Transcription:
Keeping Your Heart Healthy: Lifestyles, Medications & Treatments

Melanie:  Welcome to Bryan Health Podcast. I'm Melanie Cole. And today, I invite you to listen as we discuss clogged arteries. Joining me is Dr. Zach Singsank. He's an interventional cardiologist with Bryan Health. Dr. Singsank, it's a pleasure to have you with us today. Tell us a little bit about the prevalence of clogged arteries and do we know what causes them?

DR. Singsank: The prevalence in the US happens more as people get older. Like most cardiovascular diseases, it's a process of aging and a culmination of risks. And that's what I think you're referring to is how does this happen. Generally, clogged arteries, which is called atherosclerosis happens because inflammation happens to the blood vessels and ultimately plaque builds up in the arteries.

At first, it  grows around the arteries and then can  expand inward to block blood flow in the heart arteries. That inflammation and then subsequent plaque build up happens from a lot of risk. Like I mentioned, age, diabetes, smoking, inactivity, genetics, high blood pressure, high cholesterol, poor dieting, among many other reasons, a lot of which we don't really have well-defined.

There's still a lot of unknowns, but generally the thousand-foot view of it is just any unhealthy lifestyle, unhealthy and sedentary lifestyle would contribute a lot to that.

Melanie: Thank you for that. So tell us a little bit about complications, the risk of stroke or heart attack if you have atherosclerosis and which arteries tend to get clogged more often.

DR. Singsank: So the more risk factors you have, the higher degree of plaque buildup you have, the risk of heart attack and stroke goes up. And generally, if you have atherosclerosis in one artery, you can have it in any, so you can have it in your heart and your neck, your brain, your leg arteries. And the arteries that tend to get clogged most often is really just patient specific. There is no predictor and we don't look at all arteries all the time. Generally, if somebody has symptoms of a stroke, then you find confined clogged neck or brain arteries. If somebody has symptoms of clogged heart arteries, you do testing and then find that. There's not a ton of routine testing that people do to look for which arteries might be clogged more than the others. And there really isn't one artery that specifically is worse than the other.

Melanie: Then Dr. Singsank, how do we know? Are there symptoms of atherosclerosis before they cause those complications? How do you diagnose them if somebody is not experiencing symptoms? How do we know?

DR. Singsank: If somebody has significant risk factors for having coronary artery disease, we can do a calcium score and that's a pretty inexpensive and low-risk procedure where you just have essentially a CT scan, which is a higher degree of an x-ray and takes a picture of your heart to see if you have any hardening your arteries that would suggest that you have atherosclerosis and people can do that and see if they have any plaque buildup and try to work on ways to limit more plaque building up or from heart attacks or strokes happening. Generally, that's lifestyle and medications, which we could definitely talk about. But if somebody were having symptoms of chest pain on a recurrent basis or very sudden severe chest pain, those are often signs of either a major blockage or a heart attack happening. And then we could do different tests like stress test, blood test, EKG. It just depends on how they're presenting.

Melanie: Before we talk about treatment options, doctor, if someone does find out that they have atherosclerosis or the beginnings of it, where does exercise, diet, where do these things fit into the picture? What's your first line of defense for partially clogged arteries?

DR. Singsank: So the lifestyle changes as we call it, wouldn't be the most important. That's the dieting and exercise. Keeping your weight down. Generally, exercise, we say at least 30 minutes, five days a week would be a good start of aerobic exercise. I don't tend to and then guidelines really don't either have any specific heart rates or any specific exercise modalities.

The biggest benefit is people that don't exercise going to starting exercise, whether you do a mild amount, a moderate amount or extreme amount of exercising, like triathlons, it doesn't matter. The point is you have to do some physical activity to lower your risk of having heart disease or from your heart disease progressing.

And then additionally diet is very important. Unfortunately, the vast majority of Americans probably eat an unhealthy diet. Processed foods, high fat, salt are real toxic and create a lot of that inflammation in your blood vessels. High fructose corn syrup, carbohydrates are like that as well.

Generally, what I tell people is the more plant base you can eat while still enjoying things like a cheeseburger now and then, pizza now and then. You still have to enjoy life. But on your average, you should eat less, avoid carbohydrates and move more.

Melanie: That's certainly is great advice. As an exercise physiologist, I concur completely. Now, if someone has tried these lifestyle modifications, what are the first line medications that you might use to help clear the way a little if these things are not having an effect?

DR. Singsank: Just to be clear, the lifestyle changes and the medications don't generally clear up the arteries. Once the disease starts, the idea is to prevent it from having complications such as a heart attack or stroke or symptoms, or from the disease getting worse. The first thing we talk about would be lifestyle changes.

And the second thing is statin therapy and a lot of statins get a lot of bad press, because people get muscle aches and pains with them, but nothing really dramatically reduces the inflammation of blood vessels like a statin does. Even people that have coronary artery disease, but have normal cholesterol levels, which a statin normally is being used to lower cholesterol. If you have atherosclerosis, you still want to be on a statin, even if you have good cholesterol, because it also reduces the inflammation in your blood vessels. It really lowers your chances of heart attacks and strokes. In addition to that, you want to screen for diabetes. You want to screen for high blood pressure. You want to have people not smoke. Any of the other risk factors for developing it, you want to screen for and treat if needed.

