Be Smart - Protect your Heart: How to Prevent Heart Disease

Intro: This is Weekly Dose of Wellness brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Hello, good morning and welcome to the show. You are listening to Weekly Dose of Wellness brought to you by MemorialCare Health System. I'm Deborah Howell and today's guest is Dr. Rob Greenfield, who is board certified in internal medicine, cardiovascular diseases, and clinical lipidology. Dr. Greenfield's research includes the fields of lipidology, acute coronary syndrome, and risk factor modification. He's currently on the board of directors of the Pacific chapter of the National Lipid Association and is the Vice Chief of Staff and Director of Non-Invasive Cardiology, Bioethics, and Cardiac Rehabilitation at Orange Coast Memorial Medical Center. Welcome and good morning to you, Dr. Greenfield.

Robert Greenfield, MD: Good morning, Deborah. Nice to be here.

Deborah Howell (Host): Today we're going to be talking about being smart about your heart and preventing heart disease. So let's begin with the basics. What exactly, in layman's terms, is heart disease?

Robert Greenfield, MD: Well, Deborah, in the United States, heart disease commonly refers to atherosclerosis, which really means hardening of the arteries due to cholesterol plaque buildup, which could lead to complications of heart attack and stroke as well as vascular disease or blood vessel disease anywhere in the body. Now heart disease also encompasses some other factors like valve disease and muscle disease, but clearly atherosclerosis, cardiovascular disease, affecting the blood vessels is clearly the most common cause.

Deborah Howell (Host): Okay, so who now is at risk for developing heart disease?

Robert Greenfield, MD: It's a great question, and the way we like to determine risk is to find out how many risk factors somebody has. So traditionally, the American Heart Association came out with a list of risk factors, and simply it involves one, your age. For men, if you're over 45 years old, you could be at risk. Women, over 55 years old. It seems that women develop heart disease about 10 years later than men, but I have to say that women are catching up very rapidly as women tend to live longer than men. The actual number of heart attacks in women are actually higher now than they are in men. Another risk factor would be family history. And if you have close relatives like a mother or father or brothers that had a heart attack or a stroke less than 55 years old for a man and less than 65 years old for a female or woman, well, that's a risk factor for you too because it means there's some familial predisposition or some familial or family tendency that you could be at risk for heart disease.

Deborah Howell (Host): Our DNA is all connected, isn't it?

Robert Greenfield, MD: It is. Smoking is a very big risk factor, and I think with our public health policies, we've been very successful in decreasing the incidence of smoking in this country. High blood pressure is yet another one. And having a low good cholesterol, a low HDL, which maybe we could talk about a little later, is also a risk factor.

Deborah Howell (Host): Very good.

Robert Greenfield, MD: Now, here's the problem with risk. I didn't mention a lot of other risk factors that initially were not mentioned as traditional risk factors. For example, diabetes or a very high bad cholesterol, that's the LDL, or the whole idea of stress, obesity. And the whole concept of inflammation, when someone has some inflammatory disease or inflammation, well, they may be at higher risk for heart disease as well. So it's complicated, but risk factors, when they're calculated, oftentimes could estimate somebody's risk.

Deborah Howell (Host): Okay. So if you have some of these risk factors, what steps should someone take?

Robert Greenfield, MD: Next step would be to go see your doctor and there's nothing that substitutes for good history and physical exam and a blood test and a basic blood test should include what's called a lipid panel and that's just the blood test that would include your total cholesterol and also a measurement of your bad cholesterol the LDL the good cholesterol the HDL and triglycerides, another fat in the body, and one fat that tends to increase significantly with diabetes or obesity. And then if you're having any symptoms that need to be questioned, whether they could be from the heart or not, a routine treadmill stress test oftentimes could be very helpful. So that would be my first step.

Deborah Howell (Host): All right. What about another step, including diet? Does diet really help? There are so many diets out there to choose from. And which ones are you recommending these days to help live a heart-healthy lifestyle?

Robert Greenfield, MD: Well, a simple question, a complex answer, but I'm going to try to make it very simple. Diet definitely helps. And certainly for people who are overweight, diet is doubly and triply important because it's so important. And you could reduce so many risk factors by weight reduction and trying to achieve an ideal body weight. When people ask me, doctor, what should I eat? It's usually a one-word answer, less! We tend to eat too much. Our portions are large. Sometimes our food choices aren't the best. So I think, though, if I had to narrow it down, the Mediterranean diet is still probably the best diet to recommend to our patients. It's what we call a low glycemic index diet. It doesn't have a lot of sugary foods. It doesn't have a lot of saturated fat. And the two types of saturated fat in America usually occur in red meat fat and milk fat. So whole milk cheeses and all products that are made out of whole milk usually contain saturated fat. And they should be avoided. The American Heart Association feels that it should be less than 7% of your calorie intake in the form of saturated fat.

