Hi everybody.
We'll begin in just a few minutes. Thank you for joining. We had an excellent response to today's health chat with our experts. So I'm just giving some folks a chance to join from our waiting room. So we'll begin in just a minute.
Okay, and I haven't unmuted yet. We're gonna go ahead and get started. We had a lot of questions to cover today and I want to give our experts plenty of time to do that.
Good afternoon, thank you for joining us today. We will begin. I'm Shanna with Adventist HealthCare. I'll be the moderator today and, today's health chat is about strong women, strong hearts and we are excited to provide some very meaningful information to our community today. Before we begin, everybody's muted to limit any background noise. In today's chat, if you have any questions for our experts please put them in the Q and A at the bottom or top of your screen, however your orientation is, and we will be sure to get to them as our time allows. We have a lot of people already ask questions when they registered so we're going to start with those first.
We ask that you please only submit general health related questions for specific health matters.
We encourage you to speak with your healthcare provider. We're recording today's webinar so that you can access it later so don't worry about taking all the notes. You'll be able to access it on our blog in a few days.
And then it is my pleasure to introduce our experts for today to discuss our topic of heart health in women and new information about some cholesterol guidelines that came out earlier this year.
We have Doctor. Daisy F. Lazarous, a cardiologist and a women's heart specialist with Adventist HealthCare Cardiac Associates. She's located in our White Oak area of Silver Spring and in Rockville. And then also Julian Panello is the clinical manager excuse me, of the Center for Fitness and Health at Adventist HealthCare Shady Grove Medical Center. Thank you both for joining today.
Absolutely.
We will go ahead and get started and we are gonna deviate a little bit from our regular no slide format because we had some new cholesterol guidelines that came out earlier this year.
They're much more detailed than past guidelines and so we wanted to cover those right away upfront so that our participants got the new information right away. So Doctor Lazarous, let me know when you need me to change the slide, but here you go. You should be able to see it.
On to the cholesterol guidelines, just want to say this came at a very opportune moment. I'm sure many of you read that death rates among young women are rising very fast. So we know that between the 1990s and now women twenty to forty years old, it has a fourfold increase in mortality or dying rates from heart disease. So this came at a very good time, I believe.
So the new cholesterol guidelines were updated from the ones in twenty eighteen and just released in March of this year, and it's very maybe a little difficult to understand, but I'm going to make it very concise. We want to emphasize that this is a lifetime risk. Cholesterol is building up in the arteries of your heart, LDL specifically, and the risk starts early it goes on throughout your life. So we're trying to reduce that lifetime exposure to unhealthy cholesterol.
So the old guidelines said you started treatment at around forty years of age, now it's thirty years of age. So we're trying to catch younger and younger people to reduce the risk. So when do you check for cholesterol? You check for cholesterol around nineteen years of age in an adult and in children before puberty because some of the lipids like the LP falls during puberty, so nine to eleven years.
Before we used to do like a ten year risk, but now we do a ten year risk and a thirty year risk, and there are calculators I don't need to go into that. But the most important thing is that we have very specific goals for LDL cholesterol and non HDL cholesterol. What's non HDL cholesterol? It's the total cholesterol minus the HDL and the lab will give you a number for that.
It generally should be thirty plus your LDL goal. If it exceeds that, it's bad. So the guidelines say now that if you have any established heart disease, you had a heart attack, you had a TIA, when I say heart disease it includes strokes, strokes and heart attacks. You had a mini stroke, they saw atherosclerosis in the arteries, all that makes you a very high risk individual and your LDL has to be below fifty five.
That's all new. In the old guidelines we didn't have that. And then if you're sort of intermediate risk it has to be less than seventy. That's going to go away because as soon as these guidelines were published, a huge study came out that said that if you have any atherosclerosis every individual should bring the LDL down below fifty five.
Now if you to prevent a first heart attack just with risk factors, your LDL should be below one hundred. Can you go on to the next slide, Shyamal?
Now lots of you ask us about LP little a screening and ApoB screening. Yes, that's in the guidelines now.
LP is genetically determined so we can't we don't have any therapies to alter it at this moment. There are a few therapies coming. We recommend that you measure it once in your lifetime, not repeatedly, And a high level above one hundred twenty five signifies a higher risk. In fact if it's double that, two fifty, it's a twofold increase in risk of heart attacks and strokes.
And the APO B, what's APO B? So why are we measuring? It's because just having your LDL at goal doesn't negate the risk. There are other cholesterol, other lipid forms floating around that increase your risk, and that's all included in the Apolipoprotein B.
And once you have your cholesterol down to target, we check the apolipoprotein B, especially in certain individuals like diabetics, if you have a high triglyceride level, and if you have metabolic syndrome or kidney disease.
