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Heart Disease: Know Your Numbers and Risk Factors
Dr. Carlos Velasco discusses heart disease and why it's important to know your numbers.
Featured Speaker:
Carlos Velasco, MD
Carlos Velasco, MD, FACC, is an interventional cardiologist on the medical staff at Baylor Scott & White Heart and Vascular Hospital Dallas and Baylor University Medical Center. A long time medical leader for cardiovascular services, Dr. Velasco is currently the medical director for cardiology quality assurance and is also Vice Chair, Internal Review Board for Human Research Studies, Baylor Scott & White Health, Core Faculty, Baylor University Medical Center, Clinical Professor of Medicine, Texas A&M College of Medicine. Transcription:
Heart Disease: Know Your Numbers and Risk Factors
Alyne Ellis (Host): When it comes to your heart health, what do you need to know? And if heart disease is suspected, what tests will help you and your doctor know more? Today for HeartSpeak, we’re talking with interventional cardiologist Dr. Carlos Velasco. He’s on the medical staff at Baylor Scott & White Heart and Vascular hospital Dallas and Baylor University Medical Center. I’m Alyne Ellis. And thanks Dr. Velasco for joining us today.
Carlos Velasco, MD, FACC (Guest): You’re welcome. Thank you.
Host: So, let’s start with the most important numbers that we need to know about our heart health and that’s our blood pressure numbers.
Dr. Velasco: The importance of the numbers is to try to obtain self-control of our health. And the first number is a blood pressure which should be 120/80 or lower, while at rest when taken outside of the doctor’s office.
Host: And what happens if that goes up? Obviously, medication is probably the most advisable thing?
Dr. Velasco: Well, not necessarily. To begin with, we need to define if that hypertension is real in which case several determinations will have to be made. More and more we trust determinations made outside of the doctor’s office as to eliminate stress as part of the abnormality in the blood pressure. But once the blood pressure is deemed to be abnormal, meaning above 130/80; for sure then we start with the simple measures like low salt diet, and weightloss.
Host: Now what about our cholesterol levels? What should those be?
Dr. Velasco: Cholesterol levels that is a bit more complex. The total cholesterol has to be less than 200 milligrams. The good cholesterol which is HDL should be above 40 milligrams for a man or 50 milligrams for a lady. The bad cholesterol, which is the LDL, that depends on several factors. And in general, the lower the better.
Host: And what about body mass index? That seems like something we should pay attention to.
Dr. Velasco: Definitely. Because that has a lot of interaction with the blood pressure. Body mass index is defined as our weight divided by height and that can be easily calculated at home getting on the internet. The American Heart Association has a beautiful table for that. But body mass index should be below 25 kilograms per meter squared, below 25. The lower limit of normal is about 19.
Host: Now when it comes to BMI, how is that different from how heavy we should be? Should we be watching our weight at the same time or would the body mass index give us enough information?
Dr. Velasco: Well the body mass index has to do with weight. In other words, it’s one of the key factors for defining if our weight is normal or abnormal. A BMI less than 25 is ideal. Between 25 to 29 we are talking about somebody who is overweight and 30 or higher is considered obesity.
Host: And how do we check our BMI?
Dr. Velasco: The body mass index is obtained by getting our weight divided by our height. And there are tables to run that. You can get in the internet and calculating based on the tables of the American Heart Association or the National Institutes of Health. It’s very easy to obtain. Upper limit of normal is 25 kilograms per meter squared.
Host: And then finally, what about our blood sugar levels? That’s something to check too.
Dr. Velasco: Yes. And the fasting blood sugar should be less than 100 milligrams per deciliter. And that is somebody who has been fasting for at least eight hours.
Host: So, when we have all of this checked out and depending on the findings; what types of diagnostic tests do you need if heart disease is suspected?
Dr. Velasco: Well, if there is a suspicion of heart disease, it depends on the age of the patient, the level of suspicion or concern about how this is. The easiest test that we have besides the electrocardiogram is to run a stress test. If you look at how most people end up having heart disease, it will be because of cholesterol build up in the arteries of the heart. And that impairs the blood flow and probably the easiest way to demonstrate that is obtaining a stress test. There are more involved ways to evaluate the patient, but we usually start with the stress test.
Host: And then sometimes you move on to a calcium screening for example?