Melanie: Well, that's certainly an important point. Now, if it becomes interventional, tell us a little bit about a stent. What's it used for? What is it and what point does someone need one?

DR. Singsank: There's a bunch of different reasons, but in general, you need a stent if it's going to help you. You shouldn't get a stent just because somebody sees a blockage and feels they can put a stent in there. That's  an old school and unfortunate way that some people practice.

There's two main scenarios. Either you're having symptoms that are stable, meaning they're not getting worse, but they just happen on a regular basis that we can't control with medications. Or you're having a heart attack. Those are two different things. So a heart attack is a pretty pronounced event and you have a lot of benefit of getting an artery open with a stent, and you put a stent in there for a heart attack, because it reduces your chances of dying, having more heart attacks and having subsequent symptoms or more procedures needed to treat that blood vessel.

Whereas if you have stable symptoms, stents don't do that. As compared to medicines, stents are just as good at reducing death and heart attacks. That's a really one of the most common misconceptions people have about stents, that, "Oh, hey. I have a blockage. It's causing me symptoms. We found it on a stress test. They did an angiogram. And I see I have a blockage." Putting a stent in there is not going to save your life. It's not going to make you live longer and it's not going to prevent a heart attack. And everybody thinks a blockage is going to lead to a heart attack, but that's not true. Medications and stents have the same ability to reduce death and heart attacks. The big difference is if the medicines don't help you, stents will lessen your symptoms.

Melanie: Wow. That's quite something to say and so important for listeners to hear. So tell us when you would use it and is it a permanent fixture? Tell us a little bit about the procedure itself.

DR. Singsank: So you would do a heart catheterization or coronary angiogram as it's called where you would go up to the heart with catheters and inject dye into the heart artery so you can see what the arteries look like and where a blockage may or may not be. If you're already at that point where you're having an angiogram, generally, the idea would be that if you see something, you would be there to fix it as well.

So say you've had chest pain for a couple months and your medications aren't really getting rid of your chest pain and it's affecting your life, well we would go do this coronary angiogram. And if I would see a blockage, we could fix it with putting a stent in or stents. Sometimes we find that people have so many blockages that it's too much for stents to be done and we would have them discuss with a heart surgeon about doing a bypass surgery, that's open-heart surgery. Once you have a stent in, it's a permanent thing. There are some stents that have the ability to dissolve, but studies haven't been very good on the outcomes of those. So in general, stents are metal tubes that provide a scaffolding for the heart artery. The heart artery is just a tube that supplies blood to your heart muscle. And the stent provides the scaffolding. It's a metal stent generally with some drug on it to prevent any scarring on the stent. And it stays in there forever. You have to be on blood thinners for six to 12 months after having a stent placed. And then you're usually on aspirin for the rest of your life because stents are not supposed to be in your body and your body tries to fight it by forming clot on it. So blood thinners will help protect that.

Melanie: That was an excellent explanation. Doctor, tell us about some natural ways. We've talked about diet and exercise, but natural ways to help reduce plaque buildup. There's a lot of myths floating around about routine fasting. Does that help to reduce that plaque buildup? How about things like garlic, apple cider vinegar, lemon juice, honey? There are all kinds of things today that are touted. Do any of these work?

DR. Singsank: None that have been proven and it's easy to just blanket say that, but it's true. The only thing that's been shown to have any regression of plaque. So once you already have plaque, it's there. There's no clearing it out. It's not like you drink some apple cider vinegar and your arteries are going to become clean. That's not how it works. Once the plaque builds up, it generally does not go away. Some studies have shown that if you take a statin, there is some regression in the plaque, but it in general doesn't go away. It just gets a smaller volume of plaque in your arteries, but no natural remedy will get rid of plaque.

The idea is once you have plaque or you don't want it to form at all, living a healthy lifestyle, like we talked about earlier is the best thing you can do. I see a lot of people that are worried because they have brothers, sisters, aunts, and uncles, everybody that had heart attacks. If you don't want to have a heart attack and you otherwise aren't having any symptoms, the only thing you need to do is live a healthy lifestyle and talk to your cardiologist or primary care provider about checking your cholesterol or screening for diabetes, or maybe having one of those coronary artery calcium scores. There's no real natural remedy or natural replacement to living healthy.

Melanie: That's great advice and an excellent place for us to end. Thank you so much, doctor, for joining us today and sharing your incredible expertise explaining atherosclerosis to us. That concludes this episode of Bryan Health Podcast. You can visit our website at BryanHealth.org for more information and to get connected with one of our providers.

Please also remember to subscribe, rate and review this podcast and all the other Bryan Health Podcasts. Be sure to share this show with your friends and family on social media, because that's how we are learning from the experts at Bryan Health together. And this show gave you a lot of good educational, informative information. I'm Melanie Cole.