Your heart and vascular health is important to us. That’s why it is so important to know and understand your risk of heart disease. Some of them may even be risks you are unaware of.
At Bryan Heart, we offer many free and low-cost screenings to you and our communities.
Joining the show, for your peace of mind, and to share great advice on hidden risk factors you may not even know are contributing to heart disease, is Dr. Keith Miller. He is a cardiologist with Bryan Heart.
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You Feel Fine, But Are You at Risk For Heart Disease?
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Learn more about Dr. Keith Miller
Keith Miller, MD, Bryan Heart
Dr. Keith Miller is a cardiologist with Bryan Heart.Learn more about Dr. Keith Miller
Transcription:
You Feel Fine, But Are You at Risk For Heart Disease?
Melanie Cole (Host): There are well known risk factors for heart disease such as high blood pressure, diabetes, being overweight and family history. But some little-known risk factors can also threaten your heart and you may not even be aware of them. My guest today is Dr. Keith Miller. He’s a cardiologist with Bryan Heart. Welcome to the show Dr. Miller. So, who is at risk for heart disease? Is it fair to say there’s a lot of hidden risk out there, people are not necessarily aware of?
Dr. Keith Miller, MD (Guest): Yeah, good morning Melanie. And I really appreciate the chance to talk about this topic which is something that I’m really very much interested in and spend a lot of time talking to patients about every day. And you are absolutely right. There is a lot of hidden risk out there,that people may not be aware of and even without thinking beyond the well-known risk factors like high blood pressure, and high cholesterol that you talked about; there’s a lot of risk that people aren’t aware of but there are some other things beyond that like depression or other things like that that might be important as well.
So, if you think about it, when I think about risk, first of all as you said, there is a lot of risk that is not hidden, it’s very apparent to us. The people that are at highest risk are people that have things like diabetes, people that have already had a heart problem, maybe they have had a stent, or they have had a heart attack in the past; they are important targets of our risk reduction strategies because we know they are already at risk and then there are people that have very high levels of bad cholesterol which of course you wouldn’t know unless you had it checked. So, it’s very important to check those things but beyond those people that are very obvious to everyone; there are people that may have hidden risk and we can often discover that with really very little additional effort.
They are the people that don’t have a history of cardiovascular disease. They don’t have diabetes. And I think an important point to remember is that based on the most recent guidelines on managing risk; almost half of US adults have enough risk of a heart attack or a stroke to warrant some kind of preventive therapy which may include lifestyle, but it may also include cholesterol lowering drugs or possibly blood pressure lowering drugs and that amounts to over 56 million US adults out of 115 million adults; it’s almost half of people that have enough risk to warrant some kind of treatment, potentially with cholesterol lowering drugs for example and so if you look at different age groups about 30% of younger adults have a high enough risk to be treated with something. And more than three quarters of older adults over 60 – 60-75 years have enough risk to warrant some kind of treatment.
You have to keep in mind that cardiovascular disease, we have made a lot of progress in treating and preventing this but it’s still the single leading cause of death in the United States accounting for about a quarter of all deaths and shortly followed after that by cancer and then there’s a big drop to the third cause of death which is lung disease at about 6% and I think also very important to note is that more than a half of the cardiovascular disease related deaths occur in people that were traditionally thought of as having relatively low risk.
Melanie: So, if somebody doesn’t have diabetes or they don’t smoke, they don’t have some of the well-known risk factors; are they still at risk and then in which case if they don’t have high blood pressure or high cholesterol; how would they know?
Dr. Miller: Yeah. That’s a great question. And a lot of it seems really abstract but it’s not because these things are knowable to some degree and we can never predict perfectly. But we can do a lot to try and understand that and really the starting point for trying to understand a person’s risk of having a heart attack or stroke is to use something called the heart risk calculator that’s part of the guidelines on the assessment of cardiovascular risk that were published in 2013 by the American College of Cardiology and the American Heart Association. And we use these guidelines every day. I use them in clinic every day and I go through this kind of a calculation with my patients.
We use it to guide the assessment of people’s risk and make recommendations about risk reduction strategies like making better lifestyle changes and treatment for high cholesterol, high blood pressure and obesity and if you know your cholesterol numbers and your blood pressure, you can do your own calculation by going to a website called cvriskcalculator.com or there’s an excellent tool that you can find on our website at bryanheart.com and you can plug in your own numbers and what this does is it gives you an estimate of your ten year risk of having a heart attack or stroke and it might be helpful just to give a couple of examples because people might be surprised at their risk like for example, and I just plugged these numbers in last night. If you are a 55-year-old male with pretty average cholesterol numbers and normal blood pressure; that person has a 5% risk of having a heart attack or stroke in the next ten years. If that same person was 60 years old with same numbers; that person has about a 7.7% risk. And those numbers may not sound that high, but both of those men would have a high enough risk that it may warrant at least a discussion about certainly good lifestyle changes and even cholesterol lowering therapy. And that’s just a 55 or a 60-year-old man with fairly normal blood pressures and cholesterols.
