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Scott Webb: Though cardiovascular disease is a killer, the good news is that it doesn't have to be if we address our risk factors and seek treatment early. Here to emphasize these points today is Dr. John Osborne, Head of Cardiology for the Low T Center. This is age is just a number by the Low T Center. I'm Scott Webb. So Dr. Osborne always great to have you on. Thanks for being back with me today. Let's talk cardiac health today. Let's talk tickers. Who's at the greatest risk for cardiovascular disease?

Dr. Osborne: So if one were to think of the people at highest risk for cardiovascular disease, well, I'll tell you. So it's actually pretty simple. Those who had and survived a prior cardiovascular event. So specifically I'm talking about people who had a heart attack, who had a stroke or a TIA or mini-stroke, people who had what we call unstable angina. So even if he didn't have heart damage, but you had symptoms of a blocked vessel. People who have had heart failure in the past, which is really another symptom of heart disease. And also people who had prior balloons, stents, bypass surgeries, and heart attacks. In fact, actually some of the most devastatingly affected populations with heart disease and at some of the highest risks are actually patients with underlying kidney disease, which is kind of underappreciated. And also patients who have what we call peripheral arterial disease.

That's basically blockages in the legs can also be in the arms too. These are the people that can show up with symptoms of when they walk. I got pain in my legs. That gets better when you rest, and even can extend out to the extreme version of that in some people even to require amputations of toes and feet and legs. So pretty horrible disease. And those are some of the people at the very, very highest risk. But the thing is though, that even if we think about people at the highest risk and those people with, we'll call established cardiovascular disease, that half of men and two thirds women, the first symptom of this disease is it kills you. So remember when I'm talking about the people who have established disease, I'm really implying this is the half a man and the one third of women who had an event, a cardiovascular event and survived it, who then were diagnosed with, Oh, you have heart disease, you have blockages in your heart and your carotid arteries or whichever artery.

Because historically we'd basically just sacrifice half the men, two thirds women, they die as their first symptom and we go, that's terrible. Let's not have that happen again. And then we kept doing that and that's why for me, I am delighted and excited and passionate about preventative cardiology because I'm really very, very interested obviously in anyone at any risk and particularly the high risk patients. But at the same time I want to make sure that no one suffers the first cardiovascular event, which in half of men and two thirds women, as I said before, can be fatal.

Host: Absolutely. And I've heard you say this before many times that unfortunately for a good number of people, the warning sign is death, unfortunately. And that's what we're trying to really get at here is to get people to understand that don't wait for the warning signs, get yourself checked, understand maybe, perhaps how genetics play a factor in this. And I wanted to ask you about that. Are genetics a factor in the disease?

Dr. Osborne: Oh, absolutely. So it's a fascinating condition as far as the factors that play a role. There's certainly many genetic factors, so people who are genetically predisposed to developing diabetes, you know, there's some people that get it even though they do their darndest with diet, exercise, keeping the weight under control that still can develop diabetes. And then similarly with cholesterol disorders. There are literally are scores of different cholesterol disorders that are very, very much genetically determined. And you know, as an example, one of my favorite stories about the role of genetics and heart disease was a guy that flew fighter pilots for the US Air Force. Incredibly great health, triathlete, marathon, probably about 7% body fat, absolutely ripped and saw him first about age 33 and no bad habits, no diabetes, no high blood pressure, no smoking, none of those things. But as it turns out, as I told him, he chose the wrong ancestors.

So as it turns out, he has a horrible family history, most coming from his mom but also his dad too, of cardiovascular disease and blockages and plaque formation all over, not just the heart but all over. And as it turns out, this 33 year old guy who looked to be externally the height and peak of fitness needed bypass surgery because the fact that he chose the wrong ancestors and that completely out of his control, his cholesterol was terribly high. So he had what we call familial hypercholesterolemia or basically just genetic high cholesterol. And that alone, even despite that, he did everything perfectly was enough to cause blockages in multiple vessels that required him to have bypass surgery. Now the good news is that was about 20 years ago. We got his cholesterol taken care of. It's been controlled ever since then. And he's had no further events. In fact, interestingly his daughter, as you could imagine she's at risk for having the same cholesterol issues. I saw her when she was a teenager, later teenager still in high school and then she went off to college and her cholesterol looked just like dad's difference was, she was, you know, 25 years younger.

So we actually ended up treating her and I'm very excited to say, I'm proud to say that she probably will not face the issues that he had because he was never diagnosed and treated beforehand. Whereas we were very aggressive and proactive about treating her and getting those cholesterol issues down so that they never ever caused any problems. So yes, genetics plays a large role in a lot of these things. And the same thing with high blood pressure. There's certain people that develop high blood pressure despite eating right, exercise, all the appropriate things, watching sodium, and they still develop high blood pressure. So genetics plays a very, very large role in a lot of this. Not to say that lifestyle doesn't play a large role, but genetics plays probably an underappreciated role in a lot of this. So if you have a family history, if you have mom, dad, brothers, sisters, even extending out to maybe even aunts, uncles, cousins with early cardiovascular disease, strokes, heart attacks, balloons, stents, bypass surgery, you need to get looked at and checked out because you may have it, you just maybe not have had the symptoms of that condition yet.

Host: Yeah, definitely. And hearing you speak there about the, you know, the rip pilot and then the daughter and early detection, right. That's a common thread. Whenever I talk to you is, is how key early detection is. So let's talk about what tests are available at the Low T Center, specifically for cardiovascular disease.

