Shanna M 00:11
Hello, Welcome to the Adventist HealthCare & You podcast. I'm Shanna, and usually I'm joined with Nimeet. But he couldn't make it today, but he'll be joining us again in future podcasts. So today, it's just me, but I'm actually joined with Dr. Daisy Lazarous. She is a cardiologist and a women's heart specialist. She is the Director of our Women's Cardiology Program here at Adventist HealthCare, has been with us for about seven years. Welcome, Dr. Lazarous.

Daisy Lazarous, MD 00:36
Thank you, Shanna.

Shanna M 00:37
I've known you for almost the entire seven years. And so we've talked a lot about heart health over the years. And so now, I'm glad we're having you on this podcast. So you can tell our listeners all about heart health, and specifically, women's heart health, too.

Daisy Lazarous, MD 00:52
I'm so delighted to be here to discuss this very important topic.

Shanna M 00:55
Yes. Okay. Well, let's, let's go right into it as just a general first step, what is heart disease,

Daisy Lazarous, MD 01:02
heart disease, the commonist kind of heart disease is what we call coronary artery disease. And that is a buildup of bad fat or LDL cholesterol inside your arteries. And over time the arteries will clog and give you some symptoms of a heart attack.

Shanna M 01:19
Okay? And what are maybe some early warning signs?

Daisy Lazarous, MD 01:24
Sometimes you don't have any warning signs, those are called silent heart disease. Women, particularly, we know that two thirds of women who die of a heart attack never had any symptoms before. But most, sometimes you do have symptoms, I will say most times you do have symptoms. And those symptoms could be what we call chest pain or angina, a feeling of oppression in your chest, especially when you're active, or it can be shortness of breath, or it can be a decrease in your exercise capacity, not being able to do what you could before. So there are different symptoms. And most importantly, if you feel something unusual, please be sure to check with your primary care physician.

Shanna M 02:04
So you know, you don't just suddenly have a heart attack. There are maybe some early, some of those early warning signs. But do people generally know they have heart disease before they have a heart attack? Is there certain indicators that you're at a potential risk?

Daisy Lazarous, MD 02:19
Absolutely, we have cardiac risk factors, they are very, very, very important. And those risk factors are, as you can imagine, smoking high blood pressure, being overweight or obese, not exercising, drinking too much alcohol, diabetes. So if you have any of these risk factors, you should be aware that your high risk for heart attacks and strokes. So if you have these risk factors, and it is estimated that more than 54% of all Americans have at least one of these risk factors. So most of us are at risk. So if you have them, please check with your primary care doctor.

Shanna M 02:54
And one thing I've heard you say, over these many years we've known each other, is so much of heart disease is preventable.

Daisy Lazarous, MD 03:01
Oh, absolutely. What I like to say is heart disease is almost completely preventable. More than 90% of all heart attacks and strokes are preventable if you do the right things. But still start early. I would like to say start early in your good habits. Because I talked about the bad cholesterol and building up blockages or plaques. In American diets, it has been shown that that process can start as early as nine years of age.

Shanna M 03:28
Okay

Daisy Lazarous, MD 03:29
So don't wait! Start your healthy lifestyle changes as soon as you can.

Shanna M 03:34
Okay, so we've kind of talked about general heart health for everyone. How is it different in women?

Daisy Lazarous, MD 03:40
That is a very, very important question, Shanna, and a topic very dear to my heart. So we know that women can experience symptoms that are different from men. So in both men and women, chest pain is the commonest symptom of having a heart attack. But women can have some unusual symptoms like being excessively tired, or having pain in your jaw, your throat, in your neck, or nausea, vomiting, shorter breath. So these symptoms may not be necessarily be picked up in an emergency room as being that of a heart attack. So we know that women are often under diagnosed, they are about seven times more likely to be sent home with a heart attack than a man is. So we know about under diagnosis, we know about under treatment, because sometimes women don't get the treatments that they need for heart disease and under researched, because we know that a lot of the research is done in men, and that notion was that women were small men, so that research has extrapolated to women, which isn't always the case. So, both men and women have traditional risk factors and we talked about that at the beginning of the broadcast. The smoking, the drinking all of those but women are very unique in that they have non-traditional risk factors. They can have pregnancy related complications like eclampsia, preeclampsia, a preterm birth all of that places women at a tremendous risk for future heart attacks and strokes, and inflammatory disorders. We know that heart disease is from inflammation, and women particularly who have lupus or rheumatoid arthritis, or other inflammatory disorders are at risk for heart disease. So those are some unique things in women that men don't have.

