Joey Wahler (Host): This is Health Matters: Insights from WCH Medical Experts. Thanks so much for joining us. I'm Joey Wahler. Our guest is Dr. Aaron Meinke. He's a primary care physician. Hi there, Doctor. Welcome.

Aaron Meinke, MD: Hello. Thanks. Nice to see you. Nice to be here.

Host: Same here. We appreciate the time. So first, we're discussing controlling our cholesterol. And many think their cholesterol is just fine, I'm sure. But could someone conceivably have normal cholesterol numbers and yet still be at risk for heart disease?

Aaron Meinke, MD: So, a normal cholesterol is a tough question, because what some people feel is normal, in today's standards, the goal cholesterol LDL level is getting lower and lower. Despite the people who think their cholesterol is normal or well, just for a fact, 800,000 cardiac events in US every year, 200,000 of those are repeat offenders. So, you know, the bulk of people with certainly heart disease, and these are people who have had the heart attack where the atherosclerosis or blockage has gotten to the critical point. Not to mention all the others who have ongoing atherosclerosis or plaque forming in their arteries that are asymptomatic, because they haven't reached that critical point yet.

Host: And before we go any further, Doctor, just how often should most of us have our cholesterol checked? Just during annual checkups or perhaps, in some cases, more often?

Aaron Meinke, MD: Truly, we try to catch people in their teen years or early 20s just to identify that subset of people that have just a hereditary, familial, really bad cholesterol just because they're at so much more increased risk. They have early onset cardiac events. I usually like to make sure everybody's screened like that at least in the 30s, to make sure we're not dealing with a level that is maybe truly unacceptable.

After the age of 40, once every year thereafter. At least, the studies at 40 to 75 years of age, right, should probably have an annual lipid level. And then, you know, I'd recommend following up with your physician, just to see what they'd like to do with it.

Host: And for those joining us that are sometimes procrastinators, et cetera, just how important is it to stay on top of that annual checkup for cholesterol checks and beyond, of course?

Aaron Meinke, MD: We appreciate it as physicians if you would come in maybe more than once a year to air all your grievances, right? So, there's so many times after going through multiple things, been going on through the course of the year that I get the, "Well, what if" or "Just one second" or, you know, "One more thing," and that's usually the most crucial thing that's impactful for the entire visit, right? That's like, "You know, I'm taking out the trash over the last month, and I'm having chest pain." I'm like, "We should have probably, one, started with that, or maybe when you had symptoms, you should have probably just come in.

Host: Yeah, burying the lead as they say in journalism circles, right, Doctor? So, how have cholesterol guidelines changed in recent years, and why are doctors like yourself taking cholesterol management more seriously than perhaps ever before, right?

Aaron Meinke, MD: So, I think we've always tried to take it seriously to a certain extent. But when the guidelines and the goals get lower and lower, you have to be more serious about it if you want to try to have people reach those goals or guidelines that supposedly is going to improve their risk. And also, unfortunately, a lot of people just are very against, one, taking meds at all, but two, I don't know why stats have gotten such a bad rap.

Host: I'm going to ask you about statins in some more detail in just a moment or two, but just getting back to those guidelines that we alluded to that have changed in recent years, what specifically has evolved there?

Aaron Meinke, MD: So, just some numbers. So, one, there's some other proteins that we look at that you should have checked at least once in your cardiovascular risk screening. But for the average Joe off the street, now we're looking at LDLs. We're not talking total cholesterol. LDLs, which is the bad particle of 100 or less.

So, that's just your standard, which very many people naturally can get there. Then you look at, you know, primary prevention, which let's say somebody who's been identified that has not had an event but has atherosclerosis or other health issues like diabetes, which really promote the blockage of coronary arteries or a bad family history. Now, they're looking at 70 or less. And then, we go to, you know, secondary prevention, where you've already had an event. We want you less than 55. So, these numbers are very difficult to reach. And certainly, you got to be fairly aggressive if you want to help people get to their guidelines.

Host: And you touched on it there briefly, Doctor. There's also what's called good and bad cholesterol, right? So, what's the basic difference between them.

Aaron Meinke, MD: So, the good cholesterol, the high density lipoprotein tends to have protective effects, right? So, it makes your LDL particle, which is the one that causes the problems, and then, we'll say, his cousin, triglycerides are up. They tend to make the LDL a little bit more atherogenic and nasty. HDLs are up or elevated. That's the good cholesterol, tends to help improve some of that atherogenesis that the bad particles are creating. That's why total cholesterol you can look at. But, you know, there are people that I have that are fortunate, you know, they have HDLs 85 or 100, right? And their total's very elevated. But in actuality, it's a good thing. LDLs elevated, never good.

Host: You mentioned statins. I have a few questions about those. First, what do we mean by statin? Because we're talking now about treating unhealthy cholesterol levels, right?

Aaron Meinke, MD: So, yeah, statins have been around for quite some time. There are some new players there. They get a bad rap from the standpoint of, I think, most likely myopathy or people get muscle pain secondary to the statin use. That can be improved with either lowering the dose or sometimes there's some other supplements we can add. There are multiple statins out there. Some of the newer ones tote less of the muscle pain symptomatology. There's also a couple of the older ones that are broken down almost specifically in the liver. Some of the other statins cross over, and have a little bit of action in the muscle, which is why they cause more of the muscle pain

Host: And so, when you talk about those side effects, Doctor, many patients naturally can be hesitant to take these statins. So, what do you usually tell them about the risk versus reward, if you will?

