You're eating a heart-healthy diet and exercising regularly, but your blood pressure and cholesterol numbers — not to mention your triglyceride, C-reactive protein, and homocysteine levels — still aren't as good as they should be. Although leading a healthy lifestyle can eliminate or improve most risk factors for heart disease, the later you begin adopting healthy habits, the more likely you are to need the help of medications prescribed by your doctor.

If everyone followed an optimal diet and exercise program from early childhood on, heart attacks and strokes would be rare. Furthermore, many other chronic diseases of the Western world would also be dramatically reduced. The longer we wait to implement constructive changes in lifestyle, the more likely it is that these measures alone won't be sufficient to undo the damage of too many years of bad eating and sedentary living. This is when the right medications can become lifesaving.

Medications can also make a huge difference in people with a strong genetic predisposition to heart disease. Over the years, I have observed many cases where a patient's optimal lifestyle has delayed but not stopped bad genes from increasing atherosclerosis and causing chest pain or a heart attack. For these people, adding medications to their healthy lifestyle can restack the genetic deck in their favor.

How do you know whether you have reached a stage when a healthy lifestyle isn't enough and you need one or more medications to prevent heart disease? It largely depends on your own risk profile. Once atherosclerosis is present — for example, if you have a high Calcium Score or if you have already experienced a heart attack — then I feel very strongly that medications should be used. I also recommend medications for people who are at moderate risk, but whose risk factors are not responding adequately to lifestyle changes and who are developing atherosclerosis as a result. The decision to take a medication should always be made in consultation with your physician, but the more you know about your options, the easier it will be for your physician to counsel you.

Many patients bristle at the suggestion that they take medications, because they think that all medications have side effects. While side effects, as well as effectiveness, have always been a consideration when weighing the pros and cons of drug treatment, there has been real progress in the quality of medications. When I began practicing medicine more than 30 years ago, there were relatively few drugs available for treating heart disease, and the ones we could choose from weren't very effective. They often had to be pushed to the limits of their tolerability and be taken several times a day to work. Now we have many more choices. The great majority of heart drugs need to be taken just once daily, and they are more effective and have fewer side effects than their predecessors. Moreover, their benefits and safety have been well documented in many large clinical trials.

Today, more often than not, the benefits of taking medications far outweigh the risks, a point that has not yet registered with many people. Sometimes I find that the usually healthy skepticism of patients regarding taking medications goes too far. When it does, it can interfere with the critical decision to take a potentially lifesaving drug. Or, if a patient does reluctantly decide to take the drug, it can affect their compliance with taking it regularly.

In recent years, the availability of powerful statin drugs for reducing high cholesterol (along with other medications such as prescription niacin and angiotensin-converting enzyme inhibitors) has made the likelihood of having a heart attack or stroke less than ever before, even among high-risk patients. Moreover, thanks to cutting-edge diagnostic tests such as the heart scan and advanced blood testing, we can better identify who would most benefit from drug therapy and be more precise about which drugs to use.

If your doctor hasn't brought up the subject of medications, but you are aware that you may be at risk for heart attack or stroke, ask your doctor whether medications might reduce that risk.

It's possible that you may need more than one drug to achieve the best results. I often combine two or more drugs to get my high-risk patients' bad LDL down to the optimal level of 70 mg/dL or below or to treat patients who have multiple risk factors such as high cholesterol, high blood pressure, and high triglycerides.

In addition to prescribing medications as needed, I also recommend nutritional supplements — conservatively. Unlike drugs that are regulated by the FDA, supplements are unregulated and, as a result, can be marketed to the public without undergoing the rigorous scientific review required of drug manufacturers' products. I much prefer that people get their nutrients from food. However, in rare cases I do recommend supplements that have been scientifically proven to be both safe and effective.