1. Since angiogram is not a common part of routine health check-up, how does one assess one’s likelihood of having arterial blocks? Is an annual ECG test enough?
2. Anti-Cholesterol drugs – are they safe for long-term use? Do they damage the liver? Are periodic liver function tests necessary? Is it safe to reduce the drugs to half-dose as soon as the cholesterol level is normal?
3. During medical check-ups, are a full Lipid Profile test required, or Total Cholesterol and HDL/LDL ratio only?
4. Cardiac blocks – how to diagnose them before they turn out fatal or serious? The general understanding is, a person whose BP is under control, with or without drugs, and who has a normal Lipid Profile, is not a candidate for blocks. But I’ve met people with normal BP and normal cholesterol readings, falling prey suddenly to illness, and an angiogram reveals major blocks.
I do agree coronary angiogram is not a part of a routine health check up. Annual ECG test is definitely not enough in assessing the cardiac status. I would recommend at least a 2D echocardiogram and stress test as part of a regular check up for anyone over 35 to 40 years. If stress test reveals any changes then further investigation would be needed. The only way to diagnose arterial blockages conclusively is a coronary angiogram and/or CT coronary angiogram, a relatively non-invasive method.
Cholesterol or lipid lowering drugs are quite safe for long term use and their benefits far outweigh the potential risks involved. However it’s important to follow up with your physician and have regular blood tests if you’re on these drugs, to assess their effect on not only cholesterol levels but also on the liver. Statins do not permanently damage the liver, but they do cause transient increase in liver enzymes which are reversible once the drug is stopped.
During a medical check up, we recommend a full lipid profile and not only the cholesterol levels. Reduction of dosage of cholesterol lowering drugs should be done by your doctor at his discretion depending upon the lipid values at any given time. It is true that in a significant percentage of the population heart attacks occur despite the absence of cardiac disease. At the same time people who have severe coronary artery disease do have some symptoms, which they unknowingly attribute to gas or acidity and the condition remains undiagnosed. Hence the need for annual physicals after age 40. If you have any of the major risk factors, you should probably be evaluated at an even earlier age rather than waiting till a problem occurs.