• Risk Factors for Coronary Artery Disease
• Hypertension (High Blood Pressure)
• Exercise
• Smoking Cessation

The answer is to focus on the phrase, "risk factors." It is very unfortunate that some popular magazines and newsletters imply (and sometimes even state) that if you get sick you must have done something wrong. This is simply not true, and it is unkind to say that it is. The fact is that (almost) anyone can get any (almost) illness. The likelihood of getting a serious illness may be increased by engaging in certain habits or behaviors, but it is (almost) never zero.

Recently, I cared for a physically fit young man with a strong family history of coronary artery disease and a cholesterol of 400 or so who came in with a heart attack. He had done everything right, including trying to control the cholesterol. The fact was that his family history predicted that he would have a heart attack before the age of 30, and he did. Medical science does not know how to prevent this from happening in all cases.

A while ago, I cared for a young woman who suffered a heart attack. We had trouble believing our eyes because her cholesterol was normal and she was still menstruating (and therefore had plenty of estrogen to protect her). Yet, on cardiac catheterization, she had significant blockages in two of the three coronary arteries. She had none of the known risk factors. That is one reason that medical research continues in the area of risk factors for coronary artery disease.

Then there are the risk factors you can control: cigarette smoking, diabetes mellitus, high blood pressure, and high cholesterol. Each of them is important, and they are synergistic. Synergy means that combinations of two or more is worse than the sum of the individual effects of each factor alone. In brief, you should stop smoking cigarettes, control your blood sugar and blood pressure if necessary, and make sure your cholesterol is "reasonably" well controlled. There has been much talk since the mid-1980's about the value of reducing total cholesterols in the range of 230 to 260. It looks like that may actually be a good idea. Apart from that controversy, it is quite clear that cholesterols greater than 300 are bad news. If your cholesterol is in the range of 300 to 500, you have a very high likelihood of dying from a heart attack unless you get the cholesterol down. See a doctor about that.

One piece of good news about being really overweight. If you are - let's call a spade a spade - really fat, then you will have a tendency to have high blood pressure and diabetes mellitus. But, if you lose weight, that tendency disappears. And, since fat requires energy to maintain itself, it is easier for you to lose weight than it is for people with more normal weights. Having said that, it's hard to lose weight, so good luck!