Now if you take somebody who is a little different let’s say they have high blood pressure as defined by the new blood pressure guidelines, a blood pressure of say 135/85 at 55-years-old, that person jumps up to 6% risk and if their cholesterol isn’t so hot that gets them over 10% risk and that actually – that risk really starts to accumulate. So, if you look at the current guidelines, based on that standard recommendations; anyone with a ten-year risk of over 7.5% benefits from risk lowering strategies like being on a statin cholesterol lowering drug and even in people with a risk of 5-7.5% risk in ten years; it’s really worth a discussion at least with your doctor about whether you want to take a statin drug and certainly working on diet and other things like exercise to try and reduce your risk.
Melanie: So, Dr. Miller, when people hear about these hidden things that they are not quite really aware of; people hear well about stress and depression and even sleep apnea has been in the media lately. So, speak about these things and how do we know if they are affecting us or not?
Dr. Miller: Yeah, those are difficult topics because there has been talk about the relationship between things like emotional stress and psychological stress and heart disease for years and there is no question that people who have depression and people who are under a lot of psychological stress do seem to have a higher risk of having heart problems and, so we certainly encourage people to try and manage those things and try and use stress management tools to try and reduce their risk.
Sleep apnea is a very interesting topic because really, I think in the last ten or fifteen years we have just become a lot more aware of the importance of sleep apnea in patients with cardiac disease and patients at risk of having cardiac disease and just briefly, sleep apnea is a condition that we see typically in people who snore. Most of those people are overweight and what happens is that periodically during sleep, people with sleep apnea start to obstruct their upper airway, so they don’t exchange air in and out of their lungs and they literally stop breathing for brief periods frequently during the night and as they do that; their oxygen drops and pretty quickly their brain figures out we are not breathing anymore here, and it wakes you up. Not so much that you might recognize it, but enough to disrupt your sleep. And this cycle can go on multiple times an hour throughout the night and it can make you not get restful sleep. You can be in bed 10 hours but with sleep apnea; you may not be getting any good quality sleep. So, the people that want to think about maybe getting a screening for sleep apnea are the people who are typically a little overweight, they snore, maybe a spouse or a partner has seen them stop breathing while they are asleep.
But the real hallmark is they are just tired, and they are miserable, and they wake up in the morning after being in bed all night and they still don’t feel like they have gotten a good night’s sleep. They may fall asleep with little provocation during the day, stopping at a stop light in their car if they have a few moments, they might doze off during that. After a meal in the afternoon, they might get very tired and those are the people that might want to talk to their doctor about getting screened. But that’s also sleep apnea is an important risk factor for heart disease. So, it is an important way to kind of highlight people that might be at risk and then we typically in those people take a look at some of their other risk factors too like their blood pressure and their cholesterol and help them develop a strategy to try and reduce their risk. And one thing I tell a lot of people that maybe are middle aged people who have gained some weight and have recently been diagnosed with sleep apnea. Usually that is treated with a mask that you wear on your face overnight to try and help relieve the obstruction. But a lot of those people can actually cure or at least improve their circumstances just by losing weight.
Melanie: Well it is such important information Dr. Miller. So, in summary, what’s your best recommendation for people listening for how to understand and manage the risk and even some of those hidden risk factors?
Dr. Miller: Yeah, I think the first thing is just to pay attention to it and don’t ignore the potential for risk. Even if you are in your 40s, it’s the perfect time to start thinking about these risk factors. Because again, a lot of the heart attacks that happen, happen in people that we have traditionally thought of as being at low risk and it’s not too early to think about that risk. So, do something to try to identify your risk, get on one of those websites, get on Bryan Heart, take our survey about what your risk might be, go to your doctor, talk about your risk factors and develop a plan.
Because these things are very manageable and by and large the vast majority of the risk is modifiable, and it is within your control. We love to talk about the risk of my family history and my genetics and those things aren’t within our control. But the vast majority of the risk can be changed and can be improved. So, just get in, talk to somebody and develop a plan. And it’s the new year, a lot of people are kind of having a thought in their mind about maybe it’s a good time to lose some weight, maybe it’s a good time to work on my diet. But in combination with that; sit down and get together with your doctor. Do one of these risk assessment tools, figure out what your risk is because you might want to have a discussion about in addition to exercise and diet, maybe taking a statin drug or maybe with the new definition of high blood pressure coming out recently; you might even have high blood pressure and you may need a medication for that. So, just develop a plan.
