Caitlin Whyte: Knowledge is power. And the more you know about your risks for cardiovascular disease, the more you can control those factors. Joining us today to discuss more. Is Dr. Nirav Shah, the Medical Director at the Kaplan Family Center for Cardiovascular Medicine and Interventional Radiology. This is Doc Talk presented by Montefiore St. Luke's Cornwall. I'm your host, Caitlin Whyte. Now Dr. Shah, to start us off today, who is most at risk for cardiovascular disease?

Niravkumar Shah, MD, FACC, FSCAI: So it's again, based on the risk factor and that's what we're going to talk about it today. So, I mean, just give you a little bit of background about what is cardiovascular disease and why it is important and what are the risk factors. So it's one of the leading cause of death, as we all know, the cardiovascular disease, not only in industrialized and developed countries, but also in developing countries.

And again, it could be from lifestyle changes in the population, socioeconomic or cultural transition, or any other important reason, that increased rate of cardiovascular disease. And again, prevalence is increased recently to a younger generations. And as we all know that the cardiovascular disease starts, you know, the building in the plaques and that we all talk about in little while, but they all start from childhood, young adolescent age.

So I think the controlling the risk factor, it's very important in order to prevent this to happen or to the have an end organ damage or any other ontoward cardiovascular event.

Host: Absolutely. Well, what are some lifestyle changes that we can make to avoid cardiovascular disease then? 

Niravkumar Shah, MD, FACC, FSCAI: Sure. Yeah. I mean again that goes towards the, the main topic is our risk factors, right? I mean, what are the risk actors? There are traditional risk factors and there are a few emerging or new risk factors and, you know, as far as the traditional risk factors are concerned, we categorize them into two major divisions.

One is something called modifiable risk factor and something called non-modifiable risk factor. And I'm talking first of all, what is non-modifiable risk factor? Meaning that you cannot do anything about it, which is advancing age, right? It's inevitable. Everybody's going to get older. Something hereditary or genetically inheritance from our family, right?

Family history of significant coronary artery disease, genetic predisposition that we cannot change. Gender, male, female, or whatever, that's again, nothing can be changed. And ethnicity and the race. I mean, you know, that's there. I mean, you come on the world with that kind of a background. So those are non- modifiable risk factors that you cannot do anything about it.

Having said that, there are major modifiable risk factors, which includes, for example, high blood pressure, right? I mean, you can do many things to control the blood pressure. And, you know, we talk more about the individual risk factor later on our podcast, but you know, one of them is high blood pressure.

Abnormal level of the cholesterol, right? Hyperlipidemia that you can modify, you can control it, the diet and exercise and taking medications. Tobacco use, chewing tobacco or smoking, which is one of the significant risk factor that you can modify by stopping, cutting back or eventually completely, you know, discontinuation of the smoking. Diabetes, obesity, physical inactivity, unhealthy diet. All those are major modifiable risk factors, meaning that you can do something to those risk factors in order to prevent progression of the coronary artery disease, or even at some point you can halt, prevent it to happen. And there are certain other, modifiable risk factors, not a major risk factor, but still you can do something about it, which includes like, you know, low socioeconomic status, right?

I mean, you know, that can be modified. Alcohol intake and use, mental health, psychosocial stress, all those are minor, but it's very important modifiable risk factors. So again, I think what we discuss in detail, it's major modifiable risk factor. These are very important risk factor that has to be controlled.

Host: Great. Well, when it comes to cardiovascular disease, are there any other symptoms that we can watch out for?

Niravkumar Shah, MD, FACC, FSCAI: Sure. I mean, you know again for cardiovascular disease itself, I mean the major symptoms is you know, if someone is having heart attack or stroke, right, that includes cardiovascular, but I think more we talk today is about the coronary artery disease, cardiovascular including mostly the heart related rather than vascular or brain related.

But as far as the heart related disease concerned, of course, the shortness of breath or chest pain or palpitations, or, you know, sometimes the peripherals, lower extremity swelling. I mean, those are the symptoms to watch out for to make sure that you're not developing any sorts of cardiovascular disease.

Host: Great. And as we wrap up today, Doctor, you know, asking for support can be hard for some folks, but how do you encourage those who may be at risk to seek further care and really make those changes?

Niravkumar Shah, MD, FACC, FSCAI: Absolutely. I mean, you know, again, you have to discuss initially, of course, with your family and friends, but again, to seek out help and attention to your primary care doctor, right? I mean, you've got to go and see the doctor. I mean, those are all the preventive modifiable risk factors and you can prevent certain things to happen.

Routine checkup with the primary care physician, checking the blood work routinely, but more and almost important thing is to do healthy diet, right? Daily exercise, walking, certain step that you do. If you are obese, you have to lose weight with exercise and diet. Of course, nowadays there are a lot of help available as far as the pharmacological medicines are concerned to reduce the obesity.

Controlling the diabetes by decreased carbohydrate or bread intake, pizza and pasta. I mean, there are so many things, or if someone is smoking, you know, definitely need to stop smoking. There's so many things can be done and help is always available. Not only from the physician, primary care or medicine aspect of it, but also through the friend, family. And there are a lot of other helps available through the American Heart Association and New York State website, especially for smoking cessation is concerned.

Host: Absolutely. A key factor right there. And Doctor, on cardiovascular disease, anything else that listeners should know or anything we didn't touch on today?

Niravkumar Shah, MD, FACC, FSCAI: Most improtant risk factors that we have discussed about the modifiable major, which includes hypertension, diabetes, hyperlipidemia, obesity, inactivity, or the lack of physical activity or unhealthy diet, but there are emerging other risk factors that also some one need to pay attention to it, not that we do it on routinely fashion, but something called lipoprotein A level. When you look at the lipid profile, it's called LP little a, which is also very important. I mean, there is something called ankle brachial index, which is kind of a marker of the peripheral arterial disease, because all those abnormal findings, for example, the intima midi thickness in the carotid arteries, homocysteine level, C reactive protein, cardiac calcium score, all those other risk factors are there. Initially they are emerging. Now they are well established. But one can dig deep into it and look at those things and make sure those markers are within normal range because any of those are abnormal, person can at risk of having coronary or, cardiovascular risk and cardiovascular disease.

So yeah, we can look at the traditional risk factors, but then also emerging or newer risk factors. And as again I can mention those LPa, c-reactive protein, homocysteine level, cardiac calcium score, carotid, inter in, arteries, uh, intima media thickness, ankle brachial index, all myelo peroxidase level, all those things are very important going forward in order to break down a further whether one person is at risk or not. So, apart from the existing traditional risk factor, there are a few new risk factors that also one should look into that.

Host: Great. Well, to learn more about MSLC's Kaplan Family Center for Cardiovascular Medicine and Interventional Radiology, visit Montefioreslc.org. Please remember to subscribe, rate and review this podcast and all of the other Montefiore St. Luke's Cornwall podcasts.

Thanks for listening. I am your host, Caitlin Whyte.