MEN'S HEALTH MATTERS: If my father died of a heart attack, how likely am I to develop heart disease?
Q MY FATHER died at 45 years of age from a heart attack. I am now 40 and I would like to know how I can find out if I am at risk of heart disease?
HEART ATTACKS represent the most common cause of sudden death in people over 35 years of age. In general, most people who suffer heart attacks have at least one identifiable risk factor and usually more.
These include cigarette smoking, hypertension (high blood pressure), diabetes, obesity, high cholesterol, peripheral vascular disease or a family history of heart disease. In rare circumstances, none of these risk factors is present.
In order to determine your risk you should see your GP who can check your risk profile, measure your weight, cholesterol and do a physical examination.
The lower your cholesterol the better but it should be less than five. Stopping smoking, taking daily exercise (eg walking 30 minutes every day), diet and relaxation can all reduce your risk of having a heart attack.
It is important to be vigilant if you develop any symptoms. If you have an episode of chest pain or shortness of breath when you walk then you should consult with your GP.
It is possible to have a stress test to further determine if you are at risk of a heart attack, if you have any symptoms or even if you have several risk factors or are just worried that you might be at risk.
A stress test involves walking on a treadmill attached to an ECG machine (this records the activity of the heart). If you fail the test, it suggests that there may be a narrowing in a coronary artery. The stress test will not detect minor narrowing of the coronary arteries which are less likely to lead to problems.
Another way to identify if you are at an increased risk for a heart attack, especially if you have a family history and one other risk factor is to have a non-invasive coronary CT angiogram.
For this investigation you just hold your breath for 20 seconds while an X-ray dye is injected into a vein. This test can be very effective at ruling out coronary artery disease in patients with risk factors. It does expose you to a small amount of radiation and there is a small risk of a reaction to the dye.
Q I am 55 years of age and have had a colonoscopy and biopsy of a large polyp in my bowel. My father died of colon cancer at age 60. I am concerned this will be cancer and if so what are the implications?
A Hopefully your results will show a benign polyp, but even so the entire polyp will need to be removed and fully examined and you will need further colonoscopies in the future to determine if you have developed more polyps.
Your situation highlights the importance of colonoscopy (telescope test of the bowel) especially with a family history of colorectal cancer.
Colonic polyps are small benign growths on the inside lining of the bowel. If undetected, they can gradually enlarge over many years.
If left untreated the cells within these polyps can change (dysplasia) and ultimately turn into invasive bowel cancer.
Once cancer develops there is potential for spread outside the bowel. Routine colonoscopy before the onset of symptoms, with identification and removal of polyps, can prevent cancer.
Colonoscopy is essential for those with a strong family history of colon cancer and in some countries routine colonoscopy for everyone over the age of 50 years is recommended.
Should your biopsies demonstrate cancer you will need referral to a specialist colorectal surgeon for investigation and treatment in a centre with full modern diagnostic and therapeutic facilities where a specialist multidisciplinary team with expertise in bowel cancer will co-ordinate your care.
This team will include cancer surgeons, radiologists, pathologists, radiation and medical oncologists. Scans will be performed to assess the extent of the tumour and potential spread to other organs.
A CT scan is often sufficient but more detailed scans such as MRI or PET/CT scans may be required.
Based on your investigations your team will recommend a plan of treatment designed to optimise long-term cure.
Most patients will initially require surgery to remove their tumour and subsequent chemotherapy may be required. With tumours of the rectum, or lowermost bowel, treatment is more complex and many patients will have radio- therapy and chemotherapy to shrink the tumour initially and then have surgery to remove it.
Surgery for cancer of the colon or rectum can now be performed in up to 90 per cent of patients using laparoscopic (keyhole) surgery. This technique allows removal of the colon without opening the abdomen and results in a much faster and easier recovery with a shorter hospital stay, reduced risk of complications and speedier chemotherapy if required.
Advances in diagnosis and treatment are gradually improving outcome and more than 50 per cent of patients are fully cured, the chances of cure being much better the earlier the cancer is detected.
After treatment your surgeon will recommend a routine schedule of long-term follow-up including regular examination, scans and colonoscopies.
• This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James's Hospital, Dublin with a contribution from Dr Robert Kelly, consultant cardiologist, Beacon Hospital and Santry Sports Clinic, Dublin and Mr Diarmuid O'Riordain, consultant colorectal and laparoscopic surgeon, Beacon Hospital, Dublin and Adelaide and Meath Hospital, Dublin