Maggie McKay (Host): February is American Heart Month. So today's guest, Cardiologist at Sinai Chicago, Dr. Mihaela Stancu, will fill us in on why it's so crucial to pay attention to our hearts. 

Welcome to the Sinai Chicago Health and Hope Podcast, where caregivers from Sinai, Chicago share insights, updates, and important advice on the health topics impacting our communities. From the latest in medical research to practical tips for improving wellness; our doctors, nurses, and health professionals are here to help you and your families take control of your health. I'm your host, Maggie McKay. Thank you for joining us, Dr. Stancu.

Mihaela Stancu, MD: Hi Maggie, nice to be here. Thank you for having me.

Host: Absolutely. Could you start by explaining why heart health is so important and what makes it such a priority, especially in February during American Heart Month?

Mihaela Stancu, MD: Yes, thank you. I always explain to my patients that heart is kind of like the engine of the car, so engine of the body. If we are imagining the body as a car, the heart is the engine. The function of the heart is to pump blood regularly to our all our cells or our individual units or all our organs in the body.

So as we all know, when the engine of the car goes down, everything else goes down. So when heart is not working properly, all our major organs, will start failing and we don't want to get there.

February is also a very important month. It's a special month for heart health. It was designated, I think in 1964 as the heart month and it's mainly to raise awareness and education and to encourage research regarding heart problems, cardiovascular problems.

So February is a very important for heart health, and for cardiology in particular. Also is the month of the Valentine's Day. So let's remember that is tomorrow. So there is some kind of a symbolism in, in that, and we like that.

Host: There is that. Some people even call it love week. What are the most common heart health issues you see in your practice and what can we do to prevent them?

Mihaela Stancu, MD: Yeah, so I'm particularly an electrophysiologist. I specialize more in arrhythmia of the heart. So the one important problem of the heart that I treat and I deal with is atrial fibrillation, but there are other, in my practice, I also treat like heart failure and I see a lot of that.

A major common conditions of the heart would be high blood pressure, valvular problems, coronary artery disease, and of course, heart failure, arrhythmia of the heart, et cetera.

Host: Could you walk us through the major risk factors for heart disease that people should be aware of?

Mihaela Stancu, MD: Yeah. When we talk about risk factors, you can split them into three groups. The one group would be risk factors that are modifiable. So those are the important ones because we can do something about them. And those important risk factors would be hypertension. A lot of patients, I think they don't understand actually the significance.

We all tend to say, well, I have hypertension. I have high blood pressure. What's the big deal about it, everybody has it, but it's actually one of the most important risk factors for cardiovascular disease because with that it's linked into heart failure, arrhythmia developing, stroke, renal insufficiency, and so on and so forth.

Other major risk factor would be high cholesterol, which can be genetic or it can be something that we do to ourselves through diet, through inappropriate diet. Other risk factor would be obesity, which seems to be a very important topic nowadays. And there is an epidemic of obesity and overweight unfortunately, in the United States and around the world.

Other important risk factor is smoking. Luckily us in general, the smoking is trending downwards, but it's a very important risk factor for cardiovascular disease. Inappropriate sleep, even stress would be something that is an important risk factor. The other, physical inactivity, you know, comes to my mind is as a modifiable risk factor for cardiovascular disease. The unmodifiable ones, the one that we cannot do anything about it would be age, none, we cannot change that, it would be some genetic predisposition for cardiac condition. It would be sex.

So, males. Men tend to have cardiovascular disease early in their life, but for females, once the menopause started, the risk becomes equal with men. And we discussed that before, that it's important for females to also understand that postmenopause or their risk of cardiovascular disease is very similar with men, and many times their symptoms are ignored, and presentation is delayed, and usually pretty serious.

Host: Yikes, I had no idea, especially about the menopause and then it kind of equals out as far as equal with men's chance. So, we know the risk factors now. Let's talk about the most effective lifestyle changes someone can make to lower their risk of heart disease. What should we do?

Mihaela Stancu, MD: The things that we are always hearing and never paying a lot of attention. And there are also the things that many doctors actually don't discuss during meetings with their patients because, those are not treatments that we consider. But I think now the tendency changes a lot.

So diet and exercise. Having a proper diet, what we call a Mediterranean diet, something that includes less fat, is mainly focused more on vegetables, fish and chicken as the protein, and less the red meat, including unsaturated fats from olive oil and avocado and nuts, all in proper quantity to reduce the caloric intake.

Other, things that we can do is physical activity. So we are looking at around, the recommendation would be 150 minutes a week of moderate intensity activity or 75 minutes of vigorous intensity of exercise. When we are talking about moderate intensity, that would be somebody who is briskly walking.

When we are talking about vigorous activity, it would be somebody who is jogging. Okay. Now, if you develop atrial fibrillation, by guidance, the recommendation would be around 210 minutes. That means 30 minutes all days of the week, seven days a week, of moderate intensity, physical activity.

Other risk factors are smoking cessation. Smoking is a very, very, very important risk factor for cardiovascular disease. And it's not only for coronary artery disease, which people kind of linked into you know you're smoking, it's on the cigarette package, you're going to get heart attack, but actually smoking is also linked into atrial fibrillation, something that I treat. And guidelines actually recommend that you should have a discussion with the patient about smoking cessation and offer counseling and even treatment if they are ready to quit. Reducing alcohol intake, it's a very important thing that we can modify, and we can do something about it.

