Traci Manis, BSN, RN (Host): Hi, I'm Traci Manis. And I'm here with Dr. Stephen Gimple from NKC Health Heart Care. And we are going to have an empowering conversation today about heart disease prevention. Dr. Gimple, thank you for being here today.

Stephen Gimple, MD: Oh, I'm happy to be here.

Host: Thank you. All right. So, tell me a little bit about your background. What drew you to cardiac care?

Stephen Gimple, MD: Yeah, a lot of it was in my medical training. Just the people that I interacted with who I really got along with best and liked what they did was the cardiologists at my medical school at Vanderbilt.

Host: Okay.

Stephen Gimple, MD: Yeah. So, that really led me to that.

Host: So, that was always the plan?

Stephen Gimple, MD: No, the plan was to be an orthopedic surgeon like my father. But then, when I got to school and started doing clinical rotations, I really liked cardiology, that it has a lot of diagnosis and having to kind of find problems and figure out what the problem is, but then still have things that we can do to fix those problems. It was really nice that it had both the kind of thinking side and the doing side of medicine.

Host: Yeah, I like that.

Stephen Gimple, MD: Yeah.

Host: It's interesting because our hearts beat all day long, every second, every minute.

Stephen Gimple, MD: Yeah, 100,000 times a day.

Host: Every minute. Yeah, it's crazy, and we don't ever think about it.

Stephen Gimple, MD: Yep.

Host: But there are certainly things that can go wrong with our hearts. And what are some of the things that you would suggest for our community to prevent heart disease? It's the number one killer in the United States of adults. What can we do to prevent it?

Stephen Gimple, MD: Yeah. So, there's a lot that can be done for prevention. And yes, a lot of heart disease starts very early and takes years to develop and build up. And so, changes that we make early on can have a big difference to preventing actual heart complications later on. And we've actually done very well with prevention over the last 20 years. We're actually now number two cause of death. Cancer has now surpassed heart disease as the number one.

So, there are really a lot of things that we can do for prevention. Really, a lot of it's lifestyle related. So, you know, how we eat, how much activity we do, how we handle stress and sleep are all really important. And then, really recognizing that there are several other disease conditions that are big risk factors for heart disease.

And if you have those disease conditions, you want to treat them and control them to prevent you from developing cardiac complications later on. And, you know, a lot of those are things like high blood pressure, it's called hypertension, or high cholesterol or diabetes. And so, avoiding those things, or if you have them, treating them is what will prevent heart problems down the road.

Host: Yeah. What do most people get wrong when they're thinking about what their risk factors are for heart disease?

Stephen Gimple, MD: So, a lot of people think that if you're not the worst person at some risk factor, that they're not going to have the heart attack, meaning they're like, "Well, you know, I'm not a two-pack-a-day smoker and, you know, I go to the gym occasionally," and then they are surprised when they have, you know, developed heart disease.

But, you know, the honest truth is, in our cath lab, the patients who are coming in with heart attacks on average have about the average American cholesterol level, right? So, all of these risk factors, you know, from blood pressure to cholesterol to weight to how much you exercise to what you eat to your blood sugar, all of those have, you know, effect on your cardiac risk. And so, you know, trying to control all of those things as best you can is what lowers risk the most.

Host: Yeah. Because you do hear about athletes and people who are in fantastic shape actually having heart disease, and they don't even know about it. So, I think that's a myth, right? What are some other myths that you hear in your practice? Like, does an apple a day really keep the doctor away?

Stephen Gimple, MD: In some ways, yes, it probably actually does. So, you know, eating healthy is good. So, I will say things people get wrong or they don't understand is, you know, people don't understand a lot about cholesterol and what that means. And one thing people believe is that, you know, the only way I get cholesterol in my body is by eating the cholesterol, and that's a myth and not true. Most of the cholesterol in your body, your body's able to synthesize from other building blocks. So, you know, what your cholesterol levels in your blood has a lot to do with your genetics and the way your liver metabolizes cholesterol. It does have something to do with what you eat, but not as much as people expect.

Host: Okay. You talked a little bit about prevention, you know, and what we eat, how active are we. How early should people start thinking about prevention in their lifetime?

Stephen Gimple, MD: Yeah. The earlier, the better, right? There's no too early to start thinking about this. So, you know, if you have those risk factors like high blood pressure or high cholesterol, studies have shown the sooner you treat it, the better. Even into the pediatric population, we've learned if somebody has really high cholesterol, if you treat them at age 10, that's better than waiting until they're 18 or 25 to start treating it. So really, this is a lifelong journey towards avoiding heart disease.

Host: Yeah. So, knowing what your blood pressure is, having some labs, knowing what your cholesterol levels are. What are some other tests or screenings that can be done to help us know what our risk factors are?

