Transcription:
The Latest in the Diagnosis and Treatment of Heart Disease

Melanie Cole, MS (Host): The CDC says that heart disease is the number one killer of both men and women and is more deadly than all forms of cancer combined. That’s really amazing when you hear it spoken like that. My guests today are Dr. Andrew Ho, he’s an interventional cardiologist and the director of the cardiac cath lab at Temecula Valley Hospital, and Dr. Candice Kim. She’s a non-invasive cardiologist and a member of the medical staff at Temecula Valley Hospital. Dr. Kim, I'd like to start with you. Please tell us a little bit about the current state of heart disease today. What’s the prevalence? And as I just said, is it  really more deadly than all forms of cancer?

Dr. Candice Kim (Guest): So as you said, it is the number one killer in the United States, and actually worldwide. I do think there is a lot more awareness nowadays about cardiovascular disease. Specifically in women, I think there’s a lot more awareness about how cardiovascular disease specifically effects women. Because, in the past, there’s been much more attention focused on men and heart disease, and I think finally there is a lot more awareness with regards to women.

Host: It’s certainly true. As all the Framingham studies and all the studies had been done on men. Dr. Kim, do you feel that now as we look forward to heart disease research and what’s going to happen in the future, that now we are concentrating a little bit more on women and how our symptoms and our presentation are different than men. Do you see that the studies are headed towards that direction?

Dr. Kim: Absolutely. You know we’re actually looking at multiple different studies on not only how women present differently, but how we can treat women differently from men. Right now, we’re still using the same standard medications that we use for men. But I know there are studies happening at like Cedar Cyanide where they're looking at different medications and different imaging studies for women even to detect heart disease.

Host: Dr. Ho, let’s talk about some of the comorbid conditions that can either contribute or be caused by heart disease, and the risk factors that you think are the most prominent. The ones that we really need to be paying attention too.

Dr. Andrew Ho (Guest): Yes. So just as Dr. Kim said previously, there’s definitely much increased awareness in the U.S of heart disease being the number one killer. However, having said that, we still see a lot of lot of deaths. That’s because we’re not doing that great of a job of reducing the number of patients who have risk factors. For example, smoking is still prevalent in the United States. Smoking very significantly leads to an increased risk of someone having heart disease and heart attack. Also diabetes. So many people are still obese, and therefore, have obesity induced diabetes. Diabetes is, by far, one of the greatest risk factors for heart disease and ultimately having heart attacks.

Host: Dr. Ho, one thing that’s been in the media lately is about aspirin and taking an aspirin a day to reduce that risk of heart disease or heart attack or even stroke. What do we know now that’s different? I mean this just came out recently. What do you want us to know about that?

Dr. Ho: So this whole debate about aspirin in the media recently is a very interesting topic, and it very well demonstrates how medical knowledge evolves over time. I have seen so many things in the last decade of my practice, items that we knew before were true turn out not to be true. Aspirin is one of them. We thought before that aspirin is something that we should give to everyone over the age of 45 or 50, even if they never had heard disease. But now, the date is coming back definitely that in those patients who has never had heart disease, an aspirin a day actually is of no benefit to them at all. That’s why the current recommendation is to not give it as the primary prevention. Meaning patients who’ve never had heart disease probably would not be helpful to give them an aspirin every day.

Host: Thank you for clarifying that because it is confusing when we hear these sorts of things. They also discussed eggs recently too. Dr. Kim, when we think about women, we’re multitaskers. We’re going to talk a little bit about diagnosis and the cath lab as well with Dr. Ho too, but stress. When we think of risk factors and we hear smoking and family history, where does stress come in? Now we’re learning so much more about inflammation and its role in heart disease. Tell us a little bit about how that is now playing a big part in this picture, this total picture, when we’re looking for heart disease.

Dr. Kim: Right. So, I think over the past several decades, we’ve identified certain risk factors for heart disease, like you said. You know high blood pressure, diabetes, smoking. But we have seen over the past several years that people who have chronic inflammation have a higher risk for cardiovascular disease. So people who have underlying arthritis or other chronic inflammatory states. Stress can be an inflammatory state as well because when you're under a lot of stress, your body releases a lot of different hormones and different steroids. That can kind of simulate a similar inflammatory state and put you at a little bit of a higher risk for developing cardiovascular disease.

Dr. Ho: I would like to add to what Dr. Kim said. So Dr. Kim accurately said that stress really causes patients to be in this state where it leads to increased risk of heart disease and episodes of heart attacks. That’s exactly what I see in the cath lab. When patients come in to the cath lab with a special heart attack called ST elevation myocardial infarction. A lot of times patients that—let’s say they have had heart attacks like this with no prior risk factors. They didn’t smoke, they're not obese, they don’t have diabetes. You ask them more often than not, they’ve had a recent episode of some kind of stress, whether it be personal, financial, et cetera. I see that a lot.

For example, in 2007 when I first started my practice, I really all of a sudden noticed a huge influx of patients who have heart attacks, and young patients especially. It really correlates when you ask these patients how they ended up in the hospital, it correlates well when at that time we had the major recession when a lot of people were in financial troubles. So, exactly what Dr. Kim said. Stress is such a huge determinate in some cases when patients come in with heart attacks.

Host: Dr. Ho, you're in the cardiac cath lab. You're the medical director. Tell us a little bit about what that really even is. What does it mean to say interventional procedures? While we’re talking about some of the latest procedures to diagnose and treat heart disease is catheterization diagnostic in nature? Is it curative? What can be revealed? Is it both?