Melanie: Thank you so much and if you are concerned about your heart health, take our free quick and confidential heart aware online screening at www.bryanhealth.org/heartaware . That’s www.bryanhealth.org/heartaware . This is Bryan Health podcast. I’m Melanie Cole. Thanks so much for listening.
You Feel Fine, But Are You at Risk For Heart Disease?
Melanie Cole (Host): There are well known risk factors for heart disease such as high blood pressure, diabetes, being overweight and family history. But some little-known risk factors can also threaten your heart and you may not even be aware of them. My guest today is Dr. Keith Miller. He’s a cardiologist with Bryan Heart. Welcome to the show Dr. Miller. So, who is at risk for heart disease? Is it fair to say there’s a lot of hidden risk out there, people are not necessarily aware of?
Dr. Keith Miller, MD (Guest): Yeah, good morning Melanie. And I really appreciate the chance to talk about this topic which is something that I’m really very much interested in and spend a lot of time talking to patients about every day. And you are absolutely right. There is a lot of hidden risk out there,that people may not be aware of and even without thinking beyond the well-known risk factors like high blood pressure, and high cholesterol that you talked about; there’s a lot of risk that people aren’t aware of but there are some other things beyond that like depression or other things like that that might be important as well.
So, if you think about it, when I think about risk, first of all as you said, there is a lot of risk that is not hidden, it’s very apparent to us. The people that are at highest risk are people that have things like diabetes, people that have already had a heart problem, maybe they have had a stent, or they have had a heart attack in the past; they are important targets of our risk reduction strategies because we know they are already at risk and then there are people that have very high levels of bad cholesterol which of course you wouldn’t know unless you had it checked. So, it’s very important to check those things but beyond those people that are very obvious to everyone; there are people that may have hidden risk and we can often discover that with really very little additional effort.
They are the people that don’t have a history of cardiovascular disease. They don’t have diabetes. And I think an important point to remember is that based on the most recent guidelines on managing risk; almost half of US adults have enough risk of a heart attack or a stroke to warrant some kind of preventive therapy which may include lifestyle, but it may also include cholesterol lowering drugs or possibly blood pressure lowering drugs and that amounts to over 56 million US adults out of 115 million adults; it’s almost half of people that have enough risk to warrant some kind of treatment, potentially with cholesterol lowering drugs for example and so if you look at different age groups about 30% of younger adults have a high enough risk to be treated with something. And more than three quarters of older adults over 60 – 60-75 years have enough risk to warrant some kind of treatment.
You have to keep in mind that cardiovascular disease, we have made a lot of progress in treating and preventing this but it’s still the single leading cause of death in the United States accounting for about a quarter of all deaths and shortly followed after that by cancer and then there’s a big drop to the third cause of death which is lung disease at about 6% and I think also very important to note is that more than a half of the cardiovascular disease related deaths occur in people that were traditionally thought of as having relatively low risk.
Melanie: So, if somebody doesn’t have diabetes or they don’t smoke, they don’t have some of the well-known risk factors; are they still at risk and then in which case if they don’t have high blood pressure or high cholesterol; how would they know?
Dr. Miller: Yeah. That’s a great question. And a lot of it seems really abstract but it’s not because these things are knowable to some degree and we can never predict perfectly. But we can do a lot to try and understand that and really the starting point for trying to understand a person’s risk of having a heart attack or stroke is to use something called the heart risk calculator that’s part of the guidelines on the assessment of cardiovascular risk that were published in 2013 by the American College of Cardiology and the American Heart Association. And we use these guidelines every day. I use them in clinic every day and I go through this kind of a calculation with my patients.
We use it to guide the assessment of people’s risk and make recommendations about risk reduction strategies like making better lifestyle changes and treatment for high cholesterol, high blood pressure and obesity and if you know your cholesterol numbers and your blood pressure, you can do your own calculation by going to a website called cvriskcalculator.com or there’s an excellent tool that you can find on our website at bryanheart.com and you can plug in your own numbers and what this does is it gives you an estimate of your ten year risk of having a heart attack or stroke and it might be helpful just to give a couple of examples because people might be surprised at their risk like for example, and I just plugged these numbers in last night. If you are a 55-year-old male with pretty average cholesterol numbers and normal blood pressure; that person has a 5% risk of having a heart attack or stroke in the next ten years. If that same person was 60 years old with same numbers; that person has about a 7.7% risk. And those numbers may not sound that high, but both of those men would have a high enough risk that it may warrant at least a discussion about certainly good lifestyle changes and even cholesterol lowering therapy. And that’s just a 55 or a 60-year-old man with fairly normal blood pressures and cholesterols.