Stephen Gimple, MD: Yeah. So, the big thing is really know your numbers, right? And so, that's talking about knowing what your blood pressure is, knowing what your cholesterol levels are, knowing your blood sugar, knowing your weight, and kind of keeping track of all those things so that they don't get out of control.

And so, a lot of that involves going to see your family doctor for routine physicals, and getting those things checked up on is really important. And then, as people get older, where they start getting in where they might have higher risk and they may start developing the disease, there are some tests we have to help find cholesterol plaque in the arteries before it causes problems.

So, the most useful one is a test called a cardio scan that gives a number called a calcium score, which really has nothing to do with calcium and everything to do with atherosclerotic plaque in the coronary arteries of the heart. So, it's a cheap screening test, just a little CT scan of the heart. I think they currently cost $50. And it lets us see if there's any plaque in the arteries or non-plaque in the arteries. So, that starts to become helpful in middle age. So, age about 45 for men, 50 for women, and is useful up until about age 75 or so. We encourage a lot of people to, you know, know those numbers, get that screening test done when they're kind of in that middle age range and plaque might be starting to develop, and that helps us be more precise with knowing who needs more aggressive risk factor modification.

Host: Okay. I had a cardiac scan done.

Stephen Gimple, MD: Okay, good.

Host: Yeah, it was so easy.

Stephen Gimple, MD: Yeah?

Traci Manis, BSN, RN (Host): Yeah. I liked my results.

Host: They were good.

Stephen Gimple, MD: Good.

Host: I feel pretty good about it.

Stephen Gimple, MD: I won't make you tell everybody your results.

Host: Zero.

Stephen Gimple, MD: Good. And if it's zero, that's the only time when maybe it's useful to repeat that test. So you know, if your score is zero, then, you know, five, seven, 10 years down the road, you know, you may not stay zero life-long. So, you know, repeating it is helpful. Once your score is elevated and you know that there's plaque growing, it really answers the question which is, is there plaque there? Is there not plaque there? And then, repeating that test just to see if it goes up for a whole variety of very technical reasons is not so helpful.

Host: Yeah. How important is family history?

Stephen Gimple, MD: So, family history is helpful. It is a very hard thing for us to quantify because genetics are ridiculously complex. And so, you know, obviously, having a family history of early heart disease does put you at higher risk. It really is mostly for first-degree relatives, meaning your parents, your siblings, your children. If they have heart disease at a relatively young age, say less than age 60, that can be a risk factor for you. Now, having a grandparent who had a heart attack when they were 80 probably doesn't increase your risk at all.

Host: Okay. Very good. Okay. So, we see our doctor. We know our numbers, but we only do that once a year. What can we do day to day to help us be in better shape or to help us prevent heart disease?

Stephen Gimple, MD: Yeah. So yeah, as far as the numbers, it's not only knowing the numbers, but treating those numbers. So, a lot of people want to come to me and have me, you know, get them a cardio scan and check their cholesterol and check their blood pressure. But then, when I recommend treatment to control those things, they go, "Well, I don't really want to do that. You know, I just want to see you every year, and then I won't have a heart attack." And obviously, I don't have magic cardiology pixie dust. And so, the main thing is, you know, if, your physician recommends that you need some treatment, you should follow their advice. And often that involves a little bit of medicine, but a lot of that now is cheap and generic and very well-tolerated. So, I'd say knowing the numbers and then treating the numbers as your doctor tells you to is the most important thing.

As far as daily activities and whatnot, you know, heart-healthy diet's really important. I just tell my patients, google Mediterranean diet and read up on that. It's not some fancy diet plan that you have to buy this and cook that. It's just kind of basic principles about what kind of foods are healthy and what's not healthy. And so, really, it's avoiding ultraprocessed foods, avoiding fried foods, avoiding, you know, things made in factories, and eating more things that were grown on farms.

So, you know, eating lean protein, getting omega-3 good fats in the diet, and that's the kind of fat that's found in fish, olive oil, avocados, that sort of thing, and then avoid those fried or processed foods.

Host: I've always heard people talk about shopping the perimeter of the grocery store. So, everything that's on the outside that's fresh and refrigerated is usually going to be your best bet with that.

Stephen Gimple, MD: Correct.

Host: Okay.

Stephen Gimple, MD: Correct.

Host: Very good.

Stephen Gimple, MD: And then, exercise and activity is the other really important thing. And, you know, there's one study that showed that people who exercise 20 to 30 minutes a day, five days a week live five years longer than people who don't do any activity. And that's a big number, adding five years to your life just by a little activity.

And I do think it's really just about how active overall that you are. You know, as we age, we become less active, not by purpose. But sometimes just, you know, we have a little less energy, or we get some orthopedic injury and we can't do as much. So, trying to battle that just by being as active and getting as much physical activity as you can on a day-to-day basis is really important. So even simple things like parking in the back of the parking lot and walking into the grocery store instead of trying to fight for the closest spot. I think adding a few hundred extra steps a day is probably more important than going to the gym once a week.

