to maintain when the chronic phase of the disease is reached, that is, one year after having had the heart attack.
“Fortunately, we have more and more patients in the chronic phase because mortality from heart attacks is decreasing and the life expectancy of the population is increasing,” says Dr. García. However, although the mortality of patients admitted for a heart attack continues to decrease, the prevalence of this disease continues to increase. “The risk control of cardiovascular factors is not carried out as it should be done. It is something that has to worry us,” says the cardiologist.
One of the main keys “is to keep LDL cholesterol as low as possible because it is one of the most important cardiovascular risk factors. It is at the same level as diabetes, hypertension or smoking,” says Dr. García. The so-called bad cholesterol has a great capacity to form atheromatous plaques, which are those that end up blocking the coronary arteries and causing angina, a heart attack or a stroke.
The stability of the disease does not mean that it no longer exists. In fact, some patients lose their fear. “After the first year, it is not uncommon for them to smoke again, stop exercising, diet is not adequate and adherence to medications is not as good as in the first months,” points out Germans specialist Trias i Pujol. Sometimes the patient is not aware of being poorly controlled and months later this can lead to a heart attack. “The biggest problem is that when they move away from the acute phase, they lose awareness of the disease,” he says.
In the case of Tomás, the routine prior to the heart attack was reestablished and, nine years after the first cardiovascular accident, the second would arrive. Tomás was already 57 years old. At six in the afternoon, while he was in his office, that symptomatic pain in his chest returned, although he did not say anything to his family. “It couldn't be. “You yourself deny that it is happening to you again,” he acknowledges. But when Tomás saw that night was approaching, he began to distrust himself and his son took him by car to the hospital. “In the emergency room they scolded me because I had waited a long time to go when it had already happened to me again and the symptoms were the same. It was a big mistake on my part,” he admits.
That second heart attack was a major setback for him. “It changed my mentality a lot,” he says. And the circumstances, too: he retired early at 59 years old. “I accepted that I couldn't continue working and then it changed my life completely,” he explains. Tomás took more care of his diet and went for walks every day. “It was up to me to lead a healthier life that would allow me to live many years,” he says. In his case, the genetic factor could have played a role, but also high cholesterol, a sedentary lifestyle and a high-stress job. Furthermore, Tomás smoked until the year before he had his first heart attack. “I had all the numbers for it to happen to me,” he says, convinced.
Many people with chronic illnesses can lead normal lives, but they should never let their guard down. In some cases, after a new cardiovascular event, the patient goes to the doctor's consultation, reducing its severity. Among the reasons for this attitude are the lower mortality due to infarction in the acute phase and a hospital stay that is usually short. “Although we try to raise awareness that it is a chronic disease with no cure and that risk factors must be controlled, unfortunately, these patients do not change their habits too much,” highlights Dr. García.
However, a patient who has already had a heart attack is a patient who is not only chronic but also very high risk. His condition is lifelong and he will always have to control his cholesterol and ensure that he achieves his control goals: an LDL-C below 55 mg/dl. It is very important that those affected carry out the recommended follow-up to control their pathology - periodic tests and scheduled consultations -, that they adhere to a healthy lifestyle and that they comply with the pharmacological treatment.
“It seems much more serious to say I have had cancer, rather than a heart attack,” says Tomás. Therefore, for him, much more work must be done on prevention and society must be aware that atherosclerotic cardiovascular disease is the main cause of heart attacks and strokes, and causes 85% of deaths related to cardiovascular diseases in around the world, according to the World Health Organization. Despite its prevalence, cardiovascular diseases remain a health challenge hidden in plain sight.
When the former economist looks back, he reflects on the lack of psychological support he received after his first diagnosis. Something that, apart from the undeniable family support, does occur in patient associations. “In the last ten years the patient has been greatly empowered. There is a tendency for him to know his illness, to know what his limitations are and how far he can go,” he explains. For Tomás, who voluntarily helps other patients, it is very important that those affected live in a healthy cardiovascular environment, that is, that they interact with people to whom the same thing has happened and can lead a normal life.
Experts point to the need to improve coordination between the hospital and primary care, especially when the initial phase of the disease has passed, the specialist sees the patient less frequently and follow-up is done by the family doctor. At no time should controllable risk factors be lost sight of, such as diet, physical exercise, maintaining an appropriate weight and avoiding tobacco, in addition to remembering that they must remain consistent with the established pharmacological treatment.
Specialists advocate for atherosclerotic cardiovascular disease (ASCVD) to be recognized as a priority public health problem due to its high impact. “We have a lot of information thanks to the associations, but we believe that in health care there is still a lack of this point of information for the patient, about what they have had and the chronicity of their disease,” claims Tomás, while the cardiologist assumes the importance of continue spreading. “We must remind patients that they must have healthy habits,” insists Dr. García.
For Tomás, doing so is not so difficult if you commit yourself. “There are risk factors that you can control yourself, such as walking about 45 minutes a day, eating a healthy diet, not smoking, and reducing alcohol consumption. This information must reach the population,” he defends with the lesson learned and without avoiding getting excited. “My illness is a sword of Damocles, but as the years go by I can live with it. I don't have to die before someone else. If you take care of yourself and lead an orderly and healthy life, it doesn't have to happen to you,” he concludes, convinced.
