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Ask the Doctor: August 2008

Question: I am a 58 year old man, and was upset by the recent sudden death of Tim Russert. I haven’t been to the doctor in a while and have gained some weight. What do you recommend for me to do so I can get healthy and not have the same fate as Tim?

Answer: This is a question I have been asked more than a few times since Tim Russert’s sudden death. There are quite a few things you should do to take care of yourself. The first thing you need to do is to see a doctor for a routine physical. While all doctors differ slightly in what to they do routinely, there are standard things that all men over 50 should have checked on a regular basis. Your doctor can also help you with your lifestyle changes, so you can have the highest level of success.

First, you need your blood pressure checked every year. High blood pressure is a risk factor for heart disease. Normal blood pressure today is considered to be 120/70 or 115/70 if you have certain other risk factors. Any levels higher than that will increase your risk of a heart attack or stroke in the future. Based on your blood pressure, you can design a treatment plan with your doctor to get you back into the safe range with lifestyle changes and/or medications. The other risk factor for heart disease that needs to be monitored on a yearly basis is your cholesterol. The total cholesterol number is not as important as it used to be. The more important values are the HDL (good cholesterol) and the LDL (bad cholesterol). Your HDL should be more than 40 in order to reduce your risk of heart disease. Your LDL goal will vary depending on your other risk factors for heart disease, including family history, other medical problems like diabetes, and your personal history of smoking. You have to keep in mind that being male and over 50 are two separate risk factors, neither of which you can control. That’s why we have to work to control your other risk factors.

In addition to your blood pressure and cholesterol, smoking and fitness level ARE two things that you can control. If you are a smoker – even if it’s only the occasional cigar on the golf course – you need to quit as soon as possible. The cigarette smoke and the toxins that you inhale add inflammation to the body and the arteries, making any plaques you might have in your arteries unstable. When the plaques are unstable, heart attacks occur. There are many options and programs available to help you quit smoking, and you can talk to your doctor about which option is best for you. As for your fitness level, your heart is a muscle that needs to be worked out on a regular basis like any other muscle in your body. Before you start an exercise program, you need to consult your doctor to make sure you don’t need your heart checked first. Otherwise, regular cardiovascular exercise 3 to 5 times a week for 30 minutes is generally recommended.

There are some other tests that your doctor might order, based on your current symptoms and risk factors like an EKG, stress test, or cardiac calcium score. These heart tests are not done on a regular screening basis and should be ordered in the appropriate clinical setting. Keep in mind; they may not always be covered by insurance either. In addition, your doctor may recommend aspirin therapy with 81mg, or low dose, of aspirin. However, aspirin therapy is not recommended for everyone, so this is something else to discuss with your doctor before getting started.

The most important lesson to learn from Tim Russert’s tragic death is that the first sign of heart disease can be a fatal heart attack. This is why it is SO important to control the risk factors that you can, so that you can live a long and healthy life. Good luck!

Dr. Karen Lockwood is a graduate of University of Oklahoma College of Medicine.  She completed her residency in Internal Medicine at Henry Ford Hospital in Detroit.  She is board-certified in Internal Medicine and is currently in private practice in Troy, MI.

If you would like to submit a medical question to Dr. Lockwood, Please email your question to askthedoc@healthandleisureonline.com.

*Advice found within this article is for informational purposes only and should not replace the advice or recommendations of your physician.