Bill Klaproth (Host): This is Columbus Community Hospital Healthcasts. I'm Bill Klaproth. With me is Dr. Sabu George, a dedicated Cardiologist from the Columbus Cardiology Clinic. Dr. George is here to discuss risk factor modification and crucial aspects of cardiovascular health and how we can all work towards prevention of cardiovascular disease.

Dr. George, thank you so much for being here.

Sabu George, MD: Glad to be here.

Host: So, Dr. George, what are the most common risk factors for cardiovascular disease or CVD, and how can individuals effectively modify them?

Sabu George, MD: Yeah, so traditionally the risk factors you look at are things like high blood pressure, diabetes, high cholesterol, smoking, family history, obesity, stress, the lack of sleep. Things like stress and a lack of sleep are more recent risk factors that are identified, and unhealthy eating habits.

So the way to modify them, people, I always see a lot of patients who come to me and say, well, I want to be sure I don't have heart disease. And they want to get all kinds of tests. I always have this discussion with many people in the clinic that a test does not reduce your risk at all. All the test does is it tells you at the point you got the test, what are the status of certain things in your heart, like what's the status of the blood supply?

Like you may have an abnormal stress test or you may have an abnormal CT angiogram. It does not reduce your risk in any way. What reduces your risk are addressing your risk factors. And most people know these, these are good common sense things that everybody knows, but it's just, it's always in the back of their minds and they don't pay attention to it or they don't focus on it.

 So unhealthy eating habits. So if we were to discuss that for a minute, we'll just say, well try not to eat processed food. So try to eat food that is natural, that you go to the grocery store, you buy the fresh vegetables, you come home, you look up a recipe on YouTube and you make it. You make everything from scratch.

You don't take stuff that comes out of a can or a Ziploc bag. If you want to have a chicken sandwich, you go, you buy the chicken breasts. You bring it home, you marinate it, you bake it, you slice it, you put it between multi-grain bread and you put some fresh vegetables on there and you have a decent, healthy sandwich.

Host: You're making me hungry now.

Sabu George, MD: My second hobby is actually cooking, so I do quite a bit of classes on cooking as well. So that is much healthier than going to any fast food place and buying the chicken sandwich.

Host: Absolutely. So diet can play a major role in the prevention and management of cardiovascular disease then. So thank you for sharing those tips on healthy eating and some of the other things you said. Sleep, we're going to explore a little bit later on. I want to talk about physical activity though for a minute.

How important is physical activity in preventing cardiovascular disease and what types of exercise are most beneficial for heart health?

Sabu George, MD: I would say that almost everybody has a smartphone nowadays, and you can download any number of free walking apps on to your phone. I have it on my phone and I use it. So you want to get between six to 10,000 steps a day, or if you follow the American College of Cardiology's recommendations, you want to get between 150 to 200 minutes of exercise a week. How you get it is up to you. If you are at work and you can get like three, 4,000 steps in at work, then after work, you go to the gym and you get an extra 30 or 40 minutes of walking. It's fine. When you're younger, you can do more vigorous activity. When you are above the age of say 50, 60, you have to be careful with the physical activity you're doing.

If you overdo it, you can injure your joints and then you are limited in the kind of activity that you do. You have to be very watchful there. So that's why we always tell people, particularly people with already preexisting hip and back problems, the walking is good enough. If you get between six to 10,000 steps a day, you're doing okay and you can track it on your phone.

That's one. The second thing is that you asked what types of exercise. The types of exercise are dependent, I would say, on the type of disease processes you have. Say for example, if you're diabetic, aerobic activity will benefit you to a certain extent, and then if you build muscle to a certain extent, you will improve your utilization of glucose and thereby your sugar control as well.

So depending on the type of disease condition or chronic disease states that you have, would be dependent on the kind of exercise that you choose. Say elderly people, people who are frail is good to have some type of exercise that strengthens or tones the muscles to a certain extent to reduce or prevent falls, that kind of thing.