Keeping two drinks for men, one drink for women, this recommendation per day. And when we are talking about intake of alcohol, it means either a shot as a hard liquor, either four ounces of wine, or we are talking about one small beer. This kind of recommendation of alcohol intake, they will change even further, and I think the tendency is to have a recommendation is for atrial fibrillation, the guidelines, for example, recommend just three units of alcohol a week, which is much less than usual. So all of this, they are important. Weight loss is probably one of the most important things. Guidelines specifically recommend 10 percent of body weight for people that, or to try to drop the BMI below 27%. So, numbers, they are there, and they are numbers for all of us to know. 

So all these interventions are very important.

Host: I think you pretty much answered this, but just to review, you mentioned diet, exercise, stress management, smoking. How much of a role do these things play in heart health? I know you gave us some tips on how to integrate them into our busy lives, but, how much are they playing a part in our heart health?

Mihaela Stancu, MD: Yeah, I think it's extremely important to do risk factors modification. And I think us, as physicians, are recognizing that more and more and more. When we are talking about cardiovascular disease, it's not only the end of the spectrum treatments, the medications and the procedures that we can do to fix.

It's actually starting from the beginning. Now, if we can address the risk factors and to modify them, then we're actually preventing the disease. And what I'm seeing now when the guidelines are coming out is that we have more emphasis on that part of the disease than necessarily of the end part, if I make sense on what I'm saying. So, for example, if we can work on our weight, in terms of weight management, either by dietary intake, so eating healthy, eating less calories, adding some exercise, keeping negative caloric balance, and losing weight; we are improving blood pressure control, diabetes, sleep apnea. We are reducing our risk of atrial fibrillation, and if we have atrial fibrillation we are controlling better, we are reducing our risk of having heart failure, and the consequences of having heart failure. We are reducing risk of having sleep apnea. I don't know if I mentioned that. So one single intervention is affecting six disorders.

Host: Wow. So it's all connected.

Mihaela Stancu, MD: It's all connected, yes, and without addressing to the root cause, you can modify little things down the road, but if you can modify the beginning, then the outcome will be always better. And that is supported by the clinical trials that we have.

Host: So the importance of maintaining a healthy weight is pretty crucial, right? Excess weight specifically impacts heart health a lot because like you said, it's not just your heart health, it's all the other things that are connected. It's like a jigsaw puzzle.

Mihaela Stancu, MD: Yeah, I don't want to minimize because I still think that smoking is a very, very important and dramatic and traumatic thing for heart health. But I think now we are moving from smoking to obesity and all of them are important. Smoking is important, quitting cigarettes. There's so many no excuse for somebody to smoke in this.

And unfortunately, you know, marketing is targeting the most vulnerable population, which in general tend to be the young population, you know, with all this vapors, et cetera, or population that is very poor. We know statistically that those are the target mains for advertising.

So, alcohol intake also, we change our approach on what is healthy as alcohol intake or not. But I think a lot of talk is about obesity nowadays and how important, because obesity is associated with inflammation, which probably, I still don't think we know and understand what obesity is as a clinician and physician. But it is a very big connection into, between obesity and inflammation, and inflammation is not very good for bodies. It's kind of like a process that provokes scarring and body tries to fight it nonstop.

Host: Dr. Stancu, are there any resources or events or screenings that you would recommend to our listeners?

Mihaela Stancu, MD: So the best website would be American Heart Association, which is heart.org. The other, which has wonderful like, pictures and description of the disease, and I think many, many, many useful resources. I use myself, that website, and I look at it through it. So I think it's something that everybody can approach, but for a lot of people that, other good websites would be Mayo Clinic, would be NIH.gov, and CDC.gov that has a lot of information on prevention and diseases, cardiovascular disorder in general. But I think for somebody that just wants to be introduced of the obesity and like discussion around not necessarily diet, but healthy diet, I really like the documentary that I watched with my kids and that will be "Fed Up."

It's available on Netflix, it's available on YouTube. I think they even show it in schools in Chicago. It's about, you know, the importance of reducing sugar in our diet and how this can trigger like diabetes and farther down many cardiovascular disease and obesity.

Host: I have not heard of that. "Fed Up" on Netflix.

Mihaela Stancu, MD: Yeah. That's good. I think it's something to be like an introduction into this topic. It's controversial. Not everything that is there is probably super, super scientific, but it reflects a lot about food industry and relation. And I found it useful for myself and for my kids to approach, like, why we should not eat everyday chips? Why we should not eat everyday ultra processed foods? Anything that comes in package is probably not a great idea.

Host: Right. Thank you so much for sharing your expertise and giving us all this great, useful information. We really appreciate your time.

Mihaela Stancu, MD: Thank you so much for having me and thank you for your patience with me.

Host: Oh, you're awesome.

Mihaela Stancu, MD: I really appreciate this time. Thank you.

Maggie McKay (Host): Again, that's Dr. Mihaela Stancu. Please visit sinaichicago.org to book your appointment with Dr. Stancu and the rest of the cardiology team. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you.

Thanks for listening to Sinai, Chicago Health and Hope,