Keiko Nishi writes:
To Mr. Okada:
First, you should have the right information about CVD. And then you should also know that you have many risk factors for another myocardial infarction now. The following are the risk factors you have now.
1) Your blood pressure indicates moderate to high hypertension. High blood pressure contributes to the burden of your coronary arteries. 2) Your LDL-cholesterol level, 173 mg/dl, is in the category of high risk. And your HDL-level, 26mg/dl, is fairly low, because any HDL-cholesterol level lower than 35 mg/dl is considered low. 3) You have a clear symptom of angina pectoris. Angina is an indication that you are at risk of having a heart attack. 4) You are almost 20 kilos overweight. Being overweight increases your blood cholesterol level. 5) I'm sorry that your elder brother died of heart disease five years ago. That shows you might have genetic risk factors for CVD. 6) You are a cigarette smoker. A recent study shows that smoking increases the likelihood of developing heart-related problems. 7) You seldom do exercise. Little exercise causes the overweight condition, high cholesterol level, and indirectly high blood pressure. In your condition, you should not go on a hiking trip, because angina usually occurs during physical exertion.
Second, please remember what you should do if you have another heart attack. Since you experienced one symptom of heart attack, act quickly and take the following steps.
1) Sit down or lie down.
2) Call the ambulance.
3) Take nitroglycerin tablets, take up to three pills, one at a time every 5 minutes.
4) Anyway do not delay getting medical treatment.
Third, I would like give you some advice you should follow within the next few weeks.
1) Stop smoking immediately.
2) Do not work too much and relax. Emotional stress is one of the most serious risk factors of angina.
3) Please remember the list of what to do if you have another heart attack.
4) Consult your regular physician about the possibility of your taking antihypertensive medication to relieve your hypertensive status.
Fourth, I would like to give you some advice you should follow in the longer term to help prevent the occurrence of another heart attack.
1) Let's try to lower your blood pressure level to the normal category, 130-85 mm Hg. Being overweight or using excessive salt are two avoidable factors. So you should do a little exercise every day, for example, walking, to lose your weight. (Never do hard exercise, because it causes angina.) And you should have your own diet menu with a little salt and a little oil to lower your blood pressure.
2) You should try to lower your LDL-cholesterol level to less than 130 mg/dl, and raise your HDL-cholesterol level to 35 mg/dl. You are requested to be aware that saturated fat raises your blood LDL-cholesterol level more than anything else you eat. Foods high in cholesterol or saturated fat are: egg yolks, sausages, kidneys, liver, and whole milk products, such as butter, cheese, yogurt, ice cream, red meat, and vegetable oils. So the food mentioned above must be avoided in your diet menu. On the other hand, quitting smoking and losing weight help raise your HDL-cholesterol level. So let me say again to continue to do an easy exercise program and consider stopping your cigarette habit.
Finally, the most significant piece of advice I can give you for your future health is to appreciate the risk factors for CVD and understand why. And the more important is never fail to follow the advice I gave you.
I would like you to live a healthy life. Good luck, Mr. Okada!
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