Q: My friend aged 48 years has high blood pressure, a thyroid problem and diabetes. He takes Atenolol 50 + Losartan 50 for hypertension and Pioglitazane 15 mg, Metformin 500 Glimperide 1 mg for diabetes. He also takes Atorvastatin 10 mg with Ezetimibe 10 for high cholesterol and he takes thyroxine 50 mg for thyroid plus ecosprin 150. He leads a very stressful life. Right now he is under the care of an internist. He also smokes cigarettes. I told him that he is a high risk candidate for anything that may happen any time. Does he need cardiac evaluation by a cardiologist? Do you anticipate any complications at a later date? He is asymptomatic. All his ailments have been detected by accidental pathological tests. TMT and 2D Echo, done last year were normal. What precautions does he need to take?

A:There are several things that shorten life: bad genes, being overweight, smoking, stress, accidents and disease. Most of these risks are controllable, and require adherence to basic health rules, especially with respect to daily diet and exercise. It is essential to control any disease such as diabetes by lifestyle improvements and by careful use of medications with appropriate monitoring. A cardiac stress test and colonoscopy are advisable at the age of 50, and regularly thereafter. Such tests are even more essential when there is a family history of heart disease or cancer at an early age. Some people find that relaxation exercises with an instructor of yoga or qui gong (Chinese exercises) to be very helpful. Numerous herbs are used to extend life, but their value is uncertain. Optimal health is attained by working at it, but if too much effort and anxiety is also a component of the regimen, this can defeat the goal of improving health. A balanced approach is needed since no one can be perfect and we can never predict the future!