Coronary artery disease develops when the major blood vessels that supply your heart with blood, oxygen and nutrients become damaged or diseased.
Because coronary artery disease often develops over decades, you might not notice a problem until you have a significant blockage or a heart attack.
Dr. Thomas A. Joiner is here to discuss Preventative Care for Coronary Artery Disease.
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The Importance of Preventative Care for Coronary Artery Disease
Featured Speaker:
Learn more about Thomas A. Joiner, MD
Learn More About Heart Disease Prevention at Florida Hospital
Thomas A. Joiner, MD
Thomas A. Joiner, MD specialties are Cardiovascular Disease and Interventional Cardiology.Learn more about Thomas A. Joiner, MD
Learn More About Heart Disease Prevention at Florida Hospital
Transcription:
The Importance of Preventative Care for Coronary Artery Disease
Melanie Cole (Host): At Florida Hospital, the committed partners in cardiac care offer patients a wide array of invaluable heart health resources from risk assessment and nutritional counseling to wellness centers and ongoing education helping people make simple lifestyle and diet changes that can greatly reduce their risk of heart disease, heart attack and stroke. My guest today is Dr. Thomas Joiner. He is an interventional cardiologist with Florida Hospital. Welcome to the show, Dr. Joiner. Tell us a little bit about heart disease. What are the risk factors that people need to be aware of for heart disease?
Dr. Thomas Joiner (Guest): Thank you very much for having me today. Heart disease is an accumulation of cholesterol buildup in the coronary arteries that can lead to someone having chest pain or what we call “angina” or it can lead to heart attacks. Risk factors for heart disease include people who smoke cigarettes, people who have diabetes, people who don’t exercise, people that are overweight or people that have a family history of heart disease. These risk factors, Melanie, are very important. For example, women who smoke have a 19 times higher risk of having heart disease. Women who have diabetes have a two to three times higher risk of having a heart attack.
Melanie: Those are some staggering numbers because heart disease is the number one killer and people don’t even realize that. They think its cancers – and women specifically. What symptoms? Because women and men have different symptoms of heart disease, don’t they, Dr. Joiner?
Dr. Joiner: They certainly do. Men classically have the chest pressure or heaviness or tightness that occurs with exercise and it may go away with rest. Sometimes that can radiate to the left shoulder or to the jaw. Frequently though, at least a third of the time, women won’t have any of that. A woman may just have vomiting. She may just have nausea or she may just notice herself sweating very heavily or being short of breath during activity or fatigued. Significantly, she may just have indigestion. Frequently, she won’t have any of the chest tightness, per se. She may even just have tingling in her arms. Part of that has led to women being underdiagnosed by their primary care physicians and by the emergency rooms when they go to the hospital. Women, we think, fare so badly from heart attacks because they delay treatment and because they themselves are not really sure if the pain that they are feeling or the symptoms they are feeling is from heart problems or not. We know that, as you said, that women die of heart disease more every year than men. Since 1984, the gender gap between men and women has actually grown. The mortality rate for heart disease with women has outpaced men since 1984. We know that 38% of the women that have had a heart attack die within the first year but only 25% of men do. So, women’s heart attacks are more serious. Thirty-five percent of women who have a heart attack have another heart attack compared to 18% of men within that first year. Women are twice as likely to die after heart bypass surgery. Yet, in spite of the fact that women have more risk, women are underdiagnosed. Women only account for a third of the coronary angioplasties or stents, or heart surgeries because the physicians don’t think to ask the right questions when women come to their offices or when women come to the emergency room. They just assume that women are not as likely to get heart disease. Women do get heart disease at an older age. The average woman who has heart disease is 70 years old; whereas, it is 60 years old in men. We think that contributes to the fact that women do worse after their heart attack because they are older and also because they delay care.
Melanie: What tests should women be looking for? We know we are supposed to get our mammograms and our PAP smears but when we get our blood work and our annual physicals and, Dr. Joiner, we are the caregivers of society we women and, yet, we don’t put our own mask on before we put the mask on of our loved ones. What would you like women to know about what they should be looking for in their testing and their annuals?
