Scott Webb (Host): February is American Heart Month, a time to focus on protecting yourself against heart disease. And today, we're joined by doctor Carrie Rose, electrophysiologist at San Juan Regional Medical Center..

Scott Webb (Host): Welcome to Celebrate Health, a podcast from San Juan Regional Medical Center. I'm Scott Webb. Doctor, thanks so much for your time today. I know that February is American Heart Month, so maybe there's never a bad time, but an especially good time to talk today about protecting ourselves against heart disease and what that all means. So, I know that it is the leading cause of death in the U.S., but it can often be prevented, right? So, what messages do you want to share with listeners about heart disease and prevention?

Dr. Cary Rose: it's a pleasure to be able to speak to you. Cardiology and cardiac disease is the number one killer in America. If you were to take numbers two through eight and put them together and double it, you still wouldn't have the number of deaths as cardiac disease. So, not that those aren't important like cancer and things like that, but we're here to talk about heart disease today. February is heart disease month. But more specifically also, and a cause that I am very familiar with and have been supporting for years is what's called the Red Dress for Women and Women's Heart Month for a variety of reasons. But heart disease is the number one killer. I mean, there are a lot of risk factors for heart disease and things that you can do for yourself to prevent heart disease. Things like, obviously, you know, appropriate diet, avoiding smoking, avoiding certain types of foods, watching your weight, and the most important thing, the single most important thing is exercise.

When we were kids, when we were younger, we exercised, we ran everywhere, we rode our bikes. But as we get older, we stop exercising. And in my opinion, and the opinion of most cardiologists, lack of exercise is probably the number one single, easily reversible, and most important risk factor.

Host: Yeah,. So obviously, there are some behavior and lifestyle things. And of course, I remember being a kid once myself. And yeah, we were just endlessly running and riding our bikes and all that. But as you say, we start to get a little more sedentary, if you will, as we get older. You mentioned risk factors there. What are some of the signs and symptoms that someone may have heart disease and really should see their provider?

Dr. Cary Rose: I'll start of by saying that, unfortunately,.the symptoms are different for everyone. We used to tell people things like chest pain and that sort of thing, but it turns out all those things are really not always very specific, and especially in women. First of all, signs and symptoms of heart disease can be nothing. People can be completely asymptomatic up until the point where they discover they have severe heart disease. We see that all the time where patients will come in with an abnormal EKG, and we find that they have really serious heart disease, yet they claim they live a normal life and they don't have any problems.

And then, there are some people who do have problems. The things that we see as we get older, number one, is shortness of breath and exercise intolerance, which people call aging. You know, people say, "Hey, I'm getting older. I'm a little short of breath. I can't exercise like I used to." well, believe it or not, that's not normal. And a lot of people, you know, have to realize that they can live a normal life and be free of that type of thing. Especially for women. Women's symptoms are extremely what are called protean symptoms. What that means is, is their symptoms are almost not referable to heart disease. For example, the most common cause of cardiac symptoms in a woman is nothing, no symptoms at all.

The second most common is shortness of breath, which could be anything. I mean, especially in times of COVID, times of influenza, people with all their types of, you know, heart and pulmonary disease. So, women can get short of breath without realizing that that shortness of breath is actually what we call a cardiac anginal equivalent. In addition, women get jaw pain, and I can't tell you how many patients I have that before coming to see me were referred to a dentist. And not that dental work is not important, but jaw pain in a woman, especially, bilateral jaw pain. I mean, I don't know anybody that has to go to a dentist because it hurts on both sides of their mouth.

And then finally, and here's a very interesting one, it's pain between the shoulder blades, which, you know, in women, they would just sort of blow that off and say, "Oh, I just, I'm working too hard," that sort of thing. But pain between the shoulder blades is a very specific finding in women. And when a woman tells me that she has pain, like she can't get comfortable, that's the main thing, they can't get comfortable, they have pain in their upper back, that is angina until proven otherwise. And when I see those people and I listen to them, believe it or not, we have a higher index of suspicion nowadays and we get them into the lab, in which case we sometimes diagnose severe heart disease and sometimes we get to give them, you know, a clean bill of health, but at least we get them in and we see them.

Host: Right. One of my takeaways from this is that line you had, until proven otherwise, right? So you get them in and then you do the testing. And then if it's not heart-related, great, everybody can celebrate. But early detection, obviously knowing your risk factors, signs, symptoms, all of that, all good stuff. And I want to have you talk about National Wear Red Day. What is that? Why is it important? I know that you're a big supporter and maybe you can explain how you sort of express that support.

Dr. Cary Rose: in cardiology, I noticed this myself, that most of my patients were men. And it was really something. And there was a rather frightening statistic out there that for every eight men that saw a cardiologist, only one woman came in. Because again, their symptoms were not the same as men. Men have chest pain. Men have, you know, identifiable pain. Whereas women have to put up with men. So, women, you know, they ignore their symptoms. That's the big thing. Women handle pain and these problems a lot better than we do. And again, they have to put up with us as well. So, my hat's off to every woman everywhere.

