Cheryl Martin (Host): When it comes to your heart, you want to be up to date on all the latest knowledge and information available. Why? Because heart conditions are one of the leading causes of hospitalization here in the United States. We're celebrating Heart Month, and Dr. Saurabh Sharma, a Guthrie Cardiologist and the Director of the Cardiovascular Prevention and Lipid Clinic, is here to share insights on what to do to keep your heart healthy. This is Medical Minds, Conversations With Guthrie Experts, a podcast from the Guthrie Clinic. I'm Cheryl Martin. Welcome, Dr. Sharma.

Saurabh Sharma, MD, FACC, FASE, FACP: Thank you, Cheryl. Thank you for having me here today.

Host: As we celebrate Heart Month, explain its significance and why it's so important to raise awareness about cardiovascular diseases.

Saurabh Sharma, MD, FACC, FASE, FACP: We celebrate February as the Heart Month, the National Heart Month, because we thought that having a month to make our population aware of the heart disease is essential. It comes in the month of February because most of the organizations and healthcare providers, they try to raise awareness about cardiovascular diseases, in this particular month. And the significance of heart month lies in its role as an opportunity to educate public about the importance of cardiovascular health and why do we need to raise awareness? I'm going to give our audience a particular number, a few numbers from the CDC and these numbers will actually open our eyes. We know that heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups in the United States.

One person dies every 33 seconds in the United States from cardiovascular disease. And heart disease costs the United States about 240 billion each year. So it's obvious that we need to do something about the amount of cardiovascular disease that exists in the United States. And not only that, the risk factors that are associated with the heart disease are preventable.

So, if we can identify those risk factors and prevent them, the heart disease incidence and prevalence will automatically reduce. And hence, the importance of early detection and treatment for these risk factors is important. So, it's in February, we like to make our population and patients aware of the heart disease in an effort to reduce the incidence and prevalence of cardiac disorders.

Host: Well, I'm glad that you brought up risk factors and what we can do to prevent heart disease. We're going to cover those topics, but first I want you to elaborate on the most common types of cardiovascular diseases and their impact on overall health, especially in the context of today's sedentary lifestyle.

Saurabh Sharma, MD, FACC, FASE, FACP: Sure. When we talk about cardiovascular diseases, it's an umbrella term. It's a very large term and there are so many cardiovascular diseases that comes into this umbrella. However, we are, mainly concerned about a few of them because these ones are responsible for a large amount of cardiovascular deaths.

The first cardiovascular disease that is really, really concerning is atherosclerosis. Now, atherosclerosis is a pathological term, which just means plaque formation in the blood vessels, in your heart or in any organs of the body. If the plaque formation occurs in the blood vessels of the heart, it is called as coronary artery disease.

If the plaque formation happens in the peripheral vessels, it's called as peripheral arterial disease. Or if the plaque formation happens in the brain arteries, and if that plaque ruptures, that's basically can cause a stroke. So, coronary artery disease, which is a plaque formation in the heart arteries, can cause a heart attack if the plaque ruptures and causes immediate blockages of blood flow in the brain, it can cause a stroke. This is basically the two more common and more concerning heart disease, but then there are some other cardiovascular diseases that we are also concerned about. And among them are, you know, congestive heart failure, and high blood pressures.

Host: What causes that plaque to form?

Saurabh Sharma, MD, FACC, FASE, FACP: That's a very good question. So the plaque are formed usually by cholesterol. And if we could take this plaque, slice it off like a bread and look it under the microscope, we will find numerous tiny particles of what we call as low density lipoproteins or LDLs. LDL forms a very important component of anybody's lipid profile.

So, if you check your lipid profile, there will be a number called LDL, which is sometimes also referred to as bad cholesterol. These minute particles of LDL can go inside the tiny layers of the blood vessels and start accumulating there, causing the plaque formation. And if it goes to such a high extent that it forms blockages, approximately 90 percent or 95%, patients can start developing chest pains also.

Host: So what's a good LDL number to have?

Saurabh Sharma, MD, FACC, FASE, FACP: So the good LDL number varies, but on a general population, a good LDL number would be less than 100 milligrams per deciliter. And less than 100 milligrams per deciliter is for patients who do not have other cardiovascular risk factors, but the more cardiovascular risk factors you have, or if you have history of cardiovascular disease or coronary artery disease or history of heart attacks, then this number would change.