Dr. Joiner: We want women to take charge of their health. We want women, first of all, to look at their own risk factors. Anyone with a family history of heart disease, if they smoke cigarettes, if they have high blood pressure, if they don’t exercise regularly, if they have diabetes, they know that they have a higher risk of having heart disease. If they have two of those risk factors, they probably want to discuss that with their physician. The tests that we would like for that woman and her physician to do include having blood cholesterol checked at least once a year. We want them to have their blood pressure checked once every month or every other month. We want them to maintain a regular exercise program – 30 minutes, six days a week. We want two and a half hours of physical activity every week. We want their blood sugar checked at least base line to make sure they are not diabetic.
Melanie: In our blood test, we get these blood tests and we see things but we don’t know what they mean. Cholesterol levels and you mentioned and CRP – because now they are looking, Dr. Joiner, more at these inflammatory markers for our risk for heart disease. Tell us about those.
Dr. Joiner: The inflammatory markers are a useful tool to help physicians to decide who is at risk of having heart problems or people who already have heart problems who are at risk of having an acute onset or problems, including heart attacks or heart pain. We look at traditional tests like cholesterol. The goal of cholesterol that we’re looking at varies depending on your risk factors but, typically, we would like to see the LDL, or bad cholesterol, down toward 100. The other tests that we look at now are looking for any signs of inflammation in the body. Inflammation can lead to heart attacks. They can lead to a plaque rupturing. For example, someone may have plaque in their artery that has been there for years and not caused any problems and for some reason that plaque becomes inflamed. It ruptures at the edge and in a matter of minutes clots form on that plaque and that artery can become occluded and they can start having a heart attack. The inflammatory markers that we use help to tell us if someone--particularly someone with known heart disease--is having a problem or is at higher risk. It helps us judge how aggressively we need to treat those people.
Melanie: What role does stress play? Cortisol – we hear about these kinds of hormones that build up. Women--we put ourselves under a lot of stress. Is there a role or a correlation between heart disease and stress?
Dr. Joiner: There is a definite correlation. Stress isn’t good for anyone and stress certainly puts you at an increased risk of rupturing a plaque. It puts you at an increased risk of coronary spasm. It increases your sympathetic drive and increases your likelihood of having a heart pain or angina. It can be very difficult to modify stress but I’m glad you brought that up. We do want everyone to at least ask herself, what can she do? Is there a friend she can talk with, a therapist she can talk with, or are there things that she can do to make her lifestyle better? Some things as simple as exercise. People are not happy with who they are. They are overweight; they are not exercising. It’s the first of the year. Every year I always try to encourage my patients to take stock of where they stand, look at their exercise program, look at their weight, measure their abdominal waist size. That’s a good time to try to get people motivated to do better with their diet, to do better with their exercise and, typically, if they can do that they will feel a lot better about themselves. That alone may help with some of the stress they feel.
Melanie: Are we still supposed to be taking an aspirin or a baby aspirin every day? Is that still a course of treatment?
Dr. Joiner: It is, but not necessarily for everyone. We only do that for people who we know have significant risk for heart disease and that I would encourage everyone to talk to a family doctor about. If we have two risk factors or more and a woman is 55 years or older, then we might want to consider aspirin. But, aspirin does increase the risk of bleeding in the stomach, so we don’t routinely recommend that for people with no risk factors and no symptoms.
Melanie: Now, speak about the role of diet because we’ve spoken about exercise but where does our diet come into play? What do you tell patients every single day, Dr. Joiner, about what you want them to do to be heart healthy in their food?
Dr. Joiner: Diet is a huge part but I try to get people to be realistic about what they can do. I would love for all of my patients to be vegetarians but it’s not going to happen. What I do want to encourage them to do is try to limit the amount of red meat they eat. I get them to try to eliminate fried foods. I would much prefer that they eat chicken, fish and turkey every day. I want them to realize that by dietary changes alone, they can bring down their bad cholesterol level tremendously. By changing their diet, it makes it much easier to lose weight and, certainly, it lowers your risk of having heart disease by a great deal.
