Ep 033 – Heart Health

Suburban Folk 0:00
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Unknown Speaker 1:14
per meal. Do you take something like a two by six and you cut it

Suburban Folk 1:18
with a circular saw? That’s like a superpower. Those middle school years are not as fun but at that age, they’re still willing to talk to you. Welcome to the Suburban Folk podcast. I’m your host, Greg. Today’s topic is around heart health and cardiovascular disease. things you can do to be as healthy as possible when you should seek out a cardiologist and also items that you may not realize are related to your overall heart health. My guest is Dr. A new Shah. He’s a cardiovascular disease specialist and the founder and director of Apex Heart and Vascular care. He holds seven board certifications in cardiology and interventional cardiology. He graduated from one of the top universities in India, Gujarat University in 2003, with six gold medals and honors, he completed a residency and fellowship at the University of Connecticut and published more than 50 articles and abstracts in peer reviewed journals. He was trained in complex cardiac and vascular cases at Mount Sinai Medical Center in New York. Dr. Shah has held leadership positions including the director of vascular interventions at Good Samaritan Hospital and bonza Corps Hospital in New York. He also has served as the assistant professor of medicine at the Mount Sinai Medical Center. He specializes in treatment of circulatory disease, treatment of varicose veins, swelling of the legs and venous ulcers. Dr. Shah has also been named a top physician in the 2015 edition of the leading physician of the world and has been among the top doctors of New Jersey since 2015. He was recently featured in health line on artificial intelligence in a fib, Dr. Shah, thanks so much for taking some time to join the show today. How are you doing?

Unknown Speaker 2:54
Oh, fantastic. Thank you so much, Greg, for having me and absolute pleasure being here.

Suburban Folk 2:57
Yeah. I’m excited to talk to you about about certain considerations around cardiovascular disease and overall heart health, we’ve done a number of programs around exercise and in particular, I am a runner by background actually have been training for a marathon. So it will be interesting to see how lifestyle and exercise can fit into what the considerations should be around various different topics related to cardiology, can you start us off by giving your background and I’d be in particular interested in what drew you into this specialty?

Unknown Speaker 3:38
Yeah, absolutely. So awesome to hear that you are. You are a runner, and so you have done marathon or I have That’s awesome. Yeah, amazing. I’m a, I’m an I’m a wannabe marathon runner, you know, and haven’t had a chance to run one but I’ve seen a lot of marathon runner. Runners as patients. You know, as a matter of fact, I used to work with Dr. Paul Thompson. And who has run boston marathon for last, I think like 40 to 50 years. He also represented the United States in Olympics and he was my mentor, big name internationally on exercise physiology and cardiology and because of him, I actually came across a lot of avid runners, marathon runners, and have a fair share of speaking at the various runners conferences and stuff like that. But my quick background is I’m not Renu Cha, I am interventional cardiologist and vascular specialist, which means I go and I fixed blockages in people’s coronary arteries, which are the blood vessels that feed the heart as well as other blood vessels in the body and most importantly in the legs. But along with that, I also do general cardiology, which is taking care of any cardiac issue, to be honest, you know, simple high blood pressure, abnormal EKGs question about runners all the way to complex arrhythmia. and whatnot. My background is I grew up in India. I, my both my parents are pediatricians. My dad is a very famous pediatricians in India and has he used to run the Indian Academy of Pediatrics as the president for a number of years. I grew up in a very academic environment. Together with my dad, I ended up writing six or seven papers when I was in med school, past med school, almost 1718 years now, with you know, with really flying colors, got good athletes came here to the US, initially went to University of Connecticut, got my training there and eventually went to the Mount Sinai Medical Center in New York City for interventional cardiology, which is considered one of the top Institutes for interventional cardiology, not only in New York or in the US, I would, I would call it one of the top institutes in the world and Getting experience in opening blockages where most people would not dare to, to really calcific arteries, people who are not candidate for open heart surgeries, that type of stuff. Since then, I have in last 10 years, I worked as a vascular director at several institutes had more than 50 papers published. I still teach. I’m an assistant professor of medicine at Mount Sinai. And I started my own medical practice called Apex Heart and Vascular which is a premier cardiology and Vascular Institute. We have six locations in northern and central New Jersey. And we take pride in providing cutting edge compassionate cardiac and vascular care

Suburban Folk 6:45
to with your parents having a background in pediatrics was cardiology always your goal when you were in med school and then getting into residency or how did that specifically come about or catch your interest?

