As most of America knows, David Letterman underwent urgent quintiple bypass surgery after discovery of clogged arteries feeding his heart. Hundreds of thousands of these operations are done annually in the United States. What makes this noteworthy is that first, Mr. Letterman is a celebrity, and second, he is only 52 years old. A question that many people may ask is how can one know what the status of their heart may be, and what can be done to avoid heart disease?

The risk factors reported for Mr. Letterman were his high blood cholesterol level and his family history of early heart disease. His father apparently suffered heart disease when he was in his fifties as well. These are very powerful determinants of future heart disease risk, but we need to separate those which cannot be changed from those that can be changed by lifestyle or medicines. Nonmodifiable risk factors, like family history, getting older, and that males have higher risk that females until both sexes are in their seventies, by definition cannot be manipulated. But fortunately, most risks of heart disease can be altered. Considerable clinical research has proven that doctors and their patients have very powerful methods to reduce the risk of subsequent heart disease. Medications need to be added only if the patient cannot control their risks on their own. Cholesterol is one of several blood fats that affect one's risk. But also elevated blood pressure, uncontrolled diabetes, continued tobacco use, and being overweight and sedentary are clearly controllable risks. Doctors now know what the best numbers to aim for are and treatment needs to be adjusted until those goals are met.

Like Mr. Letterman, lucky patients are those that recognize their symptoms or who are sufficiently worried about their risk factors that they consult their doctors for an evaluation. Unlucky patients are the ones that have no, or unrecognized, symptoms and without warning develop evidence of advanced disease by having a heart attack or dropping dead. Your doctors can best decide what tests may be useful to evaluate your risk, and what changes in lifestyle or medications may be appropriate to reduce your risk. Whether an exercise test, a heart scan, or other diagnostic tests should be used will depend on what your particular risk profile looks like. This means knowing how you stack up in each of the identifiable risk factors. Information is the answer. But each person has to get that information. Mr. Letterman obviously did, and his example will likely help many other potential patients prevent a cardiac catastrophe.