Many years ago, I was troubled by a situation involving a man in his 30’s who had every indication he might have heart disease. He had chest pain with exertion and was an overweight smoker. The problem I had was this guy had to have coronary artery disease, but he was only 35 years old. I couldn’t make myself believe my suspicions were correct. To help myself, I called the best cardiologist on the south side of Indianapolis to ask his opinion. After some small talk about a fish he had caught, he made a wise suggestion. He told me to see if the patient had a family member who had coronary disease, or had died suddenly, at a young age. Well, sure enough he had, and a full evaluation for premature coronary artery disease ensued.
The memory of this inquiry led me to ask that question on several subsequent occasions when a young patient, especially a male, presented with symptoms highly suggestive of coronary disease. This is a very important fact a doctor should know in this situation because severe coronary disease (CAD) is hereditary and finding it early can be lifesaving. Men have CAD at an earlier age than women, in fact their risk is high 7 years sooner, around age 35. It is then, and later, that doctors’ suspicions for CAD should be heightened.
Questions like the one above have contributed greatly to screening the male population for CAD. The disease is a killer and should be taken seriously. It should be screened for annually. Men are not usually “doctor people,” meaning they don’t see a doctor any more than absolutely necessary. Doctors nationwide have collaborated on a set of four questions that are intended to screen for CAD. I think they accomplish that goal.
The four questions are:
- “When is the last time you talked to a doctor about heart health? ie. When was your last check up.”
- “Has anyone in your family died at a young age?” ie. Before age 55 did anyone die of a heart attack, stroke, cardiac arrest?”
- “What does your typical week look like in terms of physical activity? Do you exercise?”
- “Do you wake up feeling rested? ie. Do you have obstructive sleep apnea?”
The answers to these questions are important for screening for CAD. Sedentary men who smoke and have a family history of serious cardiovascular disease at a young age, and who have obstructive sleep apnea are at very high risk of potentially catastrophic CV events. These questions have been compared to screening for high Total and LDL Cholesterol, and low HDL Cholesterol.
The answers to these questions provide much more pertinent information about a patient than does a lipid panel. Unless cholesterol testing includes lipoprotein (a), the results are of rudimentary help. “If elevated, lipoprotein (a) is associated with increased cardiovascular risk, even if the HDL and LDL are at target levels.” “Obstructive sleep apnea….increases cardiovascular risk by 82%.”
These questions don’t require any expertise to ask. The doctor just needs to listen to the patient and take a patient’s complaint seriously. Minimizing classic symptoms must not occur. Knowing the answers to these 4 questions will help clarify the situation.
Reference: Stewart J. Four questions that rival a Lipid Panel for aAssessing Men’s Heart Risk. Medscape 2026 February 10.