Shanna M 05:22
You mentioned, women are under diagnosed, often misdiagnosed, sent away, what can we do as women to advocate for ourselves? If we think something's not right?

Daisy Lazarous, MD 05:32
Yes, there is a campaign that says make the call, don't miss the beat. So if you have any doubt that you're having a heart attack, or a stroke, because in hearts we say, time is muscle, and everyone knows that in strokes, you can have debilitating disabilities if you don't go on time. So make the call, call EMS. It's okay to be sent home thinking that this is reflux, but it's not okay to be sitting at home with a heart attack or stroke. The other very important thing that I find surprising is that only about 54% of women know that heart disease is the number one risk factor for dying. So educating ourselves is very important. And then learning what our risk factors are. I am a very big proponent of know your numbers, you are your best advocate for your health. Ask a doctor, what's my blood pressure? What should it be? What's my bad cholesterol? Where should it be? And what's my A1C? The diabetic number, and what's my pump of the heart, the ejection fraction. All of these are important. So educate yourself on what your numbers are, and where they should be. This goes a long way in preventing a heart attack and stroke.

Shanna M 06:41
When should we start getting those numbers? Is there an age?

Daisy Lazarous, MD 06:44
You know, we used to check cholesterol at 20. Now we are checking cholesterol as early as nine years of age.

Shanna M 06:50
Oh, my goodness.

Daisy Lazarous, MD 06:50
Because I told you the plaque can be very, very early.

Shanna M 06:53
Yeah.

Daisy Lazarous, MD 06:53
So the best way to deal with that is to go to your primary care doctor, make sure you get your physicals on time. And if you have any questions about heart conditions, talk to your primary care physician, and they will refer you to a cardiologist if they think it's appropriate.

Shanna M 07:08
Okay. All really good advice. So, one thing that we've talked about too in the past, and now it's more important than ever, and seems to be on everybody's mind is mental health, and that there are effects, you know, physically from your mental health. So talk a little bit about how your mental health can affect your heart health.

Daisy Lazarous, MD 07:28
Mental health is so important, it has got intrinsic connections with your heart health. Now, if you're depressed or anxious, your levels of cortisol, or the stress hormone in your body rises, so your heart rate goes up, your blood pressure goes up, you get more prone to inflammation, all of which can facilitate this plaque buildup that we have been talking about. We also know that people with anxiety or depression, sometimes don't have the right coping mechanisms to deal with the stress, though they may revert to smoking or drinking or eating more or being physically inactive. And especially in the field of cardiology, we know that if you have a heart attack or stroke and have depression, after I mean heart attack, stroke, or bypass surgery, and other person with depression, you will do much worse than the patient who had a heart attack or bypass surgery who didn't have depression. So there are multiple ways in which mental stress can affect your heart.

Shanna M 08:25
Well, and I would think you'd be stressed and having trouble dealing with something that life altering of a heart surgery or

Daisy Lazarous, MD 08:33
absolutely

Shanna M 08:33
something like that. And so definitely looking out for that after something like that so that you can catch it early.

Daisy Lazarous, MD 08:40
Absolutely. So

Shanna M 08:41
talking with your doctor,

Daisy Lazarous, MD 08:42
Just like you said, Shanna, immediately after having a heart attack or bypass, it is okay to have negative feelings, fear, anxiety. But if it lasts more than two to three weeks, you know, then that's not right. So you need to talk to your primary care physician.

