Are you at risk for a heart attack?
Heart disease is the leading killer of Americans—but you don’t have to be a victim of cardiovascular disease.
If detected early, heart disease is treatable-and it is also preventable.
Tune into SMG radio to hear Summit Medical Group’s Chief of Cardiology, Dr. Andrew Beamer, talk about SMG’s new Early Heart Disease Prevention Program and the importance of a cardiac stress test, among other testing.
Selected Podcast
SMG’s Early Heart Disease Prevention Program
Featured Speaker:
Learn more about Dr. Andrew Beamer
Andrew Beamer, MD
Dr. Andrew Beamer is chair of cardiology at Summit Medical Group. He is the author of articles and abstracts, which are published in prestigious, peer-reviewed scientific journals. Dr. Beamer has been featured in New Jersey Monthly "Top Doctors" listings.Learn more about Dr. Andrew Beamer
Transcription:
SMG’s Early Heart Disease Prevention Program
Melanie Cole (Host): Are you at risk for a heart attack? Heart disease is the leading killer of Americans but you don’t have to be a victim of cardiovascular disease. If detected early, heart disease is treatable and is also preventable. My guest today is Dr. Andrew Beamer. He is the chief of cardiology at Summit Medical Group. Welcome to the show, Dr. Beamer. Let’s start by talking about heart disease detection and how we would know if we have any sort of heart disease. What do you recommend people do?
Dr. Andrew Beamer (Guest): There are two different situations. The first, of course, is if you’re having symptoms. The main symptom that you have to watch out for is chest discomfort provoked by exertion and relieved by rest. By chest discomfort, it can be anywhere between the belly button and the top of the head. If you have that type of discomfort and it is provoked by exertion and relieved by rest, that is a potential warning sign and you ought to get that evaluated right away. The second group of people that we worry about is, basically, everybody. More than half of the people in the United States have at least one risk factor for heart disease and we work hard to try to figure out how to focus on the right people to try to help prevent them from having problems.
Melanie: People know these symptoms. We hear about heart disease and so many of the things that cause it. What are some of the risk factors you would like people to know are the main ones that you would like them to change for prevention of heart disease?
Dr. Beamer: The biggest one is no secret. Smoking triples your risk of having a heart attack. Smoking triples your risk of having heart disease and other vascular disease and multiplies your risk of having lung cancer by tenfold. Smoking is, obviously, the big one. It is not really rocket science here. There are only a limited number of things that you have to watch out for. If you’ve got high blood pressure or diabetes, they should be well treated, trying to keep yourself at your fighting weight, keeping your weight under control, exercising on a regular basis. You don’t have to be an athlete, but at least exercising on a regular basis will all reduce your risk of heart problems.
Melanie: So, tell us about the stress test which is still considered the gold standard. People hear all kinds of terminology thrown around. They hear nuclear stress test. They hear treadmill stress test. They are not sure what to expect.
Dr. Beamer: Stress testing is a very useful test for helping sort out somebody who has symptoms and it can be part of a screening package. Stress testing is poorly named. We should have called it an “exercise evaluation” or something to that affect. A basic stress test is a situation where you are wired with electrodes on your chest, about 12 electrodes on your chest. The person, then, gets on the treadmill and we start out very slow at a walk--1.7 miles per hour, not very fast at all. If everything is going well, every three minutes, we make it a little faster. There is no set length of time that you have to go. If you go five minutes and you are exhausted, then that’s a valid stress test. If you are in shape and you end up going nine minutes or fifteen minutes, that’s fine, too. What we monitor during this is your electrocardiogram, your blood pressure, whether you are having any symptoms and we get a lot of information from that.
Melanie: People are doing this exercise. What do you recommend? First of all, they should wear good shoes. Are there limiting factors to what a stress test can tell you, Dr. Beamer? Based on, maybe, somebody is wearing poor shoes or they have never been much of an exerciser, it’s tough for them; if the grade and incline has changed. Give us some of the basics.
Dr. Beamer: Stress testing is very good at detecting whether you’ve got serious narrowings of the arteries but it is not a particularly good test for detecting the very early signs, which is why we are going to talk about some other things later on. If people can’t exercise very well or if their electrocardiogram is already abnormal in certain ways, we will often do more advanced stress tests instead of just having them walk on a treadmill with an electrocardiogram. We will sometimes decide it is necessary to have them do what is called a “nuclear stress test”. The fundamental of the nuclear stress test is still the same where you are walking on a treadmill, for the most part. But, you get an IV in beforehand, an injection of a very mildly radioactive tracer that allows us to trace the blood flow in the heart, both at rest and then you get a second injection at peak excursion. That lets us see what the blood flow is like when you are exerting yourself. The other thing we can do is, if people really can’t exercise at all and we have reason to think that we need to be sure about whether they have blocked arteries, we can do a stress test that is done with chemicals. It doesn’t make your heart pound or race or anything like that and it’s very, very safe. It makes the arteries behave as if you are exercising and lets us do the same sort of imaging with the nuclear images.