And then the CT calcium scores become very useful in defining risk, taking an intermediate risk person to a higher risk. Next slide.
Next slide. Now there are certain special categories of patients and this is very very important. If you're diabetic, if you have kidney disease, there are five stages, anything three and above, or if you have HIV, you have to be on a statin regardless of your LDL level. So we don't we just give you a statin.
Also, in patients being treated for cancer, you have to be on a statin because we now know that we thought the treatments for cancer caused the problem with the cholesterol and the risk. Now we know that the cancer itself does, so you should be on that. And we recommend that during you're trying to get pregnant or lactation you should avoid statins because they're harmful to the fetus.
Most importantly statins remain the foundation of lipid therapy. So lots of patients ask me, Doctor Lazarous, I don't want to do Can you suggest something else? So just reminding you that statins remain the foundation of lipid therapy.
All right I jumped ahead I don't want to show our heart health tips yet.
I'm going to stop sharing my screen and we will get started with our questions.
Okay there we go. All right first question I'm going to jump into some of the questions we got regarding cholesterol just because we were just talking about that.
So question and it actually ties to what you were just saying is how do you keep your numbers healthy, your heart healthy numbers in the positive way and not go on another cholesterol medication?
Yes, so if you're on max dose statins, if the doctor started, first of all your cholesterol is high and you want to ask the doctor, I got this often I don't want to start a medication can you give me another six months one year to try bringing it down by diet.
Diet brings down your LDL only by five to fifteen percent And so that's not enough to bring it down below seventy percent or below fifty five percent. So that's why the medications become important. But you have to do it in conjunction with diet and exercise.
And once you max out the statins, then you go on to the next level of therapy, ezetimibe, the injectables, the PCSK9. So the fact remains that it's very, very hard to bring down your LDL just by diet alone.
Okay, another question around medication is can these medications affect your memory?
So the FDA had a labeling put out for statins that it can cause some very mild temporary brain fog. So that means you're like sort of afraid. And that goes away with time. It's very mild. It's reversible. It goes away with time.
There are other real memory problems.
There's no data that shows that statins do that. In fact, statins are protective. They reduce your risk of vascular dementia by fifteen percent to twenty percent. So they're actually reducing your risk of dementia, not increasing it. So again, term fog, that's okay. But long memory loss, no, that does not happen with statins.
Okay. We had a question come into the Q and A that before we move along, Doctor Lazarous, talked a lot about risk level when it comes to the new cholesterol guidelines.
Can you talk a little bit about the difference between high risk, moderate, intermediate risk?
How are those defined?
Yeah, so we go by primary prevention, secondary prevention. Secondary prevention is you have some form of heart disease.
You have atherosclerosis built on. You had some event. You had a heart attack, you had a mini stroke, you had something. Those patients are very, very high risk and their LDL cholesterol should be maintained below fifty five.
The other categories you have risk factors.
Your cholesterol is high, have pre diabetes, you're a little bit on the overweight side.
Those risk factors, those people will keep the LDL below one hundred. Now the intermediate people keeping the LDL below seventy are told it's going to go away very quickly because now it's established that everyone that has any atherosclerosis should keep the LDL below fifty five.
Make sense?
Yes, thank you.
Secondary prevention, yeah.
Thank you.
I want to switch over just a little bit. You started talking about diet and exercise a little bit and I want to ask Julian to chime in maybe first on this question is what, and Julian, you work in our Cardiac Rehabilitation, the Center for Fitness and Health at Shady Grove Medical Center. You work with a lot of patients that have had events, have had heart attacks.
What lifestyle changes can have the strongest impact on reducing heart disease and risk, especially in women?
Sure, thanks, Shanna. The NIH has recommended two main factors or, you know, you can see an eighty percent reduction in overall risk of heart disease, and that would be increasing your physical activity and stopping smoking. Right? So if we if we if those two for sure, we're okay with, and there's other factors as well.
And those are smaller factors, but chronic stress and having a heart healthy diet. We know that chronic stress, what does that do really? It raises your blood pressure over time. And then so increasing your blood pressure over time is going to inevitably cause your risk of heart disease to go up.
And then of course, we'll we'll get into this a little bit later. I know there's a few diet questions, but having a heart healthy diet, not that doesn't mean everyone has to have the same diet, but something that works for you. That's another, major factor with reducing your risk of heart disease.
Okay. Doctor Lazarous anything to add for that one that question?
Julian hit the highlights. So it's smoking and physical activity and of course maintaining your blood pressure and your cholesterol and all the other things that go with it And I want to point one thing out very quickly. Society now, I just so people know, for diabetes and endocrinologists, they put out new statements saying that obesity is not just having a BMI above thirty. You can be in the normal range but have abdominal obesity or fat inside the viscera that also is now called obesity. So I just want people to know that fat in the middle area very very dangerous for your heart.
