Selected Podcast
Are You At Risk for Vascular Disease
Dr. Michael Schwartz discusses the diagnosis and management of vascular disease.
Featured Speaker:
Michael Schwartz, MD
Michael Schwartz, MD is the Chief, Division of Vascular Surgery, Montefiore Nyack Hospital. Transcription:
Are You At Risk for Vascular Disease
Alyne Ellis (Host): Are you at high risk for vascular disease? Here to tell us more is Dr. Michael Schwartz, the Chief of the Division of Vascular Surgery at Montefiore Nyack Hospital. This is Health Track, the podcast from Montefiore Nyack Hospital. I’m Alyne Ellis. Welcome Dr. Schwartz. Thanks for joining us today.
Michael Schwartz, MD (Guest): Well thanks for having me Alyne.
Host: So, let’s start with what is vascular disease and how do doctors test to find out if we have it?
Dr. Schwartz: So, vascular disease is really any abnormal condition of the blood vessels and that includes both the arteries and the veins. But what we’re really specifically concerned about, are the arteries because those are the vessels that actually supply the important organs with blood. So, in many patients, these arteries can become clogged with plaque from cholesterol. So, if the arteries are narrowed with plaque, then the organs supplied by those vessels can be adversely affected.
So, we have numerous ways of testing to figure out who has plaque and how much plaque they have and the best ways we have is noninvasive ways which don’t involve any pain or any introduction of anything into the skin or anything. So mostly they are done with either ultrasound or Dopplers which again, they are painless and safe tests.
Host: And what types of conditions are you looking for?
Dr. Schwartz: Well in our screening, we look at arteries which supply the neck and the brain with blood. Those are called the carotid arteries. We also look at the aorta and that’s actually the large artery in the body which supplies basically the legs and most of all the organs and also the lower extremity arteries. So, we are testing for those three specific blood vessels. And the reason why we are testing them if you look at each individual artery; for example the carotid arteries, so the two paired blood vessels in the neck. Those arteries supply the brain with blood so if any plaque builds up in those carotid arteries; that restricts blood flow to the brain.
Host: And what about the aorta?
Dr. Schwartz: The aorta, it’s important because now the aorta can become narrow with plaque but what we’re looking for is something called an aortic aneurysm.
Host: And what is that?
Dr. Schwartz: So, an aneurysm develops when plaque develops in the artery, the artery can actually weaken and actually balloons out. And the reason why that’s a problem is because if it ruptures, the mortality is close to 90%. And the last thing to look at is the circulation to the legs. So, if you have plaque in the arteries which supply the legs, you’ll have less blood flow to your foot. So, people present with leg pains and stuff like that.
Host: And what about common health conditions that we might think of? So for example heart disease?
Dr. Schwartz: Well, atherosclerosis is sort of a general problem. So, if you have plaque in the leg arteries, the carotid arteries; it also can affect the heart. So, one of the most important things to realize is that if you have plaque in your legs or in your carotids; it also affects the heart arteries.
Host: And atherosclerosis is what exactly?
Dr. Schwartz: So, atherosclerosis is the development of plaque in the arteries. So, this is the plaque that we’re concerned about.
Host: So, how common is it for someone to be unaware that they have cardiovascular disease, and can I also use the term cardiovascular and vascular interchangeably?
Dr. Schwartz: Well the one thing about vascular problems is that a lot of them are asymptomatic. So, you may never know you have plaque in your arteries or in your aorta or in your legs. So, that’s why screening is so important.
Host: Can somebody recognize that they have vascular disease?
Dr. Schwartz: Well listen, the problem with vascular disease is that sometimes the first symptom can be a catastrophic event. So, for example, you may have plaque in your carotids, but you will never know it and then some patients present to the emergency room with a stroke. That may be the first evidence of carotid disease. For an aneurysm; these are silent killers in the fact that you can develop a small aneurysm and it can grow and grow and you may never know you have it until it ruptures. So, this is the reason why screening is so important. Because you can pick these things up before they become a catastrophic issue. With the legs, it’s a little different because with the lower extremity plaque, people will tend to figure out they have a problem. They start walking, they get pains in their legs and also that becomes an indicator that there is plaque in the leg arteries.
So, but it’s also important because by screening plaque in the leg arteries, you may not need anything done but if you have plaque in your leg arteries or in your aorta, or in your carotid arteries; that could mean that you have undiagnosed cardiac disease and so it’s important to test for that as well.
Host: So, when and how often should a person get a routine screening?
