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Bob Lewis (Host): WNIR. You're on the air. Go ahead.

Dr. Brianna French: Hi, this is Dr. French. I am calling in.

Host: Oh, Dr. French. Thank you so much for calling in because we have so many questions and things to ask you about Heart Health Month and about preventive cardiology. Right now, again, this is part of our programs with the good folks at the Summa Health System, different doctors talking about the different specialties. And with February being Heart Health Month, it's a natural to talk to Dr. Brianna French, who is a preventive cardiology cardiologist, that is her specialty.

So first of all, Dr. French, tell us how preventive cardiology differs from traditional cardiology.

Dr. Brianna French: Yeah. So, traditional cardiology focuses on treating disease once it's already there. Whereas preventative cardiology looks at identifying risk factors, such as family history, maybe high blood pressure, high cholesterol, diabetes, smoking, different lifestyle factors. And it works on addressing those with the hope of preventing disease before it even occurs.

Host: So, let's talk about—again, heart disease is right up there with cancer is still one of the most leading causes of death in America, and has been for the last 70 years. So, we pretty much know what some of the most common heart disease risk factors are today. So, tell us, Dr. French, what those risk factors continue to be?

Dr. Brianna French: Yeah. So, the American Heart Association, that kind of, you know, sponsors and does this whole Heart Month kind of has their eight essential things that you can do to prevent cardiovascular disease, kind of targeting those risk factors. So, one of them being diet. So, poor diet is definitely a big factor, because that contributes to high cholesterol, high blood sugar. So, they really recommend and— and we do as cardiologists—you know, focusing on a diet that's high in fruits, vegetables, whole grains, lean proteins, and really limiting sodium.

The other thing that contributes to cardiovascular disease is smoking. So, we really encourage everyone and all of our patients to avoid all tobacco products. And a big thing that has come up lately is really avoiding vaping as well. There's still data to really come out, but everything that's come out so far is just as bad if not in some ways, worse than smoking. So, avoiding all forms of nicotine and really trying to avoid secondhand smoke exposure too.

Kind of going down essentially, another thing is physical activity. So, inactivity can really contribute to cardiovascular disease. So, trying to stay active. We recommend about 150 minutes a week of moderate activity. Just anything that gets your heart rate up, that can be things as simple as gardening, going for a light walk, things like that.

Other things that contribute is obesity, high blood sugar, high blood glucose, high cholesterol, all those things, you know, really can be targeted with diet. And then, a new one that they've added emphasis on is poor sleep and stress. We're starting to learn really also contributes highly to cardiovascular disease.

Host: So, let's talk about who gets affected by cardiovascular disease. Is it primarily a problem for older people, or can younger people also be at-risk for problems with the heart?

Dr. Brianna French: Yeah, great question. So, kind of we put people in two spectrums. There are people that are born with, you know, congenital heart defects. So, they obviously are affected by cardiovascular disease at a very young age. But traditionally, I guess when we think of cardiovascular disease as, you know, coronary artery disease blockages in the heart arteries, heart attacks and heart failure, it really can affect younger adults as well. You know, there were studies that showed that we can have plaque in the heart arteries as young as 13, 14 years old.

So, it really is something that we should target at a younger age. Cardiovascular disease is actually the number one cause of death in new moms. Pregnant women, due to different hormone changes and things, can be at a little bit higher risk. And then, there's definitely certain genetic disorders that can raise people's cholesterol. So, that's actually what kind of preventative cardiology is trying to bring awareness to, that heart disease can impact us at all stages of life, and trying to identify those who are at highest risk early can really help us save lives.

Host: Now, we talk a lot about lifestyle choices and how they affect our health. What part of heart disease could be either genetic versus our choice of lifestyle?

Dr. Brianna French: So, that's a great question. Actually, about 80% of cardiovascular disease we think can be really prevented with lifestyle. So, that's kind of leaving the rest too, there definitely are genetic factors, mostly dealing with different heart failure syndromes and then high cholesterol that can contribute. But really, 80%, by targeting lifestyle changes, we can make a big impact and prevent cardiovascular disease.