Dr. Velasco: Well there are some groups of patients where it’s very important to define the presence of disease, but they have a good looking stress test, but we are still concerned about the possibility of having coronary artery disease and in those patients, we obtain a coronary calcium score. That is based on the fact that they only way to have calcium in the arteries of the heart is by having the deposits of cholesterol in the arteries.
Host: What about the cardiac MRI? Is that a test that you would normally have for a heart problem?
Dr. Velasco: It’s a test that is becoming, it has become a very important tool in the armamentarium to diagnose some cardiac problems. It offers an excellent help for example on patients who are having inflammation of the heart what is called myocarditis. It’s also important in the evaluation of some complex valvular problems. It’s wonderful for congenital heart disease. Then there are many areas of cardiology that are becoming – where the MRI is becoming a great tool and we consider it a part of the armamentarium for the diagnosis on our patients.
Host: Now what about if you are diabetic, does that up your risk for a heart problem?
Dr. Velasco: Definitely. For practical purposes, to have diabetes is considered like a heart disease equivalent. If you have diabetes, you should also be considered to be having heart disease until proven otherwise.
Host: And the American Heart Association seems to indicate that cardiovascular related deaths are higher for US Hispanics than they are for the general population. Do you have some comments on that?
Dr. Velasco: Yes, definitely that is a significant concern and that seems to be tied to significant incidence of diabetes and also tied to a population where overweight is prevalent.
Host: And finally, what about family history? How does that impact us?
Dr. Velasco: Well family history is very important because genetics play a key role on the development of heart disease mainly coronary artery disease. And there are some factors in the family history that are more important and will have a more direct impact than others. And that can be defined by obtaining the family history meaning when did the father have the first heart attack, when the first manifestation of disease happening in the family and go from there.
Host: Is there anything else you’d like to add to let us know how to protect ourselves?
Dr. Velasco: Well, it’s key to take more control of our health. If we look at how people die in our country, more than 50% died of vascular disease meaning heart attacks or strokes. Then it’s very important for us to be part of the health process. And exercise is a key factor in all of that.
Host: Thank you Dr. Velasco for joining us today. That’s Dr. Carlos Velasco, Interventional Cardiologist on the medical staff at Baylor Scott & White Heart and Vascular Hospital Dallas. I’m Alyne Ellis. Thanks for checking out this episode of HeartSpeak. To find a specialist at Baylor Scott & White Heart and Vascular Hospital in Dallas or Fort Worth, please call 1-844-279-3627 or visit www.baylorhearthospital.com. For Spanish language, please call 1-844-279-3627 to find a specialist who speaks Spanish. Advisers who speak Spanish are available. If you found this podcast helpful, please share it on your social media channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll talk next time.
Heart Disease: Know Your Numbers and Risk Factors
Alyne Ellis (Host): When it comes to your heart health, what do you need to know? And if heart disease is suspected, what tests will help you and your doctor know more? Today for HeartSpeak, we’re talking with interventional cardiologist Dr. Carlos Velasco. He’s on the medical staff at Baylor Scott & White Heart and Vascular hospital Dallas and Baylor University Medical Center. I’m Alyne Ellis. And thanks Dr. Velasco for joining us today.
Carlos Velasco, MD, FACC (Guest): You’re welcome. Thank you.
Host: So, let’s start with the most important numbers that we need to know about our heart health and that’s our blood pressure numbers.
Dr. Velasco: The importance of the numbers is to try to obtain self-control of our health. And the first number is a blood pressure which should be 120/80 or lower, while at rest when taken outside of the doctor’s office.
Host: And what happens if that goes up? Obviously, medication is probably the most advisable thing?
Dr. Velasco: Well, not necessarily. To begin with, we need to define if that hypertension is real in which case several determinations will have to be made. More and more we trust determinations made outside of the doctor’s office as to eliminate stress as part of the abnormality in the blood pressure. But once the blood pressure is deemed to be abnormal, meaning above 130/80; for sure then we start with the simple measures like low salt diet, and weightloss.
Host: Now what about our cholesterol levels? What should those be?
Dr. Velasco: Cholesterol levels that is a bit more complex. The total cholesterol has to be less than 200 milligrams. The good cholesterol which is HDL should be above 40 milligrams for a man or 50 milligrams for a lady. The bad cholesterol, which is the LDL, that depends on several factors. And in general, the lower the better.
Host: And what about body mass index? That seems like something we should pay attention to.
