How to Help Your Heart

The other key medication for you is aspirin, which slows your body's blood-clotting system. If an atherosclerotic plaque does rupture, aspirin will reduce the risk that a blood clot will form and block off the artery.

Columbia, Md.: What tests should I have to see whether I have some level of heart disease? A nuclear stress test was normal. With Lipitor, my HDL, LDL and total cholesterol are within the acceptable range; C-reactive protein is normal; triglycerides are low; blood pressure is normal; HbA1c is normal. But I am 60 years old, female, postmenopausal and overweight (with a body-mass index of 28). I have a strong family history of cardiac disease; my father had a heart attack at 53, and both parents suffered from congestive heart failure. Should I ask for more studies—for example, to evaluate the status of my small blood vessels?
I don't think you need more tests—you already know what to do. You should make exercise a regular part of your life, and you should lose enough weight so that your BMI gets under 25 (into the normal range). With your family history of early heart disease, your concern is quite understandable, but it sounds as if your risk factors for atherosclerosis are under control. (I am assuming that you are not a cigarette smoker. If you are, giving up cigarettes is the most important thing you can do.)

Are you wondering about the need for further testing because you are having chest pain that remains undiagnosed? It is true that some people with chest-pain symptoms have negative exercise tests, but later, doctors find abnormal function of very small coronary arteries. And a study published last year showed that women who had persistent chest pain despite normal-appearing coronary arteries had double the risk of developing cardiovascular problems.

Nevertheless, the risk of problems was pretty low (2 to 3 percent per year), and what you should do to reduce that risk wouldn't be affected by any further testing. You should do your best to make sure your blood pressure, cholesterol and other risk factors are at their targets, try to drop that weight and exercise to keep your arteries limber.

Monticello, Miss.: If you don't have high blood pressure or high cholesterol, what are the chances of developing heart disease if several members of your immediate family do have it?
Having normal blood pressure and cholesterol levels is terrific, but that doesn't mean you are home free—especially if your family's genes have already sent the message "watch out." There are other important risk factors mentioned in the responses to several of the other queries on this page (e.g., smoking and diabetes), and there are newer tests that can help refine estimates of your risk for heart problems, most notably C-reactive protein—a test of inflammation in your blood that can reflect the formation of atherosclerosis.

Dr. Paul Ridker and his colleagues recently published a new "prediction tool" for women that you can access at www.reynoldsriskscore.org. You just need to enter your age, smoking status, blood pressure, total and HDL cholesterol levels, C-reactive protein and whether either parent had a heart attack before the age of 60. The Web page will calculate your risk of a heart attack, stroke or other cardiovascular problem in the next 10 years.