Host: So, let's talk about, again, some of the things that people should know about any anytime of the year, not just in heart month. What are the early signs of a heart attack?

Dr. Brianna French: So, early signs of a heart attack, there is, you know, the classic what we think of crushing chest pressure, you know, elephant sitting on my chest. You know, that's the one that we kind of commonly think of. But really, other signs can be things such as being short of breath. Some people can mistake a heart attack for gastric reflux, some GERD, kind of heartburn-type symptoms.

One thing I really tell my patients to look out for is if you notice a big decrease in your exercise tolerance. So as the weather hopefully gets a little nicer here and we can all get outside, now that it seems like we may be through this cold spell, and you seem to be getting a lot more short of breath doing things that in the past didn't make you short of breath, such as mowing your grass or gardening or going for a walk. That can be an early sign that maybe something's going on.

Other things we kind of say, you know, pain spreading to both arms or the neck. And another thing we tell patients kind of how I talked about with the decreased exercise tolerance is not always, but a lot of times, symptoms, signs of a heart attack tend to come on when we're doing something more physical, when the heart needs more blood flow. So just like I said, kind of more short of breath mowing the lawn or anything that doesn't feel right with activity can be an early sign.

Host: Now, getting back to activity, you mentioned again, moderate physical activity. So apparently, we don't have to actually, you know, be bathed in sweat and have to, you know, run two miles a day just to have enough physical activity to benefit our heart.

Dr. Brianna French: Yes, exactly. Like I said, 150 minutes a week of moderate activity. So really, anything that gets your heart rate up. We sometimes talk to patients about something called the talk test. So if you can do the activity and still kind of speak in full sentences and only have to catch your breath a couple times, that's really considered moderate. you don't have to push yourself so hard, like you were saying, running two miles where you can only say a few short words at a time, hard to get them out, really anything.

Other examples could be yoga, water aerobics; pickleball, that's a big thing; dancing, even like moms pushing a stroller at a steady pace. That all really is moderate activity that's good for the heart.

Host: Now, there are a lot of devices on the market now that measure fitness, that measure your steps, that actually measure your heart rate, can tell you whether or not you have an irregular heartbeat, can give you your pulse, all these, and you can wear these on your watch or have it on your phone. All these kind of applications that are out there, do they have a benefit to people? You know, is there any good reason somebody should be constantly monitoring what their heart is doing?

Dr. Brianna French: Yeah, I think they can definitely have benefit. One, a lot of times they can have motivational benefits. So, trying to hit a certain number of steps and then increasing that day by day, week by week. It's great to track your heart rate just to see if you're kind of getting in your target heart rate zone. For moderate activity, it's different based on your age. You can kind of go online and put it in your age and gender and ask what's my target heart rate? And now, some of the newer devices can actually monitor your heart rhythm.

So, patients that have atrial fibrillation, which is an abnormal heart rhythm, they can tell by their smart watch, it can monitor to see if they are having episodes of that that maybe be going undetected. But I just think they're really great for tracking steps, setting goals, monitoring your sleep, things like that.

Host: So, let's talk about some of these other, you know, heart conditions that people can have. We talked about high cholesterol and, again, calcium buildup in the arteries. How does one know if they have calcium buildup in their arteries? Is there some sort of a screening or a test that can let you know if you indeed have that condition?

Dr. Brianna French: Yes. So, there is a test called a coronary calcium score. Essentially, plaque cholesterol as a buildup in our heart arteries, the body forms almost a thin calcium eggshell over it. It actually is a protective mechanism to hopefully prevent that cholesterol plaque from rupturing and causing a heart attack.

We use that thin calcium shell that develops to our advantage because calcium lights up very bright on a CAT scan. So, by getting a simple CAT scan, we can see any bright calcium, count all the specks in the heart arteries, and it gives a patient a score. So, zero, obviously being the best. But then, we kind of put patients in low risk, moderate risk, and high risk based on that score. And that helps us know maybe how aggressive we need to be about getting someone's cholesterol down or looking at their other risk factors, things like that.

