Heart disease is the leading cause of death for both men and women in the United States. Heart disease describes a variety of disorders and conditions that can affect the heart. The key to preventing heart disease is a healthy lifestyle. Also, the more knowledge you have about your family's medical history, the better prepared you'll be to prevent heart disease.
Medical Director for Non-Invasive Cardiology & Cardiac Rehabilitation at MemorialCare, Dr. Robert Greenfield, MD shares the simply ways you can lower your risk and avoid heart disease.
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Be Smart - Protect your Heart: How to Prevent Heart Disease
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Organization: Orange Coast Memorial Medical Center
Dr. Greenfield's Bio
Dr. Robert S. Greenfield, MD
Dr. Robert S. Greenfield, MD is the Medical Director for Non-Invasive Cardiology & Cardiac Rehabilitation at MemorialCare Heart & Vascular Institute at Orange Coast Memorial.Organization: Orange Coast Memorial Medical Center
Dr. Greenfield's Bio
Transcription:
Be Smart - Protect your Heart: How to Prevent Heart Disease
Deborah Howell (host): Hello! Good morning and welcome to the show. You are listening to Weekly Dose of Wellness brought to you by MemorialCare Healthsystem. I'm Deborah Howell and today's guest is Dr. Rob Greenfield who is board certified in internal medicine, cardiovascular diseases, and clinical lipidology. Dr. Greenfield's research includes the fields of lipidology, acute coronary syndrome, and risk factor modification. He's currently on the Board of Directors of the Pacific Chapter of the National Lipid Association and is the Vice Chief of Staff and Director of Non-Invasive Cardiology, Bioethics, and Cardiac Rehabilitation at Orange Coast Memorial Medical Center. Welcome and good morning to you, Dr. Greenfield.
Dr. Rob Greenfield (guest): Good morning, Deborah. Nice to be here.
Deborah: Today, we're going to be talking about being smart about your heart and preventing heart disease. Let's begin with the basics. What exactly in laymen's terms is heart disease?
Dr. Greenfield: Well, Deborah, in the United States, heart disease commonly refers to atherosclerosis, which really means hardening of the arteries due to cholesterol plaque buildup which could lead to complications of heart attack and stroke as well as vascular disease or blood vessel disease anywhere in the body. Now, heart disease also encompasses some other factors like valve disease and muscle disease. But clearly, atherosclerosis, cardiovascular disease affecting the blood vessels is clearly the most common cause.
Deborah: Okay. So who now is at risk for developing heart disease?
Dr. Greenfield: It's a great question, and the way we like to determine risk is to find out how many risk factors somebody has. Traditionally, the American Heart Association came out with a list of risk factors and simply, it involves one, your age. For men, if you're over 45 years old, you could be at risk. Women, over 55 years old. It seems that women develop heart disease about 10 years later than men. But I have to say that women are catching up very rapidly. As women tend to live longer than men, the actual number of heart attacks in women are actually higher now than they are in men. Another risk factor would be family history. If you have close relatives like a mother, father, or brothers that had a heart attack or stroke less than 55 years old for a man and less than 65 years old for a woman, that's a risk factor for you, too, because it means there are some familial predisposition or some familial or family tendency that you could be at risk for heart disease.
Deborah: Our DNA is all connected, isn't it?
Dr. Greenfield: It is. Smoking is a very big risk factor. I think with our public health policies, we've been very successful in decreasing the instance of smoking in this country. High blood pressure is yet another one, and having a low good cholesterol, a low HDL which maybe we could talk about a little later, is also a risk factor.
Deborah: Very good.
Dr. Greenfield: Now, here's the problem with risk. I didn't mention a lot of other risk factors that initially were not mentioned as traditional risk factors. For example, diabetes or a very high bad cholesterol, that's the LDL, or the whole idea of stress, obesity, and the whole concept of inflammation. When someone has some inflammatory disease or inflammation, they may be at higher risk for heart disease as well. It's complicated but risk factors, when they're calculated, oftentimes could estimate somebody's risk.
Deborah: Okay. So if you have some of these risk factors, what steps should someone take?
Dr. Greenfield: Next step would be to go see your doctor. And there is nothing that substitutes for a good history and physical exam and a blood test. The basic blood test should include what's called a lipid panel. And that's just the blood test that would include your total cholesterol and also a measurement of your bad cholesterol, the LDL, the good cholesterol, the HDL, and triglycerides – another fat in the body, one fat that tends to increase significantly with diabetes or obesity. And then if you are having any symptoms that need to be questioned, whether they could be from the heart or not, a routine treadmill stress test oftentimes could be very helpful. That would be my first step.
