Q. Our 65-year-old neighbor died of heart attack two days ago. What puzzles me is that he does not have hypertension. Can you have heart disease even if your blood pressure is normal? Is it true that heart disease is more common in men than in women? Can you give some advice on how to prevent heart disease?

– jockey66@yahoo.com

A. Although hypertension is a major risk factor for coronary artery disease (CAD), the underlying cause of most heart attacks, hypertension need not be present for CAD to develop.

Coronary artery disease occurs when the blood vessels that supply the heart with blood, called coronary arteries, get partially or completely clogged because of the buildup of cholesterol and other fatty substances (a process called atherosclerosis) in their walls. Aside from hypertension, there are several other factors that contribute to atherosclerosis and CAD. They include: advanced age, family history of heart disease, smoking, persistent high blood levels of cholesterol (hyperlipidemia), obesity, diabetes mellitus, a sedentary lifestyle and chronic psychological stress. These risk factors often build on each other and act synergistically in promoting atherosclerosis.

CAD is not really more common in men than in women, but the disease develops about 10 years earlier in men because before menopause, women are protected from the disease by estrogen, the female hormone.

If you go over the list of risk factors for atherosclerosis, you will note that the only ones that you cannot modify are advancing age and family history. Hence, by observing certain dietary and lifestyle practices, you can prevent CAD.

To prevent coronary artery disease, your dietary and lifestyle goals, according to the American Heart Association (AHA), should be to: establish an overall healthy eating pattern, maintain an appropriate body weight, maintain a desirable blood cholesterol profile, and maintain normal blood pressure. These goals can be met if you adopt the following measures:

•  If you are a smoker, quit.

• If you are overweight, you need to lose your unwanted weight through diet and exercise. Thereafter, maintain your appropriate body weight by matching your energy intake to your energy needs. At all times, you should avoid excessive food intake.

• Adopt a diet that contains a variety of foods from all the food categories, with emphasis on fruits and vegetables; fat-free and low-fat dairy products; cereal and grain products; legumes and nuts; and, fish, poultry and lean meat. The American Hospital Association (AHA) has stated, however, that there are foods that are cholesterol-rich but are low in saturated fatty acid content (notably eggs and shellfishes). AHA also says you can achieve your specified dietary targets even with regular intake of these items provided you limit your intake of food with high content of animal fat.

• If you drink, limit your alcohol intake to two drinks per day (note: for women, it’s just one drink per day). A drink consists of 12 oz. (350 ml) of regular beer, 5 oz. (150 ml) of wine or 1 ½ oz(44 ml) of distilled spirit (80 proof).

• Indulge in a regular exercise program, or at least be physically active.

• Learn to avoid stressful situations and to unwind after one.

Needless to say, in addition to the above measures, normal healthy adults like you need to see their physician periodically (once a year will be enough), so that appropriate medical intervention can be instituted in case any risk factor for coronary heart disease goes out of control.

(Note: Email inquiries on health matters to: medical_notes@yahoo.com)