Aaron Meinke, MD: So, just to start with that. So, the other things that people that's toting bad on statins is, one, they think it causes Alzheimer's dementia. Not true, right? Memory loss has been associated about 3% of the time with statin use, and completely reversible when getting off the statin.

So, at that rate, probably not worth crossing off the entire statin use. You have a family history of Alzheimer's, statins don't cause Alzheimer's. There's some studies actually that they help prevent Alzheimer's. So, that's one thing.

The other thing now is nobody wants to take statins because they cause diabetes. Not true, right? Statins, because of the effect they have on the cell wall, can increase your glucose levels slightly. So if you're a diabetic, yes, you might see more of an increase, but most people argue that the benefit they're going to give you is much better than the slight increase in blood sugar that we can accommodate with other treatment. And with starting a statin, your risk of heart attack or vascular event, depending on your dose, 25% to 45% reduction. Pretty significant.

Host: Yeah, absolutely. Certainly sounds like it. And you kind of dismissed some of those common misconceptions, so I can check my next planned question off the list and move on to the one after that. Well done, Doctor. Switching gears a little bit, what's a coronary calcium score, and how can it help determine someone's true risk for heart disease since that's the big picture thing we're talking about here?

Aaron Meinke, MD: So, it's a fantastic test. Again, it's a screening tool. So if you have heart disease, it's not meant for you. We don't colon cancer screen somebody who has colon cancer because screening is just to identify those at risk or who might have the disease. So, it's best for people who have a fairly strong family history and maybe no risk factors, and they're wondering what the risk is. It's good for people who maybe have some risk factors. Their cholesterol's not so great. They're very hesitant for me to let them help them lower that.

And what it does essentially—so as we get plaque that forms in our arteries, it tends to calcify. So, this CT scan measured arterial calcium, takes about ten minutes. The radiation dose is very low. There's no contrast with it. So from that standpoint, really quite safe. And it can read the amount of calcium in every one of your coronaries, and it just gives it as kind of a mild, moderate, high risk. But if you're low risk, you don't have a lot of plaque or you don't have a lot of calcium score, you should feel fairly confident and continue with whatever it is you're doing to keep you that way.

If you're at moderate and particularly high risk, then iwe need to talk. if it's really high, maybe further screening. You know, maybe we're looking at more of a visualization of your arteries like a CT angio or a cardiac catheterization. If you're moderate, you know, maybe even that or maybe, further testing. But if you have a lot of calcium scoring started, that means probably we should really pay attention to your cholesterol levels. And even on regular CT scans, a lot of times too, we'll find people, they get a CAT scan of their abdomen for abdominal pain or whatever's going on, and you can already see atherosclerosis in their aorta or their large vessel of their body. You know, that vessel is not unique compared to your other vessels. So when you start to see that atherosclerosis, it's time to really pay attention.

Host: A couple more questions for you. First, in terms of heart disease, I think it's safe to say many associate it with chest pain. But how about other possible warning signs that you find people often overlook?

Aaron Meinke, MD: Yeah. And this is usually the, "Oh, the by the way," remarks we get at the end of an appointment, right? Everybody recognizes, right, if they have crushing chest pain or they're really sweaty or they can't breathe, that those are bad things. Although I still recommend that if you have those, you don't choose to go to bed and wait till the morning to address it, right?

Probably should take things serious and realize that time is of the essence. A lot of times now, particularly with winter coming and people are going to be out push more on their lawns here next spring is a change in exercise tolerance, right? So if you're doing great at the end of this season and you got your last mow done and you felt great, but for some reason, next season, you're having a hard time, you got to stop three or four times to catch your breath, and particularly if you don't feel like you've improved your exercise tolerance halfway through the season, right? It's these changes in exercise tolerance or generalized fatigue. I have a lot of people who come in, and soft symptom for heart disease. They used to come home from work and have projects they worked on. Now, they come home and they sit in their chair and fall asleep because they're just physically exhausted. Not that other things don't need to be checked, but you might want to reflect back on your cardiovascular risk and, you know, and maybe that needs to be evaluated or assessed.

Host: So wait a minute, Doctor. You're saying some people actually do cut their own lawns? Is that it?

Aaron Meinke, MD: I know. It's crazy. I do. I cut mine, so...

Host: Good for you. Good for you. A doctor mowing his own lawn. That is certainly impressive indeed. In summary here, if someone notices some of the symptoms you've talked about or simply wants to be proactive, preventative, what are the basic steps they should take to get started and when they schedule an appointment with their primary care provider?Where's the line where they know when to do that?

Aaron Meinke, MD: Yeah, that's tough. I would say if you're having symptoms out of the ordinary and they're very chronic, super recurrent, even predictably recurrent depending on what type of exercise or activity you're doing, just hopefully you have a PCP. If not, you should find one, right? I promote everybody once a year to at least go in and get a wellness exam, whether you're completely healthy or not. Sometimes through discussions, we find some things that maybe were wrong that, the patient didn't realize, might be an issue. In addition to that, there are multiple screening tests, depending on your age that, you know, are recommended to have done, which I would continue to keep up with those.

Host: Well, we trust you're now more familiar with controlling our cholesterol and certainly heading off heart disease at the pass, hopefully. Doctor, valuable information indeed. Keep up all your great work. Good luck with the lawn. And Doctor, thanks again

Aaron Meinke, MD: You're welcome. Have great one.

Host: Same to you. And for an appointment with Dr. Meinke, please call the Bowling Green Clinic. They're at 419-352-1121. If you found this podcast helpful, please do share it on your social media. And thanks so much again for being part of Health Matters: Insights from WCH Medical Experts.