Question: I am a 79 year old man with an implanted pacemaker who has thyroid disease, and I am worried that this raises my risk for coronary artery disease. What supplements should I take; what type of exercise do I need; and what questions should I ask my doctors?

Dr. Hibberd's Answer:

First of all, just because you have an implanted pacemaker and thyroid disease does not mean you have a greatly increased risk for coronary artery disease. Many people equate pacemakers with coronary artery disease, but this is simply untrue. While they may co-exist, they are entirely different entities.

A pacemaker is required when the specialized conducting system in our heart muscle fails. The pacemaker then releases a millivolt signal to stimulate the heart muscle to contract. This failure of the conducting system often occurs independently of the presence of coronary artery disease, though it may occur as a result of extensive damage after a myocardial infarction (heart attack). There are no supplements known to specifically retard or prevent conducting system disease.

We do, however, have recommendations for those at risk for coronary artery disease (which causes heart attacks). Ask your doctor for a cardiac risk appraisal, and then customize supplements and preventive treatments that are targeted to your specific estimated risks. Optimize treatment of underlying conditions such as diabetes, thyroid disease, hypertension, obesity, poor diet, hyperlipidemia (cholesterol and triglyceride abnormalities), circulation disorders, exercise, and smoking cessation.

Then consider supplementation risks and benefits. I recommend supplementation in consultation with your doctor, as supplements often will affect the levels and action of prescribed medications, and may not be appropriate with certain medical conditions.

Many men your age take a baby aspirin (81 milligrams), a fish oil supplement (for DHA/EPA omega-3 of 1,200 milligrams), and an age appropriate multivitamin daily. Start with a high fiber diet (30-40 grams per day of fiber, preferably soluble fiber) that’s low in saturated fat (less than 300 milligrams cholesterol daily) with a preference for foods low on the glycemic index.

Avoid processed foods when possible. Eat at least three meals daily with emphasis on fruits and vegetables and avoid eating immediately before bedtime. Find a daily exercise that both you and your doctor are comfortable with.