Now if you take somebody who is a little different let’s say they have high blood pressure as defined by the new blood pressure guidelines, a blood pressure of say 135/85 at 55-years-old, that person jumps up to 6% risk and if their cholesterol isn’t so hot that gets them over 10% risk and that actually – that risk really starts to accumulate. So, if you look at the current guidelines, based on that standard recommendations; anyone with a ten-year risk of over 7.5% benefits from risk lowering strategies like being on a statin cholesterol lowering drug and even in people with a risk of 5-7.5% risk in ten years; it’s really worth a discussion at least with your doctor about whether you want to take a statin drug and certainly working on diet and other things like exercise to try and reduce your risk.
Melanie: So, Dr. Miller, when people hear about these hidden things that they are not quite really aware of; people hear well about stress and depression and even sleep apnea has been in the media lately. So, speak about these things and how do we know if they are affecting us or not?
Dr. Miller: Yeah, those are difficult topics because there has been talk about the relationship between things like emotional stress and psychological stress and heart disease for years and there is no question that people who have depression and people who are under a lot of psychological stress do seem to have a higher risk of having heart problems and, so we certainly encourage people to try and manage those things and try and use stress management tools to try and reduce their risk.
Sleep apnea is a very interesting topic because really, I think in the last ten or fifteen years we have just become a lot more aware of the importance of sleep apnea in patients with cardiac disease and patients at risk of having cardiac disease and just briefly, sleep apnea is a condition that we see typically in people who snore. Most of those people are overweight and what happens is that periodically during sleep, people with sleep apnea start to obstruct their upper airway, so they don’t exchange air in and out of their lungs and they literally stop breathing for brief periods frequently during the night and as they do that; their oxygen drops and pretty quickly their brain figures out we are not breathing anymore here, and it wakes you up. Not so much that you might recognize it, but enough to disrupt your sleep. And this cycle can go on multiple times an hour throughout the night and it can make you not get restful sleep. You can be in bed 10 hours but with sleep apnea; you may not be getting any good quality sleep. So, the people that want to think about maybe getting a screening for sleep apnea are the people who are typically a little overweight, they snore, maybe a spouse or a partner has seen them stop breathing while they are asleep.
But the real hallmark is they are just tired, and they are miserable, and they wake up in the morning after being in bed all night and they still don’t feel like they have gotten a good night’s sleep. They may fall asleep with little provocation during the day, stopping at a stop light in their car if they have a few moments, they might doze off during that. After a meal in the afternoon, they might get very tired and those are the people that might want to talk to their doctor about getting screened. But that’s also sleep apnea is an important risk factor for heart disease. So, it is an important way to kind of highlight people that might be at risk and then we typically in those people take a look at some of their other risk factors too like their blood pressure and their cholesterol and help them develop a strategy to try and reduce their risk. And one thing I tell a lot of people that maybe are middle aged people who have gained some weight and have recently been diagnosed with sleep apnea. Usually that is treated with a mask that you wear on your face overnight to try and help relieve the obstruction. But a lot of those people can actually cure or at least improve their circumstances just by losing weight.
Melanie: Well it is such important information Dr. Miller. So, in summary, what’s your best recommendation for people listening for how to understand and manage the risk and even some of those hidden risk factors?
Dr. Miller: Yeah, I think the first thing is just to pay attention to it and don’t ignore the potential for risk. Even if you are in your 40s, it’s the perfect time to start thinking about these risk factors. Because again, a lot of the heart attacks that happen, happen in people that we have traditionally thought of as being at low risk and it’s not too early to think about that risk. So, do something to try to identify your risk, get on one of those websites, get on Bryan Heart, take our survey about what your risk might be, go to your doctor, talk about your risk factors and develop a plan.
Because these things are very manageable and by and large the vast majority of the risk is modifiable, and it is within your control. We love to talk about the risk of my family history and my genetics and those things aren’t within our control. But the vast majority of the risk can be changed and can be improved. So, just get in, talk to somebody and develop a plan. And it’s the new year, a lot of people are kind of having a thought in their mind about maybe it’s a good time to lose some weight, maybe it’s a good time to work on my diet. But in combination with that; sit down and get together with your doctor. Do one of these risk assessment tools, figure out what your risk is because you might want to have a discussion about in addition to exercise and diet, maybe taking a statin drug or maybe with the new definition of high blood pressure coming out recently; you might even have high blood pressure and you may need a medication for that. So, just develop a plan.
Melanie: Thank you so much and if you are concerned about your heart health, take our free quick and confidential heart aware online screening at www.bryanhealth.org/heartaware . That’s www.bryanhealth.org/heartaware . This is Bryan Health podcast. I’m Melanie Cole. Thanks so much for listening.