Young at Heart

I was 11, sitting at our kitchen table with my father and two sisters, when Dad's eyes suddenly rolled back in his head. He slumped and fell clean off his chair, hitting the cold tile floor with a thud. The three of us jumped up, shrieking, and I called an ambulance. Dad came to before the paramedics arrived and told us not to worry. ‘It was nothing,’ he said, and then made us swear not to tell our mother.

Fast-forward 12 years. Dad, now 51, is walking around a hospital room with two stents and a pacemaker in his chest, the calling cards of his heart attack. If he (and his doctor) had known back then what I know now, his heart muscle might not have suffered irreparable damage. Passing out, you see, is a sign of arrhythmia, a treatable condition that can cause heart attacks, strokes, even sudden death.

Over the past few years, cardiologists have aggressively started trying to prevent heart disease in at-risk men, rather than treating them only after their blood pumps have broken down. Those patients who follow a preventive treatment program almost always live free of heart attacks. To help you spot subtle risk factors and correct them before they bury you, we compiled this list of things cardiologists wish you knew.

Your Heart's Mortal Enemy is often Invisible

I was taught at medical school that heart attacks take place when blood vessels have closed gradually, like pipes filling up with sludge. We now know that blockages occur suddenly due to the rupturing of soft plaque. The problem is soft plaque often goes undetected by standard cholesterol tests and exercise stress-tests.

Why it's so Dangerous

Soft plaques resemble pimples on arterial walls, only instead of being filled with pus, they're filled with cholesterol, when those ‘pimples’ pop, a small blood clot forms to heal the injury, later forming scar tissue and tiny calcifications along the arterial wall. By then, you're incubating a heart attack, which strikes when a violent explosion of one of the pustules creates a clot big enough to block an artery.

How to Spot the Problem

If you have a family history of heart disease, schedule a 64-slice CT scan. It's the only test that snaps pictures of the heart quickly enough to reveal minute calcifications in the coronary arteries. Make sure the scanner has ECG-dose modulation, the latest radiation-limiting technology. If your doctor identifies trouble, you may need to take statins.

How to Defend Yourself

Toss some pecan nuts onto your salad or over your oatmeal. Researchers at Loma Linda University, in California, had 24 people replace 20 percent of their daily kilojoules with pecans for a month and found that the nuts lowered levels of lipid oxidation (the process that turns cholesterol into plaque) by seven percent - enough to help ward off arterial damage. Pecan nuts are rich in gamma-tocopherol, a form of vitamin E that isn't in supplements. Even just a handful a day can help.

An Untrained Heart Won't Reach the Finish Line

Not all heart tests need to take place in a lab. In a 23-year study of 6 000 men published in the New England Journal of Medicine, researchers revealed that the greatest predictor of death from heart attack was the ability of a man's heart rate to adapt during and after a workout. The faster your heart rate goes down after exercise, the healthier you are.

Why it's so Dangerous

Men whose heart rates didn't drop by at least 25 beats per minute (bpm) within a minute of finishing an intense workout, were more likely to suffer a fatal heart attack than those whose heart rates dropped efficiently. The reason? How your heart adapts to exercise is a good indication of how well it will respond to the extreme stress produced before and during an actual infarction.

How to spot the problem

Do 10 minutes of sprints, check your heart rate, then check it again a minute later. It should ideally have dropped by at least 25 beats.

How to defend yourself

Improve your heart-rate variability by applying the principles of interval training to your lifting regime. Wear a heart-rate monitor and don't end your first set until the monitor reads 160bpm. Then wait till it drops below 130bpm to begin your next set.

You’ve Never Heard of the Cholesterol that wants you Dead

Researchers now realize that the size of cholesterol particles is even more important than their number. Small particles of lipoprotein(a), a type of LDL (the bad stuff), are a particularly damaging form of cholesterol. These particles are smaller and they have a tail, making it easier for them to sneak into the arterial wall.

Why it's so Dangerous

A study in the Journal of the American College of Cardiology reveals that people with high lipoprotein(a) levels are 10 times more likely to suffer heart attacks than those with lower levels.

How to spot the problem

Ask your doctor to schedule a lipoprotein(a) test (most medical aids will cover it, but check with your particular one). This blood test will tell you how much of this dangerous cholesterol is present in your blood. An ideal level is below 10 milligrams per deciliter.

How to Defend Yourself

Diet, exercise and even statins have proven ineffective against lipoprotein(a). But in a review of eight years of studies of prescription niacin, Dutch researchers determined that swallowing two grams of this potent B-vitamin lowered lipoprotein(a) by 17 percent and raised the number of large HDL particles by 18 percent. Ask your doctor for a slow-release version of niacin - it has been found to produce fewer side effects.

Carbohydrates, not fat, are the real Heartbreakers

The more carbohydrates you consume, the higher your blood sugar and, in turn, your levels of the hormone insulin, which stores glucose in the liver and muscles to lower blood-glucose levels in times of excess. But excess insulin may also increase your risk of heart disease. The inflammatory process leading to hardening of the arteries is mediated through insulin.

Translation: high levels of insulin boost your body's production of stress hormones, which send blood pressure skyrocketing. That increased pressure damages the arterial wall, making it easier for cholesterol to slip inside.

Why it's so Dangerous

Insulin may not act alone. It is thought that the excess carbohydrates that cause insulin to spike are also turned into triglycerides in your liver. And the more triglycerides there are circulating in your bloodstream, the more lipoprotein(a) - the lethally small cholesterol -  you're likely to have.

How to spot the problem

Researchers at Johns Hopkins University, in Maryland, showed that for every one percent increase in glycosylated hemoglobin (HbAlc), an indicator of long-term blood-sugar levels, patients experienced a 14 percent increase in the risk of heart disease. If there is a history of diabetes in your family, schedule an HbAlc test. If you have levels in excess of 4.6 percent of total hemoglobin, consider reviewing your diet and talking to your doctor about taking drugs to lower your blood sugar.