Tim Russert's death from a sudden heart attack at 58 sent a shudder down the spines of hundreds who suffer from coronary artery disease. Russert looked youthful, seemed vigorous, and had access to excellent medical care.

Since Russert's death, boomers are beginning to come to doctors' offices wondering if they may be at risk, says Dr. Robert Greenfield, cardiologist with California Heart Associates and associate of Orange Coast Memorial Medical Center in Fountain Valley, Calif.

"The devil is in the details," Greenfield says. "The question is: Even though Russert was on blood pressure medication, did he take the medication regularly? And if he had low HDL, as reports say, that could be an ongoing risk factor."

Greenfield, who is a certified clinical lipodologist and specialist in the field of cholesterol, concentrates on prevention of atherosclerosis or hardening and aging of the arteries.

Question: When should a person start worrying about a potential heart attack?

Answer: I tell people in their 20s to think about preventing a heart attack. We expect people to think about this in their 60s, 70s and 80s, when a health care crisis can happen. But what people do when they are younger - exercise, for example - is the best protection against heart attack and stroke.

Q: What about medication?

A: Medication in modest and reasonable quantities can prevent up to 90 percent of heart attacks. Here's the reason why: statins (cholesterol-reducing drugs) can lower cholesterol and stabilize the walls of the artery. Russert probably had plaque in an artery that ruptured and that will block the flow of blood and that will cause a heart attack. By taking medications - such as statins - long-term cholesterol levels have been lowered and this has been shown to stabilize plaque and prevent plaque rupture.

Q: But some statins - Crestor, for example - are brand-name drugs that cost more. Prescription plans often balk at paying for these medications and try to get patients to take generics.

A: What's the bottom line? If the low-cost generic gets you to your goal, that's fine. After all, some generics used to be brand-name drugs. However, some of the newer statins are stronger and not yet generic. If the patient will not do well enough on the generic, then we need to convince the insurance company to let us prescribe the drug that reduces the risk. One size does not fit all in terms of generic drugs.

Q: Doesn't it take years for most people to have plaque buildup?

A: Even though it seems to take years and decades, if medications are not appropriate, plaque will build up. Heart disease is now the common cause of death for women, although most women live 10 years longer than men. If there is a concern about clots in the arteries, maybe take an aspirin. Elevations in blood pressure also can stimulate heart attacks and strokes. It is important to ratchet these numbers down to normal levels. Blood pressure should be less than 140/90, for diabetics, 130/80.

Q: How do you live a heart-healthy life?

A: First is to eat less and move more. Just weight loss alone can lower cholesterol and blood pressure. If someone is sedentary, it's probably good to have a routine treadmill test done (stress test by a cardiologist) to determine exercisability, where to begin and what to do. If a person has arthritis in the hips, for example, it might be better to use a stationary bike or work out in warm water. Just parking further away from the entrance to your building, using the stairs instead of the elevator, all adds up by the end of the day. Get a pedometer and try to walk 10,000 steps a day.

Q: And stress?

A: Everybody has stress. It's how we let it affect us. Stress is an underrated risk factor and hard to quantify. Look at your life. Take a deep breath. Look at your diet, exercise, blood pressure and cholesterol readings. Take an assessment of where you are and do you due diligence.

Q: And genetics?

A: Genetics are funny. They can deal a hand on how to play, win or lose.

But even with a bad genetic background, certain lifestyle changes can make a difference.