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Will I get another heart attack, what care should I take?

Q: I am a male aged 33 years. I was a smoker and was diagnosed as a case of anterior wall MI two years back and not thrombolysed. The only positive risk factor mentioned was smoking with diabetes, hypertension, familial hypercholesterolemia, hyperlipidemia & obesity negative. I had an angiogram and was advised a PTCA and stent to left anterior descending artery and angioplasty was done. Post angioplasty, I have not had any problems. I exercise 7 days a week including brisk walks for 50 minutes (about 5.5 kms). I have given up smoking and alcohol consumption has been minimised to 100 ml thrice a week. I am leading a normal lifestyle, attending work as usual. My lipid profile has been normal throughout. Recently, I had a regular check up and the results were: Serum Sodium - 139, Serum Potassium - 3.7, Triglycerides - 70 mg, Serum Cholesterol -138 mg, HDL - 39 mg, LDL - 85 mg and VLDL - 14 mg. My BP is always between 110/70 and 120/80. My questions are as follows - What are the chances of the problem recurring? Will giving up smoking have any positive impact? Is moderate alcohol consumption as mentioned ok? As a part of my exercise regime, I climb stairs so is it ok? I am taking Met XL 50 mg - daily, Ecosprin 150 mg, Cardace 1.25 mg, Tryptomar 10 mg and Simvas 20 mg.

A:The best news is that you have given up smoking and continue not to smoke. Because you have no other risk factors, smoking is probably the one and only cause for your heart attack. Unlike other risk factors this is a totally reversible risk and you have done the reversal!. You have no family history and your lipids are excellent. So you are very unlikely to ever have a heart attack again. However you may periodically (once in 2-3 years) check your heart function by echo, if there was any damage from your previous heart attack. Cardace prevents your heart from dilating after a heart attack. You may continue to take Ecosprin, Cardace & 10 mg of Simvas life long. A single tablet called Polytorva is available that contains a similar combination and you may ask your doctor about it, if you are concerned about taking too many tablets. You may also test: 1) serum homocysteine and 2) Lp(a) which are cause of heart attacks in young non-smokers. The fact that you are climbing 11 flights of stairs implies that you heart function is excellent and that there was little permanent damage from your heart attack. You should continue to exercise. Your large diameter stent is unlikely to narrow down (happens only in the first 6 months after the procedure), but you may undergo a stress test to document that there is no narrowing down of the stent, after which any amount of exercise will do you only good. Your other heart tubes were evidently normal during the angiogram done during the PTCA. I would not advise more than 60 ml of whiskey or similar beverages/ day. It may do good provided you do not get addicted. I would suggest red wine as the addiction is less and it may be better than other beverages. But all this might be a moot point in your case as the only cause of you attack seems to be smoking and the risk of smokers comes down to normal levels after 2 years of smoking cessation.

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