Unknown Speaker 6:58
It always fascinated me From very beginning, I remember reading like cardiac physiology in med school, and even then it just heart is an incredible organ. I feel like I don’t know there is something about the myocardium that gets me so excited if you think about it, it’s the only organ in the entire body which which is a muscle at the end of the day but the muscle never gets tired. If you have a healthy myocardium healthy heart muscles, technically physiologically speaking, there is absolutely no reason for the muscle to get tired Imagine you are a runner you know people are people run marathon some people are ultra marathon runner running hundred and 45 miles. No matter how well trained you are your skeletal muscles always get tired. There is always lactic acid gets built up. Unlike that cardiology, I mean the heart is an organ where it never gets tired and there is never lactic acid production there and it has a certain features due to which the the D polarization and replies in match in a fascinating way. So I don’t know from medical days I was very fascinated with with heart and cardiac physiology. When I did my rotations, clinical rotations, I remember my first rotation in coronary care unit. And I was just fascinated. It’s an incredible field, you know, we make a difference in, in people’s health and in you know, sometimes within seconds, two minutes, you know, it, it really allows us to make an impact in a very, very tangible way with the results oftentimes visible very immediately and you know, it bring in sketch your adrenaline’s pumping, you know, you are dealing with complex decisions, which is something I’ve always enjoyed living up to the challenge are split second decisions could could mean a lot. You know, it could it could mean the difference between life and death for people. And also, you know, as a field, we are almost always at the forefront of technology. You know, cardiology is something where we Get all the latest technology like as late as gizmos, all the new toys, if you will, but we are also at the forefront of data. As cardiovascular disease we have tremendous data. So in terms of the the mortality that we have changed as a collective group of cardiovascular disease experts, is phenomenal. I mean, this is the only field within medicine where we have reduced mortality by 20 to 30%. Collectively, so people’s number one leading cause of death used to be cardiac disease 20 years ago, unfortunately, it still continues to remain the top cause of mortality, but the average lifespan has tremendously gone up. And most people who are dying of heart attacks and turn simple cardiac conditions, we can call them simple now. You know, we can we can very easily salvage and save those people. So very proud to be a cardiologist and obviously, I’m very passionate about it.

Suburban Folk 10:00
No matter what somebody is doing, there could be a consideration for their heart health, whether they’re doing something detrimental or if they’re doing something positive. And I wonder, with other specialties, where it’s more, let’s say obvious that something is going wrong, like, let’s say ophthalmology, I know probably pretty easily if I’ve got problems with my eyes, but maybe it’s not so clear to somebody that they’re doing damage to their heart. Do you find that that can be a frustration when you’re having to see patients or guide people in the right direction for taking care of themselves? Absolutely.

Unknown Speaker 10:38
I think just like any other field of medicine, you know, lack of understanding lack of education is huge. You know, I we see this all the time and people I mean, everyone knows right that you should be eating healthy, you should be exercising should not be smoking, and yet people continue to do the opposite. And I always say that it’s not about you. Knowing or not knowing what are good habits. You know, obviously, as a community, we have done a good job in educating people. There’s a lot of awareness right now even with that people have bad habits. And I think it comes down to fundamentally people don’t know how to form a good habit, and people don’t know how to continue to maintain a good habit. But that plays a plays a big role. One of my biggest frustrations I have seen lately is in peripheral vascular disease, which is blockages in the leg arteries. And even to this state. We have so many people who end up losing their limbs, they end up getting amputated because they have a circulation issue and then they get infection in their legs. And unfortunately, patients don’t know about it. doctors don’t know about it. It’s a huge problem that often gets ignore or misinterpreted or both, and people end up losing limbs when a lot of these limbs can be saved. The amputation prevention is is one of the big goals for cardiovascular committee. I’m very passionate about that. Being an expert in opening people’s like blockages and stuff. And the lack of awareness in this particular area of Cardiology is baffling to me. A lot of people know about heart attack. A lot of people know about stroke, but there’s just not enough aware enough awareness about peripheral arterial disease. When

Suburban Folk 12:20
I was doing some research and we were trading some information, I saw a significant amount of information about varicose veins. Is that related to these issues, is that sort of an early indicator are these completely different related topics.

