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Scott Webb (Host): I'm Scott Webb, and today we're discussing heart disease in Hispanic populations with Dr. Christina Rodriguez Ruiz. She's the Medical Director, Advanced Cardiac Imaging Memorial Care Heart and Vascular Institute at Long Beach Medical Center.

Doctor, it's so nice to have you here today. We're going to talk about heart disease through the lens of Hispanic individuals and you know, really roll up our sleeves and get to work here today. But, uh, before we get there, I just want to welcome you to the podcast.

Christina Rodriguez Ruiz, M.D.: Thank you so much, Scott. Happy to be here.

Host: Yeah. It's a pleasure to have you here. And I want to start off by just asking you like, what are the most common risk factors for heart disease among Hispanic individuals and how do they differ from other populations?

Christina Rodriguez Ruiz, M.D.: So some of the biggest risk factors in Hispanic communities are comorbidities that can cause heart attacks in the future. So high blood pressure, diabetes, high cholesterol, and obesity. And what makes it different is that these risks often show up earlier and sometimes go undiagnosed for years.

And so compared to other populations, Hispanic adults may not be diagnosed until the disease is well advanced. And so that's why screening and early checkups are so important because our families are at risk even when we look young and healthy. And how I talk about this to my patients in terms of comorbidities like obesity, is that I take it step by step.

You know, I meet them where they're at. Usually what we recommend is 150 minutes of moderate intensity exercise. So you have to build a bit of a sweat. But you know, if patients are older or you know they have knee issues, I usually recommend aqua-aerobics. And I just say, take it one day at a time, you know?

It's not a sprint, it's a marathon. So think small changes can lead to big results in the future. So just start one day and progress as such. And same thing with diabetes and hypertension. People overlook it. I kind of always have a pause with my patients, and have them understand that diabetes is equal to inflammation, for example. Once they understand that, they're kind of more concerned when you put it a big word, like inflammation into their heads, and then they can be more proactive. So that's how I kind of go about that.

Host: Yeah. And I wanted to stay with you about diagnosis, just doing some reading about this before we recorded today. Why are Hispanic adults less likely to be diagnosed with coronary heart disease despite having the risk factors, as you're saying? And what does it ultimately mean for prevention strategies?

Christina Rodriguez Ruiz, M.D.: Yeah, I think it's partly about access, Scott. Many of our families don't see a doctor regularly. And I think it's very cultural. We often put like our family members before ourselves. You know, I'm Puerto Rican and we're like all about our families and symptoms that patients present or one of our family members present get brushed off as just being tired or too much stress because Hispanic populations work very hard. So that means we miss opportunities for early treatment and then for prevention. We need care that feels like a bit more approachable, like having somebody that's bilingual or having that access and it's more centered to the idea that keeping mama, papa healthy, kind of keeps the entire household thriving. So that's kind of the point.

Host: I see what you mean. And I wanted to talk to you about Hispanic diets, you know, traditional Hispanic diets. I am a big fan of Hispanic food. But they can contribute to cardiovascular risks. So what are some practical ways families can make or things that they can do to make these meals heart healthier without losing cultural significance?

Christina Rodriguez Ruiz, M.D.: You know, our food is comfort. It's culture, it's family. So growing up, may Abuela would make what we call rocha. It's a very heavy salty meal, but very comforting. It was our comfort food, right? Simple but full of love. And I think the challenge is with these dishes, it can be heavy in salt, like you said, fat or fried foods.

We love good food, but that means all of that, right? And so the good news is we don't have to give them up. Instead of frying, you can try baking, for example, and you can swap lard for olive oil. Add more fresh herbs instead of so much salt. And so the flavors stay, but the heart gets a little more protection.

And so I always say it's not about changing our Abuela's recipes, it's about updating them so the next generation can enjoy them too, you know?

Host: Yeah, for sure. And when we think about family-centered values, which is especially, important to Hispanic families but it also affects their health decisions regarding their household. So how do we encourage them to seek more medical care, better medical care? How can we help them?

Christina Rodriguez Ruiz, M.D.: I think, family is everything in our culture. So health decisions are made together. You know, you make recommendations based like, uh, what trusted Auela said, or neighbor, you're like, I think I'll follow what they say. And it also starts like in the kitchen table, like you're saying, these small decisions that you make as a family to what to cook.

I think it can also be a strength when you make those decisions proactively, like you as a family, want to exercise a little bit more, that kind of inspires the rest of your family to do so. And I'm going to a personal example, my father did a triathlon when he was 62, and my mom, you know, is very active.

So that inspires me and my brother to look at how they compare in their sixties to other people who don't exercise and don't do as much, you know, taking care of themselves to actually be proactive about our health and that, I think setting the example as a family kind of gets good outcomes for the rest of the kids and Abuelas and everybody.

So I think that's very important.

Host: Right. It starts with grandma, it starts with the Abuelas, you know, and then mom, yeah, mom and dad. And it kind of trickles down. And you touched on this a little bit earlier about cultural sensitivity and the role that it plays and I want to better understand this, it could start with having just Spanish speakers available, of course.

But beyond that, how, how do we improve cardiovascular care for Hispanic families? And maybe you can share some examples of effective culturally tailored interventions.

Christina Rodriguez Ruiz, M.D.: I think that's absolutely critical. When we feel comfortable with our doctors bottom line, it doesn't matter who we are, then we feel like we can be honest in earnest, right? It doesn't matter your culture. So I think a doctor who understands that a patient might bring their daughter, their spouse or even their comradre, to like an appointment is more likely to build trust.

You know that you're going to be speaking to some of these family members instead of the patient, right? So even if you're not a Spanish speaker, that you can address that family member and you can be as culturally sensitive, that means a lot. And so that can also mean, instead of saying things that are very general, like, oh, you're diabetic, so you have to cut carbs.

