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Preventing a Second Heart Attack

By Lindsey Getz

RD and author Janet Bond Brill discusses five foods you can tell clients about that can help prevent a second heart attack—and perhaps even reverse heart disease.

Patients who survive a first heart attack often feel that they’ve been given a second chance to improve their diet and lifestyle—and they certainly have. In fact, clients who make crucial dietary changes can even prevent a second heart attack.

This is a topic with which Janet Bond Brill, PhD, RD, LDN, has personal experience. Her father had his first heart attack at the age of 45. Twenty years later, he didn’t survive his second. So when Brill’s husband had a heart attack in July 2009, she was adamant about ensuring it would never happen again. So she researched and wrote her latest book, Prevent a Second Heart Attack: 8 Foods, 8 Weeks to Reverse Heart Disease. In it she explores eight foods that have the power to help prevent a second heart attack. Today’s Dietitian recently caught up with Brill to discuss five of those foods dietitians can share with patients to improve their long-term health.

Extra-Virgin Olive Oil

Ditch the butter and start cooking with extra-virgin olive oil (EVOO), Brill says. EVOO is minimally processed, making it a healthier fat because of the more natural state of the plant oil and the lack of excess heat and chemicals used to process it.

“It’s also delicious, which is important because I want patients to know life doesn’t have to end after a diagnosis with heart disease,” she says. “They can still enjoy delicious food.”

Research also supports the benefits of EVOO. In one study from Greece, researchers found that those who cooked with olive oil cut their heart attack risk by 49% compared with those who rarely consumed olive oil. A similar study from Spain showed that patients consuming the greatest amount of olive oil (approximately 3 tablespoons per day) had an 82% reduced risk of heart attack than those who rarely used it.


“I recommend a dark-green leafy salad at least once daily as well as a rainbow-colored cornucopia of vegetables along with that,” Brill suggests. “I break vegetables into six categories: dark leafy greens and cruciferous vegetables; red/purple vegetables; yellow/orange vegetables; green herbs; allium vegetables; and others that don’t fit into the other categories, such as artichokes or water chestnuts. Breaking it down helps patients visualize their options.”

Lutein and its companion carotenoids zeaxanthin and beta-cryptoxanthin, which are found in high concentrations in dark leafy greens such as spinach and kale, have been shown to protect against the progression of atherosclerosis, Brill adds.

Salmon (and Other Fish)

Brill calls fish a “wonder food” since it’s the primary source of the key fatty acids known to enhance health—the twin polyunsaturated or long-chain omega-3 fats EPA and DHA. “In this country, we’re not a big fish-eating society, and that’s a problem because it’s where the omega-3s are,” Brill says. “We’ve known for decades about the power of fish to cut the risk of a second heart attack.”

In fact, in an extensive study published in the August 2009 issue of the Journal of the American College of Cardiology, researchers found that eating fish actually may reverse the course of heart disease. The authors found “compelling evidence” from data derived from almost 40,000 participants, showing that omega-3 fish oil provides maximal cardioprotection in the treatment of those with existing atherosclerosis.

“Aim for the fatty fish—the ones in the deep blue sea—such as salmon, albacore tuna, halibut, and mackerel,” Brill says. “And keep preparation simple. My favorite way to prepare salmon is to roast it and add a little bit of olive oil. It’s simple but delicious. No salt or butter needed.”

Red Wine

“Always go red over white,” Brill says. “Red wine is super heart healthy because of both the ethanol content and the polyphenol antioxidant flavonoids. Red wine has 10 times the polyphenol content of white because of the way it’s produced.”

Research published in the October 2004 issue of BMJ also found that moderate drinking after stent angioplasty lowers the risk of artery narrowing. And in the Lyon Diet Heart study, which examined the benefits of a Mediterranean-style diet, researchers found that former heart attack sufferers who drank two or more 4-oz glasses of red wine daily reduced their risk of a recurrent heart attack by more than 50% over nondrinkers.

Dark Chocolate

Brill calls this treat the “heart-healthy bonus.” People may not expect dark chocolate to be listed as a heart-healthy food, but it contains a large concentration of the flavonoid subgroup of polyphenols called flavan-3-ols, or flavanols. In a study from the Karolinska Institute in Stockholm, Sweden, published in the September 2009 issue of the Journal of Internal Medicine, scientists found that people who eat chocolate high in cocoa solids (the part that’s high in flavonoids) have increased long-term survival rates following a heart attack. In fact, those studied who indulged in dark chocolate up to once per week had a 44% reduced risk of dying from a subsequent heart attack, and those who ate it twice or more per week had a 66% lower risk.

“Of course the devil is in the details,” Brill says. “You want to eat by the piece, not the pound. I suggest about an ounce a day, and you want to look for a product that’s at least 70% cocoa.”

— Lindsey Getz is a freelance writer based in Royersford, Pennsylvania.