So doing what we can with diet, exercise, eliminating smoking when we're ready and when we can, I know that's not easy but doing whatever we can to support that heart health?
Yes.
Okay. Well, let's start maybe also, you know, we've gone through the the new guidelines and some things about risk and how to kind of get started on that heart health journey.
What are some of the common signs of heart disease in women and are they different than men?
Both men and women get chest pain, similar chest pain, but there are some atypical symptoms in women like, shortness of breath, palpitations, pain radiating up your jaw to your back, here pain below in epigastrium or down below the chest, those symptoms can be missed easily.
They can be attributed to something else. So what women should be on the lookout for is if you have new profound fatigue that's not explained by anything else, if you have new shortness of breath that's more than what you usually have, those kind of symptoms should alert you that you have a problem with your heart.
Okay, thank you. And obviously we're here to talk about women's heart health, but for men they shouldn't ignore any types of symptoms either. Absolutely.
Yeah, because one of the arteries of the heart, the right sided artery, it goes supplies the lower portion of the heart. So men and women, they can have some epigastric distress just like you were having reflux.
Lot of people ignore it. They chew on some thumbs and more antacids at home, but that could be signaling a heart attack. So just to be if when in doubt, make the call. That's what American Heart Association is.
Call nine eleven.
Absolutely.
Yes. So Doctor Lazarous, a follow-up.
Many women experience stress, men do as well, but women can be told because the symptoms can kind of overlap a little bit, but stress, anxiety, fatigue, before heart disease is even considered. What specific symptoms or combinations should women really advocate for themselves around as this isn't that, it's this?
Yeah, if you have just one day a little bit of shortness of breath or a little bit of palpitation, that's not what we are talking about. We are talking about a decrease in your exercise tolerance. You were able to climb two flights of stairs easily, now you can't.
Those kind of symptoms should alert you that something is going on with your heart. So any symptoms that are unusual to you or increasing intensity or frequency, you should approach your doctor. Go to your primary care doctor first and they will listen to you and refer you to a cardiologist if they feel the need.
Thank you. Julianne, I'm going to skip to you now. We're going to go back to exercise a little bit. That's the area your expertise is.
How much is really needed for heart protection?
You know, what are the guidelines around that?
Sure. So, we go by the American Heart Association guidelines here at Cardiac Rehab. And this generally applies to not just those with heart disease, but anyone in general, right? A hundred and fifty minutes is what they recommend for aerobic activity. And by aerobic, I mean cardio like cardiovascular.
So treadmill, walking, elliptical, things like that. In addition, they also recommend two to three days of strength training exercise per week. And that's something like full body exercise. You know, you could do upper one day and lower body the next day, but around two to three full body for each major muscle group per week as well.
And then you can add in stretching and yoga like that as well to that. But, you know, those those guidelines are just for the overall population. If your goal is to really lose weight, they recommend over two hundred and fifty minutes of aerobic exercise a week. The more we move, the more calories we will burn and the more the more efficient we'll actually get at burning them.
So cardio is actually it's a little bit easier as we get used to performing exercise on a week by week basis.
Okay. Well, Julian, let's stick with you for again, because many people don't know that a service like cardiac rehabilitation is available.
So can you talk just a little bit about how important that is in someone's journey and when they may need it?
Yeah, sure. So, you know, cardiac rehab is very, I think is one of the most important things someone can do after they've had like an intervention or some kind of major life event related to their heart. Now, most of our patients here have had some kind of heart attack or issue like that. However, you know, when you come to cardiac rehab, you don't know what you can or cannot do outside of here, right?
You don't feel like you have the confidence to exercise safely on your own. So this is really where the clinicians and myself come into play. We instill some of that confidence in you and to be able to do these activities and exercise outside of just this, clinical setting here. You you don't want to be stuck with this fear for the rest of your life because a lot of times the surgeons and interventionalists do a really good job, but they don't necessarily provide you with what to do after they've done their part.
And that's where we'll give you all the education. And that way you can live your life as you wanted to, you know, for the rest, you know, for the rest of the time.
Perfect. Thank you. So it's a really important part of someone's journey if they, when and if they need it.
Oh, absolutely.
Perfect. Thank you. Doctor. Lazarous, let's go back to you and talk a little bit more about some very specific women's, risk factors.
So, how do pregnancy related conditions like preeclampsia or gestational diabetes, affect long term heart risk for women?
I look at it this way. You have the traditional risk factors, Julian was talking about it, the smoking, the obesity, lack of exercise, diabetes, or cholesterol. Then you have the non traditional risk factors. That's where all these risk factors come in almost uniquely in women, and that includes pregnancy related complications. So if you have a preterm baby, or if you have high sugar during your pregnancy, high blood pressure, or you go on to become preeclamptic eclampsia, your risk of heart disease and strokes go up twofold, doubled. So it's very, very important that you realize that you had these pregnancy complications and allowed your primary care or your OB GYN and they will send you to the cardiologist to restratify.
