Shanna M  00:11

Hello, Welcome to the Adventist HealthCare & You podcast. I'm Shanna today I'm excited to welcome Dr. Brian White, who is a cardiologist with Advanced Health Care Cardiac Associates. Welcome, Dr. White.

 

Bryan White, MD  00:22

Well, thank you. Thank you so much for having me. I'm excited to be here today.

 

Shanna M  00:25

Thank you for coming. Let's start off, I mentioned you're a cardiologist. So what do you do to help patients? 

 

Bryan White, MD  00:31

Yeah, so I'm a non evasive general cardiologist. So I treat patients in the clinic, I treat patients in the hospital. And it's the full spectrum. You know, it's a full spectrum of preventative cardiology. So before the development of heart disease, to the onset of cardiovascular symptoms, to the onset of cardiovascular disease, and that could be anything from strokes, heart failure, coronary disease, the need for aortic valve replacements, the whole gamut.

 

Shanna M  00:56

That's one thing that I don't think people often realize is there are different types of cardiologists, so you're the one that people would see and help manage their heart health? 

 

Bryan White, MD  01:04

Yes, definitely different types of cardiologists and cardiology gets more specialized each and every day, but there are interventional cardiologists that do balloons and stents, and treat people when they're having a heart attack. There are structural interventional cardiologists that do that. Plus, they will help replace aortic valves or mitral valves or fixed mitral valves. There's heart failure specialists for people that weaken hearts, there's advanced cardiac imagers that do things such as cardiac CTAs, or cardiac MRIs, and then cardiac electrophysiologist that will do pacemakers, defibrillators, cardiac EP studies to help people with cardiac arrhythmias. 

 

Shanna M  01:41

Okay, so people come to you, if maybe they are new to needing heart care, is that right? 

 

Bryan White, MD  01:47

So there's, there's people that come to me that are new to needing heart care, there's people that come to me that want to just be, want to get a checkup, they want to make sure that they're there okay. Maybe they're having cardiovascular symptoms, and the reason I say that is, is that maybe they have a family history of heart disease, you know, and they want to make sure that where do they stand? What are their risk factors? You know, what, do they have heart disease that they do not know about? And what can they do to modify their risk. And sometimes people will have cardiovascular symptoms, such as chest pain, shortness of breath, heart pounding, heart skipping, that doesn't mean necessarily that they have heart disease. But that may mean they have cardiovascular symptoms, so I help evaluate and treat them as well. 

 

Shanna M  02:26

Okay. Well, since you brought up family history of heart disease, does that mean? So say you do have a strong family history of heart disease? Does that mean you're automatically gonna have a heart attack or struggle with your heart?

 

Bryan White, MD  02:38

Yeah, I hope not. I hope not, you know, so, you know, just, you know, in the last couple of years, my mom had open heart surgery. And I would tell you, it was very daunting looking at her cardiac cath film and the degree of coronary atherosclerosis that she had. So I think that we live in a different age, you know, a lot of times people, their family members who have had heart disease, you know, maybe they smoked, maybe they're physically inactive, maybe they are obese, maybe they were not treated for diabetes, or hypertension or hyperlipidemia. So there's a lot of things that just because you have a family history, doesn't mean that you're necessarily destined, this is a different time we have, we have a lot more choices, and we have a much better chance today to prevent heart disease going forward.

 

Shanna M  03:20

So when we talk about family history, that's a risk factor. What does it mean to be high risk for heart disease.

 

Bryan White, MD  03:28

So you know, more specifically, when we talk about high risk, we're talking about obstructive coronary artery disease, you know, we're trying to, we're not dealing with traditional congestive heart failure, erratic valve disease, we're talking about people that have blocked arteries. You know, that's the type of thing that most people are more familiar with. And we generally think about having a 20% or greater 10 year risk of having a heart attack or a small, small heart attack or some form of complications from heart disease. And we use different types of equations to help us understand what that risk is. And the number one risk factor for heart disease is age, you know, I had a patient yesterday, he's like, I can't believe I'm here in the hospital. I've had a heart attack, why? I said three letters A G E Age. So age is the primary determinant of your risk for heart disease. But there are other risk factors that are out there such as physical inactivity, obesity, chronic kidney disease, smoking, high blood pressure, high cholesterol and diabetes,

 

Shanna M  04:29

You mentioned the patient that you had, is there a way to lower your risk or reverse your risk?