So it's an all encompassing thing. And so it's, it's dependent on what kind of disease conditions you have. A little bit of weight training is good in the sense that it helps you maintain tone. But you know, you have to be careful there. Like you have elderly people who have a lot of tremors, and if you lift weights, particularly with your hands, those tremors may increase and that's not good. So you have to be, it's, it's an individual thing.

Host: Yep. So those are really good tips. Six to 10,000 steps a day, uh, between 150, 200 minutes as you said. You also have to understand what chronic disease states you might have, and then a little bit of weight training can help as well. Just to make sure you're looking toned and buff.

Sabu George, MD: That is an added benefit. However, it is important for people to realize, and there's always this misconception out there that if you exercise, you must look like our former governor of California, Schwarzenegger. Right? But the the reality is to look like Schwarzenegger, you have to spend six to eight hours in the gym, at least four to five days of the week. Then you can look like him. And that's what he did to get to look like that. Who has, nobody who is working has six to eight hours to be spending in gym. So exercise is not how you look. It is how you feel. Okay? If you are not tired, you are not fatigued, you are eating healthy, you are sleeping well, you are getting certain degree of exercise every day; you're doing well.

Host: Right. We're not asking you to look like Arnold Schwarzenegger.

Sabu George, MD: That's correct. If you end up looking like that, good for you. But if you don't look like that, it's okay. Perfectly okay.

Host: So you also mentioned stress. Let's talk about stress as well. How does stress affect cardiovascular health and what are some tips that we can do to help manage stress to lower our risk of heart disease?

Sabu George, MD: Yes, it's increasingly recognized. So there's many factors that stress people. And I always like to say, if you want to get stressed, just turn on any of the news channels, you get enough stress. So, so, that's just one aspect. Okay? If you see young people who come to the clinic, one of the biggest stressors that they have, it may be recognized, it may be unrecognized, is the influence of social media. We see a lot of people who come to the clinic, they're having a lot of palpitations. They feel they're heart racing.

When you delve into their history a little bit, they spend inordinate amounts of time on social media. Social media can stress people out in manners that you and I cannot understand. And then stress at work. Many work environments are very stressful. Any interaction that involves people interacting with people, innately is stressful.

And then when you add to that, difficult personalities, big egos and things like this, it becomes more and more stressful. And then it leads to a pattern of poor sleep at night, and then that stresses you out even more. And then you look for outlets. What are the common outlets some people do? They may drink more, they may eat more. They may start using substances.

It is a all encompassing thing. So what, and you can ask our clinic staff this. I will say that, and we are having busy clinic at least five to 10 times a week, we go through this with patients that we think have a lot of stress in their lives in the clinic, while they are here. Again, we come to the Almighty Cell phone.

We ask them to open up YouTube. They open up YouTube. We ask them to type in 10 minutes of guided meditation to relieve anxiety and stress, and any one of you can, can do this. When you type that in, you will see at least a hundred different options pop up. Open any one, and it's 10 minutes and it guides you through the meditation. And what we notice is we do it with the patient in the room and we ask them to follow the instructions. And a very interesting thing happens. At about the five to seven minute mark, most of them are asleep, just to show you the kind of stress that they have in their lives. And we tell them, do this two to three times a day. It is free.

It doesn't cost you anything. You can do it anywhere. You can do it at home. You can do it at work. It's 10 minutes. Do it and you may not have to take any medic medication to help you with anxiety. You just reduce it. So we tell them the things that help with anxiety are doing some meditation, if possible, doing some exercise.

If you can enroll in a yoga class, please do so. It's very beneficial to help with stress. Eat healthy meals. You'll be surprised, the difference between eating healthy meals and eating fast food and how that contributes to stress. You'd be very surprised. If you eat healthy meals, you are less likely to be stressed.

If you eat a lot of processed food, you feel sleepy, you feel tired, you feel fatigued. Stress affects you more. You are incapable of taking care of things. It's a never ending cycle. So we try to break those cycles in as many ways as we can.