Dr. Ho: So the cardiac cath lab is a very special procedure room that has really high tech equipment, including a very advanced x-ray camera that will allow us to actually look at the tiny coronary artery. These are the arteries that supply blood to the heart and muscle itself. With the equipment in the cath lab, we can see these arteries in real life, and we can see whether or not they have significant blockages or narrowing. Or even whether or not they have actual blood flow.

In the cardiac world, there's a form of heart attack, as I mentioned, called ST elevation myocardial infarctions. These heart attacks are associated with really high mortality rates. We have found through many clinical trials that the only and best way to treat these types of heart attacks, and to really save the patients life, is to actually rush them into the cath lab and look at these arteries in real life and actually restore blood flow to them as soon as possible. Temecula Valley Hospital is one of those facilities that is what we call STEMI-receiving centers. So we specialize in taking all these patients from the outlying areas. We fly patients in from hundreds of miles away. We have ambulance drive patients in. We have a team waiting for the patient before the patient arrives. We have cardiologists waiting.

Basically our goal is that—This is a national goal. We have to meet this. We actually meet this every quarter with 100% success rate. From the second the patient arrives in our emergency room until the patient’s artery gets opened and blood flow restored, we can do it within 90 minutes. Actually our average time at the hospital is not 90 minutes. It’s actually well below 60 minutes. So the second someone sets foot in the door, whether the patient is driven in by ambulance or whether the patient just walks in complaining of chest pain, from that moment our timer’s going. We have shown that we can diagnose the patient, rush the patient to the cath lab, do the angiogram where we look at the arteries and open up the blockage, and we can do that well below 60 minutes. That’s an accomplishment that we are very proud of.

Host: Wow. That’s really amazing, Dr. Ho, to hear you speak of it like that, and reassuring for patients of Temecula Valley Hospital as well. Dr. Kim, we don’t have a lot of time in these segments, but what would you like listeners to know about knowing their numbers? And if they're on medication for blood pressure, cholesterol, the importance of taking those medications. Tell us why it’s so important that we know our numbers and which numbers you feel are the most important for us to know.

Dr. Kim: Obviously, I think that it is very important for everyone to listen to their doctors and take the medications as prescribed. I think sometimes people kind of fall into the trap where they feel like the medication doesn’t make them feel any better. Sometimes they have some side effects from the medication, but the medications are really there to try and help reduce your risk of having any sort of cardiovascular event such as a heart attack and stroke.

The numbers that we kind of look at in the clinic are mostly at the blood pressure. We would like to keep the blood pressure for everyone under 140 over 90. We also monitor the cholesterol levels as well. That can be a little bit tricky because new guidelines have come out and they're not specifically targeting numbers but targeting a person’s overall risk of developing cardiovascular disease. So that is going to be hard for people to target a number at home, but for the blood pressure I would say try to keep the blood pressure under 140 over 90. Then for people with diabetes, just having good A1C control. So less than 7%.

Host: Dr. Ho, first last word to you. I’d like you to wrap up for us with your best information about prevention of heart disease, looking at those risk factors. Maybe looking at your exercise habits and sedentary lifestyle and even diet, and what you want us to do or think about that we can do right now today to put this whole picture together to hopefully prevent heart disease in the first place.

Dr. Ho: Well, I think certainly because heart disease, despite how much we know about heart disease, and despite how good we are at rushing the patient to the cath lab and treating their heart attack, it’s still the number one killer. The reason for that is right now we don’t have number one, an optimal prevention strategy for the whole of the United States. Secondly, I think the detection rates for the early symptoms are still not as good. Part of the reason is because patients can present so differently from one person to the other. Therefore, I think to make headway on this, we really need to improve on our education for the whole population on what are some of the symptoms of heart disease and how to recognize early.

Secondly, also to really work on reducing risk factors. So you mentioned diet. Definitely moderation in what we eat is the number one thing we can do that really helps. Certainly we can't expect everyone to all of a sudden turn into a vegan diet, but certainly if we can just moderate the quantities, we eat of each type of food I think that would help a lot.

Host: That’s great information. Dr. Kim, last word to you. I'm going to direct it a little bit towards women and heart disease. We know there are so many treatments we didn’t get to talk about today. Dr. Ho did mention some of the cath treatments that are really knew and really advanced. So you tell us, as far as women, what would you like us to know about taking care of ourselves before take care of our loved ones. Because if we don’t do that, we cannot care for everybody, which is basically what our job is. So what do you want women to know specifically about recognizing and saying, “You know what? This is not just stress. Or maybe it’s not just anxiety.” Because they can mimic each other. What would you like women to know about heart disease?

Dr. Kim: Yeah. You know, I feel like women tend to put off their symptoms or put off what they're feeling because they feel like they have a lot of other responsibilities. A lot of women do attribute what they're feeling to stress or anxiety or other life things. But I really, really would like to emphasize that you know when something is not right, or something is different. It may not be the typical chest pressure or shortness of breath, but you know when you're not able to do the things you used to be able to do. So just don’t ignore those symptoms. Take those symptoms seriously and advocate for yourself. Go be seen by a specialist to make sure that your symptoms are being addressed and that you're being evaluated for cardiovascular disease.

Host: Thank you both so much for joining us today. It’s great information and it’s more important than people even realize to pay attention to those symptoms, to recognize them, and to try and modify the risk factors that we can modify. Thank you, again, for joining us. You're listening to TVH Health chat with Temecula Valley Hospital. For more information, please visit temeculavalleyhospital.com. Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks for tuning in.