 

Bryan White, MD  04:36

You can definitely lower your risk and the ways that you do that is you work with your primary care provider, or if you need to with the cardiologists and your other specialists to focus on traditional risk factor modification. And that again, is understanding what is your level of physical activity? What is your weight? What is your body mass index? what is your resting blood pressure? What is your cholesterol? What is your fasting glucose? working with your primary care doctor or with your cardiologist and other specialists, you can definitely address those risk factors, you can modify a majority of those risk factors. And you can greatly lower your risk for development of heart disease.

 

Shanna M  05:11

Okay. So one thing we haven't mentioned is stress. That's that continuously comes up on the podcast here and there is mental health and just the amount of stress people are under. Is that a risk factor? Can it affect your heart health?

 

Bryan White, MD  05:27

So if you look at, you know, stress, that's actually a major focus of the US Surgeon General, Dr. Murthy is the identification of stress and management. And so stress can negatively affect people, both directly and indirectly, it can indirectly lead to poor lifestyle habits, such as physical inactivity, eating poorly and not getting certain issues like your high blood pressure well addressed or the high cholesterol. But directly leading to sustained elevated stress hormones or stress chemicals that can raise your blood pressure, can lead to enduring consequences and elevate your risk. So stress management is a key component to good risk factor modification.

 

Shanna M  06:09

So if you are high risk for heart disease, what are some more serious heart conditions that can happen? I heard you mentioned a heart attack anything else?

 

Bryan White, MD  06:16

You know, absolutely. So traditionally, we think of coronary artery disease as being a narrowing of an artery of greater than 50%. And having plaque buildup is not necessarily a bad thing, because the arteries want to remodel to maintain the opening to allow the blood to flow through them. So when you talk about coronary disease, you're talking about a overwhelming degree of plaque buildup to narrow blood vessels. And that can lead to small heart attacks, that can lead to large heart attacks. Many years ago, we would all worry about having the big one, you know, there are 2 million acute coronary syndromes every year, two thirds of those are small heart attacks, one thired are gonna be larger heart attacks. But we do a much better job today, the trends are in a positive direction, reducing morbidity and mortality associated with cardiac disease or acute coronary syndromes. But that doesn't mean that it doesn't still happen. And one of the long term consequences can be congestive heart failure. So we do see a lot of heart failure. Heart failure can be related to blocked arteries are coronary artery disease, it can be related to age, it can be related to chronic kidney disease.

 

Shanna M  07:29

Okay. So one of the things we like to do on the podcast every now and then is address any myths. So you're, you know, a cardiologist, you've been a cardiologist for quite some time. What are some myths that you want to address today?

 

Bryan White, MD  07:43

Yeah, so when I meet with a patient, you know, I always try to identify what are the patient's goals? How can I be their best educator? How can I be their best advocate. And so as I understand what a patient, what the patient's goals are, I can best work with them. But sometimes I run into patients who believe that their risks cannot or should not need to be modified with medication, or if they live a perfectly healthy lifestyle, that they can't develop heart disease. And a lot of times, I will see people with heart disease, the number one determinant again, is age, and there can be familial hyperlipidemia syndromes, one out of 200. So there's a lot of people running around with elevated cholesterol, that is genetically driven, that is outside of their ability to modify with diet and exercise. So those are the two myths that I try to address and work with patients, motivate them, gain their trust, and then apply medication prescriptions only as necessary to help modify the risks.