Host: So that dietary connection, I never really thought about that with stress. Really, really interesting.

Sabu George, MD: And actually, so one of my favorite chefs, may he so rest in peace is Anthony Bourdain and Bourdain did a show in Jamaica and he was interviewing a Rastafarian Cook who's vegetarian. Many people do not realize what the Rastafarians are, it's a type of religious practice. And they're, they're mostly vegetarian.

They don't eat any, any meat and they have a, a common saying that if you eat stupid, you'll think stupid. And so if, you know, if you eat healthy, unprocessed food that's natural, you are likely to metabolize things better, your likely your body is not as physically stressed as if you eat a lot of protein, a lot of carbohydrates, a lot of oily stuff.

Your internal organs are definitely, they're working more and they're taxed more. I would say that.

Host: So if you eat stupid, you feel stupid.

Sabu George, MD: That's that  a Rastafarian saying, not my saying.

Host: That was really good. I love what you had to say there, 10 minutes of guided meditation. Just open up YouTube, type it in, and there you go. So stress is a big factor for sure. I just want to say, you're not stressing me out, Dr. George. You're making me feel more calmer and at ease.

Sabu George, MD: So we, we have these discussions with multiple people in a day and it's interesting how many people we see that, it's either the influence of the work environment or something, but the, the common denominator in all of them is they have maladaptive ways of coping with stress. And this is something that we all reach a point in our lives, myself included, where we realize that our method of getting through each day is not really working.

And so what is the better way to get through the day? The better way to get through the day is to get up in the morning. Well, this is for me, okay. However it works for anybody is fine. I do a little bit of prayer in the morning, then I pack all my own food, bring it to work every day. Everything I make myself, I will say 90% of the meals that I eat are stuff I cook myself.

Bring it to work. I do eat, try to eat two, maybe three balanced meals a day. Then somewhere in the day, either at noontime or in the evening, I manage to squeeze in some exercise, do a little bit of prayer and meditation at night, and I can sleep well.

Host: Well, thank you for sharing that routine. Hearing other people's routines can often help, so thank you for sharing that. Really good advice, Dr. George.

Sabu George, MD: And it's important to have a schedule, Okay. A schedule. Now, there is no schedule that any human sticks to a hundred percent of the time, but if you are sticking to it 80% of the time, you are doing fine. And, there is no diet in the world that any human being sticks to a hundred percent of the time.

 If you have a burger once in a while or if you have a couple of slices of pizza once in a while, there is nothing wrong with that. Okay? If you want to have a beer or a glass of wine once in a while, please feel free to do so. Okay. The problem happens when it doesn't stop at one beer or one glass of wine. That's when the problem starts. So if you are not doing that, you are doing okay.

Host: And habit forming is very important. If you create a routine, a healthy routine, you have to stick to it, and that's why the habits are so important. So we hear about cholesterol all the time. Can you explain the role of cholesterol in cardiovascular disease and what can we do to help control our cholesterol through lifestyle changes?

Sabu George, MD: So cholesterol has long being recognized as a part of the puzzle. It is not the entire puzzle by any means. It is a part. Now half of the cholesterol that you measure in the blood, comes from what you eat. The other half roughly, comes from what your liver makes. The part that your liver makes is genetically determined, and it is very difficult to impact that part.

Like you'll see some people who eat only twigs and berries yet, and they look like broomsticks, yet you measure their cholesterol is very high. So these people are making the cholesterol, despite them not eating any animal protein. So, and you routinely see this in, there are a lot of Indian people who are vegetarian and vegan, but we have some of the highest rates of cardiovascular disease in the world.

It's because of this thing that I'm saying. Your liver makes cholesterol to a certain extent. How you impact it is very simple. So if you take proteins that you eat. You can say the safest protein to eat is probably fish and that, well, obviously plant protein first. Like if you're eating a lot of legumes, lentils, beans and so on, this plant protein is very healthy.

