One of Ackermann's patients, Osvaldo Gomez, had his first heart attack at age 43. He drove himself to the hospital in 2008 when he started having pain in his chest, back, arm and jaw. He didn't know he had heart problems, but his grandparents and two uncles on his mother's side had cardiovascular disease.
The event was scary, but Gomez didn't follow his doctor's recommendations. His second heart attack was a month later.
"The second time, he was noncompliant with diet and his regimen of smoking," Ackermann said. "I wasn't surprised. When he was very compliant, he does great."
In the past four years, Gomez has had three stents and four balloon angioplasties. Stents can improve blood flow and treat narrow or weak arteries. A balloon angioplasty is a ballooning of the vessel to open it.
"I've seen the results of me not taking care of myself," Gomez said.
A more heart-healthy lifestyle
These days, Gomez is on a low-cholesterol, low-fat diet. He exercises six times a week, with at least 40 minutes of cardio and 20 to 30 minutes of weight lifting. He has quit smoking. Practicing these behaviors "keeps you out of the hospital and keeps you out of trouble," he said.
Tofferi, whose husband died after snowshoeing in 2008, watches out for trans fats and has warned her three sons about heart risks. They are in good shape, she said, and none of them smoke.
"They know, with Dad having a heart event that early," she said. "I hope I've impressed them -- or just general health knowledge has impressed them -- with the importance of taking care of yourself."