Life after a heart attack was once a rather sedentary affair. Today, cardiac recovery is animated by many new technologies, aggressive intervention and an active role for patients seeking to halt the very course of heart disease.

Nowhere was this trend toward aggressive intervention more apparent than at the recent meeting of the American Heart Association, where a new class of cholesterol-lowering drugs was shown not only to reduce the risk of heart attack but to lower the overall death rate as well.This is good news for the 7 million Americans living with coronary-artery disease. About 1.5 million will have a heart attack this year. And although heart attack is still the major killer of Americans, two-thirds will survive this life-shaking event and will undergo the treatments that have cut heart-attack mortality in half since the 1970s.

Recuperating from heart attack used to be marked by long weeks of bed rest in a dark and quiet back ward of the hospital. "Back then, you wrapped people in a cocoon and wished them well," says a Manhattan physician who is on the mend and walking to work after a mild heart attack. "Now, it's a different concept. The word is, `Let's fix it.' "

Old-fashioned bed rest - paradoxically unhealthy because it promoted clots - has given way to exuberant exercise programs. Fatalism and passivity about stubborn little vices has yielded to energetic assaults on cigarette smoking and dietary fat. A once-limited armory of medicines has exploded into an array of drugs that dissolve clots, skim fat from the blood, lower blood pressure and limber up arteries. Once-dominant bypass surgery has been eclipsed by balloon angioplasty and newer technologies to clean out arteries.

The crushing chest pain of a heart attack is actually the death of muscle tissue in the body's main pumping organ. This happens when the heart muscle is starved of oxygen-bearing blood by fat plaques and blood clots that clog the vessels. These days, doctors can virtually interrupt a heart attack in progress by quickly reopening the artery with clot-busting drugs like TPA or streptokinase or with angioplasty to flatten the offending plaque.

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Drug treatments have been refined. All patients used to get nitroglycerine and magnesium - drugs still in use, but now more selectively. Staple medicines today are ACE inhibitors and beta blockers, which regulate blood flow, stabilize heart rate and lower blood pressure. For patients with high cholesterol, drugs like lovastatin, niacin and resin drugs - coupled with lean diets - can shrink fat plaques and keep arteries supple.

Surgical options have broadened. "Fifteen or 20 years ago, the bypass operation was the only option for people with persisting angina," says Robert DeBusk, director of the Stanford Cardiac Rehabilitation Program. And it's still the choice for people with three or more clogged arteries. But now for people with less severe disease, many doctors prefer angioplasty, a process of threading a tiny balloon into an artery and inflating it to compress the blockage. It's faster and cheaper, and recovery is swifter, though it sometimes must be repeated to keep arteries open.

Hospital stays are shortened from several weeks to a few days. When football legend Mike Ditka charged back to coaching the Chicago Bears just after his heart attack in 1988, it seemed a defiant move. Today, it's more the norm, with even non-jocks walking to the office after a mild coronary - if they pass their treadmill test.

At Stanford, DeBusk has pioneered a cardiac rehabilitation program based on strict smoking cessation - with follow-up phone calls by nurses. "The biggest risk patients face is a cigarette in the first 24 hours after they go home," he says. "Nurses will call to see how they're doing. They're not cheerleaders but enforcers who keep 70 percent of patients off tobacco."

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