Deborah: All right. What about another step including diet? Does diet really help? There are so many diets out there to choose from. Which ones are you recommending these days to help live a heart-healthy lifestyle?
Dr. Greenfield: Well, simple question, complex answer, but I'm going to try to make it very simple. Diet definitely helps. Certainly for people who are overweight, diet is doubly and triply important. It's so important and you could reduce so many risk factors by weight reduction and trying to achieve an ideal body weight. When people ask me, "Doctor, what should I eat?" it's usually a one-word answer, "Less." We tend to eat too much. Our portions are large and sometimes our food choices aren't the best. I think if I had to narrow it down, the Mediterranean diet is still probably the best diet to recommend to our patients. It's what we call a low glycemic index diet that doesn't have a lot of sugary foods. It doesn't have a lot of saturated fat. And the two types of saturated fat in America usually occur in red meat fat and milk fat. Whole milk cheeses and products that are made out of whole milk usually contain saturated fat and they should be avoided. The American Heart Association feels that it should be less than 7 percent of your calorie intake in the form of saturated fat.
Deborah: Well, none of us are really able to gauge 7 percent, but you kind of know. Maybe not have a red meat steak more than once a week?
Dr. Greenfield: Exactly. If you're going to have meat, it doesn't mean you could never have it, but you should choose the leanest cut. You should try to cook it where it's broiled, where the fat could drip down rather than fry it or keep it in a pan. Broiling is probably the healthiest way to cook and frying is probably the most unhealthy way.
Deborah: And the companion to a good diet of course is exercise. How much exercise do you really need to raise your heart rate enough to be good for the heart?
Dr. Greenfield: Well, here's the good news. You don't have to buy a fancy gym suit and join a fancy gym to call it exercise. Anything you do counts as exercise. There are recent studies that show that it's additive. So if my patient says to me, "I don't have time to exercise. I work too hard, I get home, I'm real tired." I would say to them, "What could you find during the day that would be your form of exercise? Can you park farther away in the parking lot? Can you take the stairs instead of the elevator? When you have a lunch break, could you have lunch and then go for a walk?" What can you do because it's all additive? If it's ten minutes here and five minutes there and 10 minutes somewhere else during the day, and you add that up and it comes out just 30 minutes most days of the week, then I think you're doing a fair job at exercising.
Deborah: Even walking the dog or you can even do exercises at your desk. You can flex your quads and glutes. There are actually things you can do even while sitting.
Dr. Greenfield: Right. There are manuals and books that are written about that, and it's all additive. And movement is the most important thing. If you combine diet and exercise, it really for most people would be eat less and move more.
Deborah: And feel better.
Dr. Greenfield: Yes.
Deborah: Can you explain how cholesterol affects your cardiovascular health, Doctor?
Dr. Greenfield: Cholesterol is a substance that we tend to get mainly in the form of saturated fats once again. What it does, it winds up depositing in blood vessels. The cholesterol is carried by the LDL, which is why LDL is called the bad cholesterol, because it is taking cholesterol and depositing it inside the blood vessel to start making plaques. When the plaques continue to grow, they can begin to block the flow of blood in an artery which may cause symptoms. So what we call angina pain, a pain from the heart, would be if a coronary artery is narrowed by a cholesterol plaque. The problem and what's worse than that is sometimes these plaques rupture and they then form a clot on top of them which totally blocks the blood flow. If that happens in a blood vessel in the heart, it's a heart attack. If it happens in the cerebral circulation, the brain circulation, like the carotid arteries that are in your neck and go to the brain, then it's called a stroke. So the thing to do to reduce plaque formation is by diet and exercise and oftentimes cholesterol medication.
Deborah: Okay. Well, let's talk about cholesterol medication. We have about a minute and a half left. Is it really worth it to take the medication and what about side effects? Everybody's concerned about that.
Dr. Greenfield: We have many, many well controlled studies that now include tens of thousands of people that demonstrate cholesterol medication can improve survival, reduce the risk of heart attack and stroke. It has to be the proper medication in the proper dose. Yes, there are some side effects that can occur. And if you look at the number of patients that have side effects versus the number of patients that are being helped by these medications, there's no comparison. We oftentimes like to stress the bad things, like the 11 o'clock news sometimes when we see all the terrible things happening in the world, but there are so many good things that are happening with these medicines. I would only stress that if they're used in the proper doses, even small amounts, they oftentimes could be very, very helpful.
Deborah: All right. Well, thank you so, so much, Dr. Greenfield, for finding the time to talk to us today about protecting our hearts from heart disease. After all, we are born with one heart and we need to take good care of it. Right?
Dr. Greenfield: I enjoyed this very much. I would say that the three most important things in my field are prevention, prevention, and prevention.
