Scott Webb (Host): Cardiometabolic Health refers to the overall wellbeing of our cardiovascular system and our metabolic system, and my guests today are here to discuss the importance of assessing our cardiometabolic risks and the value of blood tests and other screening tools for providers and patients. I'm joined today by Dr. Anthony Bashall. He's a Board Certified Cardiologist practicing at Franciscan Health, and I'm also joined by Dr. Stacey Lockard. She's a Board Certified Family Medicine Physician and the Associate Director of the Franciscan Health Family Medicine Residency Program at Franciscan Health.

 This is the Franciscan Health Doc Pod. I'm Scott Webb. It's really nice to have you both here today. We're going to talk about Cardiometabolic Health and what does that mean exactly. So let's start there Dr. Bashall, what is Cardiometabolic Health?

Anthony Bashall, MD: Cardiometabolic Health is that collection of findings in the body, which represent normal blood pressure, acceptable levels of cholesterol, no evidence of insulin resistance. It's often related with being a normal weight, having waist hip ratios within the correct range.

But it also goes that next step, which you really don't know if someone has cardiometabolic health unless you've gone looking. So you need to look for certain factors like cholesterol levels being appropriate, lipoprotein A levels, no protein in the urine, no fat in the liver. And, and as a cardiologist, one of my favorite tests when I very first meet someone, even if they, they say they don't have any symptoms, is to get a coronary artery calcium score and go looking for potential blockage.

And much of these findings will predate any kind of symptom. So it gives a good opportunity to get to someone before they've had any harm to the body, and that's the true state of health. And also to catch them early before anything serious has been done and we can play intervention.

Host: Yeah, I like that and I certainly get Doctor, why providers, why this information, this cardiometabolic health information would be good for them. But Dr. Lockard, why should the average person really care about this?

Stacey Lockard, MD: Well, Scott, it's really about quality of life. Those that have poor cardiometabolic health really tend to develop more chronic diseases like heart disease, problems with diabetes, kidney failure, even problems with sleep, like sleep apnea, and increased risks for cancer. So these diseases will lead to higher costs.

They cause a lot of disabilities, which make it a lot harder to do things that people want to do in life, and they cause a lot of hospitalizations because of the disease complications. So those in general can allow a person to actually increase their risk for dying at a, a lot younger age, and nobody wants that.

So, we know that things like diabetes can make people live a lot less time, maybe 13 or 14 years less than those without diabetes. So if there's anything that we can do to help people find those diseases sooner and to help advise them on things that they can change even with lifestyle, I think those are best found earlier and identified.

Host: Yeah, of course we can't outrun family history and genetics, but we can maybe lose weight. Dr. Bashall and wanted to find out how weight impacts Cardiometabolic Health.

Anthony Bashall, MD: It's inextricably linked. The combination of our food environment, our genetics driving us to gain weight, and then the weight gain seen over the last 20 years really drives really cardiometabolic disease. We have to say the word. And just to put it in simple terms, if someone has a normal BMI versus someone who has a BMI over 40, of which in areas of the country now 20 to 30% of the population do, they have a 10 years less of life.

And if we use the term cancer, everybody would be freaking out over there saying, we must do something about it. Whereas currently the advice we give is diet and exercise and you might get a few percent weight off, but it's insufficient. And the big problem I think with obesity as well, is the more obese you are, and this you're talking to a person here who has struggled with obesity as a whole adult life. The more inflammation you create, the more inflamm inflammation you create in your body. The more you can harm your heart, the more you promote cancer. And it really, it's hard to find a medical problem that isn't made worse by increasing adiposity. And the more obese you are, the worse it gets.

Host: Right. Yeah, we know that obesity is such a massive problem, no pun intended in America and around the world, as well. But Dr. Lockard, you know, you touched on this earlier and we're talking about weight and things that we can do to help ourselves. What are some of the lifestyle habits that have the biggest impact on Cardiometabolic Health? Is it pickleball? Like what do we need to be doing to help ourselves?

Stacey Lockard, MD: Yes, so whatever people enjoy doing, you know, whatever can keep people active. So pickleball is a great example of an activity that keeps people moving, which allows that body to find a healthy weight. Other things that are really not complicated things that everybody has heard, probably either from their doctor or even just TikTok or online is, you guessed it, eating a healthy diet, things that include those vegetables and fruits, things that look like the true vegetable or fruit that comes from the ground. Even having whole grains, which include wheat in its true form or things like oatmeal. So those are the very common things, but we also are learning more about getting optimal sleep and finding habits that really can allow that body to rest and reset and decrease a lot of that stress response that also can allow the body to thrive at a healthier weight level. So it's kind of that combination of all of them.

Host: Right. Getting, uh, better and more sleep, exercise in the form of pickleball or anything else, eating right. I love that. When do we talk to our doctors then Dr. Lockard about our Cardiometabolic concerns?

