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DEAR MAYO CLINIC: I am a 49-year-old man with a strong family history of coronary artery disease. Although I used to compete in triathlons, I just don’t have that kind of stamina anymore, and I become short of breath pretty easily. Should this be cause for concern? I also don’t have much time to exercise, so I run five or six miles just once or twice per week. Would another type of exercise be better for someone in my situation?
ANSWER: With a family history like yours, along with what sounds like a loss of exercise capacity, it would be a good idea to see a cardiologist and have your situation evaluated. Testing may be able to show if you have any heart issues that need to be addressed. A cardiologist can also assess your exercise routines and other lifestyle issues that could have an impact on your heart health.
Coronary artery disease happens when the major blood vessels that lead to your heart — your coronary arteries — become damaged or diseased, often due to a buildup of cholesterol-containing deposits, known as plaque, or inflammation.
Many factors can raise your risk for coronary artery disease, including family history. That’s especially true if a close relative developed heart disease at an early age. The risk tends to be highest if your father or a brother was diagnosed with the disease before age 55 or your mother or a sister developed it before age 65.
For an evaluation, your doctor will start by conducting a physical exam, checking your weight and body mass index, and ordering several routine blood tests, including a lipid panel to find your cholesterol levels.
Given your family history, your doctor may recommend a computed tomography, or CT, scan of your heart. That test can help determine if you may have any buildup in your coronary arteries. Depending on the results of the CT scan, you may need another test, called a coronary angiogram, which uses X-ray imaging to see the coronary arteries, as well.
An exercise stress test may also be appropriate in your situation. During this test, your health care team tracks your heart rate, blood pressure and heart rhythm as you walk or run on a treadmill. Results help determine your exercise capacity and show if you may have heart or lung problems that need further evaluation.
The exercise program that’s right for you depends a great deal on your health history and other medical conditions you may have, along with the results of your cardiac assessment. In general, though, a variety of exercise spread throughout the week is usually preferable to just one or two days of the same high-intensity workout that you describe as your typical routine now.
Consider diversifying your exercise to include not only running, but other activities, such as cycling, swimming and weight lifting. In doing so, you work your muscles in a different manner. That maximizes the effect of exercise without damaging your knees, hips and other joints — a common problem in runners as they age. To improve your exercise capacity, the best approach is to incorporate 30-minute daily workouts into your schedule, as well as a quick 10- to 15-minute brisk walk at some other point in the day.
Diet can have a big effect on your heart health, too. Review your diet with your cardiologist to see if there may be areas for improvement. As much as possible, avoid fried, fatty foods, minimize excess sugar and limit alcohol. Focus on eating vegetables and fruits, lean meats and whole grains.
Working with a cardiologist, you can assess your risk of coronary artery disease, create a plan for reducing or minimizing that risk, and find ways to exercise that will help preserve your heart health now and into the future. — Brian Shapiro, M.D., Cardiovascular Diseases, Mayo Clinic, Jacksonville, Fla.