Maggie McKay (Host): You only have one, so it goes without saying, that taking care of your heart is a must, and so is prevention. So today, Dr. Alan Chun, Physician at the PACE program at ICHS Legacy House, will tell us how to be heart healthy.

 Welcome to Together We Rise, a podcast from International Community Health Services. ICHS advocates for health as a human right and welcomes all in need of care, regardless of health, immigration status, or ability to pay. I'm your host, Maggie McKay.

Thank you so much for being here today, Dr. Chun. I think when it comes to heart health, we can't learn enough about prevention. So to start, what is heart disease?

Alan Chun, MD: Yeah, that's a good place to start. We can talk about heart disease from many different perspectives, but I think the place that most people think about first is kind of an anatomic answer to that question, which is heart disease consists of both the pumping part of the heart and I also include the blood vessels because those are a complete system.

And the most common cause of heart disease that we are familiar with, are a narrowing of the arteries to the heart, or different organs like the kidney, the brain, the extremities. But heart disease also includes things like problems with the pump itself. So heart failure, includes arrhythmias, where the rhythm of the heart is off.

 In some people it includes valvular heart disease, which prevents the blood from going in the proper direction. But I also want to think about heart disease from a public health perspective. And what we know about is in the United States for older adults, heart disease is the number one cause of death.

If we include the cardiovascular system, then stroke is the fifth most common cause and diabetes, which is kind of a brother sister relationship with heart disease is the tenth most common cause of death. I'd like to finish by talking about what does heart disease mean to you and me, to people. And unfortunately, heart disease is asymptomatic in most people.

When you talk about the heart disease, blood vessels and the narrowing of the blood vessels, this process starts in our early adult years when we're in the 20s and we're asymptomatic of any symptoms from the blood vessel or heart until we're older adults and unfortunately this means that heart disease is a silent disease and that's why it's important to talk about it and to raise people's awareness of this condition.

Host: And what are common risk factors for heart disease, diabetes, and stroke?

Alan Chun, MD: The common risk factors are many. I like to break it down into those that are non-modifiable, the things that we can't change and the things that we can change. Certainly we find that as we get older, heart disease is more common and, certainly in men, it's more common.

Their genetic factors and race and ethnicity play a role. These are things we can't change too much about except I argue that our age we can modify that and we certainly can't modify how many years we live but we can modify our biological age. The risk factors that we do pay, need to pay attention to really fall under our lifestyle.

So, things like smoking, alcohol use, our diet, our tendency to be inactive, stress in our lives, obesity. These are things that can be certainly modified by our lifestyle as well as medications.

Host: And speaking of modifiable risk factors, when it comes to high blood pressure, what are some of those that we can actually modify? What's normal blood pressure and when should you worry about your numbers?

Alan Chun, MD: Yes I really think we should know our numbers. And, the medical profession has revised it numbers in terms of what consists of a normal blood pressure. So, I would say, 10, 20 years ago we used to say a blood pressure of 140 over 90 or higher would be high blood pressure. And we would even say for older adults that 150 over 90 would be okay.

But now we're finding that after many different studies to look at the effects of lowering blood pressure, that a normal blood pressure is less than 120 over 80. And we'll find that many of us don't fall in this category, that we're higher than this. So high blood pressure we're defining now as anything over 130

over 80. And in between 120 and 130 or 80 and 90 is considered elevated blood pressure that we need to pay attention to, but maybe not need to start medications at that point. So, if you look at these numbers, then the chances are as we get older that one out of three adults worldwide will have high blood pressure. But the fact is that most people don't know that they have high blood pressure because they're not measuring it regularly. And even those that do have high blood pressure are not well controlled in that range of 120 over 80 or less.

Host: One in three. That is pretty shocking. Speaking of numbers, what about cholesterol levels? What's considered heart healthy?

Alan Chun, MD: Yeah, I think, cholesterol levels too are one where with more medical studies, over large numbers of people that we're revising what we considered normal cholesterol. So at this time, The American Heart Association is recommending a total cholesterol level of below 200, and the LDL, or what was called the bad cholesterol, below 100.

Cholesterol levels are a little bit more fuzzy than high blood pressure. High blood pressure is just a straightforward, 120 over 80, but the cholesterol level kind of depends on your age, your past history. We use a kind of a risk calculator to, to determine if this is something that's high risk or not.

But I think the tendency now is to say that the lower the cholesterol, the better, in terms of your heart risk. And so keeping your LDL below 100 is ideal for everybody. And those that already are diagnosed with heart disease, then an LDL that's lower than that, below 70 is recommended.

Host: And the big question, what kinds of food should we eat for a healthy heart? That's something we can all do.

Alan Chun, MD: Yes. Let's start with saying that most of us eat what's convenient to us, and unfortunately the foods that are convenient to us are processed. There's a lot of fast foods available, which consists of fried foods and a lot of red meats, and these, unfortunately, are not

the foods we say are healthy foods. The healthy foods are more fruits and vegetables and certainly whole grains, the less processed foods, less salt and less saturated fats. So in terms of going back to high blood pressure, we have a diet called the DASH diet to lower blood pressure.