So it's very important to know that women have risk factors outside of the traditional risk factors. So one very important risk factor is autoimmune diseases like lupus. Lupus carries a very, very high risk of heart attack and dying from heart attack. And also breast cancer treatments, we talked about cancer itself, now we have the treatments causing harm to the heart, and then also depression.
And Julian will tell you how depression affects your ability to do things after your heart attack.
Okay well that actually leads then to the next question of sort of stress and sleep and mental health factors affecting your heart health.
Not only you know as a risk factor but then could affect you afterwards if you have an event or something like that. So how do those things affect heart health?
Stress does affect your heart. So in many ways stress raises your stress hormones like adrenaline, cortisol and these hormones are raised sky high and then those will raise your blood pressure, your heart rate both not good for you and then cause vasospasm, that is spasm of the arteries of the heart. That's also not good. So what happens when they're spasming? Blood flow is reduced. Also, if you have a plaque, a cholesterol buildup that can split off and go inside the other artery and cause a heart attack. So also when you're stressed you're not in a mood to do exercise.
You take to some bad habits like smoking to relieve that stress or eating unhealthy. So all of these factor into stress. And of course, you're stressed, you're not going to go to your cardiac rehab. I can bet you, Julian, they're not showing up.
All of this play a role.
Okay.
I'll to that too.
Cardiac rehab is a three to four month program. We do a stress screening every thirty days for our patients because we want to see if there's a change from the time you started to every month from now. If we see a change in your stress levels, we want to address that because that's not going to help in your recovery. Hypertension, lack of will or energy to do anything. And then especially if you stop coming to us, we're going give you a call until we get an answer so we could help facilitate what we need to do next.
Yeah. So all of this is just take care of ourselves physically and mentally. Remember those factors. They all contribute to our health.
Julian, I'm going to stay with you really quickly and this is one of my favorite questions.
How is technology like wearables and all like the watches and all of that kind of changing how we approach our health these days especially in cardiac rehab right people may become very aware of the number of steps they're taking in their EKG readings you know it's all on your all on your watch or your other your rings and things like that.
Yeah, we've come a long way with technology even the last three years. And it's one of the few things like the wearables, the Fitbits that have actually decreased in price like TVs, right? There's been so much competition. It's become much cheaper to have one of these devices.
You can monitor your resting heart rate, your exercising heart rate. They even make watches now that detect if you're in an arrhythmia, specifically AFib. There's been a lot of that. Now whether or not it's a perfect technology yet, you know, we could still make improvements there, but that's something we never had even ten years ago.
So if you live with something like a chronic, A fib, this watch will be able to tell you if you're, you know, too high, too low of a heart rate and it can detect, store the data and then send it directly to your cardiologist. So we're, you know, this technology is going to be great for preventative measures in the future and then just monitoring day to day what you're resting and exercising heart rates are.
Yeah, for those that are interested in a deeper dive around that type of thing we have a podcast with one of our cardiologists Doctor. Millan Patel and he kind of goes into that as well but it's a great question.
So moving on, I think we had a question come into the Q and A and I want to make sure we cover those as well.
Doctor. Lazarous, how do the new cholesterol guidelines and sort of new things coming out, how does heart failure and for heart failure patients, how are they affected by these new guidelines?
So heart failure happens when your heart muscle is weakened by some process, And one big process for that is blockages of the arteries of the heart, just what we're talking about. Cholesterol buildup, a heart attack damages your heart and you go into heart failure. So it's sort of like an end process.
Your heart attack happened then you go into heart failure. So the cholesterol per se doesn't play a role in the heart failure because that event has already happened, but we still make sure that your cholesterol is kept under wraps.
But the heart failure treatments have made tremendous progress. And a few years ago, we told the patients, oh, fifty percent of you are going to be dead by two years. Now they can lead a very long normal life with all the therapies that we have.
Okay, thank you.
Doctor Lazarous, you mentioned a little bit ago when you were talking about symptoms and kind of what the differences are between concerning symptoms versus you know just you know a day of fatigue or whatever.
And I think you mentioned fluttering in the chest.
How long should you be concerned about something like that?
Fluttering in the chest actually is a very common symptom. It happens during stressful events. You're going to give a talk just like this.
I started My heart's fluttering.
And when you lie down at night, people notice that some fluttering comes on. That's very, very common.