Deborah: There you go. You couldn't make it easier than that. Thank you so much, Doctor, and have a wonderful day.
Dr. Greenfield: And you, too. Thanks so much.
Deborah: What a pleasure to have Dr. Greenfield on our show today. I am Deborah Howell. It's been wonderful spending some time with you. Please join us again next time as we explore another Weekly Dose of Wellness brought to you in part by MemorialCare Healthsystem. Have yourself a fantastic day and be well.
Be Smart - Protect your Heart: How to Prevent Heart Disease
Deborah Howell (host): Hello! Good morning and welcome to the show. You are listening to Weekly Dose of Wellness brought to you by MemorialCare Healthsystem. I'm Deborah Howell and today's guest is Dr. Rob Greenfield who is board certified in internal medicine, cardiovascular diseases, and clinical lipidology. Dr. Greenfield's research includes the fields of lipidology, acute coronary syndrome, and risk factor modification. He's currently on the Board of Directors of the Pacific Chapter of the National Lipid Association and is the Vice Chief of Staff and Director of Non-Invasive Cardiology, Bioethics, and Cardiac Rehabilitation at Orange Coast Memorial Medical Center. Welcome and good morning to you, Dr. Greenfield.
Dr. Rob Greenfield (guest): Good morning, Deborah. Nice to be here.
Deborah: Today, we're going to be talking about being smart about your heart and preventing heart disease. Let's begin with the basics. What exactly in laymen's terms is heart disease?
Dr. Greenfield: Well, Deborah, in the United States, heart disease commonly refers to atherosclerosis, which really means hardening of the arteries due to cholesterol plaque buildup which could lead to complications of heart attack and stroke as well as vascular disease or blood vessel disease anywhere in the body. Now, heart disease also encompasses some other factors like valve disease and muscle disease. But clearly, atherosclerosis, cardiovascular disease affecting the blood vessels is clearly the most common cause.
Deborah: Okay. So who now is at risk for developing heart disease?
Dr. Greenfield: It's a great question, and the way we like to determine risk is to find out how many risk factors somebody has. Traditionally, the American Heart Association came out with a list of risk factors and simply, it involves one, your age. For men, if you're over 45 years old, you could be at risk. Women, over 55 years old. It seems that women develop heart disease about 10 years later than men. But I have to say that women are catching up very rapidly. As women tend to live longer than men, the actual number of heart attacks in women are actually higher now than they are in men. Another risk factor would be family history. If you have close relatives like a mother, father, or brothers that had a heart attack or stroke less than 55 years old for a man and less than 65 years old for a woman, that's a risk factor for you, too, because it means there are some familial predisposition or some familial or family tendency that you could be at risk for heart disease.
Deborah: Our DNA is all connected, isn't it?
Dr. Greenfield: It is. Smoking is a very big risk factor. I think with our public health policies, we've been very successful in decreasing the instance of smoking in this country. High blood pressure is yet another one, and having a low good cholesterol, a low HDL which maybe we could talk about a little later, is also a risk factor.
Deborah: Very good.
Dr. Greenfield: Now, here's the problem with risk. I didn't mention a lot of other risk factors that initially were not mentioned as traditional risk factors. For example, diabetes or a very high bad cholesterol, that's the LDL, or the whole idea of stress, obesity, and the whole concept of inflammation. When someone has some inflammatory disease or inflammation, they may be at higher risk for heart disease as well. It's complicated but risk factors, when they're calculated, oftentimes could estimate somebody's risk.
Deborah: Okay. So if you have some of these risk factors, what steps should someone take?
Dr. Greenfield: Next step would be to go see your doctor. And there is nothing that substitutes for a good history and physical exam and a blood test. The basic blood test should include what's called a lipid panel. And that's just the blood test that would include your total cholesterol and also a measurement of your bad cholesterol, the LDL, the good cholesterol, the HDL, and triglycerides – another fat in the body, one fat that tends to increase significantly with diabetes or obesity. And then if you are having any symptoms that need to be questioned, whether they could be from the heart or not, a routine treadmill stress test oftentimes could be very helpful. That would be my first step.
Deborah: All right. What about another step including diet? Does diet really help? There are so many diets out there to choose from. Which ones are you recommending these days to help live a heart-healthy lifestyle?
