For months, I had been feeling pressure in my chest after running. As a cardiologist, I should have instantly recognized this feeling as angina, but I employed an elaborate scheme of denial to convince myself otherwise. As I explained in my book, A Funny Thing Happened on the Way to Stockholm, written with Randy Hall, PhD, and from which this column is adapted, my father had his first heart attack when he was 50 years old and ultimately died after his fourth. It was clear that I was on the same path, and I needed to take serious action to turn things around. The first step was quadruple bypass surgery to restore blood flow to my heart. From there, I followed a plan that I recommend to anyone working to overcome cardiovascular risk factors.

Run away from heart disease. After I fully recovered from surgery, I returned to my daily runs. I had been a regular jogger for decades, and I believe that it saved my life. Several branches of my coronary arteries were severely narrowed, and one major branch was completely occluded. Normally, such a total blockage would cause a heart attack, but my cardiac catheterization showed that I had robust collateral circulation, which was shunting blood around the blocked area. That was almost certainly the result of my exercise regimen.

Dietary changes. The cardiologist Dean Ornish, MD, has written extensively on the benefits of reducing fat intake, but not all fats are the same. Other studies have shown that saturated fats can raise “bad” LDL cholesterol levels, but mono- and polyunsaturated fats can actually help to reduce them. I now follow and recommend an almost-vegan diet featuring lots of vegetables, fruits, whole grains, beans, nuts, and olive oil.

The medication factor. Given my inherited predisposition to high cholesterol, my healthy diet could reduce my bad cholesterol levels only so far. To reduce levels further, I took advantage of several drugs, including lovastatin (Mevacor), rosuvastatin (Crestor), and ezetimibe (Zetia), which blocks the uptake of cholesterol in the small intestine. I also took medications to control another cardiovascular risk factor that I inherited from my parents: high blood pressure.

Be prepared. After surgery, about 30 to 50 percent of people experience mental fogginess and memory problems that can persist for weeks, months, or even years. This postoperative cognitive dysfunction (POCD) is most common in people who undergo heart surgery, who are older than 60, who have a lower education level, and who have some cognitive issues or undiagnosed dementia before surgery. In most cases, POCD goes away, as it did for me, but it’s wise to plan for assistance and to avoid making important decisions soon after surgery just in case.

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