Evo Terra (Host): Welcome to Doc Talk, presented by Montefiore St. Luke's Cornwall. I'm Evo Terra. And with me is Dr. M. Adnan Raufi, an interventional cardiologist from Montefiore's St. Luke's Cornwall. Today, we'll delve into the critical topic of risk factors for heart disease. Welcome to the show, Dr. Raufi.

Adnan Raufi, MD: Thanks for having me.

Host: So, do you mind if we start off with your title? Because that's a new one to me. What's an interventional cardiologist and what do you do?

Adnan Raufi, MD: That's a great question for our general audience as well. As for our training, in the US system, for instance, after med school, you do your residency and your medicine. And then, you embark on fellowships. So, the first step is general cardiology fellowship. And then, if you want to specialize or superspecialize, you would like to do one or two years of another subspecialty training in what I do, what is called interventional cardiology.

So basically, the difference between the general cardiologist, and we all work together, so those who are more procedure-oriented, we spent a lot of our time in cardiac catheterization laboratories where we take care of patients who are suffering from heart disease, for example, having heart attacks, having chest pains. So, we take them to the cath lab or cardiac catheterization lab, or angiography lab. And we take care of the arteries by putting some catheters inside the arteries and find the blockages, which we call it a culprit for them to causing heart attacks, chest pains. And we take care of them by putting balloons and stents. So, in a nutshell, this is what I mostly do.

As opposed to general cardiologists, our other colleagues who do other clinical cardiology, take care of the patients inside the CCU and, you know, on rounds, read echos and they don't do the cath lab. So, everybody has their own job to do.

Host: Got it. So, the conversation topic today is around the risk factors associated with heart disease. But I know that there are several different types of heart conditions that fall under that label of heart disease. Do they all share the same or similar risk factors?

Adnan Raufi, MD: So, let me elaborate by saying that cardiovascular disease in general, we need to understand the scale of the problem. The cardiovascular disease is the single largest cause of death or mortality worldwide. Having said that, approximately 20 million deaths per year worldwide are reported due to this disease.

Now, a disease of this scale, we need to understand what's causing it. So, anything or any condition that increases the likelihood of developing heart disease, in general, are called the risk factors for heart disease or cardiovascular disease. When we say cardiovascular, it doesn't only mean heart, it could be anything in the vasculature from head to toe. So, meaning strokes, meaning poor circulation in the legs, meaning aortic diseases, so on and so forth.

So, as a cardiologist, we deal with the risk factors for heart disease as I just elaborated earlier: heart disease, for example, having heart attacks and, you know, angina, chest pains, so on and so forth. So, the risk factors are important from that perspective. We can divide very broadly the risk factors for heart disease, for instance, into two major categories. One, we call it modifiable risk factors. And then, some of them are non-modifiable risk factors. And then, there are some which we call them as risk enhancers.

So, let me say a few words about non-modifiable risk factors. For instance, these are the risk factors where we cannot do anything, we cannot change them. They're non-modifiable, meaning your age, your gender, your family history, and so on.

The ones which we can modify, meaning that we can take care of ourselves, patients can take care of themselves, for instance, by having healthy diet, medications, so on and so forth. So, let me elaborate a few of them. For example, hypertension is one of the most or foremost risk factor. Diabetes, extremely important. Cigarette smoking or any kind of smoking, for instance. Physical inactivity, obesity, these are the salient, we call it modifiable risk factors where we can do something to change them to reduce the risks involved with them by taking care of ourselves, eating healthy, doing proper exercise, taking medications. So, the risk factors get mitigated, so to speak, and the risk overall will go down.

Host: Now, here's a question I have about risk factors, because a lot of those things that you mentioned-- alcohol, smoking, obesity-- some of these conditions that people have, these risk factors, it's been with them for a long time and they've made it into their 50s and 60s without any problems possibly, but they know that they're at a higher risk. I guess my question is, how serious should someone be about these lifestyle changes? If this has been a part of their lifestyle for decades?

Adnan Raufi, MD: So, it's an important question as well. We need to understand that as we are getting busier in this industrialized world, most people don't find time to address their health issues that well. And then, the risk factors sort of have multiple effects. For example, somebody's having hypertension as opposed to somebody's having hypertension, he or she is diabetic as well, obesity, cigarette smoking, contains family history, and in the age group of maybe 60, 70 or something, so everything adds up. So when this adds up, the risk exponentially increases.

Now, we have to start tackling them one by one. For example, if somebody is hypertensive, we need to be able to address the lifestyle issue. For example, being more physically active, reduce weight if we are obese. If we smoke cigarettes, absolutely, we have to refrain from them, both active and passive smoking. When it comes to diabetic situation, so the diabetes has to be strictly controlled. The diet has to be very, very well monitored, which means healthy diet, no fast food and saturated fats and junk food, so to speak, for everybody to understand. Cigarettes has to be stopped. Daily activity, for example, it is recommended at least 150 minutes of per week of physical activity, walking, brisk walking, So, these are the salient features, if you will, for lifestyle changes, that we must adopt and we teach our patients as well to reduce the risk for having heart disease.