It's like a pregnant woman. She doesn't feel the baby kicking when you're running around being busy during the day, but when you sit down, the baby kicks. They feel there's more kicking. Same thing for the heart. When you lie down at night because you didn't sense it during the day, you were so busy, you feel the pain. Fluttering, if it's transient, a few seconds goes away, you shouldn't bother about it. You should be Okay.
But if it happens frequently, if it's increasing in intensity, so first it came for seconds, now it's minutes, now it's longer half an hour, then you should really or if you're having associated symptoms like I'm short of breath when I get it or I have chest discomfort when I get it, those are all alarming. So you should tell your primary care physician who will then determine what needs to be done with you.
Okay, thank you.
Let's go back a little bit to risk and we had a question come in. Know what are some of the biggest risk factors for women? We've talked a lot about age and your numbers and exercise related things. What are some of the just biggest things we need to worry about especially for women?
Yes smoking is still way up on the top because there are certain conditions that affect women more severely. The consequences affect women more severely than men. Smoking is one of them. Diabetes is the other. Depression is the third. So the effects it has are worse in women than in men. So smoking is up there.
Again, talked to you about the visceral obesity.
Extremely important. So if you have a large waist circumference, you should try and Julian can help you with exercises to try to bring that down with diet and exercise.
But remember that we go through certain phases in a lifetime. Pregnancy is one of them and we talked about the pregnancy related complication. Then a big one is menopause.
Go through menopause. So the protective hormones, estrogens, progesterone go away. So we lose that protection and then we are more at risk for cholesterol buildup inside the arteries, vasospasm and all the bad effects that come from. So those are the I want to point out something and people oftentimes forget is alcohol.
Alcohol, the guidelines have changed for alcohol. We used to say one drink from women a day, two drinks for men, all that is out the door. We now know that no amount of alcohol is safe for your health.
But if you must drink, stick to two glasses of wine, five ounce, that's it. Or one beer.
But you must not.
So that's a sobering thought like we say. Not drink too much alcohol. So all these risk factors put together.
Okay, thank you. Thank you.
Follow-up question.
You know it's so important for women and men to advocate for themselves when at their physician's offices and ask questions. What are some specific tests or things that, especially for women that they can ask to assess their heart risk or you know if they're concerned about their heart health?
I always tell women to keep a symptom diary. So you can tell the doctor this happened on this, this, and this, and the doctor can see a pattern. And then write down your questions. Even I have some thoughts in my brain.
I go to the doctor's office, I forget what I was going to ask. So write down the questions and take it to your doctor. The cardiologist will do some basic tests like an EKG and an echocardiogram or an ultrasound. That's extremely important for cardiologists because we see the whole heart in the ultrasound.
All the four rooms, the pump, the valves that they're leaking, all of those things. And then some more sophisticated tests like a calcium score. We talked about the CT calcium score and the lipid guidelines, so that's a very important tool for us now to see early atherosclerosis, early buildup or what we call subclinical atherosclerosis. Extremely important test.
So those are some of the tests that and then of course the additional markers the Lp, apoprotein B, all of those things. Now patients often ask me some of the labs can do the subtypes of HDL, subtypes of LDL, subtypes of that's a total waste of money. You don't need that. We just need a regular lipid panel which includes a non HDL cholesterol.
We need a one time lifetime LP and then the APOB in certain populations so that's it.
Okay thank you. You've talked a little bit about HDL and HDL is the good cholesterol right?
I call LDL lousy and HDL happy.
What's recommended around HDL levels and if you can't take a statin for whatever reason, when should you begin talking about these types of medications?
So HTL we observed in large scale studies and epidemiological studies that if you have a high HTL your chance of having a heart attack or stroke were less. However, when we found medications that could reduce HDL, they didn't lower your risk.
And that's because your plaque, the cholesterol that's building up in your artery to cause the blockage, is pure LDL.
So HDL is not playing a role in atherosclerosis. So that's why we used to do a ratio between LDL and HDL. If your HDL was good, we said, oh, you're protected. We don't anymore. It's pure LDL, and we don't do much with HDL. So if that can answer your question.
Yes, thank you. A question came in around stenosis of the heart and I know there you know can you talk a little bit about maybe what that is and how can someone maybe prevent it from getting worse if they have it?
So that when we talk about stenosis we can talk about stenosis of the three major arteries that run on your surface of your heart the front the side and the back and they have branches that's atherosclerosis a plaque buildup so you keep your LDL below the target goal we talked about that the LDL below fifty actually all the studies from Cleveland Clinic and elsewhere have shown that if we keep your LDL below fifty the process of atherosclerosis stops normal cholesterol is put in the arteries and over time can regress that means it reverses the process which we didn't know a few years ago. We
thought once you had a blockage you had a blockage. No that's not true. So that's number one. You can also have stenosis of the valves of your heart.