Dr. Schwartz: Well not everyone needs screening. I mean there are healthy patients who don’t need anything done. But there are some risk factors that put people at a higher risk for developing vascular problems. Typically, it’s good if you have some of these risk factors to get screened. And then if you are clear, you could probably wait another five years maybe even longer. But the whole idea of screening is to pick this stuff up early because some of these risk factors are actually modifiable in the fact that for example someone presents with plaque in their leg arteries, but they don’t know they even have it because they have no symptoms, or in the carotid or in their aorta. You may not need anything done, surgically. You may just need to have some of your risk factors modified. Maybe you could be on medication to control your blood pressure. Maybe you need to be on cholesterol drugs. So, the whole idea of screening is picking this stuff up early before it becomes an issue.
Host: And go over some of the various things that make you at a higher risk please.
Dr. Schwartz: So, if you look at risk factors. There are certain things that you can’t control. Because for example, vascular disease increases with age. Okay, men are also at a higher risk than women for developing vascular problems. People can have a family history of vascular disease. Those things you really can’t adjust. But there are risk factors for example, smoking is a huge risk factor. Most of our patients who have vascular problems, the vast majority of them where smokers so if you pick up someone who has vascular problems early, cutting back on your smoking or stopping smoking or cutting back on your diet so your cholesterol lowers or managing your diabetes better, obesity is a risk factor for developing vascular problems. Losing weight, a sedentary lifestyle. All these things are modifiable. That’s why screening is so important.
Host: And so once you actually find this condition; what can be done about it. You are mentioning lifestyle, so let’s just say for example that I were to lose weight and exercise, when could I turn this around?
Dr. Schwartz: That’s a great question. We do know that if you continue with bad lifestyle, that you are going to advance your vascular problems. It’s hard to predict how much better you are going to get. But we certainly know that if you continue to smoke, you are going to end up with a life threatening problem. The same thing with diet and exercise. So, these things are hard to quantitate how much better you are going to get. But we do know that if you don’t stop, you are going to get much worse.
Host: And separate from that, including controlling blood pressure or cholesterol or dieting; what could you do perhaps surgically to fix some of this?
Dr. Schwartz: So, with vascular disease, really the most important thing even as a vascular surgeon, the important thing that we have drummed into our heads from our training is to be very conservative with these patients. Medically manage them. Exercise. But there are people who just either they present very late or they advanced their disease, so we have things available to treat this. For example for the carotid, if you developed enough plaque in your carotid artery, you are at risk for developing a stroke. And stroke is the third most common cause of death in the United States. So, if patients present with a high amount of degree of plaque in their carotid arteries, we could actually remove that plaque.
With aortic aneurysm disease, as I mentioned, if you rupture, your chance of death is around 90%. So if you find someone who has an aneurysm which is sizable, that could be treated, and we typically treat them with stents with an overnight hospital stay. But the most important thing is picking these things up. We tend to see most of our patients after having perhaps a CAT scan or a sonogram for other reasons and they find these aneurysms. I will tell you that most of the patients that I see initially, the aneurysms are small. But the reason why it’s important to follow these patients and the see us either once a year or twice a year depending on the initial size of their aneurysm; is because they will eventually get to a size which needs to be treated. So, that’s why it’s important to pick them up so we can follow them to make sure we are not missing a large aneurysm which is prone to rupture.
Host: Is there anything else Dr. Schwartz you’d like to add?
Dr. Schwartz: One of the best treatments for lower extremity plaque in the legs is exercise. And so, I think that the screening is so important because it picks these patients up early who would never have suspected that they had vascular problems and then we could either treat them again, most patients are managed medically but by picking them up early, we could avoid the disasters of stroke, ruptured aneurysm and limb loss by finding this disease at an early stage.
Host: Dr. Schwartz thanks so much for joining me today. Dr. Michael Schwartz is the Chief of the Division of Vascular Surgery at Montefiore Nyack Hospital. The Vascular Institute at Montefiore Nyack Hospital offers diagnostic tests, education and access to complete medical resources for vascular disease which left untreated can lead to stroke, heart disease, and aneurysms. The process starts with a vascular screening test from the Dare to Care Program. It is a complimentary heart and vascular screening provided as a cooperative effort through the Montefiore Nyack Hospital and the Heart Health Foundation.
A free vascular screening is available at Montefiore Nyack Hospital to any patient over the age of 60 or over the age of 50 with certain risk factors for heart and vascular disease including smoking, diabetes, hypertension and high cholesterol. Screenings are also available to diabetics over the age of 40. To schedule an appointment for a free screening, call 833-32HEART. That’s 833-324-3278. And for more information visit www.montefiorenyack.org/vascular. That wraps up this episode of our Health Track podcast. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for additional topics that may interest you. I’m Alyne Ellis. Thanks for listening.