And then you can come to things like fish and then things like turkey, chicken and then things like lamb, goat, and then beef. Beef is the one that probably taxes your system the most and leads to most formation of LDL cholesterol. The other things that make LDL cholesterol or bad cholesterol are processed meats. They are extremely high in bad cholesterol. Like if you take, say, sausage or any of the processed meats, you cook them in the pan and you let the oil drain. You give it like 20 minutes and you'll see it'll solidify completely. That is all saturated fat, and that is stuff that makes plaque inside your blood vessels. So minimizing processed food, minimizing saturated fats in your diet, these reduce the amount of LDL that you put into your system. Or the substrate that makes the LDL that you put into your system. Now another important thing in cholesterol are triglycerides. Triglycerides are fats made in the body from all the sugars you eat.

So if you eat a ton of say white bread or pasta, or you drink a lot of beer; these things get into your body and they make triglycerides and they are also the most easily impacted by changes in diet. So we tell people routinely, if you are, let's, let's just speaking hypothetically now, if your triglycerides are say, 300 and you are drinking 10 beers a day; if you reduce the 10 beers to five beers, thus you c half; your triglycerides will probably drop by half.

It is a common thing people can relate to. So we tell people, if you're eating 10 flour tortillas every day and your triglycerides are 300, eat five, then we check it in three months time. Automatically the triglycerides drop. You will not get that same effect with the LDL. Okay, so the LDL is actually difficult to drop. You can drop it with exercise, you can drop it with strict diet control and so on, but you may end up needing medication. Generally speaking, if your LDL is more than 190 by current recommendations and guidelines, you need to be on medication to lower your cholesterol or your LDL.

If it's more than 190. So if you are in your middle age and you haven't had your cholesterol checked, you should probably have it checked and then treated if needed.

Host: That's always a good idea. Know your numbers as they say. So really important. So stay away from the beef, processed meats, like you say now and then is fine, but if it's a regular diet of those things, processed foods, et cetera, you want to stay away from those.

Sabu George, MD: I would also say that when you, when you check your cholesterol, check your blood pressure also. Because it is a silent killer. Many people do not. They, it has no symptoms per se. A few people may get headaches or nosebleeds, stuff like that, but it tends to go up silently. And if you do not check it, you do not know it's high. And if you don't treat it, it'll wreck havoc on your body. So that's important thing to check.

Host: Yeah, another important number to know, but good information about the triglycerides as well. White bread, pasta, beer, those things too. So thanks for bringing that up, Dr. George. So you mentioned sleep earlier. I wanted to ask you about this, this might be a new one or thing, something that people might not think of sleep in cardiovascular health. So what sleep habits can help reduce the risk of cardiovascular disease?

Sabu George, MD: So it's a very commonly accepted thing nowadays that a lot of the patients who come to cardiologist offices have sleep problems. If you look at estimates, they will say between 15 to 20%. And it's now something that we routinely ask patients when they come to the cardiologist office, how do you sleep?

Do you snore at night? And if they are there with their spouse or significant other, the significant other generally says that they snore or they don't snore. Whether they snore or they don't snore is immaterial. The thing is that it opens the door for us to say, well, probably you need a sleep study to see how well you are sleeping.

People who have obstructive sleep apnea that is untreated, where when they sleep, the soft tissues in the back of the throat, they occlude the airway, either partially or subtotally. And they have difficulty getting rid of the carbon dioxide and they do not have restful sleep. It contributes to things like elevated blood pressure, daytime sleepiness.

It is the commonest cause of road traffic accidents, particularly in truck drivers. And, Irritability, all these things, they all go together. If you have obstructive sleep apnea, it can be treated. The first thing is to diagnose it, and if it's diagnosed, it can be treated and it's increasingly being treated.