And The American College of Cardiology and American Heart Association's recommendations are that in such patients who already have history of cardiovascular disease, this LDL number should be at least less than 70 milligrams per deciliter, and now we are talking about further recommendations that the lower the LDL, the better it is.

Host: Now, you've already touched on this, doctor, when you mentioned strokes, but what are some of the other primary risk factors for developing cardiovascular diseases and how can one identify these risks early on?

Saurabh Sharma, MD, FACC, FASE, FACP: That's a very good question, Cheryl. There are numerous cardiovascular risk factors and among those that we really struggle right now in today's world is are the high blood pressure or hypertension in medical terms, high cholesterol levels or dyslipidemia in medical terms, tobacco use or diabetes, obesity or being overweight, physical inactivity.

Unhealthy diet is also becoming an important cardiovascular risk factors. Then comes family history of cardiovascular diseases. Even age is considered to be a non-modifiable risk factors, because as we grow older, our blood vessels in the heart and other parts of the body they actually get old and there is plaque formation happens as we grow older and older.

And last but not the least, the stressors that we have in our life is also, also plays an important role in cardiovascular diseases.

Host: So, a question we often encounter is about the role of genetics in cardiovascular health. How much does family history contribute to an individual's risk of heart disease?

Saurabh Sharma, MD, FACC, FASE, FACP: So the family history is important. We can't put a number to the contribution rate to that, but the reason why it's important is because we have identified few genes that are responsible for the transmission of the cardiovascular diseases. Earlier on the talk, we talked about dyslipidemia or high cholesterol. There are some genetic factors related to abnormal cholesterol regulation in the body. Occasionally, we find people in whom the LDL numbers are fine, but sometimes we even find people who exercise regularly, they don't smoke, and you know, they do not have any other cardiovascular risk factors, but their LDL numbers are really very high.

And they always ask me, Doc, I don't smoke, I don't drink alcohol, I exercise regularly, but then why are my cholesterol levels are so high? And the answer to that question is that they're are genetic defects that happen, that occur in, in the metabolism of these LDL particles that creates high amounts of circulating cholesterol or LDL particles in the circulation, causing these plaques to form.

So this condition we call as familial hypercholesterolemia, which is a genetic condition related. Now there are some other conditions that also have some genetic component to it and they relate to cardiac muscle size, something called as hypertrophic cardiomyopathy. There are some electrical abnormalities that can also happen in the heart, which is related to the genetic defects also.

So, family history is important, and again, the reason it's also important is because in addition to genetics, families often share the same environmental and lifestyle factors that contribute to the heart disease risk. You know, these may include dietary habits, physical activity, you know, tobacco, or exposure to stress or sometimes the socioeconomic statuses that some patients live in, reduced access to healthcare, et cetera.

So, that's why sometimes directly or indirectly, family history is important in informing, in basically assessing the cardiovascular disease risk.

Host: Now, we know that lifestyle choices play a critical role in cardiovascular health and you've mentioned some of these, like tobacco and unhealthy diet. Talk about some effective lifestyle modifications that people can implement to reduce their risk of heart disease.

Saurabh Sharma, MD, FACC, FASE, FACP: We always talk about these factors in our cardiovascular prevention and lipid clinic, that we run here at Guthrie. And we feel that educating the patients is the key in making them understand how can they reduce their cardiovascular risk.

So we talked about the associated, cardiovascular risk factors. So, and the lifestyle is actually the stress and the diet actually is one of the risk factors for cardiovascular disease. So I basically start telling my patients that they have to change their lifestyle. And in changing the lifestyle, eating a healthy diet is actually very important.

I tell my patients to adopt a diet, which is rich in fruits, vegetables, whole grains, lean proteins like poultry, fish, and healthy fats such as olive oil, avocados, and nuts. So.

Host: Instead of the ice cream.

Saurabh Sharma, MD, FACC, FASE, FACP: Instead of the ice cream. Well, I always tell my patients that don't deprive yourself from the pleasures of life, but, you know, doing things in moderation is good. And, and I also tell my patients that the most important reason or most common reason why our, you know, new year resolutions fail is because we really keep very high goals for us. I tell my patients taking baby steps is the key. So that's about diet and you know, yes, you can cheat once a month or twice a month.

You can eat whatever you like, but then most of the days of the, of the month, I encourage my patients to eat healthy. So that's about diet. The second most lifestyle modification factor I recommend to my patients is exercise. And we often underestimate the power of exercise or how much we exercise.

