Heart Health

Are there risks of taking a daily aspirin to reduce the risk of a heart attack or stroke?

DEAR DOCTOR K: What are the risks of taking a daily aspirin to reduce the risk of a heart attack or stroke?

DEAR READER: I didn't have to do much homework on this one, because I take a daily aspirin and already know the answer. It was front-page news in 1988 when colleagues of mine at Harvard Medical School reported the results of a randomized trial that found that a daily aspirin protected against heart disease. A simple, cheap, over-the-counter pill could protect against the No. 1 cause of premature death: heart disease (specifically, atherosclerosis of the arteries of the heart)? It seemed too good to be true.

What do the new blood pressure guidelines mean for the 65+ age group?

DEAR DOCTOR K: I'm 68 years old and I take blood-pressure lowering medication. What do the new blood pressure guidelines mean for people of my age?

DEAR READER: You're asking about new guidelines for managing high blood pressure, or hypertension, in adults. They were published recently by an expert panel of specialists in high blood pressure.

How does exercise prevent cardiovascular disease?

DEAR DOCTOR K: I've heard it many times: Regular exercise helps prevent cardiovascular disease. But how does it do that?

DEAR READER: First, let's define terms, to be sure we're all on the same page. "Cardiovascular disease" (CVD) is a catch-all term. It includes heart attack, stroke, high blood pressure (hypertension), atherosclerosis and heart failure. Regular (not just occasional) exercise improves cardiovascular health in a number of ways:

How does a doctor decide which heart surgery to perform on a patient with multiple blocked arteries?

DEAR DOCTOR K: When a patient has one or more blocked coronary arteries, how does a doctor decide whether to perform an angioplasty or bypass surgery?

DEAR READER: Let me explain how your heart works before I answer your question. Your heart doesn't just pump blood -- it needs blood to survive. Every organ in your body needs a constant energy supply. And every organ is making waste material and needs a "garbage collector" to take the waste away. Both the energy supply and the waste removal come from the blood that constantly runs through every organ.

What is a stent — how does it work?

DEAR DOCTOR K: Two friends recently had stents put in. What exactly is a stent? How does it work?

DEAR READER: A stent is a small metal cylinder that opens up a blockage in the arteries. It looks like a miniature chain-link fence rolled into a tube. Stents have helped revolutionize the treatment of the most common form of heart disease, coronary artery disease. To understand how, we'll have to take a few steps back.

What is an abdominal aortic aneurysm — How is it treated?

DEAR DOCTOR K: What is an abdominal aortic aneurysm? How is it treated?

DEAR READER: An abdominal aortic aneurysm (AAA) is an abnormal swelling in the aorta, the body's largest artery. It occurs in the part of the aorta between the bottom of the chest and the pelvis. Most aortic aneurysms come from atherosclerosis.

What do I need to do to lower my cholesterol?

DEAR DOCTOR K: My cholesterol has always been fine, but recently it's started to rise, though not high enough for medication. What do I need to do?

DEAR READER: There are several ways you can lower your cholesterol besides taking medicine. They involve cholesterol-friendly lifestyle changes: dietary modifications and regular exercise. Start with your diet. First, let's consider fats. The types of fat you eat are as important as the amounts you eat. Most animal and dairy fats are full of unhealthy saturated fats, which raise cholesterol levels.

Are there symptoms that show heart failure becoming worse?

DEAR DOCTOR K: My doctor says I have heart failure. Are there symptoms I should be looking out for that would indicate my condition is getting worse?

DEAR READER: The term "heart failure" is often misunderstood. People think it means their heart is going to suddenly stop pumping. When that happens, that's not "heart failure"; it's a cardiac arrest -- and it's fatal unless the heart can be restarted.

How important is cardiac rehab after a heart attack?

DEAR DOCTOR K: My father recently had a heart attack. His doctor recommended cardiac rehab, but he refuses to go because he "already has a gym membership." How important is cardiac rehab?

DEAR READER: Cardiac rehabilitation is a safe, proven way to reduce risk factors for heart disease. Dr. Daniel Forman, director of the exercise testing lab at Brigham and Women's Hospital and assistant professor at Harvard Medical School, feels strongly about the subject. He says that for reducing deaths and increasing quality of life, cardiac rehab exceeds any pill or procedure.

Is the C-reactive protein still considered an important indicator of heart disease risk?

DEAR DOCTOR K: A few years ago my doctor told me that C-reactive protein was an important indicator of heart disease risk. At my last checkup, he didn't mention it at all. Is it still considered important?

DEAR READER: C-reactive protein (CRP) is produced by the liver in response to inflammation anywhere in the body. Inflammation contributes to atherosclerosis, the buildup of fatty deposits in blood vessel walls that's responsible for most heart attacks and many strokes. CRP from inflamed plaques of atherosclerosis spills into the blood.