Scott Webb (Host): Today we're discussing healthy habits that build a healthy heart, especially for women with Dr. Anthony Bashall. He's a board-certified cardiologist practicing at Franciscan Health, and he's here to discuss the association between excess weight, inflammation, heart disease, and so much more.

 This is the Franciscan Health Doc Pod. I'm Scott Webb.

Doctor, it's nice to have you back on the podcast. Today we're going to talk about healthy habits that build a healthy heart, and just about everything in between, of course. So I wanted to start with getting a sense from you, like what's the association between excess weight, inflammation, and heart disease?

Anthony Bashall, MD: Yes. Well, thank you for having me back. It's great to be back and that's a great question. But let's just start a little bit beforehand. We, we often associate fat or adipose tissues as we docs call it, inflammation negatively, but they actually have a good role. If you have the right amount of adipose tissue, it's, it performs a great role for energy storage and it helps balance out our metabolism with lots of signaling molecules it sends throughout the body.

So that's the good. It actually also helps ameliorate inflammation in the right amount. And if you think about inflammation, when you cut yourself and bacteria jump into the cut, it's inflammation that kill the bacteria and prevent you getting a really nasty infection. And then it brings the healing properties to the wound to heal the wound up and it's very self-limiting.

So that's the good, that that's what the sort of adipose and fat tissue is for, and that is what inflammation is for. Unfortunately, as we gain weight, the adipose tissue starts to release low grades of inflammation into the bloodstream. And if you remember, you know, inflammation is designed to, to kill bacteria and it actually damages the lining of the blood vessel in a very slow process.

And then when the lining of the blood vessel gets damaged, even if cholesterol levels are fairly normal, cholesterol can often jump in there and start to plug up vessels. And this is what leads to the bad, and to the ugly, which is where you go on from that to lead to your heart attacks, which is a blocked blood vessel, a stroke, which is a blocked blood vessel in the brain. And the actual inflammation can stiffen up the muscle in the heart leading to a form of heart failure that is particularly prevalent in people who carry excess weight, particularly in men and particularly in women.

So that's kind of the role there. And what we really want to do is these patient's often present us in the ERs, in the hospitals, or come to our clinics when they're actually symptomatic. And one of our goals, and, and hopefully the goal for today's talk is a little bit, is how to catch it early or even before it begins.

Host: Yeah, and that's, you know, if we all had crystal balls, of course, but we don't, but it's important then, because we, you know, absent of the crystal balls to see into the future is, as you say, understanding the association between excess weight, inflammation, heart disease, knowing our risks, spotting the warning signs, even if they're kind of subtle.

So then what doctor can women do to prevent heart disease?

Anthony Bashall, MD: So I think getting assessed early. Don't wait for symptoms. And let me, I will touch on symptoms here in a little bit because men, men and women do share symptoms. And both can be a little unusual, not the classic, oh, my chest really hurts, although that's still fairly common as a symptom.

But we'll talk about it's how do we get to it beforehand, before we have the symptoms. And the heart can also be very sneaky. You can actually be developing symptoms. And blame a lot of other things. Things like fatigue, things like shortness of breath. You say, oh, well I'm getting a little older or I've gained some weight, and sometimes this can be actually early building heart disease.

But one thing I would really encourage people to do, particularly in that 30, 40, 50 age group coming through is, is you've gotta get an assessment of your future risk. And so while we don't have a crystal ball, we can actually make fairly good predictions of where you lie on the spectrum. And obviously there's always normal and there is mild and there is high-risk.

And if you are normal, that's not like you're out in the woods. That's like saying, well, your younger normal, a normal evaluation, we want to keep it that way.

Host: Right. Yeah.

Anthony Bashall, MD: And then if you have mild, there are ways of treating it. So certain things, one of the first things most people need to do is kind of go to their primary care physician, their primary care provider, and get in a proper assessment.

And I think some of the traditional ones still run very, very true. And time tested. One is blood pressure. A good well-controlled blood pressure will go a long way to preventing future cardiac events and stroke events. A, a good cholesterol, well-controlled, if you're a smoker, advice and support on smoking cessation strategies goes a long way for prevention.

