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Melanie Cole (Host): Welcome to Back to Health, your source for the latest in health, wellness and medical care, keeping you informed, so you can make informed healthcare choices for yourself and your whole family. Back to Health features conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine. I'm Melanie Cole and today we're discussing checking and improving your heart health. Joining me in this panel is Dr. Joy Gelbman and Dr. Andy McCullough. They're both Assistant Professors of Clinical Medicine at Weill Cornell Medicine. Doctors, thank you so much for joining us today in this very important topic. And really we can just never hear enough about heart disease, the symptoms and prevention. Dr. Gelbman, I'd like to start with you. Tell us a little bit about what you've been seeing as far as heart disease. Do you see more awareness? Tell us about the prevalence, how common it is.

Joy Gelbman, MD (Guest): Well, thank you so much, Melanie, for having us on to talk about heart disease. It's an issue, no pun intended, very close to both of our hearts, I'm sure. And I think building awareness about heart disease is so important because so many of the risk factors for heart disease are modifiable. And so we do have an opportunity to prevent heart disease. Heart disease is the leading cause of death for men and women in the United States. To give you some sort of quick facts about it, one person dies every 36 seconds in the United States from cardiovascular disease and about 655,000 Americans die from heart disease each year. So, it's a big problem that most listeners probably know either have had heart disease themselves or have somebody close to them who has suffered from heart disease. So, I'm so glad that you're giving us this opportunity to continue to raise awareness about it.

Host: Dr. Gelbman, thank you so much for that. And Dr. McCullough, speak about some conditions that can either contribute to or be caused by heart disease. Tell us about risk factors.

Stephen McCullough, MD (Guest): There are a number of different risk factors that we see as both traditional risk factors for heart disease and newer risk factors for heart disease that we're discovering as we continue to publish science on heart disease and especially how to prevent heart disease. Traditionally, we look at three different kind of categories of risk. One is your inherited risk. What genes do you have from your parents and grandparents? And so, a family history of heart disease tends to portend heart disease in the children and it can propagate throughout families. Then we have other conditions which directly cause and contribute to heart disease. The biggest being high blood pressure, high cholesterol and diabetes. We view those three as our three main categories of disease based risk. And then, without question, the number one risk factor for heart disease is current cigarette smoking. So, we do make an effort to try and get our patients to prevent cigarette smoking and stop smoking with whatever means that we can do to help them do that.

And then in the last 10 years and the issue of screen time has been raised as a risk factor for heart disease. And there's some decent science that has come out that shows that if you spend more than four hours a day on screen-based entertainment, then your risk of developing heart disease or cardiovascular death is 150% if you didn't have more than four hours a day of screen-based entertainment. And so, we consider physical inactivity, that'd be a newer modifiable risk factor for cardiovascular disease development.

Host: Yeah, sitting is the new smoking. Right? I mean, this is something we found out, as you said, Dr. McCullough in the last 10 years or so. And Dr. Gelbman, as Dr. McCullough mentioned all of these modifiable risk factors, whether it's smoking, high blood pressure, cholesterol, diabetes, why is it important to know our numbers for these things such as where our blood pressure runs on any given day or our cholesterol? What do these numbers mean as far as our risk and what would you like listeners to know about adhering if their doctors have told them that they have high cholesterol or high blood pressure, how important is it that they adhere to the regimen set forth to help them control those?

Dr. Gelbman: You know, it's such a good question because, fortunately or unfortunately, many of the risk factors for heart disease are asymptomatic. And by that, I mean, you may not feel your high blood pressure, or you may not have any symptoms related to your high cholesterol or your sugar might be high for a while before it starts to cause any kind of signs or symptoms. So, it is really important that folks know to see their doctor in a regular way so that they can get to know the numbers, as you said and, because you know, knowledge is power. And if you know that your blood pressure is high, the silver lining to that is that you can treat it either with lifestyle measures, or with medications, the same being true for the cholesterol and the sugar.

Also knowing, another number to know is your body mass index, which is sort of your weight indexed for your height, to know whether or not you fall into the overweight or obese range. So, knowing these things, can help you on the road to prevention of heart disease. So, just because a person feels good doesn't mean that they don't carry any risks factors. So, it is important to have that regular check-in with your doctor to try to understand what your risk is and what, if anything you can do about it.

Dr. McCullough: Yeah, I just want to emphasize what you said Dr. Gelbman is that, you don't necessarily know if your blood pressure is high. Some people will feel that their blood pressure is high at extreme ranges, but the blood pressures that we're talking about that can really contribute to the development of heart disease, are blood pressures that are normally not felt. And so, it can be difficult to convince people to take a medication that doesn't make them feel better. But if it can potentially prevent the development of heart disease and help them live longer, I think those are equally important goals and helping people understand that and realize that I think is important.