Host: Is there any way to get rid of the plaque that builds up in our arteries? Or is it once it's there, is it there for the rest of our lives?

Dr. Brianna French: Yes, very common question. I wish there was a way that we could go in and Rota-Rooter it out, but there really isn't a way to get rid of plaque. That's why we recommend, once we know that plaque is there and we've identified it with something like a coronary calcium score, to really try to work to get the cholesterol, patient's overall inflammation, everything as low as possible to help stabilize the plaque and prevent more from building up.

Host: And what about , again, either exercise or some sort of supplements that keep the arteries flexible as we get older, like with everything else, you imagine that they tend to stiffen up, especially if they have calcium deposits. But if we can keep them flexible, well, we also, again, minimize the risk of having a heart attack. So at least the vessels are still able to open up enough to let enough blood through to the heart.

Dr. Brianna French: Yeah. So, exercise, as you said, very important. Really, supplements, fish oils have had some data, but you kind of have to take a lot of fish oil to really impact that diet-wise. We tend to recommend the Mediterranean diet or, if patients can, really kind of avoiding any sort of high cholesterol meats. So, focusing on fish, chicken, leaner meats, fruits, vegetables.

And then, medication-wise, really, statins kind of tend to be the mainstay. They sometimes get a bad rap, but we have lots of data that they're very safe and effective. They slow the buildup of plaque, they reduce the growth of existing plaque. They help stabilize plaque, which is a big benefit. So, they reduce inflammation inside that cholesterol plaque, and make them much less likely to rupture and cause a heart attack. They improve kind of the vessel lining as you were asking about. They reduce that vascular inflammation. They don't erase calcium in plaque. They don't make them disappear. But they, as I said, reduce inflammation, improve the vessel lining and reduce the risk of the plaque rupturing. There are other medications that also lower cholesterol, but statins really kind of tend to be the mainstay because they have those other benefits.

Host: Let's talk about blood pressure. First of all, what is considered nowadays a healthy blood pressure? I mean, the standard for many years was 120 over 80. What is that? Does that still remain or is the blood pressure going to vary from individual to individual? What is a healthy number?

Dr. Brianna French: So, it does vary individual to individual, somewhat based on age. You know, as patients get older, we tend to maybe not target it as aggressive of a blood pressure, but really we do say less than 120 over 80 is considered the ideal blood pressure, whereas, you know, 120 to 129 for that top number is considered elevated. And even blood pressures in the 130 for most of our patients are considered stage 1 high blood pressure.

So, we still actually are trying to target less than 120 over 80. But it is important to always talk to your doctor because, depending on other risk factors, age, some patients may be prone to more blood pressure fluctuation, so highs and lows. But really kind of less than 120 over 80 is the target. And it's important to really get accurate blood pressure readings. I can't emphasize that enough. So, you really want to take your blood pressure after you've been seated quietly for five minutes. You want to have your back supported with your feet flat on the floor. You want to make sure you haven't had caffeine, your morning cup of coffee, smoked, which we already talked about is bad, or exercised kind of 30 minutes before you take the blood pressure., And you really want to make sure you have a proper blood pressure cuff size. So, an upper arm blood pressure cuff that fits well is the best. And if you have any questions about your home monitor, a great thing I tell patients is just bring it in if you're seeing your primary care doctor or any doctor. And we should get similar readings with your home monitor and our monitor in the office. But it's important to get an accurate blood pressure.

Host: And once again, we're talking to Dr. Brianna French, who is a preventive cardiologist at the Summa Health System here in Akron. Of those two numbers on your blood pressure, which is more important to be lower, should it be the lower number? You know, I often heard that if the lower number is lower than the upper number, that's really good. But if the upper number and the lower number are both high, that's bad. I mean, what is the ratio there that you like to see?

Dr. Brianna French: So really, to be honest, both matter. After the age of 50, sometimes we think that that top number, that's your systolic blood pressure may matter a little more. So, the top number, the systolic blood pressure, is when the heart squeezes. And then, the diastolic pressure, the bottom number is when the heart relaxes. So, some studies have shown that that systolic top number over the age of 50, if it's high, can predict things like heart attack, stroke, kidney disease. But really, if I'm going to be honest, both numbers are almost equally important in treating and getting to goal.