Dr. Osborne: Sure. So obviously with your first visit, you know, we're going to get labs, we'll check cholesterol, thyroid check your blood pressure, you know, all of those other factors too on everybody. And then depending upon, you know, your risk factors and other things like that we may also suggest a very, very simple widely available, incredibly validated by the scientific literature now endorsed by organizations such as American College of Cardiology, American Heart Association as a tool that is used to pick up early heart disease long before you have symptoms. Or as I like to tell people or convey it as I call this the cardiac colonoscopy because we're very familiar with using tools to screen for cancers, whether breast cancer, colon cancer, cervical cancer, prostate cancer, right, with blood tests or with colonoscopies, pap smears, mammograms, etcetera for cancer. But we've really never done that for heart disease. But there is a tool that is widely available, really quite inexpensive, usually a hundred bucks or less generally.

That takes a few minutes, no prep, no ID, no contrast. Results are generally, you know, discussed with the patient at that time. And that's called a coronary artery calcium score, whereas we abbreviated called a CAC score or CAC. And basically what we do is we put people in a CAT scanner, no contrast, no IV, takes a few minutes. We look for any calcification in the blood vessels of the heart, which is literally the hardening of the arteries, and now the normal person should have no calcification, which is very easily and simply and readily detected with these CAT scans of the chest of the heart. If you have any calcification, it says that you have plaque and then we can then sit down and have a discussion about how we're going to change that trajectory to make sure that plaque doesn't grow and progress. And then down the road turn into what we call the acute catastrophic cardiovascular event that we call a stroke or heart attack or needing stents, balloons, bypass surgery because of that plaque that we can detect years early with the calcium score is the stuff that ultimately progresses on to cause what we call historically balloon, stents, bypass surgery, heart attack. So we can use this to detect it years before we ever get into that situation.

Host: That is so amazing. For a hundred bucks or less. You know, it's a lifesaver. It's truly remarkable. Right? so cool. So let's talk about treatment at the Low T Center. When we talk about cardiovascular disease, what are we doing in the way of treatment?

Dr. Osborne: So the big four factors. Now all of this has to be personalized and individualized and we certainly specialize in that as well. But in general, the big four factors that that I can fix, that we can fix, that we attend to here fall into the categories of in no particular order, frankly tobacco use. And so tobacco is just never good for your blood vessels, no matter how you ingest it. I tell people I don't care where they smoke, snort it, inject it, Bath in it, rub it on your skin, uses colonic. Tobacco is just not good for your blood vessels. So that's obviously one thing that if that's an issue that we focus on. Next would be things like blood pressure. The most common cardiovascular disease, which is high blood pressure affecting over 103 billion people monitored 3 million adults in the US in fact, 50% of all adults that is over the age of 18 have high blood pressure. From the age of 40 the lifetime risk of developing high blood pressure is 90%, that's nine zero nine 19%.

It is by far the most common form of cardiovascular disease, which again could be very readily treated both with diet, exercise, lifestyle, sodium restriction, which is always of course plan A for us at the Low T Center, but if that fails or we can't do that, we don't have to say, well, you're going to suffer the blindness, the strokes, the heart attacks, the heart failure that go with high blood pressure. We have very, very effective protocols and algorithms and tools to be able to successfully and highly successfully treat that. Next would be doing things like cholesterol disorders. Again, there's been a revolution in different ways of treating that and a whole variety of new ways of treating that. In fact, we'll probably see at least two new completely novel drugs with whole complete mechanisms of action coming out this year to treat high cholesterol, which is very exciting for us. That focus on lipidology or the treatment control management of cholesterol disorders, giving us even better, more effective tools that are increasingly even safer than prior generations and even more effective.

And then the last big thing again in no particular order is diabetes and prediabetes, which can be absolutely devastating. In fact, what's interesting is, you know, diabetes is bad if you have diabetes, all other factors equal your of a heart attack or stroke is increased two to four fold in general, if you have diabetes, but you're a woman, that risk is not two to four fold increased. It's about four to eight fold increased. So diabetes is bad, but it's really bad if you're a woman. So obviously those are the kind of the big topic, big things that we focus on every single day. But again, all this has to be individualized and personalized to you, your genetics, your family history your level of exercise, diet, all of that stuff. So we personalize all of this to our patients here at the Low T Center

Host: And Dr. Osborne as we wrap up here today, anything else we can tell people about keeping their hearts healthy and how the Low T Center can help them?

Dr. Osborne: Absolutely. So we are firmly committed to making people not just live better and stronger and happier with less diseases and all the conditions and all the burdens that diseases bring on such as heart disease, sleep apnea weight problems, loss of energy, fatigue issues, erectile dysfunction, all of those issues. We really want to be transformative, not just making you feel better, but also understanding over the next, as I like to tell my patients, over the next 50, 60 years what's going to be coming up that could kill you. And a lot of that revolves around both heart disease as well as cancer. And most of those are detectable early, are very, very highly preventable as well. So we want to not only make people feel better, of course, but also make them live longer and it's about just surviving until you're a hundred as I tell my patients, we want you to be thriving when you make it into your triple digits.

Host: Hey, triple digits, Doc. That sounds good. I'll take that. Thanks so much, Dr. Osborne for being on. Just love having you here. Love your passion, love how you put things in layman's terms. Stay well.

Dr. Osborne: Always pleasure, Scott. Take care.

Host: That's Dr. John Osborne, head of cardiology for the Low T Center. Call (866) 806-8235 or go to lowTcenter.com for more information or to book an appointment. And thanks for listening to Age is Just a Number of podcasts by the Low T Center. If you found this podcast helpful, please share it on your social channels. Check out our entire podcast library for topics of interest to you. I'm Scott Webb. Stay well and we'll talk again soon.