Based upon a physical examination and your answers to questions about your symptoms, medical history, and habits (such as smoking) that are known to put you at risk, your doctor may suspect heart disease. The next step is to conduct tests to determine the presence, type, severity, and cause of the heart condition.

Tests used to investigate heart disease and its consequences may include:

• Blood and urine tests

• Electrocardiogram (also called an ECG or EKG), which shows information about the heart based on its electrical activity

• Chest X-ray

• Echocardiogram, which uses sound waves to view the heart

• Stress tests, in which you either walk on a treadmill or receive a medication and the effects on your heart are examined by your symptoms, an ECG, and sometimes also by pictures of the heart (also called an imaging test, which is conducted by a echocardiogram or a scan of your heart after the injection of a radioactive substance that can be detected by special cameras)

• Cardiac catheterization (also called an angiogram), in which a special X-ray procedure is done to look at the heart’s blood supply

• CT scan, which is used to look for calcium in the arteries, a telltale sign of coronary artery disease; and

• MRI, a new test that is not yet commonly used in clinical practice, which provides pictures of the heart and information about narrowing of the arteries.

Who Gets Heart Disease?

Coronary heart disease is the world’s most common heart ailment. In the United States alone, more than 12 million people have the disease and another 650,000 people are diagnosed with it each year. Heart disease affects women and men, both old and young, and is the leading cause of death and disability among adults.

Over the years, researchers have demonstrated conclusively that some people are more susceptible to heart disease than others. The most famous of these studies, the Framingham Heart Study, tracked the health of more than 5,000 residents of Framingham, Massachusetts, to find out what factors contributed to heart disease.

In time, the family members and children of these original subjects also became part of the study. Now the grandchildren are being invited to participate. Over the course of half a century, the researchers have identified a number of characteristics, commonly called risk factors, that are associated with heart disease.

Some of these risk factors can’t be changed—and doctors call them “non-modifiable” risk factors. Age is one. No matter who you are, the older you are, the higher your risk of heart disease. Your family history is another. If others in your family have had heart disease, your own risk of the disease is higher than someone with no heart disease in his or her family.

Non-Modifiable Risk Factors:

• Age: you are a man over 45 or a woman over 55
• Family history: your father or brother had a heart attack before 55, or your mother or sister before 65

But many risk factors involve conditions or ways of living that you can do something about—and doctors call these “modifiable.” Modifiable Risk Factors:

• High blood pressure: your blood pressure is greater than 140/90 mmHg (or 130/80 mmHg if you have diabetes or kidney dysfunction) and/or you’ve been told your blood pressure is too high

• High blood cholesterol: if you have heart disease, your total cholesterol level is 200 mg/dL or higher or your LDL (“bad cholesterol”) is 100 mg/dL or higher (70 mg/dL or higher for high-risk individuals) or your HDL (“good cholesterol”) is less than 40 mg/dL

• Diabetes or high blood sugar: you have diagnosed diabetes or a fasting blood sugar level of 126 mg/dL or higher

• Overweight: you have a body mass index (BMI) score of 25 or more

• Physical inactivity: you exercise (or exert yourself) less than 30 minutes per day

• Smoking: you are a smoker

These factors don’t just increase your risk for heart disease; if you already have heart disease, they increase your risk of future heart problems.

Seven Key Strategies

When it comes to beating heart disease, information is important but action is critical. This book spells out the very best medical knowledge on heart disease treatment available today, knowledge that can help you get the best possible care available and protect you from future heart problems.

But information alone won’t cure you of heart disease. What will make the difference between illness and health is your own active involvement in your treatment. Here’s a good example: national surveys have revealed that many people with high blood pressure are never even identified as having this life-threatening condition.

Of those who are identified, many are not treated. Of those who are treated, many do not receive the correct treatment to ensure that their blood pressure is properly controlled, including being advised about the critical importance of taking their medication regularly.

Because high blood pressure causes no obvious symptoms (until it gets extremely high or causes complications) many people have no sense of the seriousness of their condition and do not take their medications. The result? Every year there are hundreds, even thousands, of preventable heart attacks and strokes related to high blood pressure.

By contrast, patients who are involved actively in their own care, who understand the importance of controlling their blood pressure, and who work with their doctor to do so, often can avoid this result. There’s another reason for taking charge of your own heart disease.

Because there is no “typical” heart disease patient, your illness is different from any other heart disease patient’s, and your experience of the illness and the treatments that are best for you may differ as well. Since every patient is different, doctors need to customize the treatment options available to meet the individual needs and preferences of each patient.

The more you know about your heart disease and the options available to you, the more likely it is that you’ll succeed in working with your physician to develop a plan that is best for you and most likely to lead to the results you want. This means you have a shared responsibility for your care.

It is true that doctors undergo years of training so they can diagnose, treat, and manage diseases. But when it comes to your own health, nobody knows your needs and preferences better than you do. Since much of what will need to be done for you to recover from heart disease must be done by you, your doctor’s role over the long term is to provide guidance—but you are the key.

Good doctors welcome and encourage their patients to participate in their own care—for the simple reason that it yields better health results. Only about sixty years ago, the most powerful man in the world, President Franklin Delano Roosevelt, died from a stroke because his doctors had no effective medicine to treat his high blood pressure. They were powerless to reduce his risk as his heart disease worsened.

Today, we can—or, more accurately, you can. The good news is that scientific advances made during the last fifty years have improved the outlook for heart disease patients dramatically. Not only do we know what puts people at risk for heart disease, we also have evidence that certain strategies will lower these risks.

How strong is this evidence? So strong that it represents the top strategies recommended for doctors, nurses, and other health professionals by the American Heart Association, the American College of Cardiology, and other groups. Not surprisingly, perhaps, these strategies aim squarely at those risk factors that are modifiable—that is, those you can do something about:

1. Control your blood pressure
2. Manage your cholesterol
3. Exercise
4. Control your weight
5. Watch your blood sugars
6. Quit smoking
7. Take the right medications