Are You At Risk for Vascular Disease
Alyne Ellis (Host): Are you at high risk for vascular disease? Here to tell us more is Dr. Michael Schwartz, the Chief of the Division of Vascular Surgery at Montefiore Nyack Hospital. This is Health Track, the podcast from Montefiore Nyack Hospital. I’m Alyne Ellis. Welcome Dr. Schwartz. Thanks for joining us today.
Michael Schwartz, MD (Guest): Well thanks for having me Alyne.
Host: So, let’s start with what is vascular disease and how do doctors test to find out if we have it?
Dr. Schwartz: So, vascular disease is really any abnormal condition of the blood vessels and that includes both the arteries and the veins. But what we’re really specifically concerned about, are the arteries because those are the vessels that actually supply the important organs with blood. So, in many patients, these arteries can become clogged with plaque from cholesterol. So, if the arteries are narrowed with plaque, then the organs supplied by those vessels can be adversely affected.
So, we have numerous ways of testing to figure out who has plaque and how much plaque they have and the best ways we have is noninvasive ways which don’t involve any pain or any introduction of anything into the skin or anything. So mostly they are done with either ultrasound or Dopplers which again, they are painless and safe tests.
Host: And what types of conditions are you looking for?
Dr. Schwartz: Well in our screening, we look at arteries which supply the neck and the brain with blood. Those are called the carotid arteries. We also look at the aorta and that’s actually the large artery in the body which supplies basically the legs and most of all the organs and also the lower extremity arteries. So, we are testing for those three specific blood vessels. And the reason why we are testing them if you look at each individual artery; for example the carotid arteries, so the two paired blood vessels in the neck. Those arteries supply the brain with blood so if any plaque builds up in those carotid arteries; that restricts blood flow to the brain.
Host: And what about the aorta?
Dr. Schwartz: The aorta, it’s important because now the aorta can become narrow with plaque but what we’re looking for is something called an aortic aneurysm.
Host: And what is that?
Dr. Schwartz: So, an aneurysm develops when plaque develops in the artery, the artery can actually weaken and actually balloons out. And the reason why that’s a problem is because if it ruptures, the mortality is close to 90%. And the last thing to look at is the circulation to the legs. So, if you have plaque in the arteries which supply the legs, you’ll have less blood flow to your foot. So, people present with leg pains and stuff like that.
Host: And what about common health conditions that we might think of? So for example heart disease?
Dr. Schwartz: Well, atherosclerosis is sort of a general problem. So, if you have plaque in the leg arteries, the carotid arteries; it also can affect the heart. So, one of the most important things to realize is that if you have plaque in your legs or in your carotids; it also affects the heart arteries.
Host: And atherosclerosis is what exactly?
Dr. Schwartz: So, atherosclerosis is the development of plaque in the arteries. So, this is the plaque that we’re concerned about.
Host: So, how common is it for someone to be unaware that they have cardiovascular disease, and can I also use the term cardiovascular and vascular interchangeably?
Dr. Schwartz: Well the one thing about vascular problems is that a lot of them are asymptomatic. So, you may never know you have plaque in your arteries or in your aorta or in your legs. So, that’s why screening is so important.
Host: Can somebody recognize that they have vascular disease?
Dr. Schwartz: Well listen, the problem with vascular disease is that sometimes the first symptom can be a catastrophic event. So, for example, you may have plaque in your carotids, but you will never know it and then some patients present to the emergency room with a stroke. That may be the first evidence of carotid disease. For an aneurysm; these are silent killers in the fact that you can develop a small aneurysm and it can grow and grow and you may never know you have it until it ruptures. So, this is the reason why screening is so important. Because you can pick these things up before they become a catastrophic issue. With the legs, it’s a little different because with the lower extremity plaque, people will tend to figure out they have a problem. They start walking, they get pains in their legs and also that becomes an indicator that there is plaque in the leg arteries.
So, but it’s also important because by screening plaque in the leg arteries, you may not need anything done but if you have plaque in your leg arteries or in your aorta, or in your carotid arteries; that could mean that you have undiagnosed cardiac disease and so it’s important to test for that as well.
Host: So, when and how often should a person get a routine screening?
