Dr. Roberts: A heart healthy diet is a plant-based diet. To reduce your risk of developing heart disease you need to eat a variety of colorful fruits and vegetables, whole grains, and legumes (beans). You need to treat meat as a condiment, not an entrée. And remember, chicken is meat! I would suggest having meat at most once or twice a week. You can obtain all the protein you need from eggs, whole grains, legumes and sea food.

You should consume only dairy products made with skim or 1% milk and olive oil should be your main source of fat calories (more about fats below). Unless you have a history of alcohol abuse, one glass of (preferably red) wine a day may also lower your risk of heart disease.  

You need to incorporate heart healthy fats in your diet. For many years fats have had a bad reputation, mainly because we Americans consume far too many of them, and choose the most unhealthy forms, saturated and trans fats, rather than the healthy fats, monounsaturated fats and omega-3 polyunsaturated fats. The food choices described above comprise the Mediterranean diet, which has been shown to be the healthiest diet in the world, based on many scientifically valid studies dating back to the 1950’s. 

Saturated fats are animal fats, and they raise the level of cholesterol in the blood, particularly LDL cholesterol, more than eating pure cholesterol does. The only vegetable fats that are high in saturated fats are palm oil and coconut oil.

You need to read food labels and avoid anything that says it contains "partially hydrogenated vegetable oils." These so-called "trans fats" lower the level of good or HDL cholesterol and raise the level of bad or LDL cholesterol, just what you don’t want. Congress allows food companies to label their products "0 trans fats" if they contain less than a half a gram per serving. But if you eat several servings, you will be taking in a significant amount of these dangerous fats.

Monounsaturated fats raise the level of HDL "good" cholesterol. High levels of HDL cholesterol (over 60 mg/dl) actually protect you from developing cardiovascular disease (CVD) and low levels of HDL cholesterol (less than 50 mg/dl in women or 40 mg/dl in men) are a very strong risk factor for developing CVD. Olive oil and canola oil are good sources of monounsaturated fats but extra virgin olive oil has more phytochemicals, substances found in plants that have anti-inflammatory and anti-oxidant effects, than canola oil, so olive oil is a healthier choice. Your aim should be to take in two to three tablespoons of monounsaturated fats a day.

Omega-3 polyunsaturated fats are found in fatty fish, walnuts, flax seeds and canola oil. Consuming fish-derived omega-3 fats appears to protect against sudden cardiac death, and in doses of 3 to 4 grams a day, omega-3 fats lower another blood fat called triglycerides. Triglycerides, when they are elevated, increase the risk of CVD. Omega-3 fats are also important for the healthy development of brain tissue in the fetus. A recent British study suggested that skimping on seafood during pregnancy may lead to developmental problems during childhood. However there is a warning about seafood that women who are pregnant, or may become pregnant need to be aware of. Women who are pregnant should avoid swordfish, king mackerel and shark. This warning comes from the fact that some fish contain high levels of mercury, which can cause severe damage to the nervous system, particularly of a fetus. Mercury contamination of ocean fish mainly occurs in the large fish at the top of the food chain, such as those mentioned above. Smaller ocean fish like cod, salmon, and herring do not in general pose a risk of mercury contamination. The American Heart Association recommends that you consume fish like salmon, herring or trout at least twice a week.

In my opinion the best single indicator on a food label to look for is the absence of any partially hydrogenated vegetable oil.

Dr. Roberts: The usual symptoms of influenza (flu) are sore throat and/or cough accompanied by fever, headache, muscle aches, and weakness. Cough and sore throat would be unusual with a heart attack, although the pain of a heart attack may be felt in the neck rather than the chest. In addition, the fever with flu is often quite high, whereas with a heart attack fever is absent or mild.

It is true that women have more "atypical" symptoms with a heart attack than men do. (Because what happens to men is considered "typical"!) The typical symptoms of heart attack are crushing sub-sternal (under the breast bone) chest pain accompanied by sweating, shortness of breath and a feeling of impending doom. Women are more apt than men to have a "silent" heart attack, that is, one with no pain at all. But even in a silent heart attack, women usually experience shortness of breath. They may have pain in unusual locations such as the shoulders, back, jaw, wrist, upper abdomen or arms. They will often have felt unusually fatigued for weeks before, and may experience marked nausea and vomiting with a heart attack.

You need to know your own level of risk. If you are under the age of 55, exercise regularly, are not obese, have never smoked, do not have diabetes, high blood pressure, unhealthy cholesterol/triglyceride levels, or a family history of premature coronary artery disease, then you have a very low risk of having a heart attack. On the other hand if you have a lot of risk factors you need to be concerned whenever you have any of the symptoms mentioned above.

3. Question - I read that wine can be good for my heart. Is there a specific kind of wine that is best and how much should I drink each day?

Dr. Roberts: Congratulations on quitting smoking!!!! You should be proud of yourself. Yes, the good news is that by quitting smoking you have lowered your risk of heart and vascular disease. Women who smoke 1 to 4 cigarettes a day double their risk of a heart attack. However, women who quit lower their risk of dying of CVD by 24%, with the risk approaching that of non-smoking women within 3 to 5 years. This occurs no matter how much or how long you have smoked or the age at which you stop.

More good news: stopping smoking raises your level of HDL cholesterol and increases the oxygen carrying capacity of the blood.

Once again, congratulations on kicking your nicotine habit!

Updated 6:17 pm EDT

Dr. Roberts: It’s difficult to answer this question without knowing what the specific abnormality on the EKG is. However, this change may be permanent or it may be transient. Only time will tell. The important thing is that your high blood pressure be treated and controlled, and that any other risk factors you have be addressed. Sometimes, something as simple as hyperventilating can cause an EKG to look abnormal, so I would not become fixated on this finding.