Dr. Jason Robin (NorthShore)
Great question! Diet and exercise are part of the equation but often we need to use medications to keep our heart healthy. One of the most used medications which has consistently shown benefit is "the statin." Lipitor, Crestor, Zocor etc

Dr. Jason Robin (NorthShore)
Another great question, Jo! Outside of an acute myocardial infarction or when there is multi vessel coronary disease seen on an angiogram, revascularization (stents or bypass surgery) have not been shown to improve survival. In most patients, standard medical therapy is the key-statins, anti platelet meds like aspirin, ace inhibitors etc. If one is having angina-chest pain due to insufficient coronary flow, we can alleviate the symptoms with medications such as nitrates, calcium ch blockers, beta blocker and Ranolazine. Often, people will not need angioplasty because these meds are effective. Read up on COURAGE trial

Dr. Jason Robin (NorthShore)
Hi Traci. My practice is typically to obtain a stress test every 2-3 years after someone has an event (for example a stent). You are probably getting great care with your PCP but never a bad idea to make sure i's dotted and t's crossed as the guidelines continue to chnage based on new and exciting data!

Dr. Jason Robin (NorthShore)
Okay Deb! I am going to share with you the secret formula! Go to: http://my.americanheart.org/cvriskcalculator Open up the risk calculator and enter your age, gender, total cholesterol, HDL cholesterol, systolic blood pressure, whether you are on meds for blood pressure, whether you smoke or have diabetes. IF your risk of having a cardiovascular event between now and age 77 is >7.5%, YES, you should be on a statin. If <7.5%, assuming you don't have diabetes or any real clinical events, you may not need one.

Dr. Jason Robin (NorthShore)
The best way to lower cholesterol through diet: Change Fat (Opt for mono- and polyunsaturated fats, instead. Your body needs to take some fat in, but these sources are considered healthier and will not impact triglycerides. They include olive oil, canola oil, rice brain, walnut oil, and flaxseed oil) Increase Fiber (Fiber helps regulate the way that food is absorbed and passed through your body, and high-fiber foods can significantly lower both your triglycerides and LDL cholesterol) Cut red meat, eat more fish (2 servings/week) Cut excessive alcohol Cut refined carbohydrates. White rice and baked goods made with white flour or semolina can cause elevated triglycerides in some individuals HDL is tough to increase but cutting carbs, lowering blood sugars, exercise all help My heart is racing right now!

Dr. Jason Robin (NorthShore)
It's important to know what type of family history you are referring to...a hereditary cardiomyopathy, sudden cardiac death, drowning from Long QT syndrome, atherosclerosis etc I assume you are referring to the latter which is the most common concern and is the most prevalent issues. Assumng you are not having symptoms, at the very least I would order a fasting cholesterol profile to gauge your 10 year and lifetime risk for a cardiac event or stroke. If your risk is borderline based on blood pressure and cholesterol, I may also order a blood test called a CRP or get a coronary calcium score to help further risk stratify. A stress test may be reasonable but in someone who exercises regulalarly without symptoms, probably NOT going to add much.

Dr. Jason Robin (NorthShore)
I suspect you have sleep apnea which is very common and typically duu to carrying to much weight. If you lose the weight with diet/exercise, the sleep apnea will improve, the right sided pressure will come down, and the arrhythmias will lessen or perhaps resolve.

Dr. Jason Robin (NorthShore)
Lori, If your Dad's first MI was in his 40s, I would have a very low threshold to start statin therapy (Lipitor) once you are in your 30s. Of course we would need a baseline lipid profile first. A stress test to serve as a baseline is reasonable although if you are asympotmatic and exercise regularly, it will probably be normal since stress tests are onyl abnormal when there are severe (70% or higher blockages). Occasionally we will order a CT of the heart to look for subclinical disease. But, at the end of the day, all roads lead back to statin therapy, in addition to making sure blood sugars and blood pressure is well controlled

Dr. Jason Robin (NorthShore)
As with any intervention, we must always look at risks vs benefits. As a whole, statins are VERY safe and have proven time and time again to reduce risk. Some people will devleop muscle aches with statins. This is almost always benign but we check muscle enzymes to make sure there is no breakdown of the muscle-that is a VERY rare event and when it does occur, we will temporarily stop the medication Liver enzymes can also increase in some people so we check this after we start the medication or if we increase the dose. The likelihood of causing serious liver damage with a statin is very close to 0%. We even put people who have cirrhosis on statins! If your risk is high (previous cardiac event, known diabetes, LDL >190 or 10 year risk >7.5%, almost certainly you should be on a statin).

Dr. Jason Robin (NorthShore)
Yes, kids can have high cholesterol. Sometimes pediatricans only chdeck the total which is not very useful since the total may be high because the good HDL is also very high. It is great that you are thinking about this now. Plaque starts to develop very early on in life-teens and 20s. Unless her cholesterol is dangerously high (seen with familial hyperlipidemia-very rare) I would not expose her to a statin yet and work on lifestyle modifications. Talk to your pediatrician on lifestyle changes. Sometimes a dietician can be useful. I send my patients to Lisa Bookstein in Highland Park-she is great!

Dr. Jason Robin (NorthShore)
The main issue with sitting to long is you are not burnding calories! it is more of a long term issue as being sedintary all the time will lead to weigth gain, insulin resistance and diabetes. Make sure you exercise before or after work. If you are worried about blood clots in the legs, as long as you stand up and walk around for a few minutes every hour, you should be fine! But do MOVE MORE!

Dr. Jason Robin (NorthShore)
Excellent question, Jamie! When I hear stories of father's having heart attacks in their 20s-40s, I like to start seeing the kids once they are post-adolescent. These are the kids who I may start statin therapy on at a young age and consider studies such as a 64 slice CT of the heart to look for early subclinical coronary disease. Also very important to make sure that the cause of death was indeed a myocardial infarction/heart attack. If it was due to a hereditary heart muscle or primary electrical problem, that takes us down a different path! Hope that helps:)

Dr. Jason Robin (NorthShore)
You got it Shonna! It is not uncommon for us to perform an EKG, echocardiogram, stress test or angiogram to find out a coronary artery closed off and the patient does not recall it. Often seen in older patients who are less sedintary or in people who ignore symptoms. Hope this helps!

Dr. Jason Robin (NorthShore)
Those with MVP will often have unusual chest symptoms which are almost always benign. A small segment of those with MVP will develop a leaky valve-called mitral regurgitation. If it has been a long time since your last echocardiogram, I would obtain another one. It's just an ultrasound (worst part is the cold gel). If there is any significant mitral regurg, we may want to follow it with annual or every 2-3 years echocardiograms. Most likely, nothing to worry about! remember, 5-10% of the general population has MVP-very common!