Kaori Tonaki writes:
      
      
      
1) Mr. O has some risk factors for another
        myocardial infarction such as high cholesterol, high blood pressure, being
        overweight. First, he needs to reduce his cholesterol level. The results
        of his cholesterol test are not positive. His LDL (so called "bad
        cholesterol") level is 173 mg/dl, and the HDL (so called "good
        cholesterol") level is 26 mg/dl. These levels mean that total cholesterol
        and LDL levels are elevated and levels of HDL are low. Along with fat,
        cholesterol circulates in the blood and builds up in the walls of the arteries
        and can slow or block the flow of blood. This condition is called atherosclerosis.
        Furthermore, without sufficient oxygen to the heart, this may cause chest
        pain called "angina", or if the blood supply is cut off, there
        is heart muscle injury and a "heart attack", possibly resulting
        in sudden death. Therefore, he should reduce total cholesterol level to
        less than 200mg/dl (LDL level ---less than 130 mg/dl, HDL level---higher
        than 35 mg/dl). 
        
        Second, he had better lose weight because he is almost 20 kilos overweight.
        Being overweight may also increase his blood cholesterol level. 
        
        Third, he has to stop smoking because smoking is said to prevent the flow
        of blood. Also, it is said that nearly one-fifth of deaths from cardiovascular
        diseases are attributable to smoking. Fourth, Mr. O's elder brother died
        of heart disease five years ago. Because genetic factors affect blood cholesterol
        level and can determine how much he can lower level by diet and risk of
        heart disease, he has to be careful of his health. 
        
        Finally, The relative risk of coronary heart disease (heart attack) associated
        with physical inactivity ranges from 1.5 to 2.4, an increase in risk comparable
        with that observed for high cholesterol, high blood pressure or cigarette
        smoking. Consequently, he needs to do exercise regularly.
        
        2) To get quick treatment for a heart attack can be lifesaving. When he
        experiences one or more symptoms of a heart attack, first, he had better
        sit down and lie down. If symptoms persist for 2 minutes, he needs to call
        a local emergency telephone number and say he may be having a heart attack.
        And, he had better leave the phone off the hook so that medical personnel
        can locate his address if he should become unconscious. Or, if he can get
        to the hospital faster by car than by ambulance, he had better have someone
        drive him. Then, if he has nitroglycerin tablets, he should take up to
        three pills one every 5 minutes. In short, it is important that he gets
        to the hospital and see a doctor as soon as possible.
        
        3) On improving his health outlook within the next few years, he has to
        go to hospital and see a doctor. And then, he had better have his medicine
        to lower blood pressure prescribe by a doctor. There are many types of
        this medicine. Quite often people respond very differently to these medicines.
        Thus patients must go through a trial period to find out which medicines
        are most effective while causing the fewest side effects. Also, it is important
        to stay on medicine. 
        
        4) If he wants to develop ways to prevent the occurrence of another heart
        attack,  I want to advise him to change his life style. First, he should
        reduce eating cholesterol and fat, because cholesterol consumed in foods
        is unnecessary to our body's proper functioning. (But cholesterol is essential
        to human life.) Also, saturated fat raises his blood cholesterol level
        more than anything else he eats. Food high in cholesterol or saturated
        fat are egg yolks, whole milk products, sausage and so on. In addition,
        vegetable oils, such as palm, palm kernel, and coconut oil, contain no
        cholesterol but are high in saturated fat. So, he had better eat vegetables,
        fish, seaweed, and so on. 
        
        Second, he has to do regular and moderate exercise. This reduces LDL levels
        and increases HDL levels. So, I'd recommend walking because this way that
        fat in body is easily oxidized and decomposed. In this way, regular physical
        activity may help control his weight and is associated with a reduced risk
        of heart disease and lower blood pressure. Finally, he should quit smoking
        because it prevents the blood from flowing. 
        
        If he carries out and continues these suggestions, he can solve his problem
        related to heart disease, I think. 
        
        
        
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