Eliana Witchell RD - Evidence-Based Nutrition
Case Study

Post-Cardiac Event Recovery: Comprehensive Metabolic Optimization

"I had a heart attack. I'm terrified of another one. I need to figure out food before it kills me."

— Male, mid-50s, with type 2 diabetes, prior heart attack, stent placement

Key Clinical Outcomes

A1C Improvement
6.9 → 6.0
In 6 months
Triglycerides
450 → 180
mg/dL reduction
Care Coordination
100%
Medication adherence

Clinical Presentation

Chief Complaint

54-year-old male 6 weeks post-myocardial infarction (anterior STEMI) with stent placement to LAD. Patient presenting with high anxiety regarding secondary prevention, requesting comprehensive nutrition guidance to minimize recurrence risk. Co-existing type 2 diabetes (8-year history) with suboptimal glycemic control and severely elevated triglycerides.

Medical History

  • Recent STEMI with drug-eluting stent to LAD (6 weeks prior)
  • Type 2 diabetes (8 years, inadequately controlled)
  • Severe hypertriglyceridemia (450 mg/dL at baseline)
  • Hypertension (controlled on dual therapy)
  • Obesity (BMI 32.8)
  • Strong family history of premature CVD
  • Former smoker (quit 2 years ago)

Baseline Medications (Post-MI)

  • Aspirin 81mg + Clopidogrel 75mg (dual antiplatelet therapy)
  • Metoprolol succinate 50mg daily
  • Atorvastatin 80mg daily
  • Lisinopril 20mg daily
  • Metformin 1000mg BID
  • Ezetimibe 10mg daily

Nutrition Therapy Intervention

Therapeutic Approach

Evidence-based nutrition therapy targeting both cardiovascular risk reduction and glycemic optimization. Emphasis on triglyceride reduction through carbohydrate restriction, anti-inflammatory eating patterns, and coordination with cardiology team for comprehensive risk management.

Nutrition Protocol

  • Carbohydrate focus: <100g/day to address hyperglycemia and hypertriglyceridemia
  • Protein target: 120-150g/day for satiety and lean mass preservation
  • Fat quality: Emphasis on omega-3 rich foods, elimination of trans fats
  • Fiber target: 35g+/day for cardiovascular benefits
  • Sodium limit: <2000mg/day per cardiac rehab guidelines
  • Alcohol: Eliminated due to triglyceride concerns

Care Coordination

Close collaboration with cardiology team and cardiac rehabilitation program. Weekly communication with cardiologist regarding glycemic and lipid improvements. Participation in cardiac rehab exercise program with nutrition counseling integrated into recovery plan.

Clinical Results Timeline

Month 1

  • Fasting glucose: 168 → 124 mg/dL
  • Weight loss: 8 lbs
  • Perfect medication adherence established
  • Participating in phase 2 cardiac rehab 3x/week

Month 3

  • A1C: 6.9% → 6.2%
  • Triglycerides: 450 → 220 mg/dL
  • Weight loss: 22 lbs (total)
  • Anxiety regarding recurrence significantly reduced
  • Completed cardiac rehab program with excellent compliance

Month 6 (Final Assessment)

  • A1C: 6.0% (optimal range)
  • Triglycerides: 180 mg/dL (60% reduction from baseline)
  • LDL: Well-controlled on statin therapy
  • Weight loss: 28 lbs sustained (BMI 28.4)
  • Cardiologist extremely pleased with recovery trajectory
  • Patient reports confidence in long-term management

Clinical Discussion

Key Learning Points

  1. Post-MI nutrition timing is critical: Early intervention (within 6 weeks) helped establish lifelong patterns during high-motivation recovery period.
  2. Triglyceride reduction through carb restriction: Dramatic triglyceride improvement (60% reduction) achieved through therapeutic carbohydrate restriction, independent of medication intensification.
  3. Multidisciplinary coordination improves outcomes: Integration with cardiac rehab and cardiology team enhanced compliance and outcomes.
  4. Anxiety management through education: Comprehensive understanding of risk factors and actionable steps reduced patient's post-MI anxiety.
  5. Sustainable approach prevents relapse: Focus on whole foods and practical strategies rather than restrictive "diet" supported long-term adherence.

Managing Cardiovascular Risk Through Nutrition

Evidence-based nutrition therapy can significantly reduce cardiovascular risk markers. Learn how a personalized approach could support your heart health.

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Important Disclaimer: This program is for educational purposes only and does not replace individualized Medical Nutrition Therapy or medical care.

Personalized nutrition therapy services are available only in jurisdictions where Eliana Witchell, RD, CDE holds active licensure. Always consult with your healthcare provider before making changes to your diet, exercise, or medication regimen.