Unknown Speaker 12:35
there’s a there’s a great overlap between between vein disease in general and arterial disease. So you know, when we talk about vasculature or circulation, there are arteries that feed the legs and there are veins that bring the blood back and there is a tremendous overlap. For example, when somebody is diabetic, they unfortunately end up having arterial and venous issues and sometimes the symptoms are very similar. So what we see as varicose veins is it Literally the tip of the iceberg. But there is there is a large like submerged area, you know, there’s a lot of people venous disease is common in anywhere between 40 to 60 million people. You know, a peripheral arterial disease is in around 20 million people. So these are obviously very common problem with tremendous overlap. Oftentimes, oftentimes, people get vascular disease because they have heart problems. Oftentimes, they get heart problems, they always had risk of heart problems, because they have asked for problems. So there is a tremendous overlap between the two. So that’s why it’s important to keep an attention on all of them.

Suburban Folk 13:37
So

Unknown Speaker 13:39
the good news is now it’s easy to detect. There’s numbers of screening tests. First of all, it’s easy to prevent. If you can’t prevent it, it’s easy to detect and if you if you do detect it, it’s easy to fix, relatively speaking, all these things. So the key is to find someone before it’s too late.

Suburban Folk 13:57
What would be an early indicator for somebody To say, Okay, I need to make an appointment with a doctor or I need to be taking some other preventative measures.

Unknown Speaker 14:05
So for cardiology in general, I think it all really does come down to respecters. If you happen to have risk factors, you know, it’s always a good idea to to see a cardiologist. So what are some of the traditional risk factors? Somebody who has high blood pressure, somebody who has diabetes, somebody who has high cholesterol, someone who has history of smoking, and very importantly, when people are very strong family history of cardiovascular disease, so these are the five traditional, really big risk factors. On top of that, anytime people have symptoms, so what are some of the symptoms we need to pay attention as far as the heart goes, any unusual chest pain or chest tightness or discomfort, any shortness of breath, sometimes people have this out of nowhere, they get this immediate bout of sweating profusely, what we call diaphoresis. Sometimes people get rapid heartbeat or computation or they feel like they’re gonna faint. These could all be cardiac symptoms. Same way, when we talk about vascular disease, we gotta pay attention to things like pain in the legs, discomfort in the legs, aches, cramps. Again, most people do notice when they have these symptoms, what people do miss is when they have generalized heaviness, they feel like they’re getting Charley horses out. Some people describe it. Some people get cramps middle of the night, out of nowhere. Sometimes they just have this crazy edge in their legs and they can figure it out what it is, and oftentimes, that’s a problem of a brain problem. So, you know, a lot of lot of the symptoms could be indicating or serious underlying cardiac or serious underlying vascular disease. Well, those are the reasons if somebody has either those major risk factors or any of any of those symptoms, they truly should. should see a cardiologist I’m a firm believer that if you are somebody who is even a close to 15 Or a bow. It’s always a smart idea to see a cardiologist

Suburban Folk 16:03
to get like a baseline, if nothing else, right just to make sure you’re not missing anything. Exactly. Nothing else,

Unknown Speaker 16:09
make sure you get properly examined. Make sure somebody checks your heart and make sure there is no crazy heart murmur. Or you know, there is no like lack of pulses in any of your extremities, get a basic EKG, there are a simple test called ankle brachial index is a simple test where you check blood pressure of the legs. And that can do a lot a lot of vascular disease. Those things you know and just get checked. And if you have family history, make sure your cholesterol is appropriate with the guidelines. Make sure your blood pressure is appropriate. Make sure you don’t have diabetes, but more importantly, you don’t have pre diabetes. Oftentimes people don’t realize that pre diabetes or borderline diabetes also has pretty bad consequences. So if that’s something also that should not be ignored.

Suburban Folk 16:54
Let’s talk about one of the items you mentioned cholesterol and I will say fall into the family history part that you’re talking about. So is of interest to me. Can you tell us about what the level should be what the ratio should be to know that you’re in range? And then I think in that same world is status, right? What is the intent of them? Is there any concerns when you’re prescribing a Staton? And then, you know, for anybody that doesn’t want to be taking a pill every day or anything like that? What could they be doing to manage their cholesterol along with potentially a drug regimen?