So I'm wondering if the question related to the valve of the heart. As we grow older, the aortic valve, it sits on the left side of the heart, can build up calcium and gets tighter and tighter and tighter. So you will reach a point when you'll have to do something with the valve. But that process is aging.
Has nothing to do with the calcium you take in. So you can't prevent that. It's just an aging process. Okay.
So we have talked a lot about the role of diet and exercise and physical and mental health.
Let's learn a little bit and diet as well. We had a great question come in because we hear about this all the time and maybe Julian you can start with this one. I know you work with our nutritionists and dietitians at Cardiac Rehab.
Is the Mediterranean diet really better for heart health?
Sure. So, you know, on a broad spectrum, generally it is better, especially considering most of our diets, you know, we're we're cheating here and there. But, you know, it's an emphasis on on whole grain foods, quinoa, farro, vegetables and fruit. So that will always be better for you than than the alternative. But really, the best way to develop a a plan is to meet with a registered dietitian, and they can look at what you're doing now, not change everything, but really make that personalized plan that'll fit for you and so you can have longevity in this heart healthy diet. It's it's very hard to adhere to a very strict diet, so it's not about doing that. It's about making small changes that you can consistently stay with for the rest of your life.
Thank you. Doctor. Lazarous, anything to add with that one?
Julian put it very well. Actually, it has been shown that if you follow the Mediterranean diet, you reduce your risk of heart attacks and strokes by thirty percent. It's a bit thirty percent.
Also, Julian said this, you don't have to go one day and change out your pantry and make everything Mediterranean.
You stick with the diet that's comfortable for you and take small steps. So maybe if you're eating bacon and sausage for breakfast, substitute for oatmeal. So make small small steps along and that will you know be better for you than trying to make a drastic change.
Totally agree.
Thank you. Well I don't know if oatmeal tastes better than bacon and sausage but it's tough. I'll remember that one. I know, La. I know. I liked your addressing the menopause affecting heart health.
I'm gaining on that milestone, I'm trying to take steps. I'm getting a lot out of this and I hope our participants are as well.
Julian, we're closing in. We have about twenty minutes left in our things. We have just a few more questions that have come into the Q and A and I'll get to those in just a second. But I did really want to give you an opportunity to talk. You mentioned a little bit about cardiac rehab and how it helps people.
What typically happens if you have an event, what happens at cardiac rehab afterwards and how does that help people?
Right, so you've had an event and we can kind of look at what really qualifies for cardiac rehab.
So chronic chest pain, you've had a heart attack, open heart surgery, valve repairs, heart transplant, even peripheral artery disease has now been approved by Medicare to come to cardiac rehab. So what do you do? You come to us for three to four months and we, as clinicians, work, initially one on one with you, and then we establish an exercise plan for your time here. And then as you get closer to graduating from our program, maybe a month free, then we'll look at how you can move what you've learned from here into into something on your own, into a gym of your own setting.
We don't just do the exercise, though. We talk about cholesterols, a lot of which has been mentioned by doctor Lazarous, heart healthy tips. You can meet with a dietitian if you need to. We've mentioned stress a lot.
We make sure we continue to monitor stress. And then any other core components like blood pressure and things like that we'll address as well. So really it's not just around exercise. It's total, like, overall overall, like, health and wellness kind of turnaround for you.
And it's it's a great fresh start for one of these major major heart events. It's a multifactorial thing. You know, if you have any questions with medications, we'll look at that with you.
And then if there's anything that we see while you're exercising in terms of vital signs or in a rhythm we don't like while you're exercising, we can address that immediately with a cardiologist and get that resolved.
Excellent. So it's really supportive for people, getting them back to their day to day.
Yeah absolutely.
Excellent thank you. Well we have just a few more questions left. I think most of these are geared towards Doctor Lazarous in before we get to our final slide.
Doctor Lazarous a question came in around afib and what are the recommendations for cholesterol for someone that has atrial fibrillation?
So atrial fibrillation per se we don't recommend the cholesterol but it's part of your entire risk profile.
It usually happens in people that have high blood pressure, so those risk factors. So we have a certain level of cholesterol we put in which will be if you do not have an event yet it'll be below one hundred. If you had an event it'll be below fifty five. But the danger with atrial fibrillation is a stroke.
So stroke prevention becomes the number one thing you need to be afraid of with atrial fibrillation. That's why we give you the blood thinners and please take your blood thinners don't miss it because a stroke will happen. And the other thing I want to say about A fib is when you're older and you have some risk factors, even if you have one A fib episode a year, your risk of stroke is high.
So patients come and tell me, oh, I just had that one episode two years ago and I didn't have any more episodes. I just want people to keep in mind that we have a lot of patients with AFib that it's like the iceberg in the Titanic.
What you feel is only ten percent of what's the total.