Dr. Velasco: Definitely. Because that has a lot of interaction with the blood pressure. Body mass index is defined as our weight divided by height and that can be easily calculated at home getting on the internet. The American Heart Association has a beautiful table for that. But body mass index should be below 25 kilograms per meter squared, below 25. The lower limit of normal is about 19.
Host: Now when it comes to BMI, how is that different from how heavy we should be? Should we be watching our weight at the same time or would the body mass index give us enough information?
Dr. Velasco: Well the body mass index has to do with weight. In other words, it’s one of the key factors for defining if our weight is normal or abnormal. A BMI less than 25 is ideal. Between 25 to 29 we are talking about somebody who is overweight and 30 or higher is considered obesity.
Host: And how do we check our BMI?
Dr. Velasco: The body mass index is obtained by getting our weight divided by our height. And there are tables to run that. You can get in the internet and calculating based on the tables of the American Heart Association or the National Institutes of Health. It’s very easy to obtain. Upper limit of normal is 25 kilograms per meter squared.
Host: And then finally, what about our blood sugar levels? That’s something to check too.
Dr. Velasco: Yes. And the fasting blood sugar should be less than 100 milligrams per deciliter. And that is somebody who has been fasting for at least eight hours.
Host: So, when we have all of this checked out and depending on the findings; what types of diagnostic tests do you need if heart disease is suspected?
Dr. Velasco: Well, if there is a suspicion of heart disease, it depends on the age of the patient, the level of suspicion or concern about how this is. The easiest test that we have besides the electrocardiogram is to run a stress test. If you look at how most people end up having heart disease, it will be because of cholesterol build up in the arteries of the heart. And that impairs the blood flow and probably the easiest way to demonstrate that is obtaining a stress test. There are more involved ways to evaluate the patient, but we usually start with the stress test.
Host: And then sometimes you move on to a calcium screening for example?
Dr. Velasco: Well there are some groups of patients where it’s very important to define the presence of disease, but they have a good looking stress test, but we are still concerned about the possibility of having coronary artery disease and in those patients, we obtain a coronary calcium score. That is based on the fact that they only way to have calcium in the arteries of the heart is by having the deposits of cholesterol in the arteries.
Host: What about the cardiac MRI? Is that a test that you would normally have for a heart problem?
Dr. Velasco: It’s a test that is becoming, it has become a very important tool in the armamentarium to diagnose some cardiac problems. It offers an excellent help for example on patients who are having inflammation of the heart what is called myocarditis. It’s also important in the evaluation of some complex valvular problems. It’s wonderful for congenital heart disease. Then there are many areas of cardiology that are becoming – where the MRI is becoming a great tool and we consider it a part of the armamentarium for the diagnosis on our patients.
Host: Now what about if you are diabetic, does that up your risk for a heart problem?
Dr. Velasco: Definitely. For practical purposes, to have diabetes is considered like a heart disease equivalent. If you have diabetes, you should also be considered to be having heart disease until proven otherwise.
Host: And the American Heart Association seems to indicate that cardiovascular related deaths are higher for US Hispanics than they are for the general population. Do you have some comments on that?
Dr. Velasco: Yes, definitely that is a significant concern and that seems to be tied to significant incidence of diabetes and also tied to a population where overweight is prevalent.
Host: And finally, what about family history? How does that impact us?
Dr. Velasco: Well family history is very important because genetics play a key role on the development of heart disease mainly coronary artery disease. And there are some factors in the family history that are more important and will have a more direct impact than others. And that can be defined by obtaining the family history meaning when did the father have the first heart attack, when the first manifestation of disease happening in the family and go from there.
Host: Is there anything else you’d like to add to let us know how to protect ourselves?
Dr. Velasco: Well, it’s key to take more control of our health. If we look at how people die in our country, more than 50% died of vascular disease meaning heart attacks or strokes. Then it’s very important for us to be part of the health process. And exercise is a key factor in all of that.
Host: Thank you Dr. Velasco for joining us today. That’s Dr. Carlos Velasco, Interventional Cardiologist on the medical staff at Baylor Scott & White Heart and Vascular Hospital Dallas. I’m Alyne Ellis. Thanks for checking out this episode of HeartSpeak. To find a specialist at Baylor Scott & White Heart and Vascular Hospital in Dallas or Fort Worth, please call 1-844-279-3627 or visit www.baylorhearthospital.com. For Spanish language, please call 1-844-279-3627 to find a specialist who speaks Spanish. Advisers who speak Spanish are available. If you found this podcast helpful, please share it on your social media channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll talk next time.