Unknown Speaker 17:37
cholesterol is obviously a very interesting subject. Big Issue. Unfortunately, there is no particular number that one can say is perfect or not perfect. I mean, when the cholesterol numbers are truly low, they’re perfect, but there is no Set number. That’s that’s true for everyone. So cholesterol guidelines now say, the numbers should be tailored to the individual Okay, it all comes down to so for example, you You said your family history. So it comes down to your own individual risk factors. And we got to determine what’s your future risk, what is your 10 year risk from this point on until end of 2030 to get a heart attack or a stroke, or potentially, you know, having a major cardiovascular catastrophe event and based on your risk at 10 years, and then we do the same thing for 20 years. And based on those risk factors, we can determine people based on those who are at high risk or those who are at low risk. In reality it comes down to when somebody has risk factor, we should try to lower the cholesterol as much as possible. Within cholesterol there are there are three things that is good cholesterol is bad cholesterol, good cholesterol is what we call HDL. bad cholesterol is LDL and triglycerides. So what statins do is they lower LDL, which is the most notorious and most directly linked map cholesterol, to all kind of bad cardiovascular events. So that’s why statins do lower LDL, that is also have a bunch of other potential beneficial effects apart from cholesterol lowering. And that’s why when people have high LDL, we recommend them to go and start it with you used to go by numbers up until three, four years ago, and then the guidelines have changed. They’re telling us not to go by numbers. If you do if somebody does twist my arm, I would say the ideal LDL numbers should be below 100. For most people, that would be an amazing number, reduce risk. If you really don’t have much risk factors you can say below 130 is okay, this is what LDL cannot total cholesterol. If somebody has significant risk of cardiac disease, you know they’re there. They are diabetic or they will have the pressure of they already suffered from a heart attack or stroke. Then we really try our best to get the LDL below 70 if possible. So that’s where we stand And then we also recommend what we call high dose or high intensity strategies, which has a lot of benefits and reducing vascular inflammation was part of the concept is not just the cholesterol level, but it’s the inflammation of the inner lining of blood vessel which also leads to bad events and status to reduce that. There are also a couple of other major advances that we should talk when we talk about status. One is there are newer kind of cholesterol lowering medication which are coming into Limelight and they have some incredible data to support so one is for lowering cholesterol called called repatha. Or proudly went, these are both PC SK nine inhibitors, you probably gonna hear about them very soon. In big word, they’re gonna be as popular as statins, in my opinion, very soon. Both these medications work with a different mechanism of action. And they do cause dramatic reduction in backless rolls. And they’re only injection that you take once every two weeks. So they do have tremendous benefits, we will hear more about it, we are still waiting to get some really good data on hard endpoints what we call there right now, consider second or third line therapy if people are intolerant to status. And another one is called was SEPA, which is it goes up and tile which is which lowers triglyceride, which has some tremendous data in reducing people’s likelihood of dying. So again, a lot of new excitement in the world of cholesterol reduction. But as far as standards go, you have to look at what’s the risk factor. If you’re high risk, really, really try to lower the cholesterol as much as possible

Suburban Folk 21:47
risk factor meaning just that you’re at a level that you need some sort of a prescription to help normalize your cholesterol level or risk factor meaning Are you at risk of some kind of side of effects from sentence are there side effects to be aware of that would make somebody a better candidate versus not for being on a prescription?

Unknown Speaker 22:07
Yeah, so I mean, there are side effects, right like any anything else that always effect and side effects. One of the major side effects that students can have is muscle damage. You know, muscle damage can happen in a very minor form, where you have a little bit elevation of creatine kinase, the muscle enzyme level, or it could be tremendous rise in creatine kinase, what we call rhabdomyolysis where all your muscles are getting destroyed and your kidneys go into failure because of that, that’s a very, very rare side effect happens in less than one in 10,000 people, I think less than 100,000 actually. Most people would get a little bit muscle aches occasionally they get in elevation of liver enzymes. Studying side effects are something that can be easily monitored. Within people who get started where that side effect they can. You can switch it on the dose, you can switch around type of Staton there are ways to deal with it, there are certain vitamins called coenzyme, q 10, or cq 10, which can actually replenish some of that lost point time and can actually end up reducing some of the side effects. So, you know, not everybody gets side effects. Again, when I meant risk factors, I meant what is your future risk of getting heart attack or stroke. And if you have any type of stroke, which means you are what we call high risk profile, you should really try every effort to take stat in and if you have side effects, try to switch around if possible. If that doesn’t work, you can try coenzyme Q 10. If that doesn’t work, we can go to the newer type of medications that I just mentioned, which really don’t have those side effects

Suburban Folk 23:45
prior to having those kinds of treatments as far as diet and exercise. Let’s start with diet because I feel like that’s what can sometimes get very confusing as far as low fat Avoiding carbs protein and so on are there some tried and true recommendations for a diet that would help keep your cholesterol down?

