Scott Webb (Host): As we know, articles we read on the internet are not always scientifically accurate. We're here today to discuss some of the top myths about cardiovascular disease, a very serious disease that kills more adults in the United States each year than any other disease. Our Franciscan health expert, interventional cardiologist who's sports-certified in Cardiology, Interventional Cardiology, and Nuclear Cardiology, Dr. Tansel Turgut, will share facts about the disease and set the record straight regarding some of the common myths.

 This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, it's so nice to have you here today. We're going to talk basically about the top 10 myths about cardiovascular disease. So, it's great to have you here, great to have your expertise. And one that I'm sure you hear and I've heard before is, "I'm too young to worry about heart disease." What are your thoughts on that?

Dr. Tansel Turgut: Yeah, I'm going to try to be simple and I'll give some scientific basis, but the main thing is to give some important points to, you know, people listening.

Host: Sure.

Dr. Tansel Turgut: Heart disease starting at an older age is very wrong actually because heart disease starts basically when we are born. So, there are like car accidents. Sometimes, unfortunately, young kids die and they do autopsy studies, and they find that actually fatty streaks are seen in the aorta. So, aortic disease or atherosclerosis or the heart disease doesn't start when we're like 40, 50, 60. It starts age like three, four, five. So like when we have weight, obesity, diabetes, high blood pressure, unhealthy eating habits, smoking and stuff like that, it directly affects us starting at a very, very young age contrary to what we have been thinking for many years, that it starts in an elderly.

Host: Yeah. So in other words, the clock starts ticking, you know, basically once we're born, right?

Dr. Tansel Turgut: That is correct. In other words, heart disease doesn't check our ID.

Host: That's a great way to put that, of course. And myth number two I have for you is, "Well, as long as I take my medicine, diabetes will not hurt my heart."

Dr. Tansel Turgut: So, diabetes increases cardiovascular death, like two to four times more. So even if your diabetes is excellently controlled, dying from heart disease complications is 50% more. So, diabetes, we have a couple new medications actually, which is changing this trend in the last five years. So, we have these weight loss medicine, which is important. Some of these semaglutide and, you know, similar medicines actually are decreasing cardiovascular mortality and also heart failure, which is very important because we never had any weight loss medicines that affect diabetes, that decrease mortality, cardiac mortality before.

Now, a lot of times patients wait before checking their diabetes and getting, you know, them in a better level. Like today, I saw a patient with a hemoglobin A1c, which is a marker of diabetes, was 13. It should be like less than 6. And it wasn't diagnosed until like six months ago. So now, it's 5.8. They were able to drop. These patient's triglycerides were like a thousand. Now, it is, you know, 50, 60. So, diabetes starts in a very young age. You know, for a lot of patients, it's related with weight. It increases cardiac death like almost two to four times. It increases heart failure. It's terrible. It not only also affect the heart, it affects all the vessels, including the brain vessels, leg vessels. So, diabetes is a major problem. And then, even if it's well-controlled, it has to be something that's taken into consideration very early and very aggressively managed.

Host: Okay. Myth number three, "I'll know when I'm having a heart attack because I'll have chest pain."

Dr. Tansel Turgut: So, that's another myth that, you know, over the years, I've been working as an interventional cardiologist. So if there's a heart attack in the ER, they call us, like even in the middle of the night or day. So over the years, classical chest pain is actually maybe half, maybe a little bit more than that. So, crushing, sweating, nausea, vomiting, like they cannot breathe and that heavy chest pain. It's like more in the movies, okay? Stuff doesn't happen all the time.

Host: Yeah, TV and movies, right?

Dr. Tansel Turgut: Right. So basically, women especially do not have classical chest pain a lot of times. So, nausea, vomiting, not feeling well. You know, over the years, I've seen heart attacks with ear pain, throat pain, toothaches-- I've seen heart attacks with toothaches-- back pain, abdominal pain, not feeling good, just coming to the emergency room. So, it's not classical. And then, the overall feeling is that, you know, if something is wrong, not feeling it may be a heart attack, especially women, like 40% of women actually do not have classical chest pain. So, almost 42%. So, you know, there's a good chance that may be underdiagnosed or it may not be found on time. So if you're suspecting something is wrong, sometimes shortness of breath, abdominal pain, you know, people know that something is wrong a lot of times. And then, it may be a good idea to come to the emergency room or see your primary physician immediately.