Host: Now, what about using medications to control blood pressure? You mentioned having exercise, diet. But if that doesn't bring the blood pressure down, how effective and how safe are the medications that we have that are supposed to reduce our blood pressure?

Dr. Brianna French: Yes, we have, honestly, probably hundreds of different medications to reduce blood pressure, that we've been using for many years. They're very safe. One thing I kind of tell patients is sometimes because they all kind of work a little bit different mechanisms, they target different pathways that may be making the blood pressure high, we may need to use multiple medications to really get us at goal.

For example, as your previous question, some may target that diastolic the bottom number more so than the systolic upper number. Kind of common blood pressure medications are ACE inhibitors or ARBs. You guys may have heard of like lisinopril, losartan. We have calcium channel blockers like amlodipine or diltiazem, diuretics. So, lots of different options, beta blockers. And it really kind of depends on patient's age, their kidney function, their other risk factors, like do they have diabetes, heart failure, that kind of help us as doctors choose the best medication for them. But yes, we have many medications. They're very safe and effective. It just kind of depends on picking the right one for the right patient. And then, we still always encourage patients to do those lifestyle changes like remaining active and reducing salt in the diet. Weight loss being the big thing lifestyle-wise that we can all do to help maintain and manage our blood pressure.

Host: And what about heart rate? Again, all these little devices out there will measure our heart rate. What's a healthy heart rate? And how much of a variance should we expect in a normal heart?

Dr. Brianna French: Yeah. So, in most adults, a normal resting heart rate, so when we're not doing something active is about 60 to 100 beats per minute. Lower numbers such as the 40s or 50s can be normal. Actually, very fit individuals tend to have a lower resting heart rate. And then, as far as target heart rate during exercise, we tend to say that your maximum heart rate as high as we should see the heart go is the number 220 minus your age. So, that's a quick calculation anyone can do. And then, if you're targeting how we talked about that moderate intensity activity, you want to be about 50-70% of your maximum heart rate.

Kind of, again, you kind of take 220 minus your age, and that's the maximum your heart should get if you're doing very vigorous intense activity. And then for moderate intensity, that's good for cardiovascular health, we like to see 50-70% of that. And if you're like me and someone that doesn't like to do math, you can go online. There's plenty of things where you can just plug in your age and it'll tell you your target heart rate.

Host: And you mentioned earlier, atrial fibrillation is a very common heart problem. We see again, a lot of advertisements on television suddenly about that. And we should see your doctor and have be screened for that. Exactly what is that, you know, and how is that treated?

Dr. Brianna French: Yeah. So, atrial fibrillation is an abnormal heart rhythm that comes from the upper chambers of the heart. So, it's a supraventricular tachycardia, supra meaning kind of the upper chambers above the ventricles. And it is actually the most common heart rhythm condition that we treat. So instead of the regular lub-dub, lub-dub, lub-dub beating of the heart, those upper chambers start to beat very irregularly and faster than normal. So, that's where the term like fibrillating, fluttering, not beating regularly. And that causes a problem, one, because if the heart beats very fast, it can make us feel tired, lightheaded, short of breath. The heart's, you know, beating very fast as if we're running a marathon and we're just sitting there.

And then, the other kind of issue with atrial fibrillation is that because of that abnormal squeeze of those upper chambers, blood can start to pool and form a clot. And then if that clot travels somewhere such as the brain, it can cause a stroke. So, that's why you're kind of hearing and seeing all those commercials and atrial fibrillation awareness kind of being put out there, because some patients don't necessarily feel it when they have atrial fibrillation. So, it's important to kind of talk with your doctor to see if you have risk factors. Again, those smart watches, some of them do screen for atrial fibrillation. And it can help us pick it up and treat it before patients have a stroke. And that's kind of why a lot of the commercials you're seeing are for the blood thinners that we use to help prevent blood clots in our patients that do have this condition.

