Reader: Before age 69, I was told that "scar tissue reveals patient had heart attack." It's hard to know when. I take HCTZ, Toprol XL, and Diovan. I am now 73. Am I apt to have another heart attack?

Dr. Zipes: The heart is a muscle and requires a blood supply to provide oxygen and nutrients in order to survive and function, just as do other muscles in the body. When the blood supply in the coronary arteries that nourish the heart is cut off, a heart attack can result, causing death of heart muscle and subsequent scar formation. You know that when you cut your finger, it heals and leaves a scar. Damage to the heart follows a similar healing process. It is difficult to say whether you are at risk for another heart attack, although people with a prior attack are at greater risk for a second one compared to those who have not had one. The presence of a heart attack indicates that they have some obstruction to blood flow in the coronary arteries. You need to pay attention to common risk factors such as elevated cholesterol, high blood pressure (it sounds like yours is being treated), obesity, smoking, inactivity, and diet. Check to be sure you do not have diabetes, and if you do, treat it appropriately. Usually a baby aspirin is prescribed, along with beta blockers (you are already taking one in the form of Toprol), statins to reduce cholesterol, and often a drug called an ACE inhibitor. You need to check with your cardiologist as to your risk of having a future heart attack and what you need to do to prevent it from occurring.