Stacey Lockard, MD: Well, I think coming from, I'm a, a family medicine doctor by training and you know, having that background in primary care allows me to see so many people actually coming in before or at the earlier stages of when they start developing some dysfunction that can create this poor Cardiometabolic Health.

So my big ask is that you start talking to your doctor now. You know these are things that primary doctors can take care of. And now we have many specialists that also can help take care of one's health. But the earlier, as Dr. Bashall said, the earlier that we can screen for these things in our environment and the stressors, any psychosocial factors that impact our health.

If we can know those from the get go at the very beginning, before our bodies develop, you know, a weight gain of a hundred pounds or more; it's so much easier to get on top of a healthy cardiometabolic diet than to wait many, many years. It really gets harder as time goes on, and those habits that may not be so healthy, that get us into having poor metabolic health, can really come back to bite us.

Host: It's certainly easier and less expensive and less stressful and all of that, Dr. Bashall to prevent things, right, to to have early diagnosis before things turn into much bigger concerns. So I want to have you talk about some of the tests or screenings that you typically use.

Anthony Bashall, MD: So to start with, often very simple tests and the more tests we often put in front of a patient, sometimes that can be a barrier to care as they have to take time off work to do them and pay for them. As everyone knows, there's a money crunch in the medical field right now, so doing high yield tests to reveal risk to the person and the patient and see what we can treat early. If it comes back that it looks like they are to increase risk for problems, then we can proceed to other testing later. But many tests can just be done. Simple blood work, checking liver panels, checking kidney panels, checking the urine for protein can go a long way to indicating how much further risk for the kidney and indeed the heart because what damages the kidney, damages the heart. We can check liver labs. What damages the liver, damages the heart. And this can lead to some very simple testing, like some heart scans, some liver scans. And very simply, we can work out the risk of, of future harm to a person or indeed that they are undergoing higher risk currently and proceed to more testing, which is more revealing.

Host: We were, uh, joking a little bit before we got rolling here, doctor, about, you know, robots and AI and all of that. And I don't know that you're going to get into that, but I, I am interested in some of the new treatment options that you're using and the patients are using to help manage these conditions.

Anthony Bashall, MD: I think the one that's front and center and is very successful are the GLP category of meds. And just to put it in perspective, they're not that new. Some of them have been out for 20 years, but our understanding of how they work is new. And let me put it this way, even if these meds did not cause weight loss, I would use them in my patients because they have an anti-inflammatory effect. They protect against heart attack and stroke, before the weight loss occurs. They, we believe they prevent dementia, reduce the risk of cancer, joint pain, they can reverse fatty liver and improve kidney status. It's almost like what's not to like, and this often happens before the weight loss.

You add the weight loss on top, particularly weight loss above 10%, and you actually get significant cardiovascular benefit. And there's not an a regulatory body in the country. The kidney people, heart, AHA, ACA, GI, ACC that don't recommend GLPs in patients who have shown to have diabetes and heart disease complicated by obesity. It's even been shown in stances to reverse sleep apnea.

Host: Mm. Yeah, it's really amazing. As you say, you know, they've been around for a while, but we seems like in speaking with more and more experts from Franciscan Health, I keep learning more and more about these wonder drugs, really. So, amazing stuff. Glad to have you both here today. Dr. Lockard, I just want to finish up, and you touched on this a little bit, but because you said, regular doctors, if you will, your family medicine doctors, regular practitioners can help with a lot of cardiometabolic things, risks and so forth. But if we are trying to find a doctor, if we're, if we don't already have one or we're trying to find one that specializes in cardiometabolic risks and issues and all of that, how best to do that?

Stacey Lockard, MD: Well, I think honestly, if you are looking for a doctor, I think everybody can search online these days to say, what, what is the closest one around. We have the Cardiometabolic Center Alliance that has a lot of organizations that are enrolled, that specifically focus on Cardiometabolic Health. For those that are interested in more of the lifestyle changes that can be made and some of the coaching that goes along with that; the American College of Lifestyle Medicine has a provider search as well. And I know many of our colleagues at Franciscan Health, are big proponents of finding cardiometabolic health indicators and assessing risk, and I know we are all very happy to assist any person in making their life a little bit healthier.

Host: Yeah, anyone who has access, I don't know if they make phone books anymore, but certainly anyone who has access to the internet can at least find some doctors, try them out, try to, you know, build a relationship, trust all of that. But I really do have a better sense from both of you today of Cardiometabolic risks and the importance of catching things early, so early, you know, screening, scans, diagnosis, all of that. I appreciate your time and your expertise. Thanks so much.

Anthony Bashall, MD: Thank you.

Stacey Lockard, MD: Well, thank you so much.

Host: And for more information, visit franciscanhealth.org and search Cardiometabolic Health. 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.