Unknown Speaker 24:11
Yeah so diet is is very tricky it’s again one of those controversial subjects because there are so much is done and yet so much more needs to be done. As far as cardiovascular disease goes, there’s only one diet which has shown truly improvement in cardiovascular outcomes which is Mediterranean diet, which is high and good cholesterol, you know, plant you know, which has a lot of nuts and olive oil and stuff like that. Every other type of diet is probably good but you know, every other type of like recommended diet, which is a low fat diet, low cholesterol, low sugar diet, keto diet, all those types have, you know, there are a lot of proponents of these, this, you know, these different diet, you know, types. Unfortunately, none of them as demonstrated long benefit for cardiovascular disease. There is no particular diet except for the one that I mentioned Mediterranean diet which has shown that the future risk of heart attack or stroke is reduced. There are other benefits you know certain diets have more weight reduction certain diets will truly lower your cholesterol which hopefully will translate into say, you know, into reducing heart attack and stroke. But as far as diet goes, we know that stick to something right pry You know, I think a lot of this is common sense, you know, try to avoid bad fat try to avoid unnecessary fat. simply try to avoid like unnecessary carbs and sugars. We don’t recommend no carb diet anymore. either go with a low sugar, low carb diet or you can go with a low low fat diet. They both work pretty good. And they both have benefits in improving your strength and stamina and energy levels. It has improvement in cholesterol levels as well as improvement in weight reduction. So Other diets, I typically end up recommending my patients. keto diet is something new, the jury’s still out with sort of how to see how much long term benefit we’re gonna see from this. I know it’s a tough diet to stick to you know, a lot of people try it, but then they kind of give up on it because it’s just not easy to to stick to

Suburban Folk 26:20
remind me. Does the Mediterranean diet generally include fish? Or is it mostly just straight vegetarian

Unknown Speaker 26:26
to fish, poultry, B, B, beans and eggs of all part of Mediterranean diet, all grains, vegetables, fruits, moderate portion of dairy products, not a lot of dairy products in Mediterranean diet and their limited intake of red

Suburban Folk 26:41
with emphasis on red meat in particular being the thing that’s cut out of the overall diet. That’s right.

Unknown Speaker 26:47
But the good thing is the red wine is part of Mediterranean diets.

Suburban Folk 26:50
Red Wine versus red meat. I’ll take that one. Time was a question I had for you kind of a little bit off topic, but again, when I saw some of your information, it was around heartburn medications, which is in particular lately, it feels like those are also medications that have gotten some bad press. So related to cardiology, is there any risks as far as you’re aware of or anything people need to keep in mind if they have chronic heartburn?

Unknown Speaker 27:20
Yeah, so it’s interesting. So the medication that we’re in, there’s a lot of buzz about something called proton pump inhibitor or ppis. So BP is where supposedly everybody thought that there are some adverse cardiovascular effect. And unfortunately, the data is somewhat conflicted. But the current existing data says that we don’t have enough data. That’s what it says that to say that TPS are particularly bad for the heart. The one particular thing that there was bothersome because there’s a lot of literature if somebody is on certain blood thinners. If somebody has a blocked artery, we put Oftentimes put people on a medication called clopidogrel, which is a type of blood thinner typically people get after getting a stent. And there were early on initial data saying that when people get people get proton pump inhibitor, it actually reduces the efficacy of clopidogrel. In other words, if you have a heart attack and have a stent, and you need this very important buttering medication, by the virtue of being on heartburn medication, it actually eliminates the good effect. And then it can subject to the risk of heart attack. So that actually got a lot of bad press. Since then, there have been studies looking at this and they really haven’t found enough evidence to suggest against it. You know, we’re still researching this more but right now, there is no convincing evidence to say that their heartburn medications have really bad impact on causing any kind of heart attack. So I actually for my own patients, I give them heartburn medications without any hesitation as a matter of fact, eliminate some of these atypical symptoms, because you know, the reason it’s called heartburn is because people feel like they’re having a heart attack. And actually being on heartburn medication reduces that. And it reduces anxiety of patients, but also anxiety of doctors, because sometimes we get confused. So I’m very comfortable telling my patients to take the heartburn medications.

