Like many of my older friends, Jo had a familial history of heart disease. Although her mother lived well into her 90's her dad died at age 72 after engaging in his favorite activity-ballroom dancing. Immediately after sitting down he suffered a "widow maker"-a sudden blockage of his left descending artery that triggered a massive heart attack and immediate death. Jo told me she'd known her dad had cardiac disease-he'd been one of renowned cardiac surgeon, Denton Cooley's early recipients of bypass surgery. So, it wasn't a big surprise for her to learn, later in life, that despite a much more active life than her dad had led, she had a total cholesterol reading that was "off the charts."

In addition to her exercise program-running 3-5 miles daily, ballroom dancing two nights a week and chasing grandchildren, Jo immediately went on a saturated fat free diet in an attempt to lower her cholesterol. A month later she'd lost weight but her total cholesterol was still high. Jo was now told she had familial hypercholesterolemia, a genetic disorder believed to be caused by the body's inability to bind and remove excess cholesterol.

On the other hand, Jo had some reassuring and challenging news. Her very active lifestyle contributed to high blood levels of HDL (the good cholesterol), but she also had very high blood levels of LDL (the bad cholesterol). Years later, when statins, the popular drugs that block a chemical in the liver that's necessary for making cholesterol, Jo agreed to participate in a double blind drug study. A double blind study means that neither the doctor nor patient knows if the medicine is the drug being tested or a placebo. A month later her blood cholesterol levels were normal. Relieved, she agreed to begin to take statins daily. She was surprised to learn that her levels never rose no matter what she ate! However, several years later Jo developed terrible muscle weakness and pain-a dangerous side effect of statins for some patients. She went off the statin and her cholesterol soared again. Not knowing that there are specific statins for specific issues Jo's doctor switched her to another statin. It was a year before the muscle weakness and pain reappeared. After a three-month break she switched to a third statin. This time the side effects appeared immediately. Although worried knowing her cholesterol would soar again, she was off statins for good.

The February, 2012, my column included information about the specific indications for statins currently on the market. It was eye-opening for Jo. Her doctor had prescribed the least expensive statin even though another was more suitable for her. When we crossed paths she told me about her nagging fear that her high cholesterol combined with an inability to use a statin would contribute to a heart attack-despite her ongoing fitness regimen. I urged her to get a CT Angiogram. This noninvasive diagnostic test uses X-rays and an injected dye to produce 3-dimensional images of the blood vessels and surrounding tissues-including the heart. Add a "calcium score" to detect deposits of calcium in any plaque-a primary cause of atherosclerosis (hardening of the arteries). Additionally, I urged her to ask her doctor for a VAP cholesterol test. This relatively new blood test provides more in depth information about the various kinds of HDL and LDL particles in a reading. Most important, an LDL particle test can discover whether LDL is made up of small, dense particles (Type A) seen when there is an increased risk for heart disease vs. large, fluffy particles (Type B) that are less risky.

Happily Jo's images showed she had very little plaque in her arteries-probably because her active lifestyle trumped her genetic predisposition to serious heart disease. There was other good news. Her LDL particles were primarily Type B-further reassuring her that her exercise and lower in saturated and trans fat diet was keeping her healthy.

Heart disease continues to kill more US citizens (more than 33,000 in 2011) than all forms of cancer. Thirty six percent of women have cardiovascular disease-most of it without symptoms. If you have a heart attack statistics show that without major lifestyle changes your life span will be shortened by fifteen years.

Few people would deny a lower in fat, lower in sugar, higher in fiber diet is good insurance for healthy living. Exercise is mandatory. If you want to lose weight building a movement program that adds up to 10,000 steps a day (walking an 18 hole golf course is a good guideline) will wake up your heart. Weight training can jump start your metabolism. All these options are available, with guidance, from the staff at our state-of-the-art gym. It's up to you to get started.

For more information on the VAP Cholesterol test see: www.medfusion.net/templates/groups/7241/12677/VAP.pdf. For more information about CT Angiogram testing see: www.webmd.com/heart-disease/guide/ct-heart-scan.