Melanie: What is that one called, Dr. Beamer, for the listeners?
Dr. Beamer: That is called a Lexiscan, the brand name is Lexiscan, the generic would be to call it a “pharmacologic nuclear stress test.”
Melanie: Now, we’re going to go into prevention just a little bit. You have an early heart disease prevention program at Summit. Tell us a little bit about what this involves.
Dr. Beamer: One of the things that we all struggle with is how to pick out that people who are at risk before they start having problems. Once somebody has had a heart attack or needed stents or by-pass, it is very easy to know that these are people you need to concentrate on in terms of reducing their risk factors, lowering their cholesterol and all that. But, of course, that is a little late. We don’t really want to pick people up that way. We want to pick people up before there is a problem. Stress testing is a useful part of that screening. That is part of the package. We do a stress test. But, stress testing can only go so far. If you have mild, mild narrowings before they are bad enough to limit blood flow, then you will not pick it up on a stress test. For years, we have been looking for something to combine with a stress test to be able to pick up those more subtle blockages. The second piece, then, is what is called a “coronary artery calcium score”. Although it has “calcium” in the name and we do measure some calcium deposits, we don’t really care that much about the calcium. What it is is a CT scan of the heart. A very, very, very quick CT scan with just one breath hold and very low radiation dose that allows us to take pictures of the arteries that feed the heart and look for calcium deposits. You can only get calcium deposits in those arteries if you have some plaque. So, by measuring the amount of calcium, we can tell how much plaque you have. This test has been done on enough people that we know what is normal at different ages. We know what is bad news, in terms of having a lot of it, or having a lot compared to other people your age. We can, then, put people into risk groups by looking at this. People who have a lot of calcium, we tell them that we really need to focus on whether you’ve got a problem already and look at how to best reduce that risk. People who have no calcium or very little calcium, we encourage them to continue a healthy lifestyle but they are really not at very much risk and don’t need to have all of the drugs thrown at them to try to lower their cholesterol and such as much.
Melanie: Dr. Beamer, people get their blood taken every year and they get their lipid profile and their cholesterol and those sorts of things are looked at. What about the inflammatory markers and what is their relationship to heart disease? Are you looking at those as predictors, too?
Dr. Beamer: We use them in some people, although if you look at the cholesterol and you look at the inflammatory markers and you look at calcium scoring and a variety of other testing that you might do, calcium scoring can actually reclassify people from a low risk to a high risk or high risk to low risk about 60% of the time. It is a very potent test for being able to reclassify people. The inflammatory markers can make you more suspicious of a problem, but they are not as potent a test in asymptomatic people or in people who don’t have known coronary disease. I do use them sometimes, although I don’t think they have as much value in a screening population as the calcium score does. In terms of the cholesterol, we actual will often do, depending on the person’s history and family history, we will often do more advanced lipid testing than the usual testing where we actually look at the number and size of the LDL particles and such. For most people, that doesn’t add that much new information but when people have some family history or some evidence of having vascular disease already, I’d say about between 10-20% of people, we find out that the regular test isn’t giving us the whole story.
Melanie: So, in just the last few minutes, Dr. Beamer, give the listeners your best advice for preventing heart disease, cardiovascular disease, taking an exercise stress test and the early prevention program at Summit.
Dr. Beamer: The basics are easy. Keep yourself at your fighting weight. Don’t let yourself become obese. Obesity, as we know, is an epidemic in the United States. That’s the first thing. The second thing is exercise on a regular basis. I can’t neglect to mention smoking. If you are a smoker, get help to quit as soon as you possibly can. It’s never too late to quit. But, if you don’t smoke, don’t start. That triples your risk of heart disease. Be aware of the symptoms of heart disease, in particular, for coronary artery disease. Be aware of chest discomfort provoked by exertion and relieved by rest is the hallmark danger sign. In terms of the early heart disease screening program, we, actually, at Summit, now have put together a package of early heart disease screenings that includes a stress test, a calcium score, a blood cholesterol testing, if you haven’t had it already, and a screen for diabetes. I think that package is sensible to do around age 50 if you are a man and someplace between 55 and 60, if you are a woman. Or, if you have a family history of heart disease, I would say do it probably 10 years earlier than your family history. If dad died at 50, then if you’re a 40-year-old man, then you ought to be looking at it because you don’t want to wait until the plaque has developed so far that you already have problems. You want to jump in and start modifying your risk factors in advance of that.