And so, what began with the American Heart Association, and hats off to them, a campaign to say women have hearts too, and women need to be seen by cardiologists as well. Believe it or not, just as many women as men die from heart attacks. It's true. The only main difference between men and women is that women's arteries and veins are about 30% smaller. And so, according to the American College of Cardiology, women are more likely to die of a first heart attack than men. And this is important because when a woman has symptoms, again, she has a higher mortality risk. That alone should buy her a trip to the cardiologist, number one.

Number two, the Red Dress for Women, which was founded many years ago, and I've been a very, very avid supporter. And yes, I'll answer the question now, I wore the red dress, and there is a picture of it somewhere floating on the internet, and I don't know where it is. I actually have it here with me. It's a size 22 red dress. And I want to say this to all women everywhere. I have great respect for you for putting on dresses, because it took two people to get me into this thing. And I'll tell you something, I don't know how you guys do it.

But anyway, the Red Dress for Women is just an amazing organization that promotes wellness. It promotes understanding of women's health and women's heart care. And basically, just every single year, it sends to a lot of women the message, "Hey, you know, your symptoms may not be heart disease, but you know what? Get yourself checked out and you might be very surprised. And whenever we do this, we always get a lot of people calling the office and people come in, and you know what? We save a few lives that way. And that's the whole meaning of this.

Host: Yeah, that's great I did a quick search to try to find you in the red dress. I found a lot of red dresses for sale. I couldn't find you, but I'm going to keep looking after we're done here. But while we're still on the line here, you talked about weight and exercise and how, you know, important that is to preventing heart disease and many other things as well. Let's talk about foods. What are some foods that are good for our hearts? And then, maybe contrast that with things that are just obviously bad for our hearts.

Dr. Cary Rose: Well, it's interesting. I mean, there's no one specific diet. There's a lot of diets out there. I read some study that there's 118 different diets. The American College of Cardiology has approved, or at least given its stamp on a number of diets. For example, the DASH diet for avoiding hypertension or the Mediterranean diet, a diet full of fruits and nuts, legumes, lean meats, lots of fruits and vegetables, the Mediterranean diet. And all of these diets have been demonstrated to lower cholesterol.

Finally, vegetarian diets. It took a long time, but the ACC has demonstrated that patients who adhere to a vegetarian diet as opposed to a meat diet have dramatically lower cholesterols, and there's a reduced risk of coronary disease. It would seem intuitive that people on a vegetarian diet are at lower risk for heart disease. But for many years, I guess, we didn't have enough data, but they said that just as many vegetarians die of heart disease as people who don't. So, very interesting that that is the case. But I think our data is now showing the opposite where more and more people who are on a vegan or a vegetarian diet do have markedly reduced cholesterol. And I think that they have a demonstrated lower risk of heart disease.

Obviously, you know, your body is a balance of calories in and calories out. Calories out meaning exercise, for example, exercise and avoiding high risk factors, avoiding, you know, excessive alcohol, smoking, all of these types of things. Obesity in America, let's face it, it's an epidemic. I read recently where they've now classified, I think, almost two-thirds of all Americans, 65% as overweight or obese. That's unbelievable, two-thirds. I also talk about this. I give lectures on this and that, if you go back to 1960, the Chicago Bears football team, the offensive line, this was shown, the average weight of the offensive line of Chicago Bears in 1960 was 178 pounds. Let me say that again, 178 pounds and these were football players, okay? Whereas today, the average weight-- well, it's not been officially catalogued, but it's said sort of behind the scenes is somewhere close to 300 pounds, as it is for many football teams. I'm not trying to single out the Bears, but they were used as an example. Human beings have just morbidly gone up in weight. We're all guilty of that myself. And I try to exercise as much as I can. But it truly is that obesity, in my opinion, is becoming the number one risk factor, because obesity results in what we call pre-diabetes. Pre-diabetes results in a higher risk of coronary disease, and it just all stems from there.

As far as diet goes, obviously, you know, lowering things like red meat. People ask questions about chicken, and I'm going to say this, chicken and red meat are the same. There is no benefit to eating chicken over red meat. It's the same risk. Obviously, a diet higher in fish, fruits, vegetables, and lower in calories, and finally lower in sugars. I myself I take my own advice and people who know me, I have cut out almost all sugar from my diet. It took a while to do it, but I really rarely eat any sugar at all and I don't miss it. And I can't believe how much weight I've lost just not eating sugar. It really is amazing. I mean, I'm going to be honest, people know me, I'm a chocoholic. But, believe it or not, the rest of my food, I just don't use sugar. And I always look at the labels and avoid sugar. So, that would be my recommendation for people. Sugar is a very big deal. And no, sugar does not give you diabetes. It is one of those old wives' tales. But what sugar does is it causes all kinds of problems in the human body and can put you at higher risk for other diseases such as diabetes.

