We doctors have been on your case to take better care of your heart for a couple of decades now. So, unless you've just been rescued from a desert island, you've probably gotten pretty used to being reminded to eat better, exercise more, and quit smoking.

The question is, guys, have you been listening? According to a recent survey published in a MetLife bulletin, the answer is "yes but."

From 1970 to 1990, the death rate from heart disease among U.S. men has taken a real nose dive: from 365.6 to 206.7 per 100,000. Some of this 43 percent decline is undoubtedly a result of better emergency medical care, but there's little doubt that less saturated fat, more activity, and a drop in cigarette smoking account for a large share of the lives saved. Congratulations are in order!

What about the "but" part, though? Some other things didn't change over the decades. For one, women made just as much improvement, and they started from a much better place. Women are now dying off from heart disease at about one-half the rate we are-108.9 per 100,000. Congratulations are certainly in order for our spouses.

We're also falling short in the international competition. True, we did make up some ground between 1980 and 1990 from our eleventh-out-of-fifteen position. But we still rank ninth among the industrialized nations. Japan, with its traditionally low-fat diet, is tops, but French, Swiss, Canadian, and Icelandic men all have heart-disease death rates at least 25 percent lower than we Yanks do.

How do we improve? I think you know the routine by now, but let's look at just how much difference a little change can make:

1. Quit smoking: Reduce your risk of heart attack by 50 to 70 percent within five years.
2. Reduce your cholesterol: A decline from 240 to under 200 halves heart-attack risk.
3. Control your blood pressure: Every point drop in diastolic pressure (the lower number) reduces risk by 2 to 3 percent.
4. Take one aspirin every other day: Your risk will drop as much as 33 percent.
5. Take 400 units of vitamin E each day: The votes aren't all in, but early returns point to a significant benefit.

These five steps are the keys to more successful decades of combatting the number-one killer of men. Let's get going.

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