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For more than a generation, Americans have lived with the widespread, well-publicized fear of having a heart attack. Coronary heart disease (CHD) is our leading cause of death. We know we are all at risk.

Where do these deadly events come from? Is it our heredity? Is it "race-based?" Was it just "bad luck?" What can we do to cut our risk of having a serious cardiac event?

There has been a lot of guessing.

Although hearing your doctor say: "You've just had a heart attack" has seemed like a bolt from the blue for many individuals who couldn't imagine they'd be "tagged," upon closer examination, in a large majority of cases, conventional warnings of increased risk were present -- but no one thought to look. Medicine is that way; to get the right answers, you have to ask the right questions, and opportunities to head off heart disease were missed.

What are the right questions? First, the basics:

* Do you have hypertension? (high blood pressure, defined as BP >130/80, strains the heart and raises risk of CHD.)

* Is your diabetes in good control? (HBA1c<7; higher numbers raise risk of CHD.)

* Do you smoke? (cigarette smoking substantially raises risk of experiencing a dangerous "cardiac event.")

* Is your cholesterol elevated? (keeping your numbers down in the "normal" range, by diet, exercise, and medications, substantially reduces risk of CHD.)

A recent study of 122,458 patients, published in Endocrine Today (Vol. 2, No. 4), suggests that in 85 to 90 percent of cases, these "traditional risk factors" were present. Where such factors are found, the researchers suggest lifestyle change as the single most potent intervention. And note, you and your doctor have to find them -- which means regular physical exams can save your life.