Suburban Folk 29:21
So let me restate that back to you. So the actual potential added benefit of Harper medication is so that you if you’re actually having some sort of a heart issue, you won’t think that it’s just another heartburn, that there really might be something else going on. They’d be eliminated and an

Unknown Speaker 29:41
unnecessary simulator, right? So heartburn is a great mimicker of a true heart attack or a heart angina pain. And you know, you’re eliminating that one cause you know, by taking the medication, hopefully it’s effective, and then you don’t get test symptoms. You don’t get fooled that you know, because oftentimes People get this symptoms and they they feel like it is heart attack and we they end up getting unnecessary testing. On the flip side, you know, they, they’re not on medication and they get the symptoms and then they feel and they’re actually having a real heart problems, but they just think, Oh, it’s probably a heartburn. It goes both ways, you know, so I think it actually helps eliminate this unnecessary mimicker out of the way.

Suburban Folk 30:25
Yeah. So that people are not just ignoring what could be a bigger problem because I think it’s just another case of heartburn. Okay, interesting. So let’s go to one of the big ones I think that people think of in your field of coronary artery disease and blockages and what can cause blockages so I think of this being one of these things that are out of sight out of mind, like we were talking about at the beginning, that people don’t really think about ways to prevent blockages and just living healthy until unfortunately, they’re starting to have signs that there’s a problem and at that point, not that it’s too late, but it’s further along than then it could otherwise be if they’re taking care of themselves and reducing risks of blockages.

Unknown Speaker 31:11
Yeah, no, absolutely. So coronary artery disease is the blockage of the heart arteries. And you know, it really is one of the biggest, biggest issue that leads to people’s mortality. I mean, globally, it affects more than 110 million people and causes close to 10 million deaths per year, which basically constitutes for, you know, almost one fifth of all causes of mortality. So, in other words, more people die of heart problems and coronary artery disease specially then all the gun related violence combined. All the I hate to include this but all the pandemics that at least up until now what we have seen, combining that combining that with any terrorist attack, combining that with any top five cancers coronary artery disease is that big of a lethal killer of humanity upon still, even to this date. So it’s obviously a very serious issue. And unfortunately, you know, it got a lot of good press, and people used to think all about it. And I feel like, lately, we’re seeing a resurgence, where older people get it a little bit less so because you know, they’re on the good medication and stuff. But on the other side, the younger people, it used to be a disease of people in the 50s and 60s and 70s. But lately, we are seeing this in people in their even 30s and 40s. Which is shocking, you know, and it never used to be the case. I think it’s because of unhealthy lifestyle, again, reduce ignoring the risk factors. And obviously, early detection. That’s how we pick it up. Now, we’re seeing a resurgence of it. So it’s a big problem. How do we avoid it? we avoided by controlling risk factors and getting checked, right. So if you have again, as I said, high blood pressure or diabetes, smoking or any family history of heart problem, you get checked, you get seen you get an EKG if you have any symptoms of pain, pressure, tightness, discomfort in the chest, sometimes pain pressure, tightness in the left arm or the joy area. If you’re shortness of breath if you have unusual sweating or what we call freezes. If you have feeling like your heart’s racing or skipping beats, if you have a feeling of impending doom, if you have a feeling that you’re gonna pass out, all those could be symptoms to get it checked. Checking is very easy, simple. electrocardiogram can tell us a lot of things. Oftentimes, people need more testing like putting them on a treadmill and doing what we call a stress test. And figuring it out if people have blockages and disease or not. And that way we you can pick it up you can, you can avoid any bad consequence. And obviously, you know, healthy lifestyle controlling your risk factors. As you said, exercising is great. Rolling and eating proper diet, those things can truly prevent you from getting the blockage in the first place.

Suburban Folk 34:06
How much does stress play a role in this, if any, especially like you said, it is kind of alarming that you’ve got younger and younger cases of people dealing with these blockages, is there other factors like that, beyond diet and lifestyle exercise or like smoking, you know, the sort of the obvious ones that can also be pointing to?

