Can you further lower heart disease risk if your numbers already look good?

Q. I am a 52-year-old man with a family history of heart disease. My doctor says my blood pressure and cholesterol are great. My latest LDL cholesterol was 98 and my HDL was 45. I exercise regularly and I try hard to stick to a Mediterranean-type diet. Is there anything else I should do?

A. Congratulations! You've already got the primary lifestyle approaches to a healthy heart covered (assuming that you don't smoke!). From a scientific standpoint, the evidence on how much you would gain from doing even more is unclear.

But your question suggests that you are the type of person who may be willing to take things to the next level, so here are some ideas. First, I would start with increasing your duration and intensity of exercise.

Basic recommendations say that we should all get a minimum of 150 minutes of moderate-intensity physical activity per week (not all at once). However, most experts suggest 45 to 60 minutes most days of the week to achieve a level of fitness optimal for promoting cardiovascular health.

For someone like you, I'd recommend incorporating a mix of the following activities into your workout routine:

• endurance aerobics
• interval training with short bursts of high-intensity exercise
• resistance training using machines and/or free weights.

Regarding your diet, the choice of a Mediterranean-style diet is a perfect place to start. You want to have at least five servings of fruits and vegetables daily — and you may want to aim higher, for example, eight to 10 servings a day. Keep red meat to a minimum. Fish, especially those rich in the omega fats, appear to be best.

Older studies suggested moderate alcohol consumption might help prevent cardiovascular disease. But based on new data, lifestyle factors in moderate alcohol users was the reason, not directly related to alcohol consumption. If you do enjoy an occasional drink, up to an average of one per day, no reason to stop. But if you are not a drinker, don't start because it won't improve your health.

Since your blood pressure is normal, salt restriction is not mandatory, but there is no downside to moderating your intake of sodium.

Given your family history of heart disease, you might discuss additional blood tests that measure levels of another lipid particle called Lp(a) and C-reactive protein (CRP), a marker of chronic inflammation. A blood test can look for subtle increases in CRP that are associated with a higher risk of coronary artery disease and heart attacks. With a high level of CRP or Lp(a) and a strong family history of heart disease at a young age, your doctor may suggest taking a low-dose statin to lower your LDL cholesterol even more.

Definitely keep up your efforts, and work with your doctor to fine-tune a strategy to keep heart disease at bay.

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