Host: Yeah. Those little things have to add up in a big way, I would think. We've talked about what we eat, how we sleep, activity. How does stress play into heart health, and what would you recommend—I mean, you probably lead a stressful life. What do you do to ease stress and kind of take that factor out of creating heart disease?

Stephen Gimple, MD: Yeah. So, stress is very hard to quantify. And so, it is hard to count, give numbers for people about, well, how much does my stress increase my cardiac risk, just because there's such a spectrum of how much stress people have and how people handle it.

But without question, stress increases cardiac risk and we see that every day when people in stressful situations come in with heart attacks, stress-induced cardiomyopathies and heart rhythm problems and all of this. So, yeah, it's hard to quantify, but definitely plays an important role.

So, I think several things really help with stress, you know, handling stress and relieving stress. So, exercise, which I know we've talked about a bunch already, is, you know, a great way to release endorphins, which are those kind of good-feeling chemicals, neurotransmitters in your brain that help you feel good and have been shown to release stress. So, exercise is a great way to do that. I think relationships are a great way to do that, right? Like, human interaction is a very good way to release, relieve stress. And our current society's not so great with that because we're all now online on our phones. But I think trying to nurture personal interaction with other people is a way we can help relieve stress.

And then, you know, good sleep is very helpful. So, you know, lots of studies about good sleep, lowering stress hormones like cortisol, which are not good to have elevated levels of. And so, you know, trying to go to bed at the same time each night and wake up the same time each morning's helpful. And sleep in a dark room and not with the TV on. And, you know, put your phone on do not disturb so it's not waking you up. Those kind of things can, over time, you know, make a big difference to relieving stress.

Host: Yeah, absolutely. I think self-care is kind of a big buzzword. So, finding your way, whether that's gardening or crocheting or running or whatever it is that allows you to kind of release that, I think, is important.

Stephen Gimple, MD: Yeah.

Host: If someone wanted to be proactive about starting to take better care of their heart, what would you suggest as a first step?

Stephen Gimple, MD: Yeah. As a first step I'd say, you know, go see your family doctor and just tell them that's what you want. And then, educate yourself on, you know, heart-healthy diet, what foods are good, what foods are less bad for you. Start reading labels in the grocery store. Start doing more of your own cooking and less at restaurants where the foods are more prepared foods with more processed. And then, start being, you know, active. You know, doing something to get your heart rate up and pumping for at least 20 to 30 minutes a day, five days a week. That's really where you should start.

Host: And information is available to us everywhere. You know, we can Google just about anything that you want to know. Does it concern you that people will get bad information on Google? What should they be, I don't know, more discerning about, I suppose?

Stephen Gimple, MD: Yeah, there is lots of bad information on the internet. That is true, and that's a problem that's becoming more of a problem as time goes on. So, you know, the best place to get detailed, personalized information really is from your own physician who, you know, has gone through, for cardiology, did 14 years of school after they graduate high school to learn to be a cardiologist.

And then, you know, I've seen 50,000 patients over my career, and so I can take kind of what I've learned from each of those patient encounters and help tailor the scientific training I have to tell you how best to take care of yourself. So, I think that's really important, is just listening to your own doctor that you have a relationship with.

But on mine, you know, sticking to, you know, well-known websites that have a connection to, you know, good scientific medical literature is what's most beneficial. So, there's lots of those. You know, Mayo Clinic's websites are really good and written to a level that most patients can understand. So, those are a fantastic resource. WebMD is a very good resource that you can use. The American College of Cardiology and the American Heart Association websites have a lot of very good patient information. So, those are probably the best places to go.

Host: But nothing beats that relationship with your own doctor who gets to know you and knows your history and kind of follows you throughout your journey with heart care. So, thank you for being that doctor for so many people.

Stephen Gimple, MD: Yeah. It's amazing. I tell patients every week, you know, I've been doing this quite a while now, and I still see something new that I've not run into every single week. So, you know, humans are so complex, and people, everybody's situation's a little different, and it's hard to paint everything with a very broad brush that, like, everybody should do this and nobody should do that. I mean, that might be true most of the time. But for individuals, you know, sometimes there are exceptions. And I think that's where the patient-physician relationship is most useful.

Host: Very good. Well, thanks for being here today. This has been a great conversation. I learned some things, and I'm sure a lot of other people did, too.

Stephen Gimple, MD: Okay.

Host: Thank you very much.

Stephen Gimple, MD: Thanks for having me.

Host: You bet. Thank you for joining us. We look forward to having more insightful conversations in the future to make our community healthier than ever.