Host: What a great point, Dr. McCollough, that you may not feel it and the hesitancy to take medication that doesn't make you feel better, but it's so important because it can help you reduce this risk and Dr. Gelbman, we hear that signs and symptoms of cardiovascular disease are different in men and women and not necessarily impending heart attack, but the disease itself. Many of these symptoms are similar to stress, panic attacks. Certainly in this time of COVID, we're all feeling such high stress. Tell us a little bit about some of the symptoms that you would notice in men versus women and why they mimic some of these other things. And how are we to know if we feel that chest pain, that it's not just stress, that it might actually be heart disease?

Dr. Gelbman: I appreciate your taking the time to highlight the sort of differences because they're so important for people to know. I think most people, most of your listeners have probably seen in the movies or on television, what a heart attack is supposed to look like. They see sort of the older, heavy set gentleman, clutching his chest, and that's I think sort of the universally recognized picture of a heart attack looks like. And certainly, you know, it can look like that. It often looks like that. But not everybody has those same typical type of symptoms and particularly women, they often do have atypical symptoms, as do diabetic patients. And so in men and women, heart disease might also present with a feeling of indigestion or feeling sweaty or nauseated, or just kind of a general malaise, feeling not yourself. And so I do think it's important for folks to recognize that your symptoms may not be what are described in a textbook and they still might represent heart disease.

And so any type of symptom like that, that feels outside of your norm, if you're feeling different than you usually do, and it's not a symptom you've typically had, that it ought to be checked out. And it is time sensitive. So, especially, you mentioned women, women tend to put their family first, put others first. But with this, women really do need to take these symptoms seriously, and seek medical attention in a timely fashion. And on the other side, on the sort of on the medical establishment side, even medical professionals, don't always identify heart disease in women as quickly as they might in men, or don't have the same sort of level of suspicion for heart disease in women. And just for patients to make sure to sort of push and question their doctors about whether or not their symptoms might represent some manifestation of heart disease. It's very important that you highlight those differences. And I might add that I think women don't think that heart disease is going to happen to them. They think of heart disease as a men's disease, but heart disease is the number one killer of women just as it is in men.

Host: That's so true and so important as we have to be our own best health advocates. So, as we're asking these questions to our physicians and taking the time, of course women, we take care of others, before we take care of ourselves, as you said Dr. Gelbman, and in this case, no pun intended, we have to put our own mask on before we put the masks of our loved ones on and right. That's pretty timely right now. And Dr. McCullough, as we go around and we talk about these things, how do you diagnose the presence of heart diseases? Is it simply from the blood tests that we get at our yearly's that gives you this indication, but then are there some tests? Do we need stress test? When would we need any of these other things? Echocardiography? When do the tests start to come?

Dr. McCullough: That's a great question. And I think that you have to listen to the person who's sitting in front of you. And so like Dr. Gelbman said, all of us experience life and live life in different ways. And you're going to be more effective at figuring out who does and does not have heart disease if you listen to the story that the person that's telling you, that's sitting in front of you.

And I think that, that connection that you make with the patient in the exam room is so important because subtle things may clue you into the presence of heart disease. And so, in the past, we used to do stress tests and echocardiograms on everybody. However, we find that if we just take a one size fits all approach and test everyone, we end up getting a lot of what are called false positives or positive tests that lead patients down a road of getting more and more tests that never benefits them or helps them feel better. And so, our goal in testing is to really listen to the patient and try and figure out, do the symptoms that they're telling you, could they be secondary to heart disease and then target testing against those symptoms. So, for, the marathon runner who's time goes from four hours to run a marathon to seven hours to run a marathon. They may not have chest pain. They may not have shortness of breath, but their heart may be unable to keep up with the level of physical activity that they had beforehand. That would be a person who you may do a stress test on, even though they seem otherwise healthy, to try and figure out if there's hidden heart disease there or what we call subclinical disease that could be making their performance worsen.

And so it's not a one size fits all approach. In general, some tests that we do to try and determine based on patient's symptoms, determine whether or not they have heart disease would be an EKG to determine what their heart rhythm is, an echocardiogram to determine if there are problems with the function of the heart or with the valves of the heart or a stress test, to look for blockages within the coronary arteries or what we call coronary artery disease.

Host: So, Dr. Gelbman, we look at these lifestyles, you've told us about testing and we've talked about adherence to whatever regimen, if someone has high blood pressure or diabetes or high cholesterol. When we think of lifestyles, diet, we've mentioned sedentary living, we've mentioned smoking and all of these other things, but we haven't really touched on diet. Can you please briefly just give the listeners a little rundown on why diet really does and we've found out more and more really can contribute to heart disease or on the flip side, actually help?

Dr. Gelbman: Yeah, more important than any medication that I can give a patient really is lifestyle measures. And we always try to start with lifestyle measures whenever possible before adding medications, when we can. And, exercise, a hundred percent. I mean, the American Heart Association recommends at least 30 minutes of exercise most, if not all days of the week, and exercise doesn't have to mean, putting on a track suit and going to a gym, it can be really, anything that gets your heart rate up, whether it's vacuuming, gardening, walking, anything, and even, more and more studies are showing that something is better than nothing. Getting your body moving for at least some period of time during the day, is helpful. As far as diet, absolutely diet is critical to all of this, to both preventing that first event and preventing another event if you've had your first event.

