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It’s Important to Stay on Top of Hereditary Heart Risk

Dear Dr. Roach: I am 69. Two years ago, I had a heart attack followed by double bypass surgery; two vessels on the back of my heart were blocked. I had no symptoms. My doctor, family, friends and I were stunned. I was too healthy to have been struck by a heart attack. I was at risk due to my male family members having heart issues. My father died of his third heart attack at the age of 60. I followed a heart-healthy lifestyle: low body fat, healthy weight, no smoking, no drinking, no red meat, lots of exercise indoors and out. My cholesterol readings had always been in the good range.

I am now on simvastatin and losartan daily. I regularly take my blood pressure readings. Since my heart attack and my surgery, I have followed the therapy lifestyle diet in an American Heart Association publication. A year after my heart attack and surgery, I had a treadmill stress test, and all was well. I see my cardiologist every six months and my primary doctor quarterly.

What preys on my mind the most is whether or not plaque is building up in any of my blood vessels, leading to a killer heart attack. I wish there was a noninvasive means to at least annually determine the health of my blood vessels. I do not want to wait for symptoms to occur. I want early detection to prevent another heart attack. — M.S.

Answer: Your letter underscores that heart disease can happen even when you do everything right, that a family history is a significant risk factor and that heart attacks happen even in people with good blood cholesterol.

Your question is about a screening test for heart disease, to see whether there are blockages that need treatment before any symptoms develop. There are two kinds of tests: those that look at the anatomy of the heart, such as an angiogram or CT angiogram, and those that look at its function, such as a stress test.

The problem with pictures of the blood vessels is that it’s likely you have some blockages. However, small blockages actually may be more likely to cause a heart attack than big ones, since the smaller ones can rupture and cause a blood clot, which starts the heart attack. A stress test, such as the treadmill ECHO you did, is better at showing if the heart is getting all the blood it needs during exercise.

My colleagues in cardiology and I recommend a good diet and exercise regimen, a statin, blood pressure treatment such as what you are getting, daily low-dose aspirin and a periodic stress test. An angiogram would be considered with any new symptoms.

Dear Dr. Roach: What can you tell me regarding a hydrocele? — D.D.

Answer: A hydrocele is a fluid-filled sac inside the scrotum. It isn’t cancer, doesn’t affect fertility or sexual function, and usually doesn’t need to be treated. A hydrocele is diagnosed by physical exam, sometimes using a light test (a hydrocele allows light to pass through, where a solid mass does not) or sometimes an ultrasound. They only need treatment if they are symptomatic, and they can be removed surgically if that’s the case.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or write to P.O. Box 536475, Orlando, FL 32853-6475.