Heart Health

Should I take a low-dose aspirin if heart disease runs in my family?

DEAR DOCTOR K: Heart disease runs in my family, and my doctor thinks I should take low-dose aspirin even though I don't have heart disease now. What do you think?

DEAR READER: Your question seems simple enough, and I wish I had a simple answer. The problem is that aspirin, like virtually all medical treatments, has benefits and risks, and they are different for one person than for another. The main risk of aspirin is bleeding. For some people, the decision to take aspirin is easy.

Heart disease runs in the family, how do I talk to my kids about what this means for them?

DEAR DOCTOR K: I had a heart attack in my 50s, and so did my dad. Heart disease obviously runs in the family. How do I talk to my kids about what this means for them?

DEAR READER: As a parent, you already know that taking care of your children is just as (if not more) important as taking care of yourself. If you have a family history of heart disease, that means teaching your children what they can and should do to prevent heart disease.

Should I eat fish, or take fish oil supplements to prevent heart disease?

DEAR DOCTOR K: Heart disease runs in my family. Should I eat fish, or take fish oil supplements?

DEAR READER: Eating fish regularly reduces a person's risk of sudden death from heart disease. It's also brain-healthy. For that reason, I and most doctors recommend a regular diet of fish for people who have heart disease. And also for people like you where heart disease runs in the family. Fish oils are rich in omega-3 fatty acids, a kind of "healthy fat."

Angioplasty and bypass surgery, a new hybrid procedure

DEAR READERS: In yesterday's column, a reader asked why a friend had undergone both bypass surgery and an angioplasty to restore blood flow to the heart. The reader had thought that a person had either one or the other, but not both. I replied that this has been the case until recently: When one or more blocked arteries were discovered, cardiologists and cardiac surgeons had traditionally decided whether to do one procedure or the other. However, a new hybrid approach is gaining favor. It makes sense only for some patients -- and it sounds as if the reader's friend is one of those patients. In yesterday's column, I explained both angioplasty with stenting and coronary artery bypass graft (CABG) surgery.

Can you have a bypass surgery and angioplasty at the same time?

DEAR DOCTOR K: My friend said he had bypass surgery and angioplasty at the same time. Isn't it usually one or the other?

DEAR READER: It is usually one or the other, but your friend may have been treated at one of a few select medical centers in the United States currently offering a new hybrid approach. If so, he may have had both bypass surgery and angioplasty during the same surgery. To answer your question, I need to explain both the traditional approach and then the new hybrid approach. The hybrid approach cannot be used in all patients. However, when it is used, the goal is to make the surgery less grueling, and the beneficial results of surgery more long-lasting.

Can ibuprofen reduce my heart attack risk as well as my pain?

DEAR DOCTOR K: I take ibuprofen every morning for my arthritis. My doctor wants me to take low-dose aspirin every day to reduce my heart attack risk. Ibuprofen and aspirin are both NSAIDs, right? So will the ibuprofen help my arthritis and my heart? Or should I take both?

DEAR READER: When joints ache, many people turn to nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief. Aspirin is a type of NSAID. So are ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn). NSAIDs are widely used because they perform double duty. They relieve pain and also reduce inflammation.

Does ischemia have to be treated if it’s not causing any symptoms?

DEAR DOCTOR K: The results of a recent stress test showed that I have "silent ischemia." I haven't felt any pain or discomfort. I wouldn't even have known about it if not for the stress test. Does it need to be treated if it's not causing any symptoms?

DEAR READER: The word "ischemia" comes from a Latin term that means "stopping blood." If a stress test shows you have cardiac ischemia, blood flow to a part of your heart muscle is less than the heart muscle needs when you exercise. The most likely culprit is a coronary artery narrowed by cholesterol-laden plaque.

Common medications used to treat heart failure.

DEAR READERS: Yesterday, I answered a question about treatments for heart failure. It's a big topic, and so today I'm talking about the medicines that are typically used to treat heart failure. As we discussed, heart failure is a condition in which the heart cannot pump efficiently enough to meet the body's need for blood. As a result, tissues and organs throughout the body don't get enough oxygen. Also, fluid builds up in the lungs and other body tissues. Taking heart failure medicines as prescribed is perhaps the single most important thing you can do to feel better and live longer. The medicines available today are dramatically more potent than the medicines that were available when I was in medical school.

How can I stop my heart failure from getting worse?

DEAR DOCTOR K: I've been diagnosed with heart failure. Thankfully, it is still in the early stages. What can I do to keep it from getting worse?

DEAR READER: The function of the blood is to carry nutrition to every cell in the body and to carry away waste from the cell. The function of the heart is to keep pumping blood so that the blood reaches every cell in the body. Heart failure is a condition in which the heart cannot pump efficiently enough to meet the body's need for blood. As a result, tissues and organs don't get enough nutrition, and fluid builds up in the lungs and tissues.

What is atherosclerosis?

DEAR DOCTOR K: You mention atherosclerosis in many of your columns. Could you explain what this word means?

DEAR READER: My readers ask me many questions about atherosclerosis, and for good reason: It is the No. 1 cause of premature death in developed nations, including the United States. Atherosclerosis is a narrowing of the arteries. Arteries are blood vessels that supply fresh, oxygen-rich blood to the heart, brain, intestines and other organs. The narrowing is caused by the buildup of plaques in artery walls. The plaques are filled with LDL cholesterol -- so-called "bad" cholesterol.