Transcription:
Risk Factor Management

Caitlin Whyte: There is a lot that is still in your control when it comes to keeping your heart healthy. To tell us more about risk factor management is the medical director of the Cardiovascular Institute at Montefiore St. Luke's Cornwall, Dr. Neel Khanna.

This is Doc Talk, presented by Montefiore St. Luke's Cornwall. I'm your host, Caitlin Whyte. To start us off, doctor, I want to talk about cholesterol management and its effects on heart disease.

Neel Khanna, MD, MPH: Sure. Cholesterol is one of the biggest risk factors for developing any type of atherosclerotic disease, meaning plaque buildup in any of the arteries of the heart, including the heart, and also arteries that go to the brain. Cholesterol is actually the major component of plaque. There's also calcium, some fibrin tissue, but cholesterol is the main thing. Now, there's a lot of factors that cause cholesterol buildup in the arteries, but your actual cholesterol numbers are amongst the biggest and most important contributors to that.

Caitlin Whyte: So, let's dive into some of those factors a bit more and which has more of an impact on plaque development.

Neel Khanna, MD, MPH: So, it's hard to tell exactly for different people. It's different ones for some people. Smoking is an important risk factor that almost acts as a glue that causes cholesterol to stick to arteries. Diabetes acts very similarly to smoking actually in causing plaque buildup in arteries. But, you know, closely tied with that is your actual cholesterol numbers, which is why I emphasize to all my patients, for them to know what their total cholesterol is, what their LDL or bad cholesterol is, and what their triglycerides are. Those are all very important risk factors. And if you know what your numbers are, you can know how far you are away from your goals, and that can influence how you eat and whether you are a candidate for medication for certain people and how strict you have to be about certain other things.

Caitlin Whyte: Absolutely. It's always so important to stay on top of your numbers. I also know weight management is critical to discuss when it comes to risk factors, but can you tell us why that's so important?

Neel Khanna, MD, MPH: Well, weight management, specifically what we call central obesity, which is fat accumulation along organs like around the liver. For example, people have heard of fatty liver, but also central obesity, meaning fat around your midriff around the stomach area has been for a long time very closely linked to your risk of heart attack and stroke, even more than fat in other areas of the body. And there's some proposed mechanisms for this. You know, central obesity contributes more to insulin resistance, meaning insulin in your body doesn't work as well, and then people have higher sugars then develop diabetes or pre-diabetes, which we know causes coronary disease and increases your risk of stroke.

So, you know, weight management is incredibly important. I know personally we see often with our patients that patients who drop a considerable amount of weight and get their BMI, their body mass index, close to a normal range or slightly above normal, often are able to dramatically decrease the amount of medications they're taking for diabetes or taking for high blood pressure or even cholesterol. Weight is at the center of all these contributors to coronary disease and vascular disease in total. Weight, I always tell patients, is a central thing.

So aside from, you know, eating low cholesterol foods and eating foods that are low in sugar, which is incredibly important, I tell people, my patients who are overweight, to really target weight loss. Don't even think as much what you're eating, just make your goal to drop weight and then all the other parameters will improve as the weight drops.

Caitlin Whyte: Well, let's talk about that a bit more. Weight management is so key to heart health, but weight loss and maintenance is kind of hard to do. So, can you give us any tips or guidelines when it comes to maintaining your weight and heart health?

Neel Khanna, MD, MPH: Yeah. Exercise is incredibly important. I always say diet is number one and exercise is a close number two. Those are the two primary components of weight loss in keeping your weight at a healthy range. If you target that and keep the weight low, then your heart health will definitely be better. But we're at a new age in medicine where, with medication, because we know that some patients really struggle for a variety of reasons, genetic reasons, and otherwise, they really struggle with weight loss. And we're at a point in medicine where we have really groundbreaking medications that not only help with weight loss, but also help with heart health, meaning we have proven studies that show that these medications can cause you to lose weight and really improve some of your cardiac outcomes altogether.

There's a class of medications that are called GLP-1 agonists. One of the famous ones that people may have heard of, Trulicity, Wegovy, Ozempic. These are medications that really have dramatic results. I've seen patients who've lost 30 pounds on these medications. They work by inhibiting your appetite. And as a result, we've seen really good cardiac endpoints with this also, meaning it lowers your risk of heart attack, it lowers your risk of stroke. Because along with the weight loss, like we mentioned, your cardiac health gets better too.

So, I always tell patients the hallmark is diet and exercise. That's always the first choice. But for those of us who struggle with that, and despite trying to make dramatic improvements, there are other options available including these medications and also weight loss surgery, which has become more and more available to the general population and is approved by insurances to a greater degree. You know, things like a relatively straightforward procedure like a gastric sleeve can help with dramatic weight loss. It can really improve your long-term outcomes in terms of your heart health and also reducing your risk of stroke.

Caitlin Whyte: Well, wrapping up here, doctor, some great takeaways, but is there anything else you'd like to add about heart health and risk management?

Neel Khanna, MD, MPH: Yeah. I encourage all patients over the age of 40, but even before that, to really know their risk factors. You should know what your cholesterol is. You should know what your hemoglobin A1c, which is a marker of diabetes is. when you know the numbers, you know when there's something wrong. So, really take a proactive step in, you know, preventing heart disease. I also tell people to have a frank discussion with your physician, especially if you're overweight or obese and you've really struggled with weight and you have other risk factors like high blood pressure and diabetes. Speak to your doctor about what are the options available if you've tried to lose weight and have been unable.

We are, like I mentioned, at a groundbreaking point, I feel in medicine where we really have for the first time really effective medications and procedures that can help people lose weight and also help their long-term cardiac health. So, ask your doctor, ask your physician about this, and maybe they'll refer you to another doctor who has more expertise, but the options are available and just take advantage of them.

Caitlin Whyte: Well, thank you so much for joining us today, doctor. You can always visit montefioreslc.org for more information about the Cardiovascular Institute. And if you found this podcast helpful, please share it on your social channels, and be sure to check out all of our other Doc Talk episodes. This has been Doc Talk, the podcast from Montefiore St. Luke's Cornwall. I'm your host, Caitlin Whyte. Stay well.