Atrial fibrillation

Reducing stroke risk through other medication and lifestyle changes after diagnosis of atrial fibrillation

Alongside anticoagulant (blood thinning) medication, people with atrial fibrillation (AF) can help reduce their stroke risk by managing hypertension and cholesterol and leading a healthy lifestyle. We asked people to tell us what they did.

Managing hypertension and cholesterol with medication
As well as medications to control heart rate and rhythm and anticoagulants to thin the blood, people with AF may also be on blood pressure medication such as candesartan, ramipril, frusemide, amlopidine, bisoprolol, and atenolol, and/or statins such as simvastatin and atorvastatin to help keep arteries clear, reduce cholesterol and minimise their risk of stroke. Elisabeth X, who is in her seventies, said, ‘it’s fairly standard for somebody of my age who’s got a heart thing’ to be on blood pressure medication. Statins have helped David Y get his high cholesterol ‘under control’, while taking simvastin to keep his cholesterol level down has helped Chris Y ‘live with’ his AF. Some people are taking statins even if their cholesterol is not high. Keith was prescribed simvastin after his TIA/minor stroke, and Ann takes simvastin, as ‘a precaution’. 

While people we spoke to recognised the benefits of these medications, they also spoke of side effects. Glyn takes a cholesterol tablet every night even though they give him ‘horrible nightmares and a dry mouth’. As he put it, ‘if it stops you having a heart attack or keeps your arteries clear, it’s well worth going through that’.
Leading a healthy life with AF
People we interviewed were aware of the need to adopt a healthy lifestyle as a way of reducing their risk of stroke.
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Many commented on how exercise and eating a low fat ‘healthy’ diet with plenty of fruit and vegetables were already part of their everyday lives. James said he was careful of his cholesterol intake and had cut down on alcohol. As Jeni commented ‘I haven’t really changed very much – I had a healthy diet and led a boringly healthy life anyway’. Recent warnings about the increased health risks associated with eating too much red meat had encouraged some people to include more chicken, fish and vegetables in their diet. Glyn tries to eat as much white meat and oily fish as he can to minimise his risk of stroke.
In many cases, people had cut down or given up caffeinated tea and coffee and/or alcohol after finding they triggered palpitations. Bob believed that it was an enzyme or yeast rather than alcohol that triggered his AF, as he still had symptoms drinking alcohol-free beer. Chris X found that chocolate, and MSG (monosodium glutamate) in Chinese food triggered his AF. George Y now avoids eating bananas after finding they triggered his AF. Geoff cut out wheat and found this dramatically improved his AF symptoms. Keith gave up smoking and drank less after he had a TIA/minor stroke. The stroke ‘did the trick’ as he had steadfastly ignored his doctor’s advice before this.
Some people we spoke to made few changes to existing fitness programmes. They continued to walk, swim and go to the gym as they had done before their diagnosis. For others, a diagnosis of AF led to a commitment to exercise more, or to adjust their exercise routine. Janet reported feeling ‘a lot fitter and a lot better in myself’ after investing in a personal trainer and regular exercise.
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People told us that losing weight was an important part of a healthy lifestyle and would help minimise their risk of diabetes and stroke. Paul spoke of undertaking a ‘lifestyle change’ with his wife and losing weight: ‘I was trying to do something positive because of the AF’. Dot decided to ‘lose some weight’ and gain a sense of control over her AF. Others tried to get more sleep. Freda noticed that lack of sleep affected her AF. Some tried to slow down and manage stress.
Despite good intentions and an awareness of the importance of adopting a healthy lifestyle ‘when you’ve got AF’, some people found that this was not always easy. Mary, a woman in her eighties, described how ‘ready meals came in handy’ despite her desire for a healthier diet; Raymond, while adopting the message of ‘five a day’, was confused about quantities: ‘Is one little sliver of carrot a portion of carrot?’ Janet spoke of the difficulty of losing weight: ‘I’ve cut down on carbohydrates but my weight doesn’t seem to shift’; Vera was trying to lose weight, but found that an increased appetite which she attributed to taking prednisolone for another condition, hindered her weight loss efforts. Raymond, who recently had surgery for knee and spinal problems, expressed concern that he would put on weight through lack of exercise.
(For more see ‘Atrial fibrillation, stroke risk and blood thinning medication’ and ‘Heart rate and rhythm medication for atrial fibrillation’).

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