Melanie: In just the last few minutes, your best advice about heart disease prevention. What do you really want people to know?
Dr. Joiner: What I want people to know is they are in charge of their health and they alone are in a better position to affect their risk of a heart attack than any physician can. I want everyone to exercise. I am a stickler for that. Exercise alone tremendously lowers your risk of heart problems. I want everybody to eat right. I want everybody to see their physician one time just to have their cholesterol checked, their blood pressure checked and their blood sugar checked so they can see where they stand. You want to know what your risk factors are and you want to know where you need to put emphasis at. If your cholesterol is high, you’ve really got to hammer the diet. If you are overweight, you’ve really got to work with the exercise and with the diet alone. I want people to understand that when there is a weight problem, it’s not just a dietary problem. It’s an exercise problem that we want to get to. Exercise trains the heart. Exercise lowers your heart rate. Exercise decreases your risk of having heart problems going forward.
Melanie: Why should patients come to Florida Hospital for their care?
Dr. Joiner: We think we provide a good screening service for people. We like to help people – women in particular is what we’re emphasizing this month. We’re trying to get people in just to discuss what their risk factors are so we can find out if they need to be worried or not. If people have two or more risk factors or if they are having symptoms, then we would recommend stress tests, treadmill stress tests or a good screening program, to help tell us if somebody is at risk of having a heart attack. If we have an older person – 50 or older - who is not in an exercise program, we like to do a screening treadmill test first to make sure it is safe for them to start an exercise program. We’ll work with them on trying to establish what would be a good exercise program for them. Some of our heart patients who have really gotten out of shape and really haven’t been seeing physicians regularly, we can get them involved in our cardiac rehab program where we can train them to exercise. We use physical therapy and cardiac rehab nurses where we can monitor them and help prescribe a safe exercise program for them that they do under the care of a medical technologist for probably three months. After that, we prescribe a program that they can do at home on their own.
Melanie: What great information. So beautifully put. Thank you so much, Dr. Joiner, for being with us today. You’re listening to Health Chat by Florida Hospital and for more information you can go to FloridaHospitalHeart.org. That’s FloridaHospitalHeart.org. This is Melanie Cole. Thanks so much for listening.
The Importance of Preventative Care for Coronary Artery Disease
Melanie Cole (Host): At Florida Hospital, the committed partners in cardiac care offer patients a wide array of invaluable heart health resources from risk assessment and nutritional counseling to wellness centers and ongoing education helping people make simple lifestyle and diet changes that can greatly reduce their risk of heart disease, heart attack and stroke. My guest today is Dr. Thomas Joiner. He is an interventional cardiologist with Florida Hospital. Welcome to the show, Dr. Joiner. Tell us a little bit about heart disease. What are the risk factors that people need to be aware of for heart disease?
Dr. Thomas Joiner (Guest): Thank you very much for having me today. Heart disease is an accumulation of cholesterol buildup in the coronary arteries that can lead to someone having chest pain or what we call “angina” or it can lead to heart attacks. Risk factors for heart disease include people who smoke cigarettes, people who have diabetes, people who don’t exercise, people that are overweight or people that have a family history of heart disease. These risk factors, Melanie, are very important. For example, women who smoke have a 19 times higher risk of having heart disease. Women who have diabetes have a two to three times higher risk of having a heart attack.
Melanie: Those are some staggering numbers because heart disease is the number one killer and people don’t even realize that. They think its cancers – and women specifically. What symptoms? Because women and men have different symptoms of heart disease, don’t they, Dr. Joiner?