And then some of the newer testing emerging, we're going to see and, and you perhaps have to advocate for yourself with your primary care doc or or provider and say, you know, I'd like to for you to measure the inflammation in my bloodstream. Very recently, even just in the last few months of 2025, the ACC has recommended testing high sensitivity, CRP.

And if it's elevated, even if you have a normal cholesterol, they suggest you get your cholesterol treated because that high level of inflammation is what leads to some damage of the blood vessel wall and can lead to a future event. And that is particularly true of a woman's body. In addition, an emerging marker of risk, and we're not sure whether to treat it directly, but certainly indirectly is the emergence of the lipoprotein A, a, a genetically derived cholesterol that is a marker of risk and it is being studied very closely now to whether we need to treat it directly or not, but once again, it adds to that crystal ball prediction.

If your number's high, then ways of treating it, ways of treating the things we can control. Perhaps there's a final one, and people find this a little confusing to understand is you need to ask them to check the protein in your urine. It's called a urine albumin creatinine ratio, and if you have a little protein in your urine, it's a sign of inflammation and some damage to the kidney.

And if you have that damage in the kidney, you have that damage in the heart and it portends an increased risk of some heart disease. So putting this just so real simply together. And the nice thing about all this, it's a single visit. It's some blood work, it's a urine test, it's a visit to your doc, perhaps check some blood pressure numbers at home.

I know people don't have much time, so a single visit to assess your risk and get this done early and perhaps a couple of other things just to throw into the mix. I know a lot of people have very limited time and some testing can get quite expensive, is to get a heart scan and that's also known as a calcium score. What exactly is that?

Host: Yeah. What is that?

Anthony Bashall, MD: Yeah, the heart scan is, is a quick CT scan. It's usually charged less than 50 bucks. And what happens when the inflammation damages the lining of the blood vessel and the body puts bits of cholesterol in there, it then tops it off with calcification and the heart scan can see that calcification.

So if you have an abnormal scan, it means you do have some coronary artery disease and while it can't see the cholesterol, it can see the calcification as a marker of blockage, and it allows us to risk assess the patient and the person, and it allows us to take us down a pathway of treatment and let's say to if you have a zero score, this is really good news.

Now you might have a little bit of the cholesterol that we can't see. The idea is then to keep it that way with good blood pressure control, and, you know, smoking cessation, exercise and things like this. But if you have a higher score, sometimes it leads us to trigger some testing and say, oh, well, is this causing some problems?

Is this causing some symptoms that we haven't fully recognized? I had a case recently where a lady had a very low cholesterol, but when we tested her, she had a moderately high score, and we put her on cholesterol medicine and she said, well, my number's good. I said, I understand that.

Host: Mm-hmm.

Anthony Bashall, MD: But you have a little bit of blockage, the main ingredient in blockage is cholesterol. So by using cholesterol med, we'll prevent its progression. So just by doing this test in someone who is asymptomatic, continues to be asymptomatic, we've reduced her risk of a future heart attack and stroke event substantially. And this was just out of a simple test. And if the score's a bit high, then it does lead to additional testing and evaluation.

But it does lead to a, a situation where we can prevent future harm from heart attack, and potentially people needing stents and bypasses or having strokes.

Host: The, the bad stuff, as you said before, right?

Anthony Bashall, MD: Yeah, exactly. And that's the whole goal here is let's get on this early and then let's treat early to prevent the bad stuff and I think one thing that is emerging as a test that people perhaps can talk with their doctor and their primary provider, and that's emergence of their liver evaluation.

And if you are found to have fatty deposition in your liver, it's a marker of risk that you may be having similar harm to the heart. So this, again, is a good early warning indicator and that we can use some lab work to decide whether a FibroScan of the liver is appropriate.

Host: Right. Brings me to this question, doc, you know, just this understanding the association, you talked earlier about excess weight, inflammation, heart disease. How does that then inform or help women to know their risks and really pay closer attention to their symptoms? Because as you're saying, a lot of these symptoms we chalk up as being something else. Oh, well I'm older. Oh, I'm, I haven't been sleeping well. You know, we find ways to sort of explain these things away, whereas an expert like yourself might know exactly what's going on.