Ninety percent is below the surface or subclinical. You don't feel it, but it's happening.
Okay, thank you.
A question came in and I think we've heard about this a lot over the years but is chewing aspirin or taking aspirin I guess I don't know if you chew it or not but is taking aspirin a first aid treatment for heart attacks?
Absolutely. What's the recommendation for that?
Absolutely the best thing you should do. Provided the patients awake and can talk. Don't do that in an unconscious Okay so what a heart attack is is a plaque, cholesterol buildup, because the LDL cholesterol is vaccine ruptures.
So then the platelets that's one part of your blood component come and block out the whole artery. So why you're chewing the aspirin is to prevent the platelets from sticking together.
Very very very important so if the patient is awake and able to swallow you have to crush the pills or have them bite it because it's absorbed faster so any aspirin that you have at home usually the higher dose the three twenty five milligrams.
Okay and then a couple questions that came in so if there are we're closing in on twelve forty five.
A few questions came into the Q and A just a minute ago so we'll address those. So if you have any last questions go ahead and drop those into the Q and A and we'll answer those before we move on to our ending tips.
So if your cholesterol levels are good but your lipoprotein A is positive and you follow the diet you know lifestyle changes Is there anything left to do beyond that?
The way we use lipoprotein A is in patients who have reached the LDL target, they came to where we want them to be, but there's still some residual risk. That's when we look at the Lp to intensify treatment. So we can go on to the next step, the injectables or something else.
Lp, like I said, is measured really once in your lifetime.
So you don't need to keep measuring it and there is no genetically determined and there's no treatment for it yet although several treatments are in the pipeline to come for it so just remember that.
So much has improved over the years for sure. Last question that I see that has been put in there, going back to the menopause as a risk factor and the importance of estrogen, is that a recommendation to take estrogen for those that have gone through menopause?
Currently the data is that you use estrogens if you have unbearable what we call vasomotor symptoms, hot flashes, you can't sleep, it's terrible all of those symptoms. Then you use estrogens for a period of time usually ten months or so.
But long term it's still felt that it will increase your risk of thrombosis or clotting of the blood and increase your risk of strokes and heart attacks. So not recommended long term although I have a different of opinion on that but also remember that if you are a smoker your risk for thrombosis and clotting is higher so please don't yeah take the hormone things so that also goes for birth control pills.
Everyone is different which is why it's important to talk with your physician about your particular risk levels.
And I also want to mention Shana that early menopause is a very potent risk factor because you're losing your estrogens protective estrogens early in life and that's defined as earlier than forty five years of age.
Okay, we have one last question that came in before we move on to our tips.
It's actually about aspirin, we'll go back to a question before.
Obviously you mentioned it is still being used you know if you are in an event but is taking one a day necessary like a baby aspirin?
If you have already had an event that's called secondary prevention you must take an aspirin a day. Very very important. If it's for primary prevention you have high cholesterol, have some of the other risk factors but you haven't had an event yet, then it's not recommended to take the aspirin. Okay.
Yes, and then one last question that just came in.
They keep adding them and I keep saying one more but hopefully this is the not hopefully. If you do have a question, we'll try to get to it. We have talked a few times now about the importance or or how much smoking can impact your heart health and and improve if you are able to quit.
Are some of the, you know, smoking is obviously very harmful but what about some of the other types of nicotine products out there like, I'm sorry the the name of them are escaping me but oh vaping.
Secondhand smoke is harmful to you. Yeah. We estimate there are several thousand deaths a year in the U. S. From secondhand smoke. Also all these other products, vaping and all of that, they may say tobacco free some of them, but the FDA wants us that there may be tobacco. And it's not it's the minute particles in those things.
They go inside your lungs and cause harm to your lungs so you will hear the pulmonologist say that don't go anywhere near any of those aerosols or any of those things that because they're very harmful to your lungs and your heart.
Okay another question was put into the chat there. If you are not able to take a statin for a variety of reasons, are there alternatives?
Yes, there are alternatives, but I want to point out that true statin intolerance is in less than five percent of people. Less than five percent. So generally, if you say I feel aches, pains, we can ease you into that. If you're afraid of taking a statin, you're worried your mother had aches and pains, I will start you at two times a week, small dose, and ease you into it slowly, slowly increasing the dose. So most people, ninety five percent of people should be able to tolerate statin. So that's the message. But there are other treatments.
But statins are the foundational treatment. But if you can't tolerate the statins, there are injectables and other treatments that are available.
Okay. All right. Well, we are at twelve.
For Julian.
I do have a question.
Julian, please ask.
Okay. Uh-oh.
Do you know that women are referred less for cardiac rehab? You know, they get less referrals to cardiogenic. They get less less of everything.
How do you promote and they have caregiver responsibilities.
