Patient-directed, nonprescription approaches to cardiovascular disease

The control of coronary artery disease requires both physician-directed interventions and patient-directed lifestyle changes that may include nonprescription supplements. All patients should be encouraged to exercise regularly. They should be advised to avoid exposure to tobacco smoke and to strive to attain ideal body weight. Patients should also be encouraged to establish diets that are low in cholesterol and fat and high in dietary fiber. Supplements of water-soluble fiber may be useful for selected patients. Diets rich in antioxidant vitamins should also be stressed. Antioxidant supplements may be warranted in individuals with coronary artery disease or risk factors. Pending further study, patients should be encouraged to consume more fish but not fish oil supplements. Therapeutic doses of niacin should not be used without medical supervision. Chromium and other nutritional supplements, however, may merit consideration in selected cases. Physicians should stress the use of nonpharmacologic means to reduce blood pressure and discuss interventions that could reduce excessive stress. With appropriate screening and precautions, selected individuals should benefit from low-dose aspirin prophylaxis and possibly from low-dose alcohol consumption. Because these patient-directed interventions receive less attention in the scientific literature, they were selected for review herein.