How to Help Your Heart

Austin, Texas: Is wine good for your health, and how much per day is healthy?
Dr. Thomas H. Lee: No one should start drinking alcohol to improve his health, but there's also no reason to stop for people who drink a moderate amount of wine or other forms of alcohol. "Moderate" means one to two drinks per day for men, and one drink per day for women. (The lower recommended amount for women reflects their smaller body size, not male gender among the authors of the guidelines.)

People who drink moderately have lower rates of heart disease than teetotalers, presumably because alcohol raises levels of high-density-lipoprotein (HDL) cholesterol—the so-called good cholesterol. Some researchers have speculated that the benefit might be greatest with wine, particularly red wine, which is rich in flavonoids and other "antioxidant" chemicals that might help protect artery walls. However, a major epidemiological study published in 2003 in The New England Journal of Medicine found that all types of alcohol offered about the same amount of benefit.

If some is good, isn't more better? Not in the case of alcohol. Higher amounts increase risk of heart disease and stroke by raising blood pressure and directly weakening the heart muscle. And alcohol has a lot of calories, so people who drink heavily tend to gain weight, which raises their risk of diabetes.

Durango, Colo.: Are there any promising treatments on the horizon for removing calcified plaques from the arteries?
You don't have to wait for promising treatments to lower your risk for a heart attack if you have calcified plaques in your coronary arteries. There are medications that can help you right now, and you may already be taking them.

First, though, you should focus on the real goal. You don't need to make these atherosclerotic plaques disappear; you just want to prevent them from breaking open. If they do rupture, the injury to the artery wall can cause the formation of a blood clot that chokes off blood flow. The result can be the death of the heart muscle supplied by that artery.

Plaques break because they have gooey cores filled with cholesterol, and you can reduce the risk of having a plaque rupture by lowering your "bad" cholesterol (LDL) with statins and drugs that block cholesterol absorption from the gut. Another approach is to raise HDL, which helps transfer cholesterol out of the body, but a promising HDL-raising drug developed by Pfizer failed spectacularly in late testing last December. Older drugs like niacin can raise HDL, but have high rates of side effects. So until researchers come up with better medications, the best way to raise HDL may be exercise.