 

Shanna M  08:46

I like that so you can not know that you have a risk factor or that, that you have sort of something pre existing and still be susceptible for a heart attack. And then also, you can take some medication to help you get a little better with your heart health to

 

Bryan White, MD  09:06

Yes, yes, you know, medications aren't always the first step medications can be an important step. If I see a patient with elevated cholesterol, I really try to focus on a quality diet. For most of my adult patients. That means less than 2000 calories a day, less than 2000 milligrams of salt a day, less than 300 milligrams of cholesterol a day, and less than 200 milligrams of saturated fats. And I really try to have people do the salt count, the calorie count, the cholesterol count and the fat count. Understanding that one egg contains 150 milligrams of cholesterol. So I start there and I give everyone the benefit of the doubt of being able to modify the risk factors of lowering your blood pressure, improving glycemic control and lowering their cholesterol by diet and exercise. But for for those people that have very high elevated cholesterol levels that are most likely genetically driven, or those with refractory cholesterol levels, then those are the people that need prescriptions.

 

Shanna M  10:07

So there's a lot somebody can do on their own. 

 

Bryan White, MD  10:09

Absolutely 

 

Shanna M  10:10

Yeah, thank you. So what are, you've already mentioned a couple of tips. So let's just bring them all together, what are your top two or three tips for heart health.

 

Bryan White, MD  10:20

The first thing is to establish care with a with a quality primary care provider.  We're very lucky in this community to have a lot of strong primary care providers. Secondly, work with them, again, to identify those risk factors. That weight, that body mass index, that level physical activity, identify your your resting blood pressure, your resting glucose levels, or fasting glucose levels, and your fasting cholesterol levels, so that your risk factors can be identified your overall risk profile quantified, and then decisions made from there. Establishing care routinely is the most important first step. 

 

Shanna M  10:59

I like that, and we've talked about that before on the podcast a lot of times is ensuring that you have a really great relationship with a primary care provider that can help you assess your risk and then help you take those next steps.

 

Bryan White, MD  11:11

I totally agree. And I come to Adventist after 25 years in the Air Force, and the majority of my last five to 10 years has been focused on improving the relationships from the cardiologist to the primary care providers, and everyone wins. The patients definitely win when that relationship is strong. That is something I'm definitely trying to do here. As best as I can. When I have a patient, I try to reach back out to that primary care doctor, share with them my thoughts with regards to their cardiac care, sometimes they have overt disease and primary care doctor really needs that immediate feedback. So we can work together on a strategy to treat that patient, but also to help have these type of discussions. Because as the patient sees a primary care doctor, and knows that their primary care doctor and the cardiologists are working together are on the same page with regards to primary prevention. Everyone wins.

 

Shanna M  12:02

Yes. Thank you for that. Last question is you just joined Adventist HealthCare, and Adventist HealthCare has a Heart and Vascular Institute. So what's special about getting your heart care here at Adventist HealthCare?

 

Bryan White, MD  12:14

No, absolutely. So we really care about the patients, we really care about their families, we really care about their quality of life and your outcomes. And so between the abilities to take care of patients in the ambulatory setting and in the clinics, acutely in the hospitals, and also in the rehabilitation, we can offer the full spectrum of care to ensure best quality outcomes for our patients. 

 

Shanna M  12:36

Yeah, and that helps with the communication you just talked about is having that full spectrum allows it a little bit of an easier communication too.

 

Bryan White, MD  12:43

Absolutely. 

 

Shanna M  12:44

Well, thank you for joining us today. This was wonderful information, making me realize I need to make my physical this year, haven't made it yet. So that'll be my, that's my little resolution there. So thank you for being here. And thank you to our listeners. To find information about Dr. White, you can visit AdventistHealthCare.com, click on find a doctor to search. All his information is there and then information will also be available in today's show notes. We'd also love to hear from our listeners, you can let us know if you like the podcast by leaving a review or you can email podcast at Adventist healthcare.com and let us know what healthcare topics you want to learn more about. We really are looking forward to hearing from you so we can bring you the health topics that you want to learn more about. Don't forget to subscribe so you get our new episodes. Thank you and be well!