Melanie: Thank you so much. It is absolutely great advice. Thank you so much, Dr. Beamer. You’re listening to SMG Radio. For more information, you can go to SummitMedicalGroup.com. That’s SummitMedicalGroup.com. This is Melanie Cole. Thanks so much for listening.
SMG’s Early Heart Disease Prevention Program
Melanie Cole (Host): Are you at risk for a heart attack? Heart disease is the leading killer of Americans but you don’t have to be a victim of cardiovascular disease. If detected early, heart disease is treatable and is also preventable. My guest today is Dr. Andrew Beamer. He is the chief of cardiology at Summit Medical Group. Welcome to the show, Dr. Beamer. Let’s start by talking about heart disease detection and how we would know if we have any sort of heart disease. What do you recommend people do?
Dr. Andrew Beamer (Guest): There are two different situations. The first, of course, is if you’re having symptoms. The main symptom that you have to watch out for is chest discomfort provoked by exertion and relieved by rest. By chest discomfort, it can be anywhere between the belly button and the top of the head. If you have that type of discomfort and it is provoked by exertion and relieved by rest, that is a potential warning sign and you ought to get that evaluated right away. The second group of people that we worry about is, basically, everybody. More than half of the people in the United States have at least one risk factor for heart disease and we work hard to try to figure out how to focus on the right people to try to help prevent them from having problems.
Melanie: People know these symptoms. We hear about heart disease and so many of the things that cause it. What are some of the risk factors you would like people to know are the main ones that you would like them to change for prevention of heart disease?
Dr. Beamer: The biggest one is no secret. Smoking triples your risk of having a heart attack. Smoking triples your risk of having heart disease and other vascular disease and multiplies your risk of having lung cancer by tenfold. Smoking is, obviously, the big one. It is not really rocket science here. There are only a limited number of things that you have to watch out for. If you’ve got high blood pressure or diabetes, they should be well treated, trying to keep yourself at your fighting weight, keeping your weight under control, exercising on a regular basis. You don’t have to be an athlete, but at least exercising on a regular basis will all reduce your risk of heart problems.
Melanie: So, tell us about the stress test which is still considered the gold standard. People hear all kinds of terminology thrown around. They hear nuclear stress test. They hear treadmill stress test. They are not sure what to expect.
Dr. Beamer: Stress testing is a very useful test for helping sort out somebody who has symptoms and it can be part of a screening package. Stress testing is poorly named. We should have called it an “exercise evaluation” or something to that affect. A basic stress test is a situation where you are wired with electrodes on your chest, about 12 electrodes on your chest. The person, then, gets on the treadmill and we start out very slow at a walk--1.7 miles per hour, not very fast at all. If everything is going well, every three minutes, we make it a little faster. There is no set length of time that you have to go. If you go five minutes and you are exhausted, then that’s a valid stress test. If you are in shape and you end up going nine minutes or fifteen minutes, that’s fine, too. What we monitor during this is your electrocardiogram, your blood pressure, whether you are having any symptoms and we get a lot of information from that.
Melanie: People are doing this exercise. What do you recommend? First of all, they should wear good shoes. Are there limiting factors to what a stress test can tell you, Dr. Beamer? Based on, maybe, somebody is wearing poor shoes or they have never been much of an exerciser, it’s tough for them; if the grade and incline has changed. Give us some of the basics.
Dr. Beamer: Stress testing is very good at detecting whether you’ve got serious narrowings of the arteries but it is not a particularly good test for detecting the very early signs, which is why we are going to talk about some other things later on. If people can’t exercise very well or if their electrocardiogram is already abnormal in certain ways, we will often do more advanced stress tests instead of just having them walk on a treadmill with an electrocardiogram. We will sometimes decide it is necessary to have them do what is called a “nuclear stress test”. The fundamental of the nuclear stress test is still the same where you are walking on a treadmill, for the most part. But, you get an IV in beforehand, an injection of a very mildly radioactive tracer that allows us to trace the blood flow in the heart, both at rest and then you get a second injection at peak excursion. That lets us see what the blood flow is like when you are exerting yourself. The other thing we can do is, if people really can’t exercise at all and we have reason to think that we need to be sure about whether they have blocked arteries, we can do a stress test that is done with chemicals. It doesn’t make your heart pound or race or anything like that and it’s very, very safe. It makes the arteries behave as if you are exercising and lets us do the same sort of imaging with the nuclear images.
Melanie: What is that one called, Dr. Beamer, for the listeners?
