• A vague tightness in the chest which can range in strength from discomfort to pain to a crushing, radiating chest pain
• Heaviness, pressure, squeezing, fullness, burning, or pain that begins at the centre of the chest and spreads to the neck, jaws and shoulder
• Unusual pain that spreads down one, or both arms
• Shortness of breath, paleness, sweating, or weakness
• Nausea, vomiting, and/or indigestion
• Feelings of extreme anxiety, fear, and/or denial

• Low-density lipoprotein (LDL) is often called the "bad" type of cholesterol because it can clog the arteries that carry blood to your heart. For LDL, lower numbers are better.
• High-density lipoprotein (HDL) is known as "good" cholesterol because it takes the bad cholesterol out of your blood and keeps it from building up in your arteries. For HDL, higher numbers are better.

• Maintain a healthy weight. If you are overweight, losing weight can help lower your total cholesterol and LDL ("bad cholesterol") levels. Calculate your Body Mass Index (BMI) to see if you are at a healthy weight. If not, try making small changes like eating an apple instead of potato chips, taking the stairs instead of the elevator, or parking farther away from the entrance to your office, the grocery store, or the mall. (But be sure to park in a safe, well-lit spot.)
• Eat better. Eat foods low in saturated fats, trans fats, and cholesterol.

• Fish, poultry (chicken, turkey--breast meat or drumstick is best), and lean meats (round, sirloin, loin). Broil, bake, roast, or poach foods. Remove the fat and skin before eating.
• Skim (fat-free) or low-fat (1%) milk and cheeses, and low-fat or nonfat yogurt
  Fruits and vegetables (try for 5 a day)
• Cereals, breads, rice, and pasta made from whole grains (such as "whole-wheat" or "whole-grain" bread and pasta, rye bread, brown rice, and oatmeal)

Eat less:

• Organ meats (liver, kidney, brains)
• Egg yolks
• Fats (butter, lard) and oils
• Packaged and processed foods
  

This is truly a frequently asked question, and most doctors have developed their own response to this question. First, what are the facts? The facts are that moderate alcohol intake (1-2 drinks/day) is strongly associated with decreased incidence of coronary heart disease and heart attacks. This is apparently true of all types of alcohol (beer, white and red wine, liquors) and not just red wine. (The mystique surrounding red wine involves its content of flavenoids, antioxidants which have been speculated to decrease heart disease risk).

Although alcohol raises HDL ("good") cholesterol, it is not clear that this is the way in which alcohol decreases risk of heart attacks. Alcohol should never be used simply as a "medication" to raise HDL or to prevent heart disease. There are certainly abundant risks associated with drinking alcohol, from driving under its influence to the risk that use could escalate and cause liver disease. However, the fact remains that moderate alcohol use appears to decrease risk of heart attacks. This is one of those questions that, once armed with the information, everyone has to decide for his or her self.

Niacin is a very effective medication for treating high cholesterol and triglycerides, and it also raises levels of HDL cholesterol. However, although it is a vitamin in low doses, it should be taken for cholesterol only under the care of a doctor.

Its most common side effect is flushing, a warm sensation soon after taking niacin that can be associated with redness and itching and can be bothersome. The body adapts fairly quickly to niacin and usually the flushing will go away over time. To avoid flushing, the starting dose should be 100 mg 3 times per day and it should always be taken after meals.

The dose can gradually be increased over weeks to at least 500 mg 3 times per day, and in some cases to 1000 mg 3 times per day. Niacin can also make diabetes worse, elevate uric acid (a cause of gout), and elevate liver enzymes. However, for the right person it can be extremely effective. You should discuss with your doctor whether or not you should consider niacin.

Not everyone with high cholesterol is destined to develop early coronary heart disease. First, a breakdown into the LDL ("bad") and HDL ("good") cholesterol should always be done. Some people with high cholesterol have normal LDL but high HDL (which is a good situation to be in!). Second, there may be other inherited factors which help to offset the effects of high LDL cholesterol. Third, some people are just lucky and defy the odds.

In any case, the lack of a family history, though a good sign, does not make anyone immune to the effects of high cholesterol. Watching your diet, exercising regularly and taking an aspirin a day would make sense as ways of decreasing risk. Whether medication is advisable would depend on your cholesterol level, your age, and the presence of other risk factors.

The concept of taking vitamins to prevent heart disease is a great one – the problem is that we don't have any proof that they really do. Our only evidence is based on nutritional surveys that suggest that people who eat foods richer in vitamins E, vitamin C and other vitamins are less likely to have heart disease.

However, these same people could be getting more exercise and watching their health in many other ways, so these studies don't prove that it's the vitamins that make the difference. Quite a few studies are going on right now to try to investigate this question. Until we have more information, it's hard to recommend any vitamins on a routine basis. However, your doctor may have specific reasons for recommending certain vitamin supplements.

Yes, amazing but true: aspirin has been proven in many studies to help prevent both heart attacks and strokes. Aspirin thins the blood a little in a way that decreases heart disease risk. Acetominophen and ibuprofen will not do the same thing. Aspirin should be a routine part of any effort to decrease the risk of developing heart disease, but talk with your doctor before starting it.

You are asking about the potential for "regression," the process by which heart blockages can be made to partially get better. There is now evidence that this is possible in some people through a combination of lifestyle changes, exercise, diet, and when needed, cholesterol lowering. However, in general the major issue is not making heart blockages go away, rather just making sure that they don't get worse or cause another heart attack. We now have tremendous evidence that future heart attacks can be prevented, especially by aggressive treatment to lower cholesterol.