You can talk about portion sizes so you can cut the amount of or rice that you're eating or the amount of tortillas that you're taking, so they know that it's, that you know a little bit about what they're eating and in terms of how. I mean, it makes a huge difference. For me personally, because, I was born in Puerto Rico, my first language is Spanish. So when they see me, their attitude completely changes, they're able to talk to me and know how I know about, usually, you know, what are their difficulties. And so that makes the conversation very real and earnest and we can get to work with goals that are realistic for that person specifically.

Host: Yeah, I'm sure you probably just see it on their faces, right? That this, you know, they see you and they think, okay, she's going to understand me. She's going to get me, she's going to speak my language. We're going to be able to, yeah, we're going to be able to communicate right?

Christina Rodriguez Ruiz, M.D.: Exactly.

Host: Yeah. And you know, it's not uncommon, obviously, doctor for saving time or whatever reasons, but we tend to speak deal in broad brushes, if you will.

But I know there's a lot of diversity within the Hispanic community, right? So we just say Hispanics, but there's such differences between Mexicans and Puerto Ricans and Central Americans. Right. So how all, yeah, how, how do these differences affect heart disease risk and public health outreach?

Christina Rodriguez Ruiz, M.D.: You are so right Scott. Like Hispanics are not a monolith. Right? We're not one group. Like you mentioned, there's many different traditions, diet, health risks within the Hispanic community. Even in the Hispanic community health study, it was found that Puerto Rican women had some of the highest obesity rates, almost 51% compared to about 31% of South American women. So that in itself is huge. And then Central American men show very high levels of high cholesterol, close to 55%. I think there's also a few data points about Puerto Ricans reporting more chest pain than other subgroups. And across the board, more than 80% of Hispanic men and 71% of women, had at least one cardiovascular risk factor.

So that predisposes you to a lot of chance of having a heart attack, you know. So a one size fits all message doesn't work. So a campaign that helps a Puerto Rican family may not reach a Mexican or Salvadorian one. So public health outreach needs to be tailored neighborhood by neighborhood.

You know, culture by culture, even if it sounds hard. I think diversity is such a strength. You know, it means that we can build interventions that celebrate differences and then unites us around our healthy hearts, you know, so we can all walk together, change our diets that are less salty, less fried, all that stuff.

Host: Yeah. Less salty. Less fried. Of course, I probably should have eaten before we recorded this doctor, because we've talked about talking about food and some of my favorite foods. I want to ask you like what are some successful examples of community partnerships or local programs that have helped to bridge gaps in heart health education and care for Hispanic families?

Christina Rodriguez Ruiz, M.D.: I think I've seen churches host blood pressure checks right after mass, schools that hold family nutrition nights and even grocery stores that partner with clinics to highlight healthier products. And so when that message comes from somebody you trust, like a priest or a teacher or local leader, I think it lands very differently. And that kind of partnership is the one that works.

Host: I want to try to understand this a little bit, like why is it important to include Hispanic populations in genomic studies, you know, related to heart disease, and how does underrepresentation, maybe that's the right word, affect treatment outcomes?

Christina Rodriguez Ruiz, M.D.: We all know that heart disease is mostly preventable, like 95%. I don't know if we all know, but 95% of heart disease is preventable for all of us. Meaning what we eat, the exercise that we do. So I really want to harp on the point that preventing heart disease is possible.

But there's that other 5% perhaps that is genetics, right? So genetics matter. And if our people aren't included in research, then treatments and risk calculators that are designed based and data, won't include our populations. So I want to put into example the ASCVD score, which is something that you might hear from your cardiologist or even family medicine practitioner. They calculate your risk factors and they put it in a score, and it's a good tool that doctors use to estimate your 10 year risk of having a heart attack or stroke.

But it was mostly built on white and black populations, not Hispanics. And so studies show that it often overestimates the risks in Mexican Americans and underestimates it in Puerto Ricans, especially women with high rates of diabetes and obesity. So that can mean overtreatment for some and undertreatment for others.

I'll give you an example. I had a patient, like a middle aged Puerto Rican man who came worried about his ASCVD score. You know, they labeled him as high risk. He was nervous asking me, Hey doctor, am I really in danger? And so I did another kind of testing called a calcium score test, which can individualize risks a little bit more and tells us the amount of calcium that we have in our heart arteries based on a CT scan.

And it was zero. And so his arteries didn't show any evidence of calcium at his, you know, middle age. So I saw the relief on his face, like I could recalculate his risk based on that.

Host: Yeah, it's really interesting and I feel like we're only really just scratching the surface here today. But it's good information and it's given me a lot to think about. And I'm sure listeners as well. Just to finish up here, like if Hispanic families want to learn more about receiving heart care that's really tailored to their unique needs, what do you recommend?

Christina Rodriguez Ruiz, M.D.: So locally, I want to plug in my Memorial Care family so families can visit memorialcare.org/lbheart or call 844-662-6484 to connect with programs that understand Hispanic needs. And more than that, families can start simply by asking their doctors the right questions, by bringing family members along, by making a health plan.

And you know, that's how we can change the future of heart health in our community.

Host: Right. Because as you say, you know that we can't outrun family history and genetics, but the other 95% right, is within our control, behavior, lifestyle, eating, portion sizes, all of that stuff. So again, I think we're just kind of scratching the surface here today. But I appreciate your time and your expertise.

Thanks so much.

Christina Rodriguez Ruiz, M.D.: My pleasure. Nice meeting you, Scott.

Host: And for more information, visit memorialcare.org/lbheart or call 844-662-6484. And if you enjoyed this episode, please share it on your social channels and check out the entire podcast library for additional topics. This is Weekly Dose of Wellness, brought to you by Memorial Care Health System.

Thanks for listening.