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 helped David Y get his high cholesterol ‘under control’. Taking simvastin to keep his cholesterol level down helped Chris Y ‘live with’ his AF.
Some people were taking statins even if their cholesterol was not high. Keith was prescribed simvastin after having a TIA/minor stroke, and Ann took 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’.
Eileen described the difficulties of trying to balance blood pressure drugs with medication for her AF.
Eileen described the difficulties of trying to balance blood pressure drugs with medication for her AF.
I went to see [consultant] and explained to him what was going on. The first thing he said to me was, “Do you know what the side effects of bisoprolol are?” And I said, “No.” So he rattled off every one of my symptoms. So the first thing they did was took me off the bisoprolol and put me back on the atenolol but by then, my blood pressure, which is not easily controlled at the best of times was haywire. So then we had three months of actually controlling the blood pressure.
James found that his cholesterol medication gave him arthritis-type symptoms in his wrists.
James found that his cholesterol medication gave him arthritis-type symptoms in his wrists.
Okay. So are you are you on anything for your cholesterol now?
I just take natural sterols, and watch what I eat, and I’m going to have another cholesterol test in a couple of weeks.
Freda experienced skin problems after taking simvastatin to control her cholesterol.
Freda experienced skin problems after taking simvastatin to control her cholesterol.
Then I deliberately didn’t take rosuvastatin until this acne disappeared because I wanted to give the rosuvastatin a clear, you know, chance to react on me and I didn’t have any spots but a tiny, tiny acne appeared on my face but I decided I’d better carry on with this, see how I get on. Fortunately, it seems to me that there wasn’t any further acne to come up and nowhere else on my body. So I continued to take this rosuvastatin. I’m on this for about four years or so.
On reading and studying that the, on, not sort of, you know, I what you can get from the internet, the statin is famously notorious for affecting the muscles like legs etcetera etcetera.
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.
Noel is conscious of the risk of stroke and monitors what he eats and drinks.
Noel is conscious of the risk of stroke and monitors what he eats and drinks.
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.
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 encouraged some people to include more chicken, fish, and vegetables in their diet. Glyn tried to eat as much white meat and oily fish as he could to minimise his risk of stroke.
Suzy has made few changes to her diet but has cut down her use of chillies and given up chocolate.
Suzy has made few changes to her diet but has cut down her use of chillies and given up chocolate.
So I drink herb teas and water and don’t really want for anything else. Other lifestyle factors, I really, really love very spicy food. I love chillies and there is a school of thought that says that maybe even very spicy food could trigger AF in people who are sensitive. I, it certainly turns up the heart rate. I haven’t given up chillies but I’ve probably cut down just a little bit, because I just haven’t wanted to rock, rock the boat of not being in AF. But it would be very difficult for me to give up on spicy food but maybe there’s no need. Chocolate I’ve given up actually, just in case.
Alongside taking medication for her AF, Pauline makes sure that she eats a healthy diet.
Alongside taking medication for her AF, Pauline makes sure that she eats a healthy diet.
In many cases, people cut down or gave 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 when drinking alcohol-free beer.
Chris X found that chocolate, and MSG (monosodium glutamate) in Chinese food triggered his AF. George Y avoided 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 it ocurred.
Despite keeping a food diary, Freda has not found anything that triggers her palpitations.
Despite keeping a food diary, Freda has not found anything that triggers her palpitations.
With regard to food diary, I have not come across any particular vegetable, any particular dish or anything like that appears to affect, not that I have any sort of varied diet.
Over a year of food diary, I have no nothing to tell myself that I would be careful with this. Neither on caffeinated drinks either but I have noticed that the lack of sleep, lack of exercise, exercises, suddenly a lack of exercise, it doesn’t give me a very good sleep. I tend to wake up during the night. So perhaps disturbed sleep, it may be something to do with a lack of lack of exercise.
Nuala explained how giving up alcohol had a knock-on effect on her social life.
Nuala explained how giving up alcohol had a knock-on effect on her social life.
I’m much more aware of it now. It was difficult, very difficult at the time because you were on a lifestyle and I really, really wanted my type I wanted my life back again, the way I had it and it wasn’t going to happen. And it was, when I look at it through, it was very much a grieving process for the life that I had, denial at first, and then really angry and really frustrated at not being able to do what I wanted to do and particularly, going out socialising, even though I went out but I was the one that was sitting that wasn’t drinking.
So in a way, some things, as I say, it’s one of the worst things that has happened to me but it’s one of the best things that’s happened to me. It’s forced me to look at my life.
Despite being fit and leading a healthy lifestyle, Noel finds AF a depressing illness. He believes nothing can be done to cure it.
Despite being fit and leading a healthy lifestyle, Noel finds AF a depressing illness. He believes nothing can be done to cure it.
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.
Since his TIA/minor stroke, Chris Y has adjusted his exercise routine.
Since his TIA/minor stroke, Chris Y has adjusted his exercise routine.
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. He '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.
Elisabeth Y realised she had to eat more healthily and lose weight or risk developing type 2 diabetes.
Elisabeth Y realised she had to eat more healthily and lose weight or risk developing type 2 diabetes.
I lost the weight in about six months. This is the bit that’s annoying me, my weight has settled at thirteen stone and doesn’t go down. The other half of the trick is portion control.
Despite good intentions and 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 80s, described how ‘ready meals came in handy’ despite her desire for a healthier diet; Raymond, while adopting the message of ‘5 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 had recently had surgery for knee and spinal problems expressed concern that he would put on weight through lack of exercise.
Dave described his exercise dilemma.
Dave described his exercise dilemma.
Carin is afraid to exercise in case it triggers an attack. She wishes she could be more active.
Carin is afraid to exercise in case it triggers an attack. She wishes she could be more active.
I used to go to the gym. I used to go to the gym like every now three four times a week. I daren’t go there anymore. So, you know, and people say, you know, my nurse, the nurse that I’ve seen says, “Oh, just go to the gym.” And I say, “Yeah, well, what happens when I’m there and I get one of these attacks?” She says, “Well, you just stop, you know. You stop, you stop moving.”
What I would like to see happen is that there is more understanding of this condition and maybe, for people like myself, I need to go to the gym you know, maybe there’s, there should be some supervised gym, you know, properly supervised by a cardio-nurse or whatever. You know, so medical people there, that when you get this, that they’re there and they can sort of help you through, because at my gym there’s nobody there. It’s unsupervised.
See also ‘Atrial fibrillation, stroke risk and blood thinning medication’ and ‘Heart rate and rhythm medication for atrial fibrillation’.
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