Scott Webb (Host): We hear a lot about cardiovascular health, but what does that mean exactly? And how does our cardiovascular health impact our overall health? My guest today has those answers and more. I'm joined today by vascular surgeon Dr. Jamil Matthews.

This is Ask the Experts, the podcast from Salinas Valley Health. I'm Scott Webb. Dr. Matthews, nice to have you back on the podcast. Today, we're talking cardiovascular system, right? And its role in our overall health. So, what does that actually mean? What do we mean by "the cardiovascular system"? I'm putting that in quotes. And why is it so central to our overall health and longevity?

Dr. Jamil Matthews: When you think of the cardiovascular system, you can break it in two parts, and it's pretty easy to do that just based on the name alone. Cardio meaning cardiac or the heart. And then, vascular meaning the blood vessels. So, as you know, the body is a stack of cells. If you think of a building as being filled with a stack of bricks or built upon a stack of bricks, think of the body as being built upon the same kind of bricks, but these are just individual cells. These cells are all living. They need oxygen and nutrients in order to function appropriately. Well, the heart and the blood vessels working together with the cardiovascular system on how those nutrients and oxygen are delivered to the tissues to keep everything functional.

So, the heart will take blood, in this case oxygen-rich blood, and pump it out to the body. And the way that it gets there is through the blood vessels. The blood vessels is just a very intricate network of essentially biological pipes that will make sure that every single cell of the body, so every single brick that makes up the human body, is delivered of oxygen and nutrients to keep it alive.

Host: Right All right. So, we're talking, analogy-wise, of buildings and pipes, and I'm totally following you here at this point. So, let's talk symptoms and risks. Like, how do age, family history,, common conditions like diabetes, obesity, autoimmune diseases, how do they change someone's risk for heart attacks, maybe increase, you know, for heart failure, stroke, heart attacks, the greatest hits, if you will?

Dr. Jamil Matthews: Remember that when we talk about the cardiovascular system, we're talking about the heart and the blood vessels working in concert. You can think of them as one general system. When you have disease of the arteries, you are affecting the delivery of blood to the tissues within the body. Ironically, that includes the heart, because the heart is a functioning organ and has its own individual blood supply or blood vessels that it relies on so that it gets delivery of the oxygen and nutrients that the blood supplies so that the heart can continue to function.

So when you're speaking about cardiovascular disease or particularly vascular disease, and you're talking about whether it's atherosclerotic plaque formation within the blood vessels, if you're talking about calcification in the setting of diabetes and what we see often in patients with end-stage renal disease, or even connective tissue disorders, that inability to deliver blood to all the vital organs of the body also directly affects the heart, which can in turn lead to heart disease.

Now, medications, lifestyle changes such as refraining from smoking, making sure you get good blood pressure control, eating balanced low-fat meals, all of that can improve your overall cardiovascular health. But again, the health of the heart, which is the pump that delivers blood through the blood vessels throughout the body, is heavily reliant on overall vascular health. So, that's why I'm saying those two are central, because there is an interdependence on one another. And without that, it can lead to a lot of different disease processes, whether that includes the heart, as I previously described, when you have disease of the arteries in the heart resulting in coronary artery disease.

But also, the blood vessels that supply blood to the brain, which can lead to risk of stroke, or blood vessels that provide oxygen and nutrients to the kidneys. When those are heavily diseased, that can lead to kidney disease. Or when you're speaking of the blood vessels that supply blood to the lower extremities, now we're talking about peripheral artery disease.

So when we're talking about vascular health, it is very important because not only is it the health of the individual blood vessels that supply blood throughout the body, but if you separate them in terms of the actual organs that they're perfusing, if they are diseased, then that can lead to disease process within those individual organs as what I talked about in terms of risk of stroke, risk of heart attack, risk of renal failure, and peripheral artery disease.

Host: Right. So, let's talk about diagnosis and treatment. Maybe you can walk us through maybe how treatment decisions are made today from lifestyle changes, medications, which you mentioned, to procedures like stents, bypass surgery, maybe some newer minimally invasive options.

Dr. Jamil Matthews: We try to start with the least invasive option first. So, you do it in a stepwise manner. The first step is always going to be your lifestyle modification, regular exercise, daily cardiovascular exercise, weightlifting or some level of resistance training, which also provides a benefit on the health of the cardiovascular system. Making sure you're not smoking. Not drinking at all if you can help it, but at least having alcohol intake in moderation, but I would recommend against it altogether. Eating a healthy diet that's low in fats, particularly saturated fats, and eating an overall balanced diet. That would be step one.

Now, within step one is the medical portion of it, and that includes daily aspirin, taking your cholesterol medication. Statins provide a lot of benefit, as are a number of other medications as well. Once we have optimized the lifestyle modification portion of it and medical optimization portion of it, if you do not improve to the level or we don't reach our health goal from a cardiovascular standpoint, now we escalate to the more interventional processes. And that includes a lot of minimally invasive procedures that we do now, such as angiograms where we can go into the arteries. And it doesn't matter what arterial bed it is. It could be the arterial bed in the heart in which our cardiac interventionalists can perform balloon angioplasty and stenting in patients with severe coronary artery disease. If you're dealing with the lower extremities, patients who have claudication, rest pain, you know, the symptoms that are related to peripheral artery disease, we too can do that same thing as vascular surgeons, interventional radiologists, and just vascular interventionalists in general can go in and treat the vessels using a combination of wires and catheters, balloons and stents to improve blood flow and overall lifestyle. And this then extends to other vascular beds as well.

