Q: What is the No. 1 thing that you can do to lower your risk of heart disease?
See your doctor on a regular basis so that you know what risk factors you have and how you can modify them. Once you know what risks you have, then you can learn how best to treat them. This usually entails lifestyle adjustments (diet, exercise, smoking cessation).

Q: What are the symptoms I should not ignore?
In the case of a heart attack, women can have symptoms that are identical to those experienced by men, but they may also have atypical symptoms. The most common symptom of a heart attack is chest pain. It is classically described as occurring under the sternum and feeling "like an elephant is sitting on my chest." But, in reality, heart attack symptoms can occur anywhere in the chest, and can also be in the neck, arms, jaw, back and epigastrum (where the stomach sits). It may feel like pain, pressure, tightness or burning and can be mild, moderate or severe. For some patients, particularly women, the symptoms of a heart attack may be isolated to weakness, dizziness, fatigue and significant nausea and vomiting. Anyone with these symptoms who is concerned about a heart attack should be evaluated in the emergency room immediately.

Q: How often should I have my cholesterol and blood pressure checked?
The frequency of monitoring will vary depending on the age and medical problems of the patient. Low-risk patients without medical problems over age 20 should have their cholesterol checked once every five years and their blood pressure checked at least every two years. Patients with borderline blood pressure should be monitored at least yearly. Higher-risk patients and those already on medication for blood pressure and cholesterol will likely need follow-up every three to six months.

Q: Should I be overly concerned about how much salt I consume?
This also depends on the medical problems of the patient. If you are healthy and don't have hypertension or heart disease, then you are at less risk for problems with salt. But everything is in moderation. Salt is in almost everything we eat, so avoiding it entirely is impossible. I tell healthy patients that a mild to moderate amount is probably OK, but a lot is likely not good for you and could cause problems down the line.

Q: Should I take an aspirin every day to lower risk of a heart attack?
There are definite proven benefits for aspirin in patients that have a history of coronary disease (MI, angioplasty/stents, bypass), cerebrovascular disease (carotid artery stenosis, TIA, strokes) or peripheral arterial disease. Patients with diabetes are also at higher risk for cardiovascular disease and should be considered for aspirin. For low-risk patients without significant health problems, the time to consider aspirin is not well established. In this set of patients, I usually recommend aspirin around age 55 to 60 years for prevention of heart attacks and strokes. Your doctor can help you decide if aspirin might be beneficial for you.

Q: I have a family history of heart disease. Does this really make a difference for me?
It depends on when the person in your family had the heart disease and which family member it involved. A first-degree relative (mother, father, brother or sister) in which the heart problem was diagnosed in a man younger than 55, or in a woman younger than 65, is considered a risk factor for you. Grandparents, aunts and uncles do not count. If you do have a significant family history, then it means that you are at higher risk. Because of this, we would be more likely to treat your risk factors more aggressively and at a younger age to prevent problems down the line.

Q: Is it possible for someone without any risk factors for heart disease to still have a heart attack?
Yes, unfortunately, it is. There are multiple things that play a role in a patient having a heart attack. A lot of the contributors we do understand, including smoking, diabetes, high blood pressure, high cholesterol and family history. But there are many other factors that make a person at higher risk for rupture of the cholesterol plaque in their coronary artery, which produces a heart attack. Some of these factors we have learned about, and some are still to be discovered. For example, we have found that inflammation seems to have some role in this process, and patients with elevated measures of inflammation in their bodies seem to have a higher long-term risk for problems.

Q: I've had a heart attack. What are my chances of
another one?
I'm asked that question all the time by my patients. Unfortunately, there is no way to predict if and when a person will have a future heart attack. We do know that those with more risk factors have a higher risk. We also know that if we improve/modify risk factors, then the risk for future events is decreased. This involves smoking cessation, regular exercise and a good diet. Treatment of diabetes, hypertension and cholesterol is also very important.