Dr. Beamer: That is called a Lexiscan, the brand name is Lexiscan, the generic would be to call it a “pharmacologic nuclear stress test.”
Melanie: Now, we’re going to go into prevention just a little bit. You have an early heart disease prevention program at Summit. Tell us a little bit about what this involves.
Dr. Beamer: One of the things that we all struggle with is how to pick out that people who are at risk before they start having problems. Once somebody has had a heart attack or needed stents or by-pass, it is very easy to know that these are people you need to concentrate on in terms of reducing their risk factors, lowering their cholesterol and all that. But, of course, that is a little late. We don’t really want to pick people up that way. We want to pick people up before there is a problem. Stress testing is a useful part of that screening. That is part of the package. We do a stress test. But, stress testing can only go so far. If you have mild, mild narrowings before they are bad enough to limit blood flow, then you will not pick it up on a stress test. For years, we have been looking for something to combine with a stress test to be able to pick up those more subtle blockages. The second piece, then, is what is called a “coronary artery calcium score”. Although it has “calcium” in the name and we do measure some calcium deposits, we don’t really care that much about the calcium. What it is is a CT scan of the heart. A very, very, very quick CT scan with just one breath hold and very low radiation dose that allows us to take pictures of the arteries that feed the heart and look for calcium deposits. You can only get calcium deposits in those arteries if you have some plaque. So, by measuring the amount of calcium, we can tell how much plaque you have. This test has been done on enough people that we know what is normal at different ages. We know what is bad news, in terms of having a lot of it, or having a lot compared to other people your age. We can, then, put people into risk groups by looking at this. People who have a lot of calcium, we tell them that we really need to focus on whether you’ve got a problem already and look at how to best reduce that risk. People who have no calcium or very little calcium, we encourage them to continue a healthy lifestyle but they are really not at very much risk and don’t need to have all of the drugs thrown at them to try to lower their cholesterol and such as much.
Melanie: Dr. Beamer, people get their blood taken every year and they get their lipid profile and their cholesterol and those sorts of things are looked at. What about the inflammatory markers and what is their relationship to heart disease? Are you looking at those as predictors, too?
Dr. Beamer: We use them in some people, although if you look at the cholesterol and you look at the inflammatory markers and you look at calcium scoring and a variety of other testing that you might do, calcium scoring can actually reclassify people from a low risk to a high risk or high risk to low risk about 60% of the time. It is a very potent test for being able to reclassify people. The inflammatory markers can make you more suspicious of a problem, but they are not as potent a test in asymptomatic people or in people who don’t have known coronary disease. I do use them sometimes, although I don’t think they have as much value in a screening population as the calcium score does. In terms of the cholesterol, we actual will often do, depending on the person’s history and family history, we will often do more advanced lipid testing than the usual testing where we actually look at the number and size of the LDL particles and such. For most people, that doesn’t add that much new information but when people have some family history or some evidence of having vascular disease already, I’d say about between 10-20% of people, we find out that the regular test isn’t giving us the whole story.
Melanie: So, in just the last few minutes, Dr. Beamer, give the listeners your best advice for preventing heart disease, cardiovascular disease, taking an exercise stress test and the early prevention program at Summit.
Dr. Beamer: The basics are easy. Keep yourself at your fighting weight. Don’t let yourself become obese. Obesity, as we know, is an epidemic in the United States. That’s the first thing. The second thing is exercise on a regular basis. I can’t neglect to mention smoking. If you are a smoker, get help to quit as soon as you possibly can. It’s never too late to quit. But, if you don’t smoke, don’t start. That triples your risk of heart disease. Be aware of the symptoms of heart disease, in particular, for coronary artery disease. Be aware of chest discomfort provoked by exertion and relieved by rest is the hallmark danger sign. In terms of the early heart disease screening program, we, actually, at Summit, now have put together a package of early heart disease screenings that includes a stress test, a calcium score, a blood cholesterol testing, if you haven’t had it already, and a screen for diabetes. I think that package is sensible to do around age 50 if you are a man and someplace between 55 and 60, if you are a woman. Or, if you have a family history of heart disease, I would say do it probably 10 years earlier than your family history. If dad died at 50, then if you’re a 40-year-old man, then you ought to be looking at it because you don’t want to wait until the plaque has developed so far that you already have problems. You want to jump in and start modifying your risk factors in advance of that.
Melanie: Thank you so much. It is absolutely great advice. Thank you so much, Dr. Beamer. You’re listening to SMG Radio. For more information, you can go to SummitMedicalGroup.com. That’s SummitMedicalGroup.com. This is Melanie Cole. Thanks so much for listening.