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Dear Dr. Roach: I recently had a heart scan, and the calcium score for one of my arteries was 145. I have no symptoms. My results showed two lesions in the left anterior descending artery, with a calcium score of 154.4. The other arteries’ calcium scores were 0 to 6. My overall cholesterol was 167, HDL 57, triglycerides 52, LDL 100. I’m 57. My father had several heart attacks and died with the last at 57. I never smoked, and my blood pressure is 130/80 on treatment. How serious is this, and can it be reversed with a better diet and more exercise?

Anon.

Dear Anon.: Coronary artery scanning is a way to look for coronary artery disease without performing a stress test or a catheterization of the heart. It uses a CT scanner to look for calcium in the walls of the arteries in the heart. Not everyone with detectable calcium in the artery (any score above zero) has blockages. The higher the score, the more likely that there is a blockage.

In men 50-60, the average score with no blockages was 56, and the average score for men with blockages was 217. Your result is in a gray zone, where we can’t tell for sure if you have a blockage. Your likelihood of having a blockage is higher than the average 57-year-old man, and about four times higher than if you had a score of zero.

I calculated your risk of heart attack in the next 10 years based on the Framingham risk calculator (available at cvdrisk.nhlbi.nih.gov) and the information you gave, and found a result of 7 percent. Although you may have a slightly increased risk because of your calcium score, I can’t precisely estimate how much more risk. Your risk is below the usual cutoff for treatment with statin drugs; even so, some physicians might choose to treat you. Treatment with a statin would be expected to reduce your risk of a heart attack by about 1 percent to 2 percent over the next five years.

But your specific question is about diet and exercise, and I am happy to say that most people can indeed significantly reduce heart disease risk through better diet. The optimum diet for reducing risk for heart disease is hotly debated, but most authorities agree that these are key components of a heart-healthy diet:

Lots of fruits and vegetables (five or more servings per day)

Very little or no refined grains; any grain consumed should be whole grain

Two to three servings of protein-rich foods daily, favoring nuts, legumes and fish, and limiting or eliminating red meat

Minimal or no refined sugar.

There has been good evidence published that healthy diets, including the Mediterranean diet I discussed last week, the DASH diet and vegetarian diets, are associated with lower heart disease and death rates than a “standard” diet.

Heart disease remains the No. 1 killer.

Dear Dr. Roach: I have a question about apple cider vinegar. I have heard that you can use it in small doses as an antacid. It seems to be a contradiction because it is acidic in nature. Is this true or just an old wives’ tale?

C.V.

Dear C.V.: Old wives’ tales sometimes contain great wisdom. In this case, however, there is no scientific data to back it up. There are many anecdotal reports of success and many theories why it might work. However, I’m a believer in evidence, not theories, and there just isn’t any. Further, vinegar can damage teeth, so if you try it, be sure to rinse carefully or use a straw. That being said, it’s unlikely to do any other harm, so it may be worth a try.

Email questions to ToYourGoodHealth@med.cornell.edu.

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