Q. A friend of mine died last month because of a massive heart attack. He was only 47. I’m 45 years old and I do not want to be a heart attack victim, too. Is there anything I can do to prevent a heart attack?

--Bob E., Manila

A. There are certainly many things you can do to minimize, if not totally prevent, your chances of suffering a heart attack, so, read on.

Heart attack is a dreadful and often fatal complication of coronary artery disease, a condition in which the blood vessels (coronary arteries) that supply the heart with oxygen get narrowed because of deposition of cholesterol and other fatty materials (called atheroma or atherosclerotic plaque) in their walls.

When a narrowed coronary artery gets completely clogged, a heart attack occurs. Complete obstruction of a coronary artery is often caused by a blood clot that gets stuck in a narrowed blood vessel. Such a blood clot can arise within the coronary artery itself (a narrowed artery is predisposed to development of a clot) or elsewhere in the body.

The deposition of cholesterol in the coronary arteries is a gradual process. It takes many years before a coronary artery narrows significantly, but the process is hastened by the presence of risk factors.

The risk factors for coronary artery, which act synergistically in clogging the coronary arteries, can be classified into either modifiable or non-modifiable. 

The non-modifiable risk factors, about which nothing can be done at the moment, are advancing age and family history of coronary artery disease.

The modifiable risk factors, on the other hand, include smoking; hypertension (i.e., persistent high blood pressure); dyslipidemia (i.e., persistent high blood levels of cholesterol); obesity, especially if the fat is concentrated around the belly; diet; diabetes mellitus (which accelerates the pathological processes involved in coronary artery disease); sedentary lifestyle; and, chronic psychological stress.

The modifiable risk factors are obviously the reasons why coronary artery disease is preventable, because they can be negated by lifestyle changes.

Here are lifestyle changes you need to adopt on a permanent basis to counteract the modifiable risk factors for coronary artery disease and reduce your chances of developing a heart attack:

• Stop smoking (i.e., if you’re a smoker, of course; if you’re not, don’t ever start).
• Indulge in a regular exercise program, or at least be physically active.
• Learn to avoid stressful situations, or unwind after one.
• Stick to low-salt, low-fat, high-fiber diet. This means 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. 
• Reduce to and then maintain an appropriate body weight through diet and exercise. For Filipinos, appropriate body weight means a Body Mass Index (BMI) of 18-5-22.9. BMI is computed by dividing your weight (in kilograms) with the square of your height (in meters).
• Maintain a normal blood pressure. You can help do this by limiting your salt intake, maintaining your healthy body weight, limiting your alcohol intake to 2 drinks per day (note: for women, it’s just 1 drink per day), and, by partaking of a diet that contains a lot of vegetables, fruits and low-fat or non-fat dairy products.
• Maintain desirable blood cholesterol and lipids profile. The first step towards achieving this goal is by limiting your intake of foods high in saturated fat and cholesterol (e.g., full-fat dairy products, fatty meats, tropical oils.)

Lastly, middle-aged people like you, should regularly see their physician to have their blood pressure checked and their blood examined for blood sugar (to rule out diabetes mellitus) and cholesterol and lipid levels. There is a point where lifestyle changes alone are not enough to keep these risk factors at bay, when drugs become necessary. There is no hard and fast rule on how often you should see a physician, but if you are asymptomatic, once every 1-2 years is enough.

(E-mail inquiries on health matters to: medical_notes@yahoo.com)