"Dr. Elizabeth Nabel, director of the National Heart, Lung and Blood Institute, will answer readers' questions about heart disease this week. Her answers will be posted at "

" The time when doctors have a chance to save most of the heart muscle is called “the golden hour.” "

"His doctor had told him to have a weight-loss operation to reduce the amount of food his stomach could hold, worried because Mr. Orr, at 6 feet 2 inches, weighed 278 pounds. He also had a blood sugar level so high he was on the verge of "

" and a strong family history of early death from heart attacks. And Mr. Orr, who is 44, had already had a heart attack in 1998 when he was 35."

" and exercising for four months and lost 45 pounds. He envisioned himself proudly telling his doctor what he had done, sure his tests would show a huge drop in his blood sugar and "

" levels. He planned to confess that he had also stopped taking all of his prescription drugs for "

"After all, he reasoned, with his improved diet and exercise, he no longer needed the drugs. And, anyway, he had never taken his medications regularly, so stopping altogether would not make much difference, he decided."

"But the surprise was not what Mr. Orr had anticipated. On Feb. 6, one week before the appointment with his doctor, Mr. Orr was working out at a gym near his home in Boston when he felt a tightness in his chest. It was the start of a massive heart attack, with the sort of blockage in an artery that doctors call the widow-maker. "

"He survived, miraculously, with little or no damage to his heart. But his story illustrates the reasons that heart disease still kills more Americans than any other disease, as it has for nearly a century. "

"Medical research has revealed enough about the causes and prevention of heart attacks that they could be nearly eliminated. Yet nearly 16 million Americans are living with coronary heart disease, and nearly half a million die from it each year. "

"It�s not that prevention doesn�t work, and it�s not that once someone has a heart attack there is little to be done. In fact, said Dr. Elizabeth Nabel, director of the National Heart, Lung and Blood Institute at the "

", age-adjusted death rates for heart disease dropped precipitously in the past few decades, and prevention and better treatment are major reasons why. "

"But the concern, Dr. Nabel and others say, is that much more could be done. In many ways, scientists� hard-won and increasingly detailed understanding of what causes heart disease and what to do for it often goes unknown or ignored."

" Studies reveal, for example, that people have only about an hour to get their arteries open during a heart attack if they are to avoid permanent heart damage. Yet, recent surveys find, fewer than 10 percent get to a hospital that fast, sometimes because they are reluctant to acknowledge what is happening. And most who reach the hospital quickly do not receive the optimal treatment � many American hospitals are not fully equipped to provide it but are reluctant to give up heart patients because they are so profitable."

"And new studies
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