Weight is one of the key factors in people who have heart disease. Dr. Mohammad Shenasa, a cardiologist who practices at El Camino Hospital in Mountain View, calls it "the challenge for the next generation." Shenasa says, "The most important issue is to manage your diet. It's not don't eat--just eat right."

The other factors Shenasa cites as causing heart disease are: blocked arteries, diabetes, high blood pressure and smoking. He says, "The only risk factor you can totally eliminate is smoking. The other risks can be adjusted or modified."

Shenasa recommends cutting carbohydrates and fat and eating more fruit and protein. So, it's wheat bread instead of white, as well as white meats and fish instead of red meat. But he cautions, "Fried chicken defeats the purpose. Just say no to pizza, burgers and french fries."

Further support of this comes from the Healthy People 2010 initiative, which calls for 75 percent of the population to eat at least two servings of fruit daily and for 50 percent to eat three servings of vegetables. The Santa Clara County survey found that only 24.7 percent of adults eat two servings of fruit a day, while 28.2 percent eat three servings of vegetables daily.

Shenasa also points to exercise as a key factor in reducing the risk of heart disease. The best exercise, he says, is walking a minimum of 30 minutes every other day.

That's backed up by Dr. Lynette Lissin, a practitioner at Good Samaritan Hospital in Los Gatos. Her description of moderate exercise is, "You can break a sweat but still carry on a conversation." She says a lifestyle that includes exercise reduces other risks such as obesity, diabetes and high blood pressure.

Lissin specializes in treating heart disease in women. Although the risk factors are the same for men and women, Lissin says, "It's the highest mortality event for women, especially as women get older, they lose protective hormones after menopause." Most women enter menopause between the ages of 50 and 52. Lissin also notes that heart disease shows up in women about 10 years later than it does in men.

Lissin says it's not unusual for women to need more diagnostic tests than men because the usual complement of stress tests have more false positives and negatives for women. "Doctors are slowly becoming aware of the differences between heart disease in men and women," she says. "But women themselves need to be more aware and evaluate any symptom related to exertion. Shortness of breath is more likely to be a symptom of heart disease in women. And high blood pressure is more common in women."

Shenasa recommends a yearly physical for cardiovascular fitness that would include diabetes and blood pressure screenings. Nor does he underplay the role of genetics.

Shenasa has written more than 200 articles and books on heart disease. To some extent, his research mirrors the findings of the county's survey: he found African Americans and Asian Indians have a higher risk of heart disease.

Both doctors agree the way to a healthy heart is prevention. This may include taking an aspirin everyday, getting on the scales daily and limiting salt intake. Shenasa says, "I would like to emphasize that medicine is moving toward prevention. It's been ignored but it's rapidly moving forward."

And Shenasa emphasized, over and over: Don't smoke.

The Behavioral Risk Factor Survey is available online at www.sccphd.org/statistics2 under the Data & Publications link.