Heart Health

Could I have had a silent heart attack?

DEAR DOCTOR K: I recently had an ECG in preparation for a surgical procedure. The doctor said it showed I'd had a silent heart attack. How could I have had a heart attack and not known about it?

DEAR READER: I know it sounds strange. After all, on television, heart attacks are portrayed in rather dramatic fashion. Typically, you see a person clutching their chest with agonizing pain. This mental image is embedded in our culture. But my colleague, Dr. Deepak Bhatt, a cardiologist at Harvard-affiliated Brigham and Women's Hospital, cites a recent study that is the latest to show that heart attacks often can be "silent."

Do I still need to fast before a cholesterol test?

DEAR DOCTOR K: I heard that fasting will no longer be required before a cholesterol test. Will the results still be as accurate?

DEAR READER: To answer your question, I need to first describe what a "cholesterol test" is. There are three types of cholesterol that typically are measured: LDL ("bad") cholesterol, HDL ("good") cholesterol and total cholesterol (basically, the sum of LDL and HDL). There is a fourth type of fat measured at the same time: triglycerides. Most doctors order all four tests as part of what's called a "lipid (fat) panel."

Does psoriasis affect body parts other than the skin?

DEAR DOCTOR K: My doctor thinks my arthritis and heart disease are connected to my psoriasis. Is this possible? I thought psoriasis was a skin condition.

DEAR READER: Psoriasis (pronounced so-RYE-uh-sis) is named for an ancient Greek word meaning an itchy or scaly condition. It is classified as a skin disease, but psoriasis is the result of an immune system abnormality that can cause problems throughout the body.

Will reducing stress reduce my risk of heart disease?

DEAR DOCTOR K: I'm under a lot of stress in my life. Of course, I don't like that, but what really worries me is that it will affect my heart. Heart disease runs in my family. If stress can lead to heart disease, does reducing stress reduce heart disease risk?

DEAR READER: We often think of the heart and brain as separate from each other, yet these organs are intimately connected. And when your emotions adversely affect your brain, your heart is affected as well.

Why did my doctor measure the blood pressure in my leg to check for blockages?

DEAR DOCTOR K: My right calf starts aching when I exercise. My doctor said she wants to do a test that is like taking my blood pressure in my leg instead of my arm. Does that make any sense?

DEAR READER: I can understand why that seems confusing, but your doctor is right. She is probably worried that the arteries to your right leg have blockages from plaques of atherosclerosis. When you exercise, your leg muscles need more blood; it provides the nutrition they need to work. When blockages prevent your leg muscles from getting the blood they need, they scream in pain.

Can you tell me about a drug combination my doctor prescribed to lower my cholesterol?

DEAR DOCTOR K: Despite taking statins, my cholesterol hasn't dropped as low as my doctor would like. I figured he'd put me on the new PCSK9 inhibitors. Instead, he suggested that I stay on my statin, but also take another drug called ezetimibe. What can you tell me about this combination?

DEAR READER: From what you say, I assume your doctor has used the highest dose of the most potent statins before giving up on those drugs. There are very few people whose cholesterol does not drop substantially on statins alone.

Are the new dietary guidelines good for heart health?

DEAR DOCTOR K: I'm at an increased risk for heart attack and stroke. Will the new dietary guidelines help keep my heart healthy?

DEAR READER: In late 2015, the U.S. government issued a new edition of the Dietary Guidelines for Americans. This report helps Americans make healthy food choices. But if you're concerned about having a heart attack or stroke, the advice in the latest update doesn't entirely agree with what many nutrition experts -- as well as the American Heart Association (AHA) -- recommend.

Did cancer treatment increase my heart disease risk?

DEAR DOCTOR K: I survived cancer, only to be told that the treatments that saved my life may have increased my risk for cardiovascular disease. What are the risks? And can I minimize them?

DEAR READER: As more people are living longer after a cancer diagnosis, more people are coping with the long-term effects of cancer treatment. Many cancer-suppressing treatments can have undesirable effects, for example, on the heart and blood vessels.

Are heart palpitations dangerous?

DEAR DOCTOR K: I often experience heart palpitations -- almost every time I'm excited, angry or scared. Is this dangerous to my health?

DEAR READER: The word "palpitations" is used differently by different people. To me, palpitations are simply an awareness of your heart beating. People aren't usually aware of their heart beating. But when it beats unusually forcefully, irregularly or rapidly, you notice the heartbeat.