Sometimes we tend to ignore a family history of cholesterol as a significant risk for heart attacks. So I had a 37-year-old health-conscious executive with a family history of heart disease come to me with furrowed brows. At the age of 35, concerned because of his family history, he underwent a detailed heart evaluation. This included a treadmill stress test and a coronary CT angiogram — a sophisticated scan that looks directly at the arteries of the heart and can detect both hardened plaque and the softer, earlier fatty deposits that can eventually lead to blockages. His arteries appeared clean. There was no visible plaque. No sign of coronary artery disease. Despite clean reports, he stuck to discipline over the next two years. He remained physically active, walked between 7,000 and 10,000 steps daily, exercised regularly, maintained a healthy weight (his BMI was 24 or normal), did not smoke and generally ate well. Two years later, he had some chest discomfort.…