Scott Webb (Host): There's been a rise recently in cases of heart disease in younger patients. And joining me today to help us understand this trend and how she helps patients is Amy Hallow. She's a Nurse Practitioner with Franciscan Health.

 This is the Franciscan Health Doc Pod. I'm Scott Webb. Amy, thanks so much for joining me today. We're going to talk about, uh, the incidence of heart disease in younger patients and why that's happening and what we can do about it. So as we get rolling here, tell us more about those younger patients you're seeing and, um, if they're experiencing heart disease, why are they experiencing heart disease? Like, what's going on?

Amy Hallow, NP: Yeah, absolutely. You know, the incidence of heart disease is totally on the rise in people under the age of 40. Just within the past two months, I've seen three people come to the ER with symptoms of having a heart attack. One of which was confirmed, and then unfortunately, one of which did not even make it from the ER to the cath lab. He was 36. So we're seeing increasing numbers a lot lately, and I think it's all associated with you know, increasing numbers of obesity, weight gain, poor nutrition, tobacco use, and really the lack of physical exercise. These cases are just going to keep climbing. So as hard as we try, unfortunately we can't save everyone.

I always tell people, you know, you need to start saving yourselves before it even falls into our hands. We're seeing it a lot more often.

Host: Yeah, you definitely are. And as you say, there's many contributing factors. Of course, could be, you know, in some cases a family history and genetics, but a lot of it seems to be lifestyle and behavior. And, uh, wondering, are there different types of heart disease? And if so, like which types of heart disease are you finding or seeing in this younger population?

Amy Hallow, NP: Yeah, absolutely. There are different types of heart disease. Couple different ones include coronary artery disease, which you have to think about the heart as a muscle itself and the muscle needs blood supply. So the coronary arteries are the arteries that give the muscle of the heart blood flow. So coronary artery disease is the problem with the vessels feeding the heart muscle blood supply. Other types of heart disease are heart failure, rhythm disturbances for the heart, cause you have to think of the heart, kind of how I explain to my patients as a pump, like with plumbing, but also like electricity because it's worked by a light switch, basically the electricity of the heart. So you can have abnormal heart rhythms as well, but coronary artery disease is the most common problem that we're seeing. And you know, these blockages could happen in one vessel, it can happen in multiple different vessels. And you know, when that does happen, it obstructs that blood flow and oxygen to the heart, which then can lead to heart failure and other different problems.

Host: Yeah, as you say, I've spoken with heart doctors before and they've referred to themselves as plumbers, those that, that handle plumbing side of it. So it is part electrical, part plumbing, uh, what are the signs and symptoms, sort of the classic signs and symptoms that, that folks would experience?

Amy Hallow, NP: Symptoms can really vary from patient to patient, but typically, patients experience chest pain, shortness of breath, fatigue, even some dizziness and loss of consciousness. I will say women, however, present completely different and I think this is definitely not talked about enough. Women are as much of an underserved population as any other you can compare it to. I think it's a demographic that's not focused on enough for heart disease. You know, women can show up to the ER feeling like nauseous, vomiting, flu-like symptoms. They're like diaphoretic or sweaty and they can just tell the ER doc, you know, I'm just not feeling well Doc and these patients, women are having heart attacks. You know, we send them straight to the cath lab and have to get them fixed. So not all women are going to experience that elephant sitting on my chest, the tightness, the tingling down the arm, you know, they present completely different.

Host: Yeah, I've heard that, that men and women present differently and definitely we could do a separate podcast on underserved populations, like women for sure. In general, men and women is at high levels of stress or emotional health that could also be contributing factors?

Amy Hallow, NP: You know, I see this more and more, and I'm thinking so because, you know, high levels of stress are definitely associated with a higher blood pressure. So when you're under stress, your blood pressure goes up because your body inherently secretes a hormone called cortisol. Cortisol is the stress hormone, and this cortisol level increases blood pressure, increases heart rate. Just like someone cuts you off in traffic, you get mad, blood pressure goes up, your heart rate goes up.

Host: Who me? That never happens to me.

Amy Hallow, NP: Never. And you know, stress and anxiety, feeling worried all the time, definitely keeps that blood pressure up, which then runs the risk of having that, you know, sustained and then feeling stressed and anxious, worried. Well, you know, that leads to keeping us up at night. So then you have insomnia, and I just read a story about a study about insomnia and lack of sleep. So if someone gets five or less hours of sleep consistently, they're associated with a 69% increase in having a heart attack. Just insomnia alone. And I think that the younger generation, we are at higher stress levels, you know, between work and kids, relationships. Life's hard. And you know, I think a lot of people turn to unhealthy coping mechanisms to manage the stress. We don't want people turning to tobacco, drugs, alcohol, like, you know, it's just adding fuel to the fire.

 So I also think that with the increasing awareness of mental health nowadays, it's not really so stigmatized as it used to be in the past. You know, bringing more awareness of it, more opportunity to help heal patients. I think people are realizing how much more stress and anxiety they have on a day-to-day basis that need to be managed better. But if it's not or it's not appropriately managed, then of course this is going to increase your risk for heart disease too.

Host: Yeah, it definitely is. So let's then talk about managing heart disease, maybe the different stages of heart disease and how it affects the quality of life for patients.

