Bill Klaproth (Host):  February is American Heart Month. The annual celebration began in 1963 to encourage Americans to join the battle against heart disease. So, how can you reduce your risk of heart disease? Let’s find out with Dr. Phoebe Ashley, a Noninvasive Cardiologist at the VCU Health Pauley Heart Center. 

This is Healthy with VCU Health. I’m Bill Klaproth. Dr. Ashley, thank you for your time. Let’s start with this. What are the risk factors for heart disease?

Phoebe Ashley, MD (Guest):  Certainly. Your first risk factor is actually your family history. If you had a father with heart disease before the age of 55 or a mother with heart disease before the age of 65 or perhaps if you have a family history of congenital heart disease, things that you are born with that are abnormal in the heart; then you could be at risk for heart disease yourself. In addition to that, as we age, we see more heart disease. We also have high blood pressure, high cholesterol, diabetes, smoking, stress, sedentary lifestyle, sleep issues such as obstructive sleep apnea. Two more unique things that can contribute to heart disease are autoimmune diseases which are inflammatory diseases within the body such as rheumatoid arthritis, or lupus or psoriatic arthritis. And then one other thing is for our young women that have issues in pregnancy. If a woman develops high blood pressure, what’s called preeclampsia or eclampsia, gestational diabetes, a premature delivery and a few other things that are considered adverse pregnancy outcomes; that woman will have an increased risk of heart disease much earlier than her peers and perhaps it’s a new risk factor that she would not have had otherwise.

Host:  So there’s a lot of risk factors when it comes to heart disease and you say start with family history. So, what else can we do to lower our risk of heart disease?

Dr. Ashley:  Oh, that’s a great question. First, I think you need to figure out what your risk factors are. So, if you don’t know what your blood pressure is or what your cholesterol or blood sugar is; then it’s very important to check in with your doctor and find out what you risk factors are. Once you know what those are, then you can become very proactive in taking care of those. And really starting with lifestyle modification before jumping into medicines usually is a very good start. So, that would be things like making sure that you’re eating a healthy diet such as a Mediterranean diet, and that you are exercising on a regular basis. Ideally, we like to see people exercising aerobically 30 minutes to 40 minutes a day most days of the week with a couple of days of strength training to help reduce cardiovascular risk. 

Limiting how much salt you take in. So, no more than a teaspoon a day. Making sure you are getting good sleep. You are reducing your stress. Those are some of the – and of course no smoking.

Host:  So, pay attention to healthy diet, exercise, and limiting salt, pay attention to sleep, and for sure make sure you are not smoking and do whatever you can to try and reduce stress. 

Dr. Ashley:  Absolutely. 

Host:  That’s a good list of things that is easy for us to try to know and pay attention to. So, then what should we look out for as far as symptoms? What are the symptoms for heart trouble?

Dr. Ashley:  Well the classic symptom that everyone speaks of is what we call angina. And angina simply means inadequate blood flow to meet the heart’s needs. And the classic symptom of that is a heavy pressure, tightness, squeezing under the breastbone that can radiate to the neck or jaw or down into an arm or both arms or into the back. That’s the classic thing that people will present with. The symptoms typically come on with exertion and are relieved with rest. But many people don’t have that classic symptom. So, other things to pay attention to are shortness of breath when you exert yourself. Or perhaps feeling nauseated when you exert yourself. Getting very dizzy or lightheaded or even fainting can also be a sign that there could be something going on with the heart. 

Another thing that I remind people of is that if you have been doing a regular exercise program and you’ve been walking three miles and now it’s hard for you to make even one mile, something’s going on. It may not be heart disease, but it warrants a further evaluation. So a decrease in your exercise capacity should alert you that it’s time to check in with your doctor for evaluation. 

Host:  And then ultimately, how do you diagnose that someone does have heart disease?

Dr. Ashley:  Well there are a variety of things that we can do depending upon what we’re looking for. If we are looking for a coronary artery process; then often, that would be a stress test where we would put a patient on a treadmill, and we would look for EKG changes. Sometimes we do advanced stress testing where we add some imaging like echo pictures or ultrasound pictures or nuclear imaging pictures. Sometimes we do things like CT angiograms or heart catheterizations. It really depends on the patient, their risk profile, how concerned we are about their symptoms as to which test, we might select. 

And then there are other types of heart disease like valvular heart disease, arrythmias; those things warrant things like echocardiograms to look at the structure and function of the heart. Sometimes cardiac monitoring to see if the patient is having some kind of underlying arrythmia that we need to treat. 

Host:  And then lastly, Dr. Ashley, can you share some healthy living tips for people with heart disease?

Dr. Ashley:  So, I really advocate for everyone to pay close attention to four pillars of health. Whether you have heart disease, or you don’t yet have heart disease. I do think that being physically active on a daily basis is very important. So, having some form of movement in your life, something that you like to do, maybe it’s dancing or swimming or walking. But something to keep you active. I like people to have healthy diet so I would advocate for the Mediterranean diet and you want to also be conscious about the number of calories that you are taking in. We know that people that keep their calories at a lower level, do better cardiac wise. And then I think that sleep, restorative sleep not just sleeping, but restorative sleep is very important and stress reduction. 

Host:  So, the four pillars of health.  I like it. So, we’ve got physical activity, try for that every day. Make sure you pay attention to a healthy diet. You like the Mediterranean diet and watch the calories. Make sure you concentrate on restorative sleep. So, get your sleep right and then try to reduce stress as much as you can. 

Dr. Ashley:  Correct. 

Host:  Dr. Ashley, this has been great. Thank you so much for your time today. 

Dr. Ashley:  Thank you very much. I appreciate it. 

Host:  That’s Dr. Phoebe Ashley, and call 804-628-4327 to schedule an appointment or you can visit www.vcuhealth.org/heart or www.vcuhealth.org/pauley. And you can do that for more information. And if you found this podcast helpful, please share it on your social channels. And explore the full podcast library at www.vcuhealth.org/podcast for more health topics of interest to you. This is Healthy with VCU Health. I’m Bill Klaproth. Thanks for listening.