Shanna M 08:55
Okay. Speaking of going back to women, I've heard you mentioned before, women experience stress differently, or it affects our heart in a different way too. Is there anything we should look out for any knowledge or awareness you want to bring to that.

Daisy Lazarous, MD 09:09
You know, there are certain conditions that affect women disproportionately, more severely, like diabetes, but one of the big factors is depression. So women have more negative effects from the depression. And I like to say that there are conditions other than the classic heart attack that can occur in women from stress and depression and anxiety. You have heard of the broken heart syndrome, that under emotional stress, and that 90% of those cases happen in women. Under emotional stress. The woman can have chest pain and elevation of the proteins being released from the heart and decrease in the pump function of the heart. That's called a stress cardiomyopathy. So women can react very negatively to stress in many ways.

Shanna M 09:52
Okay, so have you seen an increase in people dealing with heart disease over these last two years?

Daisy Lazarous, MD 09:58
Absolutely.

Shanna M 09:59
So what's happening? What are you seeing?

Daisy Lazarous, MD 10:01
What we're seeing is an increase in anxiety and depression, you know we are isolated, we don't have social contact, now that's getting easier. But in the initial phases of the pandemic, we've isolated, no social contact. And so the feelings of depression and anxiety rose very much. And then people, because they were at home, and then working from home, sometimes reverted to the not so healthy habits, so all of those negatively affected us. And we have seen a immense increase in mental health problems, including suicidal ideation and suicide risk. So all of those extremely important during the pandemic, and we found that mental health services were disrupted, just like everything else.

Shanna M 10:44
Yeah

Daisy Lazarous, MD 10:45
So all of this made an impact.

Shanna M 10:47
As we are dealing with the anxiety and the continued stress of COVID. And trying to get back on track with your health, what are some tips that we can give our listeners to be heart healthy?

Daisy Lazarous, MD 10:59
Remember, when we started Shanna, I said that prevention is cure. So more than 90% of all heart attacks and strokes are completely preventable. If you make some simple lifestyle modifications, get moving, the heart is a muscle, so you know when you exercise your muscles you get stronger. When you walk, your heart gets stronger! Don't smoke, seek help for smoking, cut back on the alcohol. Make sure your diabetes and high blood pressure are well controlled. cutting back on salt is first thing for high blood pressure. That's extremely important, eating the right kinds of foods. And then if you have anxiety, depression or stress, be sure to talk to your physician about it and be sure to maintain a healthy weight. You don't have to make a resolution I'm going to lose 25 or 50 pounds, just losing five to 10 pounds has positive effects on your heart health. So small steps in the right direction.

Shanna M 11:54
Yeah, you don't have to do it all right away.

Daisy Lazarous, MD 11:56
You don't not have to do it all.

Shanna M 11:58
Yeah, it's just like you know, as you said, your heart is a muscle you have to build it up. It doesn't happen.

Daisy Lazarous, MD 12:02
Exactly.

Shanna M 12:04
I know. I find it's hard to stay motivated. It's hard to you know, I try to remember, I hear you sometimes in my head small steps. Let's take the stairs today.

Daisy Lazarous, MD 12:13
Most people think they have to go to the gym. You don't have to.

Daisy Lazarous, MD 12:17
You can walk at home inside your house. You can walk outside, you can climb stairs, which are excellent aerobic exercise any of those, small steps in the right direction.

Shanna M 12:17
Yeah

Shanna M 12:26
Yeah, I like that. Well, thank you for coming and talking with me today. A lot of really good information. If you want to find Dr. Lazarous, you can find her at AdventistHealthcare.com. And remember to follow us wherever you get your podcasts. So thanks, everybody. Thank you, Dr. Lazarous.

Daisy Lazarous, MD 12:43
Thank you, Shanna, it was a pleasure.

Shanna M 12:44
Thank you. Will you come back again and talk with us.

Daisy Lazarous, MD 12:46
Absolutely

Shanna M 12:47
Awesome. Thank you so much.