I'll be interested to see what Dr. McCullough has to add too, but I try to be fairly broad with my recommendations, because I don't like to tell people to never eat X, Y, or Z or never drink X, Y, or Z. But I do think people really should try their best to focus on whole grain, replace all those white foods like bread, rice, and pasta with whole grain versions of these things.

Fruit and vegetables. I mean, I think most people know that to be a critical part of a healthy diet, but fruit and vegetables, for sure. Fish, things that are high in omega three fatty acids are definitely contributors to good heart health. And then really trying to avoid those processed foods, the sugary drinks, soft drinks. I think somebody once said, eat food, not too much, mostly plants, or I may be getting that wrong, but there's specific recommendations for folks who are diabetic or who are looking more for weight loss. But I think in general, these points would sort of hold true for most, folks.

Dr. McCullough: Yeah, I can't agree with you enough. I think that and some patients frequently ask what is the diet that I should be on. And that's a very difficult question to answer because like you, Dr. Gelbman, I try and give evidence-based recommendations to patients. And it's hard because the science behind diets for the prevention of heart disease is either absent or whatever is present is flawed or has been retracted, for problems with the research. And that makes it very challenging because we don't honestly know what the appropriate diet is. There's even debate about how much salt should be in somebody's diet. For our patients with heart failure is should they be restricting salt? Should they eat as much salt as they want? Does it matter? And the science there is not that clear and because the science isn't that clear, I think it's better to allow people eat to maintain a healthy weight, whatever they would eat normally without making drastic changes that may not be, sustainable for the remainder of their life.

So, patients will frequently ask about the keto diet, the paleo diet, the South Beach diet. These temporary changes to lose weight, can be important for some, but if you're unable to sustain the diet for the remainder of your life, then inevitably the weight will come back. And I think it's better to make small changes that are sustainable for the rest of your life. Like the avoidance of fried foods or adding one vegetable serving at dinner rather than try and make drastic changes that are unsustainable.

Host: What great advice. Both of you. It's so important for us all to hear this. So, I'd like to give you each a chance for a final thought. So, Dr. McCullough, starting with you, what would you like to tell listeners about the importance of knowing their numbers? And the questions that they should be asking their physicians so that they are their own best health advocate and they can get the answers so they can understand these risk factors and hopefully modify them?

Dr. McCullough: Thank you for the opportunity to be here and talk about these things. I think if there's one thing that patients should do to be able to prevent the development of heart disease, if they don't already have it is to, as Dr. Gelbman mentioned earlier, try and move your body for at least 30 minutes a day, five days a week. If you can do that, you're going to be doing more than 90% of other people. And then as you start moving, if you notice that you have chest pain or shortness of breath or your body doesn't feel well, please get seen by someone so you can get a diagnosis for what that problem is. And then when you're seen by someone, ask what your blood pressure is. Ask what your cholesterol is and try and learn these numbers. That way you can stay on top of them and recognize trends that may either be in a good direction for things that you're doing well or a bad direction are things that you can act upon.

Host: And Dr. Gelbman, last word to you. What would you like listeners to know, and especially I'd like you to speak just a little bit to women about the fact that we do care for everybody else. And sometimes we just toss off and pass off some of the symptoms, jaw pain, or chest pain, back pain, all of these things that could signal that something is going on. What would you like us to know about paying attention to of our bodies?

Dr. Gelbman: Well, I 100% agree with Dr. McCullough about staying active and knowing your numbers and seeking attention for any symptoms that feel at all off to you, and again, just to highlight for women, I think most women, if you ask them, they'll probably say that breast cancer is the number one cause of death in women. And they really just need to know that women are equally at risk for heart disease, particularly post-menopausal women. And that you're right. I know what it's like. I work full time. I have three kids. I definitely know what it's like to prioritize other things besides your own health.

But certainly, the best thing you can do for the people you love is to take good care of yourself so that you're there for them and can continue to be around and support them too. So, certainly any symptoms that are at all worrying, do not delay. Get yourself checked out for any symptoms that are worrying and also just not just for symptoms, but prevention, routine, regular visits with your doctor, just so you can A. Get to know your numbers, know your risks, know what if anything you can do to prevent it, but also, Dr. McCullough also mentioned that if you know your provider well, they will be able to better identify when there's a change in your status. So, all of these things and just being aware of being active and seeking medical attention for any new symptoms.

Host: And that's why we are learning from the experts at Weill Cornell Medicine. What a great episode. So informative. Thank you both for coming on and sharing your incredible expertise with us today. And Weill Cornell Medicine continues to see our patients in person, as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine. That concludes today's episode of Back to Health. We'd like to thank our listeners and invite our audience to download, subscribe, rate, and review Back to Health on Apple podcasts, Spotify and Google podcasts. For more health tips, go to weillcornell.org and search podcasts. And parents, please don't forget to check out our Kids Health Cast. I'm Melanie Cole.