Anthony Bashall, MD: I'm going to take the second part with symptoms first. And, and this is probably one of the most important aspects of cardiology, for both men and women, but particularly women. So, for example, a patient I was caring for earlier in the week came in to talk to me and said I just get exertional fatigue that's so intense. I just feel so tired. And it's just like last time when they stented me and it went away. Prior to the first stent going in, she had attributed that to her being older. Another patient I had, had some chest pressure but no pain, so didn't think it was a problem. And particularly women often have a cluster of symptoms.

They're often a little short of breath, maybe feel nauseated with exertion, dizzy and lightheaded, and often just struggle with exertion, which when we carry excess weight or we're older, we're tired, we're busy, we have jobs. We care for kids and our parents. It's easy to distribute it out. And then sometimes you have to advocate to yourself because you kind of go to your primary care provider and they're like, well, you know, have some diet and exercise and see how you feel.

And that's where these simple tests can come in of, of just assessing risk. And perhaps one additional test that I will often do in patients is just a simple exercise treadmill, just to see how they can exert and what their capacity is. And we can sometimes walk people for six minutes. We sometimes walk them on the treadmill.

And if a person comes back and goes, doc, I really struggled to do that. I was really short of breath. I spent incredible fatigue. My chest got tight, I felt nauseous. These are red flags that maybe we need to sort of progress testing and investigate a little more. And if you get a heart scan and compare that score with a simple test, we can really reveal your risk of current and future events very readily.

Host: Just give you a chance here, doctor, final thoughts, takeaways. When we think about these healthy habits and we think about all the things that can lead to heart disease, you know, the bad, what's your best advice?

Anthony Bashall, MD: So best advice, uh, going to the following. Be proactive with yourself and advocate for yourself with your primary care. And we're seeing a lot of the emergence of cardiometabolic physicians and providers that really address a comprehensive approach to everything we've discussed today to try and reduce your risk of future cardiac events or recurrent events.

So really getting seen and getting an evaluation. And it's okay to say to your doc, Hey, can we check my inflammation? Can we check urine protein? Can I get a heart scan? These are things and here's my blood pressure at home. These are all things go a long way. The second component, is also as people struggle, I, I, I think we shared before I, I've struggled with my weight, my whole adult life. We now have numerous ways to approach it. So yes, avoiding excess consumption and particularly processed food and eating out. Processed food is really harmful for us. And that's a podcast in itself.

Will perhaps do another time. But just to put it simply, if you eat a hundred calories of processed food and a hundred calories of non-processed food, you will gain more weight and have more inflammation. And so trying to avoid that is just that our brains love it. And this is where diet and exercise can help considerably.

But sometimes switching over to the obesity meds, because the obesity meds really are anti-inflammatory meds. They are metabolic meds. They promote metabolic health. And oh by the way, it's a secondary benefit that you lose weight. You get metabolic benefit from those meds long before you lose weight, which is why people often say, Hey, my joints aren't as sore.

Hey, my diabetes is better. Hey, I actually feel better. And then, hey, presto, in the next six to 12 months, they've lost maybe as much as 20% of their body weight. So that's something to sort of approach. And in the, historically, the prices were so challenging. They've really come down and the new meds on the way are highly helpful.

So, for the cardiometabolic person, to promote health, diet, exercise, and those medication can go a long way to really reversing a, a person to metabolic health. And the final one is just as it is, be aware of symptoms just to give you a good old-fashioned list. Chest pressure, chest pain, sweating, nausea, exertional challenges, feeling intense fatigue, sometimes pain between the shoulder blades. These are all symptoms and they often cluster, but if you're struggling with exertion and you have some risk factors, please get an evaluation.

Host: Yeah, it's all good stuff and I just love having experts on, picking their brains, you know, for 15, 20 minutes or so, something like that. You gave us some ideas of some other podcasts we can do, but for today, thanks so much.

Anthony Bashall, MD: You are welcome. My pleasure as always.

Host: To learn more, visit Franciscan Health.org/HerHeart 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.