Dr. Joiner: They certainly do. Men classically have the chest pressure or heaviness or tightness that occurs with exercise and it may go away with rest. Sometimes that can radiate to the left shoulder or to the jaw. Frequently though, at least a third of the time, women won’t have any of that. A woman may just have vomiting. She may just have nausea or she may just notice herself sweating very heavily or being short of breath during activity or fatigued. Significantly, she may just have indigestion. Frequently, she won’t have any of the chest tightness, per se. She may even just have tingling in her arms. Part of that has led to women being underdiagnosed by their primary care physicians and by the emergency rooms when they go to the hospital. Women, we think, fare so badly from heart attacks because they delay treatment and because they themselves are not really sure if the pain that they are feeling or the symptoms they are feeling is from heart problems or not. We know that, as you said, that women die of heart disease more every year than men. Since 1984, the gender gap between men and women has actually grown. The mortality rate for heart disease with women has outpaced men since 1984. We know that 38% of the women that have had a heart attack die within the first year but only 25% of men do. So, women’s heart attacks are more serious. Thirty-five percent of women who have a heart attack have another heart attack compared to 18% of men within that first year. Women are twice as likely to die after heart bypass surgery. Yet, in spite of the fact that women have more risk, women are underdiagnosed. Women only account for a third of the coronary angioplasties or stents, or heart surgeries because the physicians don’t think to ask the right questions when women come to their offices or when women come to the emergency room. They just assume that women are not as likely to get heart disease. Women do get heart disease at an older age. The average woman who has heart disease is 70 years old; whereas, it is 60 years old in men. We think that contributes to the fact that women do worse after their heart attack because they are older and also because they delay care.
Melanie: What tests should women be looking for? We know we are supposed to get our mammograms and our PAP smears but when we get our blood work and our annual physicals and, Dr. Joiner, we are the caregivers of society we women and, yet, we don’t put our own mask on before we put the mask on of our loved ones. What would you like women to know about what they should be looking for in their testing and their annuals?
Dr. Joiner: We want women to take charge of their health. We want women, first of all, to look at their own risk factors. Anyone with a family history of heart disease, if they smoke cigarettes, if they have high blood pressure, if they don’t exercise regularly, if they have diabetes, they know that they have a higher risk of having heart disease. If they have two of those risk factors, they probably want to discuss that with their physician. The tests that we would like for that woman and her physician to do include having blood cholesterol checked at least once a year. We want them to have their blood pressure checked once every month or every other month. We want them to maintain a regular exercise program – 30 minutes, six days a week. We want two and a half hours of physical activity every week. We want their blood sugar checked at least base line to make sure they are not diabetic.
Melanie: In our blood test, we get these blood tests and we see things but we don’t know what they mean. Cholesterol levels and you mentioned and CRP – because now they are looking, Dr. Joiner, more at these inflammatory markers for our risk for heart disease. Tell us about those.
Dr. Joiner: The inflammatory markers are a useful tool to help physicians to decide who is at risk of having heart problems or people who already have heart problems who are at risk of having an acute onset or problems, including heart attacks or heart pain. We look at traditional tests like cholesterol. The goal of cholesterol that we’re looking at varies depending on your risk factors but, typically, we would like to see the LDL, or bad cholesterol, down toward 100. The other tests that we look at now are looking for any signs of inflammation in the body. Inflammation can lead to heart attacks. They can lead to a plaque rupturing. For example, someone may have plaque in their artery that has been there for years and not caused any problems and for some reason that plaque becomes inflamed. It ruptures at the edge and in a matter of minutes clots form on that plaque and that artery can become occluded and they can start having a heart attack. The inflammatory markers that we use help to tell us if someone--particularly someone with known heart disease--is having a problem or is at higher risk. It helps us judge how aggressively we need to treat those people.
Melanie: What role does stress play? Cortisol – we hear about these kinds of hormones that build up. Women--we put ourselves under a lot of stress. Is there a role or a correlation between heart disease and stress?