The other thing that leads to non restful sleep or unrestful sleep are poor habits that we do on our own. So many people, they don't sleep at a regular time every day. Many people will sit up late at night watching TV for a long time. They may eat late at night when they're watching TV. They may drink at night when they're watching tv.

All these things are not things that lead to restful sleep patterns. They may have a TV in the bedroom, and these are not things that lead to restful sleep. Restful sleep means you have a routine every day. You go through that routine. You go to sleep not very late at night, it should be at a certain time every day.

And then you try to have a restful night's sleep. So these things are all things that are evaluated by pulmonologists. So when we send patients to them with sleep problems, they ask about sleep hygiene, which is part of what I mentioned. And then if needed, they get like, a sleep study to see how, whether they will benefit from being treated for sleep apnea, and they may also end up getting pulmonary function tests, which can show whether the patient has underlying lung disease that may be contributing to all these. So it is increasingly recognized, it should be treated. We send a lot of patients from our clinic, and I'm sure from other cardiology clinics as well for pulmonary evals and sleep studies.

Host: Interesting. The link between sleep and heart health, so, thank you for bringing that to our attention. So let's talk about any new or emerging treatments or technology that is out there that show promise in reducing the risk of cardiovascular disease. Can you share with us that information?

Sabu George, MD: Yes, like we all know now, there are several apps that you can get on your phone. The thing that is a double-edged sword is while these apps are there on the phone that people can use, a common one that you see people use nowadays, either an app or something to monitor the heart rate. I think it tends to cause more anxiety than anything else.

I'm not sure how much it helps per se. I am sure that artificial intelligence with the data that is out there, they may come up with more things that can be checked, let's say on a regular basis without being checked every day. People come to us, oh, my heart rate went from this, to that, to this, to that.

Or I checked my blood pressure 25 times in a day, and the first thing we tell them is, please stop doing that. It's not helping you. All it's doing is making you more anxious and worried. People's heart rates and blood pressures, they vary throughout the course of the day. When you wake up in the morning, your heart rate and your blood pressure are the lowest.

If you go and drive in a city like New York, as soon as you get onto the road, your heart rate and blood pressure will go up immediately. You don't need any, any other added stress. If you turn on the news channel in the middle of the day, it doesn't matter whether you go to one channel or the other.

 Depending on where you lie in the political spectrum, your blood pressure and heart rate goes up. So these are, you know, there's so many things that we do to ourselves that we can stay away from. I always tell people you want to feel at peace, watch the Cooking Channel and listen to music.

 Don't listen to the news. Make up your own mind about things. But watch the Cooking Channel and, uh, listen to music.

Host: That's really good advice. Watch a cooking channel and play some music. That'll never steer you wrong. Right. Absolutely. Well, to wrap us up, Dr. George, thank you so much for your time. I really appreciate this. Just if you could encapsulate this for us, what is the most important piece of advice you would give to someone looking to start improving their cardiovascular health today?

Sabu George, MD: I will say try to get a regular schedule as many days of the week as you can. Try to do some meditation, try to make all your own food, try to get some activity, physical activity every day. Try to sleep well. Check your blood pressure and your cholesterol. If you don't have a primary care doctor, you should get one.

Because there's lots of things that primary care doctors do that they keep an eye on, that keep you healthy, particularly checking things like your blood pressure, cholesterol, your blood sugar if you are. We didn't talk anything about diabetes. The blood sugar is one of the most important things that you can check, and if you are diabetic, the healthy eating and the activity helps you a great deal in controlling and managing your blood sugars.

So it ties in everywhere if you don't have a primary care doctor, and you have risk factors, you have a positive family history, you should get a primary care doctor.

Host: Always, always great advice, so get on a regular schedule, make your own food, exercise, check your numbers as we talked about earlier. Very important. If you don't have a primary care doctor, make sure you get one. Dr. George, this has been fantastic. Thank you so much for your time today.

Sabu George, MD: No problem. Welcome.

Host: For more information and resources, visit Columbus Cardiology clinic at columbuscardiology.org.

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