Host: Now, I know at least one of these risk factors, hypertension-- he said, speaking from personal experience-- can be treated with medication. What about the rest of them? Is there a magic pill to make our heart stay healthy forever?

Adnan Raufi, MD: Unfortunately, no. This is a disease, which is mostly, if it is there, it is probably going to stay with you all through your life. But the good news is that we can take care of it not only by taking medications, but also reducing the risks which are attached with it. As I mentioned earlier, we can't be smoking and think of blood pressure getting better. We cannot be inactive and think of blood pressure getting better. We cannot be eating unhealthy, lot of salt intake, lot of street foods or junk foods, so on and so forth.

So, everything comes into play when it comes to the treatment of hypertension. And we have so many patients who do take care of themselves and as an example, when they take care of themselves and then, when they become more physically active, when they reduce weight, even just by reducing few pounds, there is a reduction in the blood pressure points, which is noted, it helps controlling the blood pressure. Diet, I already mentioned. And two of the diets, which are mostly quoted for example, DASH diet, D-A-S-H diet, and the Mediterranean diet. Both work the same way. DASH diet, for example, for the hypertension, when you take more beans and more legumes and less salt and less red meat and so on. Olive oil, for example, it creates a lot of difference in somebody's blood pressure control.

Host: That's great. Let's switch from risk factors and let's talk about symptoms for a moment. Before having a heart attack and before it feels like having a heart attack, what are some things people might notice that could signal that there is an issue with their cardiovascular system?

Adnan Raufi, MD: So, thank you for bringing this up. It's an excellent question. My point in this one is, first of all, yes, you have to be cognizant about your symptoms. But as a cardiologist, as a person who takes care of a lot of patients, I always inform patients that you should be aware of the symptoms, but do not delay in self-judging or asking your friends what could this be. You should immediately take medical attention.

Having said that, you should, of course, be aware of it, what could this be? So for example, somebody's having chest pain. So, chest pain is a very important symptom. So, a lot of people present differently, and that is the reason why I'm saying it, that you should not self-analyze yourself, that could this chest pain be from muscle or from your joint or from your heart itself. Let the doctors evaluate you.

However, for the description sake of any pain, which is mostly described as a central heavy chest pain, some pain, which is getting worse by minimal or more than minimal exertion, and it is getting worse associated with shortness of breath, sweating, excessive fatigue, or somebody passes out, all of these things could point towards having a heart disease or significant heart disease. A lot of patients come with these kind of symptoms. And sometimes, people have very atypical-- we call it atypical symptoms. For example, they don't even qualify for those things. But sometimes things change. That's why awareness is important. But do not delay and self-evaluate immediately. Take care of yourself by seeking professional medical attention.

Host: Always great advice. You know, I know there's a lot of new gadgets that are on the market right now that are helping us track our heart health. At least that's what the companies say they are. In your opinion, are apps and other devices worth it to make sure you're keeping your heart healthy?

Adnan Raufi, MD: To a certain extent, yes. However, we cannot undermine a personal evaluation by a qualified physician's evaluation. So, I think that's the foremost importance. You can use these new gadgets as you just said. But again, I personally feel that, having a person to person evaluation by a professional, who will talk to you and you can describe your symptoms to them, it has much more value. But the other gadgets and these things are getting more and more refined. I'm not going to downplay them, but still a doctor's evaluation is probably the most important thing.

Host: Right. We do not yet have robot doctors. And we probably won't anytime real soon. You need a real professional.

Adnan Raufi, MD: You'll never know.

Host: Any other things you'd like to depart or pass on to the audience?

Adnan Raufi, MD: As I said before, the prevention is better than cure. It stands true. It starts from an earlier age because, this day and age, we are seeing a surge in heart disease in a younger patient population. So, I think right from the earlier age, people have to be very careful about their diets, about their risk in case if they have it, their family history, we should always know about your family history. Start taking care of themselves from a much earlier age rather than waiting for symptoms to develop.

Host: Excellent ending advice there. Dr. Raufi, thank you for joining me today.

Adnan Raufi, MD: My pleasure. Thank you so much. Thanks for having me.

Host: Thanks again to my guest, Dr. Adnan Raufi, for joining me today. And thanks to you for listening to Doc Talk, presented by Montefiore St. Luke's Cornwall. Learn more about MSLC's cardiologist services by visiting montefioreslc.org. That's montefioreslc.org. If you enjoyed this episode, please share it on your social channels and explore our entire podcast library for more topics of interest to you. I'm Evo Terra. And this has been Doc Talk, presented by Montefiore St. Luke's Cornwall. Thanks for listening.