Dr. Greenfield: Well, simple question, complex answer, but I'm going to try to make it very simple. Diet definitely helps. Certainly for people who are overweight, diet is doubly and triply important. It's so important and you could reduce so many risk factors by weight reduction and trying to achieve an ideal body weight. When people ask me, "Doctor, what should I eat?" it's usually a one-word answer, "Less." We tend to eat too much. Our portions are large and sometimes our food choices aren't the best. I think if I had to narrow it down, the Mediterranean diet is still probably the best diet to recommend to our patients. It's what we call a low glycemic index diet that doesn't have a lot of sugary foods. It doesn't have a lot of saturated fat. And the two types of saturated fat in America usually occur in red meat fat and milk fat. Whole milk cheeses and products that are made out of whole milk usually contain saturated fat and they should be avoided. The American Heart Association feels that it should be less than 7 percent of your calorie intake in the form of saturated fat.
Deborah: Well, none of us are really able to gauge 7 percent, but you kind of know. Maybe not have a red meat steak more than once a week?
Dr. Greenfield: Exactly. If you're going to have meat, it doesn't mean you could never have it, but you should choose the leanest cut. You should try to cook it where it's broiled, where the fat could drip down rather than fry it or keep it in a pan. Broiling is probably the healthiest way to cook and frying is probably the most unhealthy way.
Deborah: And the companion to a good diet of course is exercise. How much exercise do you really need to raise your heart rate enough to be good for the heart?
Dr. Greenfield: Well, here's the good news. You don't have to buy a fancy gym suit and join a fancy gym to call it exercise. Anything you do counts as exercise. There are recent studies that show that it's additive. So if my patient says to me, "I don't have time to exercise. I work too hard, I get home, I'm real tired." I would say to them, "What could you find during the day that would be your form of exercise? Can you park farther away in the parking lot? Can you take the stairs instead of the elevator? When you have a lunch break, could you have lunch and then go for a walk?" What can you do because it's all additive? If it's ten minutes here and five minutes there and 10 minutes somewhere else during the day, and you add that up and it comes out just 30 minutes most days of the week, then I think you're doing a fair job at exercising.
Deborah: Even walking the dog or you can even do exercises at your desk. You can flex your quads and glutes. There are actually things you can do even while sitting.
Dr. Greenfield: Right. There are manuals and books that are written about that, and it's all additive. And movement is the most important thing. If you combine diet and exercise, it really for most people would be eat less and move more.
Deborah: And feel better.
Dr. Greenfield: Yes.
Deborah: Can you explain how cholesterol affects your cardiovascular health, Doctor?
Dr. Greenfield: Cholesterol is a substance that we tend to get mainly in the form of saturated fats once again. What it does, it winds up depositing in blood vessels. The cholesterol is carried by the LDL, which is why LDL is called the bad cholesterol, because it is taking cholesterol and depositing it inside the blood vessel to start making plaques. When the plaques continue to grow, they can begin to block the flow of blood in an artery which may cause symptoms. So what we call angina pain, a pain from the heart, would be if a coronary artery is narrowed by a cholesterol plaque. The problem and what's worse than that is sometimes these plaques rupture and they then form a clot on top of them which totally blocks the blood flow. If that happens in a blood vessel in the heart, it's a heart attack. If it happens in the cerebral circulation, the brain circulation, like the carotid arteries that are in your neck and go to the brain, then it's called a stroke. So the thing to do to reduce plaque formation is by diet and exercise and oftentimes cholesterol medication.
Deborah: Okay. Well, let's talk about cholesterol medication. We have about a minute and a half left. Is it really worth it to take the medication and what about side effects? Everybody's concerned about that.
Dr. Greenfield: We have many, many well controlled studies that now include tens of thousands of people that demonstrate cholesterol medication can improve survival, reduce the risk of heart attack and stroke. It has to be the proper medication in the proper dose. Yes, there are some side effects that can occur. And if you look at the number of patients that have side effects versus the number of patients that are being helped by these medications, there's no comparison. We oftentimes like to stress the bad things, like the 11 o'clock news sometimes when we see all the terrible things happening in the world, but there are so many good things that are happening with these medicines. I would only stress that if they're used in the proper doses, even small amounts, they oftentimes could be very, very helpful.
Deborah: All right. Well, thank you so, so much, Dr. Greenfield, for finding the time to talk to us today about protecting our hearts from heart disease. After all, we are born with one heart and we need to take good care of it. Right?
Dr. Greenfield: I enjoyed this very much. I would say that the three most important things in my field are prevention, prevention, and prevention.
Deborah: There you go. You couldn't make it easier than that. Thank you so much, Doctor, and have a wonderful day.
Dr. Greenfield: And you, too. Thanks so much.
Deborah: What a pleasure to have Dr. Greenfield on our show today. I am Deborah Howell. It's been wonderful spending some time with you. Please join us again next time as we explore another Weekly Dose of Wellness brought to you in part by MemorialCare Healthsystem. Have yourself a fantastic day and be well.