I'm blanking on the names of what DASH stands for, but you follow the DASH diet, it's been shown to be as effective as a blood pressure medication. The other diet that has been shown to be effective for heart health, is the Mediterranean diet that many people have heard about, and those are a diet that's more using olive oil instead of the other types of oils or fried foods, whole grains, beans, and fruits and vegetables. We certainly think that replacing red meat with fish is much more healthy, and the other sorts of foods that's good in terms of oils and protein are nuts. So this is the type of foods that we think are healthy. If you can picture a plate of food, we would say if half your plate is fruits or vegetables, and maybe a quarter is a protein source like fish or chicken, and the other quarter is carbohydrates, that would be a picture of a healthy plate.

Host: That's good to remember. When it comes to exercise, I am guessing that's pretty important to our heart health. So how much exercise should we do and what types?

Alan Chun, MD: Exercise is actually I think the most important thing. I should back up and say that these diets, healthy diets, Mediterranean diets, or these exercises that I'm going to talk about are not only healthy for your heart, but they're healthy for our whole body. I talked about modifying your age by reducing your, lowering your biological age compared to your chronological age.

And exercise is one of the key components to that. Exercise is good for your brain as well as other parts of your body. So getting back to what kind of exercises, I'll break it down into, aerobic or active type of exercise. The most simple type of exercise that's effective is walking. And we say, well, let's try to accumulate 30 minutes of exercise, of being active every day, or a total of 150 minutes of active exercise if it's maybe more bunched towards the weekend.

And this is particularly good for our hearts but it's good for weight control. As we age though, there are other types of exercise that are just as important and we're finding that strength or resistance training twice a week is really important to keep your muscles strong, but also as we get older, one of the more common things that happens is we get injured by falling.

We lose our balance and our ability to adjust to different surfaces and strength or training helps with this. Also, as we age, we get stiffer, you know, it's just thing that happens as we get older and, we're always sitting and, we're not moving around as much. So stretching, I also feel is important to us and stretching, could be just an informal kind of stretch or it could be something formal like yoga or tai chi, but stretching, we should do probably most days of the week, four to five days a week to keep ourselves flexible.

And I'll add, as a geriatrician, one other type of exercise and that's balance training. And I say this is important one to two times a week, particularly as we get older. And again, to reduce your risk for falls.

Host: Yeah, speaking of balance, I think the earlier you start, the better, because I'm not that old yet, but I sort of find myself lately, not having the best balance. So I'm working on that early before I really need it. When it comes to managing stress, can you share some tips to prevent and manage stress?

Alan Chun, MD: Stress is the third leg of eating healthy, being fit, being active, and managing your stress in terms of your heart health. How does stress affect our health? We think it has to do with inflammation, that when you're under higher stress, there's more inflammation in your body and that inflammation can damage the lining of your blood vessels and other things. I'm not sure that preventing stress is the most correct term because we all have stress in our lives, you know? And the thing is, how to manage stress. There's many different aspects of it, but I think I would throw in fun as a stress reliever. You know, what do you like to do that's for fun, that's maybe active, that involves interacting with others?

A social kind of interaction. It can be exercise, it can be things that make you feel good. There's certainly things that I mentioned in terms of yoga, tai chi, there's meditation. Getting enough sleep is really important. But I'll go back to the whole thing of fun and another term that we use is go with the flow.

You know, what causes you to flow into things where you kind of lose track of time and you're like, oh, wow, I didn't know it was late. So those are the types of things that give you a clue about what's the best way to manage your stress. And this is one thing where it has to be individualized. I can't say, oh, yoga is good for everybody. It has to be something that you enjoy, So I think that's the clues that you can take to help to balance your life and to manage stress better.

Host: And you make a good point, whatever it is, to do it maybe with other people, because that's important. If you're working alone all the time.

Alan Chun, MD: It Yes, it is very important.

Host: And then you do your activities alone, it's you need interaction. How does dental health affect heart health?

Alan Chun, MD: Yeah, there's several different ways where dental health, or ill health can affect your overall health. Particularly as we get older in the population that I deal with, which is the immigrant population where dental, preventive dental care is not common; gum disease turns out to be one of the common ways that it affects your general health.

And how does gum disease affect your general health? Because, in these pockets between your teeth and your gum is a cavity that should be shallow, but becomes deeper as we get older and don't get preventive care. And these pockets contain colonies of bacteria. So the bacteria are a source of either infection as they, if they sneak into your bloodstream, but they're also a source of inflammation.

And we had already talked about inflammation as a general factor in terms of causing blood vessels to not function right and it can also affect your blood sugars and other things. So, these two things where you have inflammation and the possibility of bacteria spreading, I think are the ways that dental health is important to your overall health.

Host: Well, this has been such useful information. Thank you so much for making the time to share your expertise with us.

Alan Chun, MD: Thank you for having me. I enjoyed it.

Host: Again, that's Dr. Alan Chun. And if you would like to learn more, please visit ichs.com. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening. This is Together We Rise, a podcast from International Community Health Services.