1. Cholesterol control

If a person had never had coronary artery disease, the goal (primary prevention) is to try to achieve a total blood cholesterol level of below 200 mg/dL or an LDL level (the bad cholesterol) of between 100 – 130 mg/dL.

Once there is confirmation of coronary artery disease and especially with other added risk factors (secondary prevention) ,then the total cholesterol level should drop below 180 mg/dL and preferably below 160 mg/dL and a surrogate LDL level of below 100 mg/dL and preferably below 80 mg/dL in the very high risk groups. (Based on the Singapore Lipid guidelines)

This can be achieved with a combination use of dietary therapy and lipid-lowering drugs (eg. statins).

2. Dietary therapy

Basically a healthy diet would include the following:- Consume a diet rich in vegetables and fruits, whole grains, low-fat and non-fat dairy products, legumes, fish (at least 2 times per week) and lean meat, coupled with food choices that minimize in-takes of excess energy, saturated fat, trans fat, cholesterol and salt.

Note the importance of focusing on the overall diet quality (dietary pattern) rather than individual foods and nutrients, balancing energy intake and expenditure, engaging in regular physical activity and increasing the importance of selecting a healthy diet program when eating outside of home is of paramount importance if one’s wish is to be successful in reducing his or her blood cholesterol through diet modification.

Overweight / Obesity

The next risk factor to modify is the weight. Obviously if one is overweight or is obese, there will be a need to reduce weight. The key to weight reduction is to reduce the number of calories taken to match the physical activity of the individual. One also needs to engage in regular physical exercise to try and burn off the excess calories and reach an ideal body weight. Aim to keep BMI (body mass index) below 23 kg/m² (healthy range 18.5 – 22.9 kg/m² – source; Health Promotion Board).

3. High blood pressure

Blood pressure is another important risk factor that should be controlled to prevent coronary artery disease. Blood pressure should be kept below 130/80 mmHg and again a diet low in salt will be a good start. This couple with increased regular physical activities can reduce your blood pressure. Controlling the amount of work stress, alcohol intake and smoking, all contribute towards successful control of high blood pressure.

Diabetes Mellitus

Aim to avoid diet high in carbohydrates and a HBA1C ≤ 6.0%.

4. Smoking

If one is smoking then one should stop smoking and also avoid the use and exposure of tobacco products. To summarize, the American Heart Association had come up with a summary of the diet and lifestyle goals for cardiovascular disease risk reduction in 2006. See attached table. These are very good points to note and to try and achieve a heart healthy lifestyle and nutrition pattern and also would result in minimizing the development of obesity and diabetes mellitus as well as establishing life long healthy dietary habits.

AHA 2006 Diet and Lifestyle Goals for Cardiovascular Disease Risk Reduction

Consume on overall healthy diet

Aim for a healthy body weight

Aim for recommended levels of low-density

lipoprotein cholesterol, high-density lipoprotein, and triglycerides

Aim for a normal blood pressure

Aim for a normal glucose level

Be physically active

Avoid use of and exposure to tobacco products.