Host: Yeah. And it's always good for me when I hear that docs and nurses take their own advice. That's always encouraging to me. And I'm glad to hear the thing about the chicken because my wife is always trying to push more chicken on me, so I can't wait until I'm done with this and I can tell her, you know, "I'm not saying we should eat red meat every night, but just stop forcing chicken on me, because I really..."

Dr. Cary Rose: Well, and the other thing is this, the other thing about chicken, Scott, is, and I'm going to say this to all our people out there, I'm not a dietician, but I have studied dietary so I can advise people, especially just from a health standpoint. One of the worst things about what happened with chicken is people rarely just eat chicken, unless you're at home and you go out and buy skinless chicken, you know, tenders or breasts or whatever. When we go out to eat chicken, we don't eat chicken. What we do is we go out and eat some fried thing. And if you understood the absolute, literal, horrible nature of frying foods and what happens in places, fast food and everything, the amount of oil and bread crumbs and saturated fat that goes into frying a piece of chicken, whatever benefit of chicken as a protein, that kind of thing, is gone and has been replaced by layers of stuff that is just not good for you. And I'm sorry, since we're talking about cardiology, I have to say it, fried food is one of the worst things a human can put in their body. It is. I'm sorry. It's well known. If there's one thing I can get people out of this podcast, please reduce the amount of fried food that you eat. It's a very, very, very big health hazard.

Host: Yeah. Reduce fried foods, sugars. And I want to finish up talking about things that I know you're not in favor of. There's no chance. Let's talk about smoking, vaping, marijuana and the effects on our heart.

Dr. Cary Rose: What I can say is this, none of those are good. Anything you inhale into your body that's not natural is not good. It has been documented. Cigarette smoking, I mean, it's on every package of cigarettes. Cigarettes cause cancer. Cigarettes accelerate heart disease. What they do is the tobacco and the toxins in cigarettes cause an acceleration of what's called LDL metabolism in your body and the promotion of lipid-rich cholesterol plaque in your vessels, which of course is heart disease. And so, just the presence of smoking, dramatically increases. If you are a diabetic, smoking and fried food are the two worst things you can do to yourself. Diabetes and smoking does not mix. It is a deadly combination. And here in New Mexico, with a lot of people who are genetically predisposed to have heart disease. For example, many of the Native American populations and Hispanic populations, unfortunately, it's not their fault. It's just genetic where their heart disease appears very severely and much earlier. But add to that a poor diet and smoking, and you just have a recipe for an early demise.

And that's the purpose of the Red Dress for Women. That's the purpose of months like this to get the word out to people. It's not okay to smoke, not even a little bit. It's really not okay to eat fried food. There's so many alternatives to doing it. I know all the fast food places are going to hate me for this. But I have to do my job and I have to say, look, life is about choices. And my job is to say, "Listen, you can make choices, but many of those choices are really unhealthy for you." and when you hear it from a physician, it's not just someone trying to sit on a soapbox. It's someone to say we have proof of these things.

You mentioned vaping. I can tell you that vaping is really bad for your lungs. I've seen CT scans, what happens when people vape and they destroy their pulmonary tissue, and it never comes back. So, it's really bad. As far as vaping on the heart, I don't have any data on that. Marijuana is a subject I don't like to discuss because there's a great deal of controversy over cannabinoids and what it does for the body. There are some beneficial effects of cannabinoids, especially in people with chronic pain or cancer. There are some deleterious effects on the brain. So, I have to say that someone once said, "The beginning of wisdom is to say I do not know," and I do not know all the effects of cannabis on the heart muscle. There are some limited studies from the American College and they can be accessed through the internet. You can read about them. There's a lot of controversy both ways. I try to tell people, I don't have a lot of data, but I don't think that the effects on the heart are positive. There seem to be more negative data than positive data. At least that's what we have right now.

Host: Yeah, it does feel like marijuana especially is a bit of a third rail and understand that from a doctor's perspective as well. So, it's been really educational today, doctor. Really fun. I'm going to look for that picture. I'm going to find that picture, if it's the last thing I do today, of you in that red dress. But, you know, the messaging is important and the fact that you're so supportive and trying to explain that men and women present differently with heart disease and symptoms and all of that. And yeah, of course we can't outrun our family history and genetics, but we can control our behavior and lifestyle. So, cutting down those fried foods, the sugar, don't smoke, all good advice from an expert today. thank you so much and you stay well.

Dr. Cary Rose: Hey, listen, it's been my privilege. And one thing I would say is get yourself checked out. I mean, everything might be normal and you know what, you have a clean bill of health and you're really happy about that. But getting yourself checked out, especially if you have these symptoms, it's not normal to have these symptoms, even just because you're getting older. We're here to help. And especially, like I said, this is the Red Dress for Women and it's time for women to come forward and get themselves checked out. And that's what we're here for.

Host: That's perfect. We'll leave it there. I'm going to go look for the dress and again, you stay well.

Dr. Cary Rose: Thank you, Scott. Have a wonderful day.

Host: And thanks for listening to Celebrate Health, the podcast from San Juan Regional Medical Center. I'm Scott Webb. Stay well.