Host: Right. Yeah. They may not associate it necessarily-- because they're not doctors and nurses-- they may not associate it with their heart, but they just know something doesn't feel right, right?

Dr. Tansel Turgut: Right.

Host: Yeah. All right. "Doctor, I'll know that I have high blood pressure because there's going to be warning signs," right?

Dr. Tansel Turgut: So, that's another big problem. If the blood pressure would be controlled better, actually, like, there would be significant improvement in the amount of money we spend on healthcare actually. So, blood pressure is a lot of times not diagnosed at all. Patients come sometimes to the office, you know, like first time in their 40s with a blood pressure of 180, 190.

Host: Wow.

Dr. Tansel Turgut: And then, a lot of times, sometimes it may cause headaches. Sometimes they feel a little bit weak or, you know, a little bit tired. They think they're getting old. But this is something preventable completely because there's blood pressure cuffs, pharmacies, you know, malls everywhere. And it's called a silent killer because the damage is very slow. Same thing like some pipes in the heart and all the body constantly is being pressured by this flow. Then, the vessels are elastic, collagen and stuff, and they start getting damaged. So, suddenly, the heart vessels, leg vessels, brain vessels. And then, it may cause like strokes or dementia.

So, what I would recommend is actually getting blood pressure checks, like, you don't have to go to the doctor's office. It can be a mall or any kind of pharmacy. Getting checked at least a couple times a year when you're young. And then, you know, when you're like more than 30, actually, not even 40, getting a blood pressure, good blood pressure cuff at home may be very, very important. I mean, if there's anything that people are going to remember from this talk today is that, you know, people should have a blood pressure cuff at home and not that wrist one, they're very inaccurate. And not the cheap one-- Accurate one. Elderly, I would recommend them to check every day actually. Like, a lot of people have it in their home, but they don't even check it.

Host: Right, right. Yeah. They buy it and then they don't use it. And I think you're so right. I think a lot of us, we tend to feel like, "Well, you know, I'm older; and therefore, some things aren't going to feel right. I'm not always going to feel well." And I do find that, Doctor, that a lot of folks just say, "Well, you know, of course, I'm older, so I'm just not going to feel great anymore."

Dr. Tansel Turgut: Yeah, that's also a lot of like weak heart, valve problems, vascular problem, like only around 25% of the people have good blood pressure control in the U.S. Twenty-five percent of the people with hypertension, almost 30 to 40% people, they don't even know that they have high blood pressure. And the other ones that they know, two-thirds don't even have a well-controlled blood pressure. So, it's a big public problem. And another thing is to cut back the salt. If you have a blood pressure problem, cut back the salt is another important thing from this talk today.

Host: Definitely. So, myth number five, "Heart disease runs in my family, so there's really nothing I can do about it."

Dr. Tansel Turgut: So, that's also completely wrong. Genetics, you cannot change. So, you know, you get genes from your parents. But you know, smoking, significantly, you can cut back your risk if not smoking. Weight, you know, if you're obese, losing weight or eating healthy, exercising with the modifications, you can decrease your risk more than 50% actually, so around 46%. From you are born, you can decrease your risk of dying from a heart disease almost half doing the right thing. It's like you have a loaded gun in your hand and you pull the trigger or not.

Host: Yeah, as you say, high blood pressure , there's a reason why they call it the silent killer. And when we start talking about heart disease in our family, yeah, we really can't outrun family history and genetics. But we are in control of behavior, lifestyle, checking our blood pressure, seeing our doctors, all those things, right?

Dr. Tansel Turgut: Right. I mean, I have patients who have bypass surgery in their 20s actually, or had two bypass surgeries before age 30. So, if you know that you have family history, you don't want to wait until like you're 40 or 50 to go to the doctor. Like, 25, 30, you can go and then, you know, start working on your cholesterol profile, and then your weight and stuff. So, you know, if you see some family members, direct family members, siblings, parents who have heart disease, I think, you got to be like extra careful. And then, there are some things that can be done to decrease the risk.

Host: Definitely, as you say, quit smoking. That'd be probably at the top of the list if folks are smokers.

Dr. Tansel Turgut: Weight.

Host: Right. Weight. Blood pressure.

Dr. Tansel Turgut: Blood pressure control, sugar control. I mean, sometimes people, they don't have diabetes, they're having insulin resistance and like borderline, so they don't fit the criteria. But that's a pathway, you know, to atherosclerotic disease.