Have elderly parents that do most of the care at home. How do you encourage them to come to cardiac rehab?
Yeah. So I'll touch on this briefly. One of the barriers for women participating in cardiac rehab, and for us here, of the busiest places in Maryland for cardiac rehab. About sixty five percent of our population are men, so that leaves thirty five percent women. Right?
We know heart disease is the number one killer of women in this country. Right? So a lot of times they suppress their symptoms. They they don't have the symptoms as doctor Lazarous was speaking.
Like men, we have chest pain like an elephant sitting on our chest. For women, it may not be, so dramatic like that. So what we do, what we try to do every year, we have this campaign for Adventist and then cardiac graft specifically. Wanna promote go red for women.
We wanna show what these symptoms are. We want to make all the men that come in aware that, you know, your wife also needs to look out for these symptoms, and she needs to go to the doctor and get her regular checkups as well. She needs to make sure she's doing all the steps preventative because we don't wanna wait till a reactionary outcome. We don't wanna come to rehab afterwards.
We can do prehab as well. And we can do a lot of these healthy tips and get all the tests done, the Apo B, Apo A, lipoproteins, before having a true event, which increases your risk of dying. So really, if anyone has any questions or any concern about an important woman in their life, make them go to the doctors and get these tests done so they can get some answers prior to anything happening.
Very true, yes. Excellent. Well that leads us, very beautifully into our last little bit here, as we end.
Julian and Doctor Lazarous has put together their three sort of heart health tips to leave us with today with something positive. We covered a lot today with new cholesterol guidelines and risk and you know some new information.
And so these are the things we can leave you with for today. So I'm going to share my screen again for our participants and here we go.
Share okay heart health tips from the experts. Doctor Lazarous we'll start with you.
Yeah if I can leave you with three things that you know your numbers you have to know your risk factors so if you I can ask people even being treated for high blood pressure for years what's your blood pressure at home I don't know what's your bad cholesterol LDL I don't know You can be diabetic and not know what the A1C is. So please remember you know you can take a picture with your phone that these things are very very important. Know your numbers. You cannot that goes on to you are your own best health advocate.
So if you don't know your risk factors, if you don't know your numbers, you cannot advocate for yourself. So like I said previously, take your written questions to your doctor's office and be assertive. By assertive I do not mean aggressive. I mean assertive, okay?
And so advocate for yourself. And the last thing I want to say is aggressive prevention is the best intervention. It takes far beyond putting stent in your heart, bypass surgery, or any of those things. And then eighty percent of all heart attacks and strokes can be prevented by simple lifestyle modifications, what Julian was talking about.
So those are my tips.
Okay, And then Julian, what would you like to leave us with today? Oh, hold on.
Daryl, we talked about a lot of these.
Yeah.
We we talked about a lot of these already and a lot of the questions here. But so managing heart disease and living a heart healthy lifestyle, you don't have to be perfect. You need to find a system and stay consistent with that in whatever in whatever way that works for you. So that may take some time to build up those habits. No one is perfect. Don't worry about that.
So with that being said, and, you know, moderation is key. You can have a steak every now and then. You can go and get fast food, or you don't have to exercise while you're on vacation. Just find that moderation that works for you.
And with that, we will if we're trying to improve our lifestyle, you it's really hard to do that overnight. Right? So if you want to lose weight and stop smoking, well, let's do what's most important first maybe so we don't get overwhelmed. And that really would be let's let's try, you know, stop smoking for a little bit or and what are the steps required to do that?
By doing everything all at once, it's very overwhelming. You wanna give yourself the best chance of success. Then the third is go to doctor Lazarus. Go to your annual annual physicals.
Be friendly with your doctors. They are encyclopedias of information, but when you do go, bring your questions written down so you have the time of day to ask them. Once you're in that room, the appointments go quick. We all know that.
But if you have those questions with you, your doctors will answer them, and that's the best way to go to any doctor's appointment in the future.
Thank you. Some great information today. Well I hope that our participants were able to take a few things from today's Health Chat. I want to thank everyone for taking time out during their day to join us and I especially want to thank our two experts Doctor Lazarous and Julian thank you for taking some time out of your day to share all of this new and important information with our community today.
Thank you so Thank you for having us.
And then let me skip here. So for our participants today, if you are interested in any of our other wellness classes and future health chats, we have them on our AdventistHealthCare.com website and click on Classes and Events for all of our latest information.
We'll send a follow-up email with links to those classes where you can find more information about Doctor Lazarous and our Cardiac Rehabilitation Program if you are interested.
And we will make this recording available on our blog so you can access it And I believe that is it. Again, thank you to our participants for joining. Thank you to our experts. And we really appreciate all the wonderful information you've provided today. I hope everyone has a great rest of the day. Thank you. Thank you.