Unknown Speaker 34:31
Absolutely. So stress is actually unfortunately playing a huge role in this and it’s something that, you know, something that was not well known up until several years ago. And now we know that that emotional stress, mental stress, psychological stress plays a huge role. Because what happens is, when there is a lot of stress, you’re always in this flight or fright mode. And the reason we know this so well now is because we have all these incredible devices right which are Which are devices where you can measure like like your Apple watch or your, you know, aura ring and whoop bands and Fitbit it these devices can measure your biomarkers, it can measure, you know, most importantly a biomarker called heart rate variability. It tells us that, that what’s the overall variation of your heart rate? People who are in constant stress, they have less heart rate variability, because they’re always in this flight or flight mode. They’re never, you know, at peace, so that ability to change their heart rate quickly or dramatically is very reduced. So when people have very low heart rate variability, we know that you know, and we can we can monitor this so, so lowered variability is actually associated with poor cardiovascular outcomes. And people who can manage the heart rate variability and you know, and this is a what we call autonomic function, right. So heart is a muscle just like any other muscle So your nerves control the heart, right? your nerves control muscles, right? So same way, the nerves that control the heart, our autonomic nerves, within autonomic nervous there is sympathetic and parasympathetic, which is your flight and fright, right? So one tend to increase the heart rate and blood pressure and one tend to lower it. And at the end of the day, it’s all about the balance between the two. And this heart rate variability, resting heart rate, vagal tone, a bunch of biomarkers you can measure based on this variable devices, has shown us that when people have this poor heart rate variability in some of these other biomarkers, they actually end up dying more. They’re more heart attacks, they’re more arrhythmias, they get more high blood pressure, they get more sleep disturbance and stuff like that. So now we know that stress plays a huge role. And the contrary is true as well. When people have less stress when they have things like meditation things like you know when they do proper sleep, whether it’s the duration of the sleep as well as good quality of the sleep. When people do gratitude practice and know how to center themselves. When people have positive emotions and positive attitude, all these things, which is opposite of stressor, they actually tend to improve your heart rate variability, and they actually tend to improve your cardiovascular outcomes. Stress is definitely a big one. And also, we know that people who are under stress are the very people who are more likely now to have poor lifestyle, they’re going to sleep less, they’re going to exercise less, they’re going to eat unhealthy, they’re going to be a little bit depressed or anxious, leading to very unhealthy eating habits, higher risk of smoking and other addictions. The stress plays a role in you know, they get more high blood pressure. So stress plays a role in a lot of different ways.

Suburban Folk 37:47
Emphasis on sleep, meditation, which I think can probably take on different forms. And then, like you said, trying to recenter which I think is probably similar to meditation, do you tend to point your patients to particular specialists that have treatments or therapies for making sleep better, or just certain types of meditation, how do you go about pointing people in those directions to manage stress?

Unknown Speaker 38:16
Yeah, so it’s, you know, I thought of sit down with them. And I explained to them, I explained them the importance of why this is important. I oftentimes encourage them to, to, you know, again, sometimes people get data fatigue, but I tell them to at least gather some data where a monitor were a fit, but they know where their heart rate, then they know where their heart rate variability stand. And based on that I tailor the therapy to them. Unfortunately, you know, we still live in an era where there are no you know, we still need more data to suggest what we want to suggest. As far as sleep goes, it’s not just the duration of the sleep. It’s also about the quality of sleep, right? So how do you improve quality of sleep, it’s difficult, it’s difficult for us to tell people how to what we know is, is common practices. You know, whether it’s mindfulness, whether it’s practicing gratitude, whether it’s practicing meditation, whether it’s exercising, all those things lead to reduce the heart variability in it actually improves the quality of sleep, not just the quantity of sleep. So those are the things I hear and suggest people to go for. There are no major specialists in the medical field who are specializing in this particular aspect up until now, but it’s changing dramatically. And, you know, these are areas where things like artificial intelligence will come into play by a feedback mechanism will come into play. And, you know, there are a lot of apps now, which can actually help people that are apps like headspace, which is you know, demonstrated to reduce stress level for people that are you know, there’s there’s a apps called calm, like, there are a lot of different apps. So, you know, we’re still trying to see if these things stand the test of time, you know, it is good to see that they are reducing the biomarkers and risk factors. What we’re interested in seeing is you’re gonna see long term benefit from these things or not.

Transcribed by https://otter.ai