Dr. Joiner: There is a definite correlation. Stress isn’t good for anyone and stress certainly puts you at an increased risk of rupturing a plaque. It puts you at an increased risk of coronary spasm. It increases your sympathetic drive and increases your likelihood of having a heart pain or angina. It can be very difficult to modify stress but I’m glad you brought that up. We do want everyone to at least ask herself, what can she do? Is there a friend she can talk with, a therapist she can talk with, or are there things that she can do to make her lifestyle better? Some things as simple as exercise. People are not happy with who they are. They are overweight; they are not exercising. It’s the first of the year. Every year I always try to encourage my patients to take stock of where they stand, look at their exercise program, look at their weight, measure their abdominal waist size. That’s a good time to try to get people motivated to do better with their diet, to do better with their exercise and, typically, if they can do that they will feel a lot better about themselves. That alone may help with some of the stress they feel.
Melanie: Are we still supposed to be taking an aspirin or a baby aspirin every day? Is that still a course of treatment?
Dr. Joiner: It is, but not necessarily for everyone. We only do that for people who we know have significant risk for heart disease and that I would encourage everyone to talk to a family doctor about. If we have two risk factors or more and a woman is 55 years or older, then we might want to consider aspirin. But, aspirin does increase the risk of bleeding in the stomach, so we don’t routinely recommend that for people with no risk factors and no symptoms.
Melanie: Now, speak about the role of diet because we’ve spoken about exercise but where does our diet come into play? What do you tell patients every single day, Dr. Joiner, about what you want them to do to be heart healthy in their food?
Dr. Joiner: Diet is a huge part but I try to get people to be realistic about what they can do. I would love for all of my patients to be vegetarians but it’s not going to happen. What I do want to encourage them to do is try to limit the amount of red meat they eat. I get them to try to eliminate fried foods. I would much prefer that they eat chicken, fish and turkey every day. I want them to realize that by dietary changes alone, they can bring down their bad cholesterol level tremendously. By changing their diet, it makes it much easier to lose weight and, certainly, it lowers your risk of having heart disease by a great deal.
Melanie: In just the last few minutes, your best advice about heart disease prevention. What do you really want people to know?
Dr. Joiner: What I want people to know is they are in charge of their health and they alone are in a better position to affect their risk of a heart attack than any physician can. I want everyone to exercise. I am a stickler for that. Exercise alone tremendously lowers your risk of heart problems. I want everybody to eat right. I want everybody to see their physician one time just to have their cholesterol checked, their blood pressure checked and their blood sugar checked so they can see where they stand. You want to know what your risk factors are and you want to know where you need to put emphasis at. If your cholesterol is high, you’ve really got to hammer the diet. If you are overweight, you’ve really got to work with the exercise and with the diet alone. I want people to understand that when there is a weight problem, it’s not just a dietary problem. It’s an exercise problem that we want to get to. Exercise trains the heart. Exercise lowers your heart rate. Exercise decreases your risk of having heart problems going forward.
Melanie: Why should patients come to Florida Hospital for their care?
Dr. Joiner: We think we provide a good screening service for people. We like to help people – women in particular is what we’re emphasizing this month. We’re trying to get people in just to discuss what their risk factors are so we can find out if they need to be worried or not. If people have two or more risk factors or if they are having symptoms, then we would recommend stress tests, treadmill stress tests or a good screening program, to help tell us if somebody is at risk of having a heart attack. If we have an older person – 50 or older - who is not in an exercise program, we like to do a screening treadmill test first to make sure it is safe for them to start an exercise program. We’ll work with them on trying to establish what would be a good exercise program for them. Some of our heart patients who have really gotten out of shape and really haven’t been seeing physicians regularly, we can get them involved in our cardiac rehab program where we can train them to exercise. We use physical therapy and cardiac rehab nurses where we can monitor them and help prescribe a safe exercise program for them that they do under the care of a medical technologist for probably three months. After that, we prescribe a program that they can do at home on their own.
Melanie: What great information. So beautifully put. Thank you so much, Dr. Joiner, for being with us today. You’re listening to Health Chat by Florida Hospital and for more information you can go to FloridaHospitalHeart.org. That’s FloridaHospitalHeart.org. This is Melanie Cole. Thanks so much for listening.