Host: For sure. So, myth number six, "The pain in my legs must just be a sign of aging," as we were talking about, right? "We're just older, so things hurt. So, I don't think it has anything to do with my heart."

Dr. Tansel Turgut: So, atherosclerosis is a generalized vascular problem. So, it can be blockages in the legs, it can be blockages in the heart, it can be blockages in the neck vessels. So, neck vessels, you get strokes. You know, in small vessels in the brain, you start getting dementia. Heart, you get heart attacks. Legs, you get claudication, like a pain when walking. So, more than half of the patients in the U.S actually with leg pain are diagnosed like arthritis and, you know, lumbar back pain and stuff. So if you have leg pain, especially with walking, this may be a sign of a peripheral vascular disease and atherosclerosis.

The importance of this is. If you have a blockage in the legs, this increases your chance of having a heart problem, almost like four or five times. So if you have a blockage in the leg, there's a very good chance you have a blockage in the heart. That may be a good warning for you actually, for people to get it checked actually.

Host: Yeah. Because as we were talking about here today, sometimes there are signs and symptoms, sometimes there aren't. But if you have pain in your legs, that could be a vascular issue or arterial issue, whatever it might be, that could be the sign, that could be the symptom, and that's a good time to reach out, right?

Dr. Tansel Turgut: I mean, it can also be like cholesterol medicine sometimes can cause leg pain, low potassium, low magnesium. You know, there are other problems, but you know, vascular disease is number one.

Host: And that's a good time to let our doctors sort it out for us, right? Let the experts do their job.

Dr. Tansel Turgut: That's right.

Host: Absolutely. So, myth number seven, "I don't need to have my cholesterol checked until I am, you know, middle aged."

Dr. Tansel Turgut: So basically, American Heart Association recommends checking it by age 20. And then, acting, you know, I mean, you can modify your diet. Most people don't want to take medications and that's completely understandable. If you have a strong family history, I would recommend it much earlier than 20. I recommend a check. as I said, you know, like autopsy findings show fatty streaks on the aorta of very young children, age two, three. So, the atherosclerosis does not start, you know, we're not programmed to live forever, so we are programmed to have problems, But even in the beginning, it has problems.

So, if you have a family history, strong family history, I would recommend getting it checked very early. If you are healthy and stuff, you can start by AHA recommendations by age 20 or so. We know that decreasing the cholesterol, decreases almost like cardiac events in half. A lot of people in the U.S., you know, like half of the people in the U.S. with cholesterol problems are not treated actually.

Host: Yeah, that's definitely going to be one of my takeaways here is that, you know, if you have a family history, definitely get started earlier than maybe you would think. Certainly, don't wait till you're middle aged, right? Yeah. So myth number eight, "Heart failure means the heart stops beating."

Dr. Tansel Turgut: So, heart failure, it can be two things. Number one, it can be a weak heart. It's like a pump. So, the pump is weak. It cannot force the blood. And then, if the pump is weak, the blood goes back to the lungs and you cannot breathe. That's a heart failure.

The other kind of heart failure is you have a strong heart, but the vessels, they're resistant. So, the vessels that push, the pipes, have a high blood pressure. So, you cannot pump the blood through those pipes. So, what happens if you cannot pump it? It goes back again to the lungs. So, one can be with a weak heart, pump problem. The other one can be high blood pressure, for example, stiff. So if you have a very high blood pressure, you can have a heart failure without even any weak heart. Or you can have a very good blood pressure, but a weak heart. And then, it goes back to heart failure.

 The main thing is, again, good blood pressure control, low salt. So basically, you can cut back your hospitalization significantly with having a blood pressure cuff at home, controlling your blood pressure, and putting that low sold without doing anything else.

Host: Yeah, cutting the salt for sure. Myth number nine, "I should avoid exercise after having a heart attack."

Dr. Tansel Turgut: So, that's another myth. You know, like 50, 60 years ago if you had a heart attack, we didn't have balloon stents. So if you were like a president, you had a heart attack, they would put you in ICU, you wouldn't be able to get out of the bed like three to four weeks and they will put you on morphine. So, it's completely changed. So right now, I mean, if there's a heart attack today, you know , for example, I put stents and next day I get the patients out of the bed and start walking immediately. And then, we want them as active as possible, and we send them to cardiac rehab. That's another thing, cardiac rehab decreases deaths actually 25-30% in the hospitalizations, but only 20-30% of our patients go to cardiac rehab.

