What lifestyle modifications should I recommend for secondary prevention in patients post-myocardial infarction?

Lifestyle modifications recommended for secondary prevention following a myocardial infarction (MI) include:

• Diet: Advise patients to adopt a Mediterranean-style diet characterised by increased intake of bread, fruit, vegetables, and fish; reduced meat consumption; and replacing butter and cheese with plant oil–based products. Routine use of omega-3 fatty acid supplements or antioxidant supplements (vitamins E, C, beta-carotene, folic acid) is not recommended for preventing another MI. Individualised dietary consultations should be offered to discuss current eating habits and tailored advice provided. Healthy eating advice can also be extended to the whole family.
• Physical activity: Encourage regular physical activity sufficient to increase exercise capacity, aiming for 20 to 30 minutes daily to the point of slight breathlessness. For those not currently active, gradual stepwise increases in activity are advised, starting at a comfortable level. Physical activity advice should consider the patient’s preferences and past activity levels, and may be enhanced by tailored advice from qualified professionals.
• Smoking cessation: Strongly advise cessation of smoking as part of secondary prevention.
• Alcohol consumption: Advise patients in line with UK government drinking guidelines.

These lifestyle changes should be integrated into cardiac rehabilitation programmes offered to all patients post-MI, which include exercise components and support for behaviour change.