Q: I am 50 years old. I have been smoking for the past 25 years. I got a TMT done last year. The result was moderately positive. Now that I have left smoking and am taking all the necessary precautions like exercise, walking, eating non-oily food, my lipid profile is perfectly alright. I want to know if I should I get a TMT done again or go for angiography. My father has got his bypass done when he was 72 years of age.

A:As you do not have any symptoms, you have a very modifiable risk factor that you have changed by stopping smoking - the decision of an angiogram will depend on how strongly positive your TMT is. If you have walked more than 9 minutes on the Bruce protocol. Bruce protocol (standard protocol used in India) you can continue medicines which will include aspirin + clopidrogel and lipid lowering statins (e.g.: 20 to 40 mg of atorvastatin even if your cholesterol is normal) for 1-2 years. After 2 years of cessation of smoking the risk of clots forming is much less although your blocks will not regress and you can repeat a TMT. An angiogram becomes mandatory if have chest pain at rest at any time. You also need it, if the TMT was strongly positive or you were able to walk less than 9 minutes during the test.