Frequently, coronary artery disease has a significant genetic component and requires more than just lifestyle changes of diet and exercise to treat. In my cardiology practice of high-risk patients (those who experienced a heart attack at a young age or who never had a heart attack but are at risk of one), it is usually necessary to use a combination of diet, exercise, and often several medications to prevent heart attack or stroke.

In my experience, I have seen that patients can develop significant arteriosclerosis, or blockages, in the heart arteries and still have negative stress testing (often interpreted by doctors as a positive indicator of heart health). This is because stress testing predicts the adequacy of blood flow to heart muscle during exercise; it does not tell us what is happening in the vessel walls. Many so-called "obstructed arteries" have their own collateral vessels (natural bypasses), and this is why an exercise test can be normal despite even significant blockages. The point is that stress testing alone is not sufficient to predict whether someone is at risk for a heart attack.

It is also important to understand that cholesterol levels and other risk factors cannot accurately predict the presence and extent of heart arteriosclerosis in any individual. Each of us has our own threshold of cholesterol and other risk factors where cholesterol actually gets into the vessel wall and causes arteriosclerotic plaques. The best method to detect the buildup of plaque years before it causes symptoms is by a heart scan that uses ultrafast CT technology and by advanced lipid (blood) testing. By incorporating heart-scan technology and advanced blood testing, the buildup of plaque can be detected five, 10, or even 15 years before it becomes a major risk factor. With that knowledge, aggressive preventive strategies can be instituted in time to prevent angioplasties and bypass surgery.

I believe that people could avoid advanced heart disease or a heart attack if they follow aggressive preventive measures. Specifically, I typically recommend that all men over 40 and women over 50 work with their cardiologists and follow four major steps:

  1. Heart-scan imaging
  2. Advanced blood testing (which breaks the HDL and LDL into subclasses and includes genetic testing as it becomes available)
  3. A customized program of diet, exercise, and medication
  4. Repeat testing

The use of statins (cholesterol-lowering drugs) decreases the risk of a coronary event by only 20 to 40 percent. With aggressive prevention, we can prevent nearly all the heart disease and heart attacks in this country.

Learn more in the Everyday Health Heart Health Center.