So, that's another thing. So, we want the patients as active as possible, as soon as possible. And then, you know, sex and stuff also, it's a question that's not asked usually. I usually recommend a week after is fine for my patients. So, sometimes people are shy, they don't ask it.

Host: Yeah. Shy for sure.

Dr. Tansel Turgut: But we want activity after a heart attack. Very soon, we want them out of bed. We want them walking. I mean, reasonably. I mean, if they have symptoms, of course, they need to slow down.

Host: Right. Don't get up and run a marathon the next day, but, you know, get up and get moving.

Dr. Tansel Turgut: That's correct.

Host: So, myth number 10, last one I have for you today. And then, I'll give you a chance to give us some recommendations which I'm eagerly awaiting, because I love my job, I loved getting experts on and getting free medical advice. Myth number 10, "Since my heart is beating fast, I must be having a heart attack."

Dr. Tansel Turgut: So, most of the heart attacks don't have actually fast-beating hearts. I mean, fast-beating heart can be a lot of problems. It can be like an irregular rhythm, like atrial fibrillation, which is a problem for, you know, that can be another talk for strokes and stuff. It can be some kind of tachycardia. Some heart attacks have a bad rhythm that needs shocks and stuff like that. But most of the heart attacks, you don't have a fast heart. So if you have a fast heart rhythm, if it's very fast, like you're dizzy, passing out level, you need to go to the emergency room. Or if you have a fast rhythm, you know that's with exercise, it's usually normal; without exercise, if it's still fast, it may be a good idea to go and see a doctor. And if it's irregular, it is very important, if it's irregular and fast, it's atrial fibrillation, which may cause strokes that needs to be checked urgently.

Host: Well, it's been a real pleasure having you here. As I said, I love benefiting from the expertise of the experts from Franciscan Health. I'll give you a chance here at the end, just recommendations that you generally give patients how to live a longer, happier, healthy life.

Dr. Tansel Turgut: So, I mean, from this 15 minutes or so, if I can give some landmark things for the patients. So basically, number one is what I said, you know, blood pressure cuff, especially after age 40, preferably earlier. If you are more than like 60, I think you should check it every day actually. That can prevent a lot of passing out spells, if it's low. It can prevent a lot of stroke with the blood pressure. And then, it can also prevent a lot of long-term damage on the vessels.

Another thing is, you know, if you have heart failure and stuff like that, you need to cut back on the salt for blood pressure. So, you know, check how much salt you're taking if the blood pressures high, that can save you of taking like one or two medications less actually. Another thing is good cholesterol. Very, very important. It needs to be started at a young age, and then check your cholesterol. Make sure that, you know, it's not damaging your vessels, because by the time we diagnose heart attacks, some of the damage is already done. We cannot reverse it. Unfortunately, we don't have too many medications that can reverse the damage. So, good cholesterol.

Smoking, everyone knows about it. We even have to tell. We have studies of twins, you know, like one twin smokes, the other one doesn't. And significantly decreased cardiac events in the one that doesn't smoke. So, that's another thing. Weight loss, there are some medications, as I mentioned, which show cardiovascular benefits right now with decreased tests and decreased hospitalization, which is the first time in history that we have some weight loss medicines, which are good for the heart. We didn't have them before.

Checking legs is important. If you have a blockage in the legs, probably, you have something in the heart too. Vitamin D deficiency is important. Like all the supplements we're taking, like we were taking a lot of fish oil and stuff like that in the past, you know, most of them did not survive actually with the studies. But there's some data showing that vitamin D deficiency, actually taking some vitamin D like 5,000 units a day or something may be very beneficial. So this is like a summary, you know, we can have more detail on these, but this is from today.

Host: Of course. Well, I appreciate your time and your expertise today. You know, of course, we want folks to hear these podcasts, benefit from the expertise, you know, of the Franciscan health doctors and nurses. And then, obviously, reach out if they're having signs, symptoms, concerns, reach out to their own providers. In extreme cases, go to the ED directly, whatever it might be. But great having you here. Thank you so much.

Dr. Tansel Turgut: Thank you so much. My pleasure.

Host: And for more information, go to 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.