Host: Now, there's atrial fibrillation. Is that a life-threatening disease?

Dr. Brianna French: Great question. That's actually what I was just going to hit at. It's not usually immediately life-threatening. As I said, some patients can be in atrial fibrillation and not even know it. If the upper chambers of the heart do go fast enough, so if your heart rate gets fast enough, it can cause you to feel dizzy, lightheaded, you know, potentially kind of feel like you're going to pass out. And if it goes fast for a long period of time undetected, it can cause the heart muscle to weaken. But it's usually not immediately life-threatening. We work on controlling the heart rate, getting patients on those blood thinners to prevent stroke. And then, depending on the patient, there are different things where we target just keeping the heart rate slow versus different medications and procedures to keep them out of atrial fibrillation.

Host: Now, sleep—

Dr. Brianna French: And—

Host: Oh, go ahead, Doctor.

Dr. Brianna French: Oh, I was just going to say— I just wanted to point out many people, they live full active lives with atrial fibrillation. So, the key is really proper management and follow-up with your cardiologist.

Host: Now, you mentioned sleep and its impact on our cardiovascular health, which brings us back to basic questions, like how much sleep does an average adult get? And if they're not getting good sleep, what can they do about it?"

Dr. Brianna French: Yeah. So, sleep is a big one that we're starting to see impacts on cardiovascular health. Adults should try to get eight hours of good quality sleep. So as you kind of alluded to, poor sleep, like less than six hours consistently or waking up many times during the night can start to raise blood pressure; worsen our overall metabolic health. So, it can promote weight gain, increased appetite, things like that.

I talk to patients about kind of good sleep hygiene. So, things that you can do is try to stay away from devices, at least an hour, if not more before you go to sleep. That can really help the blue light of all the phones— iPads, different things that we use can really start to impact our quality of sleep and help us not go to sleep as well, and limit the amount of time we're in that deep full sleep, because it suppresses that blue light, some of the normal hormones that tell us, "Hey, it's time to go to bed." So if you're someone who likes to read a book and things at night, probably best to read a physical book and not be on a tablet iPad.

Try to keep a consistent sleep schedule, so going to bed at the same time and waking up at the same time, even on weekends if possible, really helps our normal circadian rhythm. Watching caffeine and alcohol. So, trying to stop drinking caffeine in the early afternoon. And alcohol really can disrupt our sleep and give us fragmented sleep. A cool dark room that's quiet creates kind of a wind-down routine, and avoiding intense workouts one to two hours before bedtime can also kind of help us get a more restful sleep and go to sleep easier.

Host: And Dr. French, if there's one thing every listener could do this week to protect their heart, what would you recommend?

Dr. Brianna French: Oh, goodness. It's hard, for one thing, for each person. So, I guess I would say something that the American Heart Association has done is kind of look at all the things we talked about. So, sleep, diet activity, avoiding tobacco and kind of knowing your family history, maybe those five and pick the one that you think maybe you're not doing the best or that you really, really could use some improvement on and focus just on making small changes there. You know, I tell my patients it's not about perfection. It's about kind of making small choices, small healthy choices that add up over time. We all have to live our lives. But if we kind of focus on. Small healthy choices day after day and create those habits, I think that's the best thing, all of the listeners could do.

Host: Once again, I want to thank Dr. Brianna French who is a preventive cardiologist at Summa Health for talking with us about preventive cardiology and about heart health in general in this February Heart month. And if you want to find out more information about the cardiology specialists at Summa Health, go to the website, summahealth.org and check out and find out if you can find a cardiologist you'd like to have an appointment with. Have your heart checked out. If you haven't had to do that on any kind of basis, on a regular basis, you should really do that. And see what's the kind of condition you're in, see what your blood pressure is, and get some of those good tips to keep it healthy and beating for many, many years as we hope it all should for all of us. So again, that's summahealth.org. Dr. French, thanks for being with us here on WNIR, Kent Akron. And again, good luck with your career and God bless you for all your activities you're doing for the community.

Dr. Brianna French: Yes, thank you for having me.

Host: I am Mr. Sunday. Bob Lewis.