- The Washington Times - Monday, July 9, 2001

A heart attack is nature's way of saying "take care of yourself." But doctors say an alarming number of heart attack and stroke survivors don't and consequently run a higher risk of an early death.
In an article appearing in today's issue of the Archives of Internal Medicine, Dr. Adnan I. Qureshi reports on a study of 1,252 survivors of heart attack, stroke or both. He finds that more than half (53 percent) of those victims who had high blood pressure before their attack still had dangerously high blood pressure long after recovering.
He found that 46 percent of the survivors who had high cholesterol immediately before their attacks had perilously high cholesterol levels after recovery, and 18 percent who smoked before their illness continued to do so after leaving the hospital.
High blood pressure, high cholesterol and smoking are known to be the most serious risk factors for heart disease and for stroke, the term for a blockage in blood flow to the brain and for bleeding in the brain. All three of those risk factors can be drastically reduced or eliminated by dieting, exercise and medication, or, in the case of smoking, just by quitting.
Dr. Qureshi, a neurosurgery professor at the University of Buffalo School of Medicine and co-director of the school's stroke research center, says, "You would think that those who have been treated for a heart attack would be in better shape." He means they should have been jarred into taking precautions against another, possibly catastrophic attack and could be expected to reduce further risk.
After all, as the doctor states in his report, "among the survivors of [a] first MI [myocardial infarction or heart attack] the rate of subsequent MI is increased 3 to 6 times." The literature on heart disease notes that 25 percent of male victims and 38 percent of female survivors die within a year of their first attack.
Dr. Robert DiBiancho, director of the cardiology research and risk factor clinic at Washington Adventist Hospital in Takoma Park, says: "Almost invariably the heart attack gets patients' attention for the interval when they're in the hospital and just after discharge. But I have seen all too frequently that patients lose enthusiasm for controlling risk factors.
"The glaring example is patients whose cigarette smoking caused their heart attack or stroke. They stop smoking temporarily. But, soon after the event, they go back to the habit. Smoking is one of the most horrendous risk factors we have because of the way it creates abnormalities of blood vessels and excessive clotting."
Dr. DiBiancho says that sometimes patients are misinformed and think that when their cholesterol is reduced by medication, they can stop taking the drug. "And after about a year they stop. But those drugs don't work unless they are taken regularly."
Both Dr. DiBiancho and Dr. Qureshi say denial also is a factor.
"It's a tendency to think things are going fine, there are no further symptoms, so there won't be another problem," Dr. DiBiancho explains. He says it's healthy to not be paralyzed by fear, but denial is excessive when patients lose their prudence.
Dr. Qureshi bases his findings on a first-of-its-kind analysis of 1994 National Health and Nutrition Examination Survey of 40,000 individuals.
Participants in the study were interviewed and subjected to a medical exam and blood tests.
The fresh analysis of the 7-year-old data shows that middle-aged people, black women and women in general are the most likely to ignore precautions needed to stave off a second heart attack or stroke.

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