Amy Hallow, NP: Absolutely. So I mean, a lot of the causes are lack of exercise, poor nutrition, high blood pressure, tobacco use. These are the main, main big ones I think of. I also wanted to touch on family history because, I mean, speaking personally, my husband's father had a major heart attack and required open heart surgery, and so people don't really realize this because I feel like also the younger generation, they don't tend to talk to their parents or loved ones about like their family history.

Like, Hey, mom, dad, like, why are you taking the meds you're taking? Or, you know, something like that. And it's important to have these conversations with your parents because a first degree relative, like a parent, if they have a premature heart attack, meaning a man had a heart attack, your father had a heart attack at the age of 55 or younger, or your mom had a heart attack at 65 or younger. This increases your risk of heart attack by 60 to 75% alone. So the more you know, the more you can keep your health on track. In addition to that family history, you know, blood pressure. Increasing blood pressure is way more common than we think. One in four young adults from the ages of 20 to 44 have high blood pressure and they have no idea because high blood pressure is called the silent killer.

People don't know they have high blood pressure. Typically, they don't get symptoms until it's too late. Right? You know, their blood pressures are 200s over 120 and they're going to the ER because they have a headache or they're about to pass out or something like that. So I think getting in the routine of seeing a primary care doctor yearly to get checked is a super good idea. But the younger generation, you know, they think maybe that they are invincible a little bit, which you know, for a while you may be, but with these numbers going up, you go out to dinner with your friends, four of you are at a table, chances are 25%, one of you guys has high blood pressure.

Host: Right. Yeah. And then you add in the ...

Amy Hallow, NP: Tobacco use is also a huge one.

Host: Right and you add in the complications of COVID of people not going to the doctor, right, for a number of years. Uh, so, you know, you've got the younger generation who maybe thinks that they're a little bit invincible and then they maybe haven't been going to the doctor, haven't been taking care of themselves, aren't aware of their family history. So good that we have experts like yourself to help us and answer these questions. What other education or advice do you have for that younger population who apparently is facing heart disease as sort of shocking and alarming as that is to think of people, you know, under 50, let's say, having to confront this, but they are. So what's your best advice, final thoughts and takeaways?

Amy Hallow, NP: Best advice is the biggest things you can do right now are five things. I think top five is maintain an ideal body weight. So you know, if you have that big waistline, that's going to increase your risk of having a heart attack. So get to your ideal body weight. You know, maintain that healthy weight. Number two, daily exercise. The guideline is 30 minutes a day, five days a week, or 150 minutes a week. Space that out, get moving because people are just too sedentary. I do also think that the younger generation of Americans, when we were growing up, we had a very bad stigma and unhealthy relationship with exercise and eating right.

It was really associated with just being a skinny model on a weight loss magazine or something. You know, exercise was just to lose weight and be skinny, look good, but that's not what it is. It's to live a healthy, long life and have good cardiovascular health and you know, help maintain that ideal body weight.

In addition, the whole foods diet. Number three. Don't restrict yourself of everything because then you're going to again have that unhealthy relationship with food. So, having things that you want to enjoy is great, but also including the whole foods, fruits and vegetables, things like that. Number four would be sleeping well, getting adequate sleep every night.

And then I think one of the biggest, most important right now is avoiding tobacco because with the incidence of vaping now, like the accessibility for tobacco products is so like high right now. In 2022, 85% of high school students use tobacco products. Of 85%, one out of a hundred of them use cigarettes. Okay?

Host: Yeah.

Amy Hallow, NP: Now one in seven are using e-cigarettes or vapes, one in seven.

Host: Yeah. Yeah.

Amy Hallow, NP: It's insane. So the tobacco products, not only have you know that bad impact on your health, but the tobacco affects your cholesterol, it lowers your good cholesterol and it increases your arteries to have that bad cholesterol build up.

So, you know, no one's, like I said, people aren't seeing their doctor to get their cholesterol checked, their blood pressure checked. So all of this, I think it's all encompassed, right? You know, maintain a healthy weight, get your exercise, avoid tobacco, sleep well, and eat whole foods diet. It doesn't have to be complicated, but people make it complicated of course.

Host: Yeah, they do for sure. And I heard something on the news this morning, said something like, just a two minute walk after a meal can go a long way to living a longer, healthier life. And I thought to myself, you know, I can spare that two minutes. I, I think most of us can probably walk for two minutes, can't we?

Amy Hallow, NP: Oh, absolutely. I mean, two minutes is what percent of your day.

Host: Right. Right.

Amy Hallow, NP: Even a 30 minute workout. You know, when I, I wake up every morning and I do work out because I feel like, you know, I have to be that image. It's a good motivation to be that image and that good leader for our generation to work out and exercise. So, you know, I wake up every morning and I work out for 30 minutes a day. I can sit and talk to my patients about this and not feel like a hypocrite. Like I'm doing it. I am busy, I work full-time. You know, you can do it too. And you know, it doesn't have to be go to the gym and spend three hours at the gym anymore. Get out and walk for 30 minutes and you're done. You know?

Host: Right. Absolutely. Every little bit, whether it's two minutes, five minutes, 30 minutes, a little bit goes a long way. And certainly understanding our family history, being aware of our own lifestyle and behavior choices and so on. So really appreciate your time today. This has been really educational. I'm sure it has been for listeners as well, so you stay well.

Amy Hallow, NP: Thank you so much. You as well. Thanks for your time.

Host: Learn more about putting the brakes on heart disease for younger generations at franciscanhealth.org/heartcare.

 And if you found this podcast helpful, please share it on your social channels. And be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.