Deborah Howell (Host): Well, none of us are really able to kind of gauge 7%, but you kind of know. Like, maybe not have a red meat steak more than once a week?

Robert Greenfield, MD: Exactly, and if you're going to have meat, it doesn't mean you could never have it. But you should choose the leanest cut, and you should try to cook it where it's broiled, where the fat could drip down rather than fry, let's say, or keep it in a pan. So broiling is probably the healthiest way to cook, and frying is probably the most unhealthy way.

Deborah Howell (Host): And the companion to a good diet, of course, is exercise. So how much exercise do you really need to raise your heart rate enough to be good for the heart?

Robert Greenfield, MD: Well, here's the good news. You don't have to buy a fancy gym suit and join a fancy gym to call it exercise. Anything you do counts as exercise. And there are recent studies that show that it's additive. So if my patient says to me, I don't have time to exercise. I work too hard. I get home, I'm real tired. I would say to them, what could you find during the day? That would be your form of exercise. Can you park further away in the parking lot? Can you take the stairs instead of the elevator? When you have a lunch break, could you have lunch and then go for a walk? What can you do because it's all additive? And if it's 10 minutes here and 5 minutes there and 10 minutes somewhere else during the day... and you add that up and it comes out to 30 minutes most days of the week, then I think you're doing a fair job at exercising.

Deborah Howell (Host): Even walking the dog, or you can even do exercises at your desk. You can flex your quads and glutes. There are things you can do even while sitting.

Robert Greenfield, MD: You're right. There are manuals and books that are written about that, and it's all additive, and movement is the most important thing. So if you combine diet and exercise, it really for most people would be to eat less and move more.

Deborah Howell (Host): And feel better. Can you explain how cholesterol affects your cardiovascular health, doctor?

Robert Greenfield, MD: So cholesterol is a substance that we tend to get mainly in the form of saturated fats once again. And what it does, it winds up depositing in blood vessels. And the cholesterol is carried by the LDL, which is why LDL is called the bad cholesterol, because it's taking cholesterol and depositing it inside the blood vessel wall to start making plaques. And when the plaques continue to grow, they can begin to block the flow of blood in an artery, which may cause symptoms. So we call angina pain, pain from the heart, would be if a coronary artery is narrowed by a cholesterol plaque. The problem and what's worse than that is sometimes these plaques rupture and they then form a clot on top of them, which totally blocks the blood flow. And if that happens in a blood vessel in the heart, it's a heart attack. And if it happens in the cerebral circulation, the brain circulation, like the carotid arteries that are in your neck and go to the brain, then it's called a stroke. So the thing to do to reduce plaque formation by diet, exercise, and oftentimes cholesterol medication.

Deborah Howell (Host): Okay, well let's talk about cholesterol medication. We have about a minute and a half left. Is it really worth it to take the medication? And what about side effects?

Everybody's concerned about that.

Robert Greenfield, MD: So we have many, many well-controlled studies that now include tens of thousands of people that demonstrate cholesterol medication can improve survival, reduce the risk of heart attack and stroke. It has to be the proper medication in the proper dose. And yes, there are some side effects that can occur. And if you look at the number of patients that have side effects versus the number of patients that are being helped by these medications, there's no comparison. But we oftentimes like to stress the bad things, like the 11 o'clock news sometimes when we see all the terrible things happening in the world, but there are so many good things that are happening with these medicines. I would only stress that if they're used in the proper doses, even small amounts, they oftentimes could be very, very helpful.

Deborah Howell (Host): All right. Well, thank you so, so much, Dr. Greenfield, for finding the time to talk to us today about protecting our hearts from heart disease. After all, we are born with one heart and we need to take good care of it, right?

Robert Greenfield, MD: It's true, and I enjoy this very much. I would say that the three most important things in my field are prevention, prevention, and prevention.

Deborah Howell (Host): There you go. Couldn't make it easier than that. Thank you so much, Doctor, and have a wonderful day.

Robert Greenfield, MD: And you too. Thanks so much.

Deborah Howell (Host): What a pleasure to have Dr. Greenfield on our show today. I am Deborah Howell. It's been wonderful spending some time with you. Please join us again next time as we explore another weekly dose of wellness, brought to you in part by MemorialCare Health System. Have yourself a fantastic day and be well.