Patients ask me, well, doc, how much, how much do we need to exercise? Do I need to run, jog? Do I need to lift weights? Become, you know, become a bodybuilder? Well, I tell them, no, you don't have to. Cardiovascular disease can easily be prevented or can get benefit in patients can get benefit of, for just exercising, 30 minutes a day.

The American Heart Association recommends only 150 minutes of moderate intensity aerobic exercises, such as brisk walking, cycling, or swimming. Or you can also do just 75 minutes of vigorous intensity exercise like running or aerobic dancing, per week. Sometimes, you know, strength training and balance training also is important.

So this is how exercise, and important exercise, not only will help patients reduce their risk of cardiovascular disease, but also reduces their, their associated blood pressure, associated cardiovascular risk factors like, you know, blood pressure or better diabetic control, etc. And then I also recommend them to have a healthy weight, quit tobacco, limit alcohol intake, manage stress in some way, and that's a little challenging topic to just say it. I know it's easier said than done. We all have stresses in our life, but I tell my patients that, don't choose another poison to treat another poison if you're using tobacco or smoking to manage stress, that's not the right way.

Adopt, some deep breathing exercises, meditation, yoga, et cetera. And most important thing is that we also underestimate is, two things actually, getting a good quality sleep. We know that when we sleep, our body recuperates, our body gets rest, at night and it is found to reduce the cardiovascular disease risk.

And regular health checkups. Now, as we talked about last, few seconds ago about the high cholesterol and the associated cardiovascular risk factors, Cheryl, meeting a cardiologist or a primary care physician on an annual basis or regularly will help our patients evaluate their cardiovascular risk.

The physicians are professionals, they can actually tell you how much you are at risk of developing cardiovascular diseases so that you can assess your cardiovascular risk factors and start working on them.

Host: Some great tips, Doctor, great tips. Before we close, I would just love for you to share some insights on the latest research or advancements in cardiovascular prevention and treatment. Are there any promising developments that we should be aware of?

Saurabh Sharma, MD, FACC, FASE, FACP: There are many. You know, as we speak, scientists are constantly working on these advancements and I can share a few advancements that, that are actually ongoing. I'm not sure if all our audiences have heard about precision medicine. You know, there's a terminology that we are using a lot.

Precision medicine is one of the most promising areas in the cardiovascular medicine. And this approach basically involves tailoring the treatment strategies based on an individual's unique genetic makeup, or lifestyle factors. There's a lot to understand here, but this is something that scientists are trying to find a genetic causes to these associated cardiovascular risk factors and creating strategies and treatment to pinpoint where exactly the problem and treating the underlying problem.

There are so many imaging modalities or imaging advancements that have come like CT scan, MRI, we actually use CT scan sometimes to identify if patients have blockages in their heart arteries or not. We talked about heart failure as one of the cardiovascular diseases. There are novel medications available. The American College of Cardiology recommends guideline directed medical therapy. There are four different classes of medications that any heart failure patient should be on, which has been shown to reduce the risk of mortality and reducing the risk of hospitalizations. So this is about heart failure.

In our interventional world, we talk about this percutaneous coronary interventions. If a patient has had a heart attack or is having a heart attack, the blood vessels can be immediately opened with the stents. It's an old technology, but as we speak, these, the efficacy of these stents are getting better and better. We can actually now change a heart valve, by simple catheter based procedures.

You know, many, many years ago, we used to send patients to cardiothoracic surgeons who used to open their chest up and sew the valve in. Nowadays, we can actually change these valves with catheters. It is simply amazing. We can also close, some structures in the heart with, you know, left atrial appendage closure devices. There are many catheter based interventions that we can do for valvular leakages. And last but not the least, you know, there's a lot of artificial intelligence that's coming into play these days. We can use artificial intelligence in reading our imaging studies, and assessing if what we are doing is good for patients or not.

Host: Well, thank you so much, Dr. Saurabh Sharma, for educating us on heart disease and how to keep our hearts healthy, and it's obvious that you are passionate about this topic, so thank you.

Saurabh Sharma, MD, FACC, FASE, FACP: Thank you, Cheryl.

Host: If you are in need of a cardiovascular specialist, you can schedule an appointment by visiting Guthrie.org/heart or calling 866-GUTHRIE. That's 866-488-4743. Now, if you found this podcast helpful, please share it on your social media and check out the entire podcast library for other topics of interest to you. This is Medical Minds, Conversations With Guthrie Experts, a podcast from the Guthrie Clinic. Thanks for listening.