Dr. Schwartz: Well not everyone needs screening. I mean there are healthy patients who don’t need anything done. But there are some risk factors that put people at a higher risk for developing vascular problems. Typically, it’s good if you have some of these risk factors to get screened. And then if you are clear, you could probably wait another five years maybe even longer. But the whole idea of screening is to pick this stuff up early because some of these risk factors are actually modifiable in the fact that for example someone presents with plaque in their leg arteries, but they don’t know they even have it because they have no symptoms, or in the carotid or in their aorta. You may not need anything done, surgically. You may just need to have some of your risk factors modified. Maybe you could be on medication to control your blood pressure. Maybe you need to be on cholesterol drugs. So, the whole idea of screening is picking this stuff up early before it becomes an issue.
Host: And go over some of the various things that make you at a higher risk please.
Dr. Schwartz: So, if you look at risk factors. There are certain things that you can’t control. Because for example, vascular disease increases with age. Okay, men are also at a higher risk than women for developing vascular problems. People can have a family history of vascular disease. Those things you really can’t adjust. But there are risk factors for example, smoking is a huge risk factor. Most of our patients who have vascular problems, the vast majority of them where smokers so if you pick up someone who has vascular problems early, cutting back on your smoking or stopping smoking or cutting back on your diet so your cholesterol lowers or managing your diabetes better, obesity is a risk factor for developing vascular problems. Losing weight, a sedentary lifestyle. All these things are modifiable. That’s why screening is so important.
Host: And so once you actually find this condition; what can be done about it. You are mentioning lifestyle, so let’s just say for example that I were to lose weight and exercise, when could I turn this around?
Dr. Schwartz: That’s a great question. We do know that if you continue with bad lifestyle, that you are going to advance your vascular problems. It’s hard to predict how much better you are going to get. But we certainly know that if you continue to smoke, you are going to end up with a life threatening problem. The same thing with diet and exercise. So, these things are hard to quantitate how much better you are going to get. But we do know that if you don’t stop, you are going to get much worse.
Host: And separate from that, including controlling blood pressure or cholesterol or dieting; what could you do perhaps surgically to fix some of this?
Dr. Schwartz: So, with vascular disease, really the most important thing even as a vascular surgeon, the important thing that we have drummed into our heads from our training is to be very conservative with these patients. Medically manage them. Exercise. But there are people who just either they present very late or they advanced their disease, so we have things available to treat this. For example for the carotid, if you developed enough plaque in your carotid artery, you are at risk for developing a stroke. And stroke is the third most common cause of death in the United States. So, if patients present with a high amount of degree of plaque in their carotid arteries, we could actually remove that plaque.
With aortic aneurysm disease, as I mentioned, if you rupture, your chance of death is around 90%. So if you find someone who has an aneurysm which is sizable, that could be treated, and we typically treat them with stents with an overnight hospital stay. But the most important thing is picking these things up. We tend to see most of our patients after having perhaps a CAT scan or a sonogram for other reasons and they find these aneurysms. I will tell you that most of the patients that I see initially, the aneurysms are small. But the reason why it’s important to follow these patients and the see us either once a year or twice a year depending on the initial size of their aneurysm; is because they will eventually get to a size which needs to be treated. So, that’s why it’s important to pick them up so we can follow them to make sure we are not missing a large aneurysm which is prone to rupture.
Host: Is there anything else Dr. Schwartz you’d like to add?
Dr. Schwartz: One of the best treatments for lower extremity plaque in the legs is exercise. And so, I think that the screening is so important because it picks these patients up early who would never have suspected that they had vascular problems and then we could either treat them again, most patients are managed medically but by picking them up early, we could avoid the disasters of stroke, ruptured aneurysm and limb loss by finding this disease at an early stage.
Host: Dr. Schwartz thanks so much for joining me today. Dr. Michael Schwartz is the Chief of the Division of Vascular Surgery at Montefiore Nyack Hospital. The Vascular Institute at Montefiore Nyack Hospital offers diagnostic tests, education and access to complete medical resources for vascular disease which left untreated can lead to stroke, heart disease, and aneurysms. The process starts with a vascular screening test from the Dare to Care Program. It is a complimentary heart and vascular screening provided as a cooperative effort through the Montefiore Nyack Hospital and the Heart Health Foundation.
A free vascular screening is available at Montefiore Nyack Hospital to any patient over the age of 60 or over the age of 50 with certain risk factors for heart and vascular disease including smoking, diabetes, hypertension and high cholesterol. Screenings are also available to diabetics over the age of 40. To schedule an appointment for a free screening, call 833-32HEART. That’s 833-324-3278. And for more information visit www.montefiorenyack.org/vascular. That wraps up this episode of our Health Track podcast. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for additional topics that may interest you. I’m Alyne Ellis. Thanks for listening.