Remember when I said that it's all interconnected. So for example, patients with carotid artery disease who are at high risk for stroke, we can treat those areas with stents as well. In addition to that, the vessels that supply blood to the intestines, which we call the mesenteric vessels, they supply blood to not only the intestines but other, organs in the abdominal cavity, including and not limited to the stomach, the liver, spleen, and then also the renal arteries which supply blood to the kidneys. All of those can be individually treated if there is impairment of blood flow due to vascular disease.

So, once we have exhausted those options, at that point, that's when we look to the more invasive options such as open surgery, bypass, and things of that sort. The minimally invasive approaches continue to advance at a very rapid pace. And a lot of the diseases that we would see that would typically require a patient to be hospitalized for a week or just an extended amount of time have now been reduced to outpatient procedures. So, it's really, really promising and it only continues to get better as we come with more and more minimally invasive advancements.

Scott Webb: So then, Doctor, back to lifestyle and prevention, right? It seems so important, right? So, how much physical activity is truly needed? I hear that 150 minutes a week to support heart health. And what do you advise for people who are older like me and have joint pain and maybe are a little scared to exercise, you know, because of their heart concerns?

Dr. Jamil Matthews: I try to give people a daily time limit to exercise. So, I often recommend to my patients to exercise 25 minutes a day. And that can include cardiovascular activity, brisk walking. I tell patients, especially those who have an underlying history of coronary artery disease, or maybe some pulmonary disease, I often recommend to my patients to ambulate at a rate to where they can have a conversation.

Also, I think resistance training is very important. As we age, we lose our lean muscle mass and it converts to fat. To help maintain that lean muscle mass, which is good for your baseline metabolic rate, but also just for joint protection, and overall activity level, I recommend that they do some level of weight resistance training, and that could be just with your body weight.

Host: I want to talk a little bit about the team and technology. You know, when a person has a heart or maybe circulation problem, give us a sense of who are the different specialists that might be involved in their care. And when patients might be thinking about building a heart team, if you will, who's on the team?

Dr. Jamil Matthews: Everything always starts with your primary care physician. You think of them as the head coach of the team. They are well-trained in being able to identify a broad range of diseases. And they can help guide what specialist the patient needs to go to for further workup and/or treatment.

The next layer of that includes your specialist. So, who are the cardiovascular specialists that are typically involved? Primarily, it's going to be your cardiologist, and that includes your interventional cardiologist, your vascular surgeon or your cardiothoracic surgeon, and interventional radiologist. All of those individuals can be involved in the diagnosis and the treatment of cardiovascular disease.

The other part that's not spoken about enough that I think, now in the age where wellness is really being pushed, is some of the ancillary groups such as, not limited to, your dietician. And to have an expert in nutrition who can help guide what would optimize a patient's overall cardiovascular health is very, very important. So, I really promote that within my practice to make sure our patients are, if they don't have a dietician directly, that our dieticians can provide guidelines, help direct them on what to eat and how to eat properly.

The other part is physical therapists and/or your personal trainers. People who can assist in how to exercise properly and reduce the risk of injury, work on strengthening aspects that can help them walk more, that can help them with their activities of daily living. I think all of those people within the team aspect are vitally important in overall cardiovascular health.

Host: Yeah. A team approach, of course, at Salinas Valley Health. And for patients, Doctor, who struggle with doctor's orders, we'll call them, you know, whether it's diet, exercise, quitting smoking, what are some maybe practical strategies or small steps you have to actually make this stuff work in real life for real people and, you know, keep them motivated?

Dr. Jamil Matthews: I recommend to patients to have a daily goal. If, say, for example, you're not a very mobile person or you don't enjoy going for walks, and I say, "Hey, why don't you try going for two blocks today? Put on a podcast, listen to an audiobook walk with your loved one, walk the dog." You know?

And it's especially easier for me to push those things here in California, because I live in such a beautiful area of the country with great weather. It's easier to get outside and do those things. So, I build up the goals. And then, as they can tolerate going around the block a couple of times and they feel good, I say, "Okay, let's double that." And then, "Okay, let's triple that."

If it comes to smoking cessation, I rely heavily on my smoking cessation experts for these things. But what I often find with my patients is that some patients are your cold turkey, they can stop smoking right away. Whereas others, you have to say, "Okay, let's do a contract here. You move to half a pack this week," or "You take two cigarettes out of your pack this week, and then we'll take another two out, and then another two out, and just kind of work our way down." I tailor those things, those lifestyle goals, whether they're exercise, smoking cessation, dietary. I tailor them basically on each individual patient and their willingness to participate and their willingness to continue to follow through with the goals that we set forward.

Host: Right. Yeah. We think about cardiovascular health, the cardiovascular system, our overall health, what would be your takeaways?

Dr. Jamil Matthews: You have to understand, number one, that you are the arbiter of your overall health in general. You are the one who determines whether you're going to get enough sleep, whether you're going to eat right, whether you're going to exercise. In the end, it comes down to you, and you can make those changes when you make the decision to do so.

Doctors are here to help. We are your team members. We will motivate you along the path. We will help guide you. But in the end, you have to be the one that wants to put in the work. My recommendations for overall health are: get all the age-appropriate screenings, get vaccinated, eat a healthy balanced diet, exercise daily, Get a good amount of sleep, no smoking and no drinking, or at least drink in moderation, and reduce as many stressors as you possibly can. I push those factors to my patients every day

Host: Right. Great words of advice from an expert. Appreciate your time. Always great to have you on. Thanks so much.

Dr. Jamil Matthews: All right. Thank you very much

Host: And to listen to more of our podcasts, please visit salinasvalleyhealth.com/podcasts. And if you found this podcast to be helpful, please be sure to tell a friend, neighbor, or family member. And subscribe, rate and review this podcast, and check out the entire podcast library for additional topics of interest. This is Ask the Experts from Salinas Valley Health. I'm Scott Webb. Stay well, and we'll talk again next time.