Heart Health Interview

Listen to Educator, Mark Abrams talk about potentially life-saving information about your heart and read the transcript below!

“This show could save your life!”
~Eli Marcus, Host of The Motivation Show

Disclaimer: The content in this interview is meant to be for general information purposes and is not meant to constitute medical advice. It represents the thoughts and opinions of Mark Abrams, which do not necessarily reflect the official view of NewYork Presbyterian Hospital or Columbia University.

Party 934: The Motivation Show
Host: Eli Marcus
Guest: Mark P. Abrams, MD
Date: January 21st, 2018

Eli: Cardiovascular Disease. And many will say, including doctors, that the current healthcare system is inadequately addressing prevention. That’s a pretty scary thought. That’s why today I brought on the show Dr. Mark Abrams who’s a cardiologist [cardiology fellow in training] and Director of Patient Engagement at Heartbeat. Dr. Abrams is a cardiology fellow [in training], internist, and educator whose work emphasizes improving the patient-doctor relationship. He obtained his undergraduate degree in Physiology from McGill University in Montreal, Quebec, Canada before completing his MD degree from Albert Einstein College of Medicine in New York. He continued his training at New York Presbyterian-Columbia University Medical Center for his residency training in internal medicine where he remains as a cardiology fellow. He has received multiple honors and awards for his commitments to humanistic care, ethics, and developing new teaching methods to help doctors be better doctors for their patients. Aside from being an educator to other doctors, Dr. Abrams is passionate about engaging patients to learn about their own health in order to live happier, healthier lives. Welcome to The Motivation Show, Dr. Mark Abrams!

Dr. Abrams: Thank you so much for having me. It’s really a privilege to be here with you.

Eli: Thanks you so much and how is your day going so far?

Dr. Abrams: Today is a great day. It’s nice and sunny here in New York. There are people out running in the park. Everybody is feeling motivated to get outside so it couldn’t be better so far.

Eli: Now, I bet you you’re happy to see people running because I’m sure we’re going to get into that topic today, aren’t we? And the importance of doing that, right?

Dr. Abrams: We will. We’ll talk about hopefully a lot of things that’ll be valuable to all the listeners out there about heart disease, but more importantly to us, heart health and what we can do to prevent heart disease.

Eli: I like that. You know, I’m certainly of that vein where I actually like to find ways to prevent things before they get out of hand if possible. So, one of the magical questions, the first question that comes to my mind is how preventable is heart disease and what role does genetics play?

Dr. Abrams: That’s a great question. Based on a lot of research out there, studies have shown that about 80% of heart disease is preventable!

80% of heart disease is preventable!

Eli: Wow!

Dr. Abrams: Yeah, I know. It’s very surprising to a lot of people. Genetics is just one tiny piece of what is “the risk factor” for heart disease. It’s really much more than just genetics. It’s diet, it’s exercise, blood pressure, cholesterol, stress, being a woman versus a man… It’s far more than just genetics. That’s why we like to educate people using studies and evidence and specialty-level knowledge about their heart health and what they can do to stay that way.

Eli: So Dr. Abrams, what is the single biggest risk factor for heart disease or heart problems besides the obvious things that are kind of self-inflicted like smoking, drugs, and alcohol?

Dr. Abrams: If I had to pick one… I think I would say high cholesterol, but diabetes and high blood pressure are definitely, if not tied, a close second and third.

Eli: So cholesterol seems to have a lot of controversy these days, but then there’s on the other hand science behind it all. I have heard of 2 different particles that my doctor keeps telling me about. These particles called HDL and LDL. Can you tell us a little about that?

Dr. Abrams: Absolutely! So first off, I think it’s important to realize: What does cholesterol do for our bodies other than cause problems. What I can tell you is our body makes cholesterol in the liver, for the most part, and that cholesterol is transported to other parts of the body to be used in making new cells, proteins, and hormones. So we do need cholesterol to live. The problem, and the reason why we check it and think of it so highly as a risk factor for heart disease is because the levels get too high and transported with the cholesterol is fat. That fat that gets put in different arteries and places in the body is what causes problems such as heart attacks and strokes. The HDL and LDL particles that you hear about are typically referred to as the good cholesterol (HDL) and the bad cholesterol (LDL), but really what it comes down to is how much fat is in that particle. LDL has more fat and tends to deposit that fat in places in the body whereas HDL has less fat and is thought of as bringing fat back from places in the body to the liver to be metabolized.

Eli: So the magic question, which I’m sure you get in your practice all the time, is: How do you raise that good cholesterol, that HDL, and how do you lower that bad cholesterol, the LDL?

Dr. Abrams: I’m glad you asked that for a couple of reasons. One is because you’ll notice a theme here during our talk and it’s that you don’t usually just change one of these risk factors, but some of the lifestyle changes that you can make – whether it’s with diet or exercise or weight loss – things like that, will not only raise your HDL or lower LDL, but it will often affect many of these risk factors at the same time. In terms of what you can do to raise HDL or lower LDL, it comes down to things like diet changes, knowing what you’re eating, and how that affects your HDL or your LDL, doing more exercise, and knowing your own individual risk profile, which your doctor can help you figure out.

Eli: Now some people’s thinking in terms of exercise is that they have to go out there and they have to run for 2 hours and lift weights for another hour. There are some people I look at in the gym and they’re kind of almost, like… possessed. Can you address what sort of the minimum levels of exercise are and what are suggested levels of exercise?

Dr. Abrams: I can and the recommendations are based on the World Health Organization and their recommendations for what they feel is adequate exercise. What I always tell my patients is for about

20-30 minutes per day, about 5 or 6 days per week,
you should try to exercise to the point where you’re sweating.

That means getting your heart rate up and doing something that we categorize as aerobic exercise. Doing it to the point where you’re sweating is probably at a moderate level, which is the recommendation. Things like jogging, walking very quickly, doing stairs, swimming… those types of things are going to be great for your heart health. In fact did shown that about 8% of deaths in total and 20% of heart disease could actually be prevented by doing that level of exercise.

Eli: Wow! Well, I’m glad I run 5 days a week then.

Dr. Abrams: There you go! Congratulations!

Eli: Thank you! So I want to get back a little bit to cholesterol and you used the word “fatty deposits” that the LDL brings into the arteries, I suppose there. I think that most people are pretty confused with the word fat. What is a good fat and what is a bad fat? There are saturated fats and there are trans fats. Can you address that a little bit?

Dr. Abrams: I can and this becomes very important when people start to read food labels or try to arrange their grocery list, decide whether they’re going to order in or make their own food, so diet is very complicated. If there’s one thing you should remember, it’s that trans fats are probably the worst kind that you can have for your heart health. The reason for that is because it usually indicates a very processed food. It’s not something that’s naturally occurring in plants or even in animal fats. It results from the processing and cooking of oils and fats to high temperatures where they become this other term that we may hear, “partially hydrogenated oils.” That’s really just another word for trans fat. Those will definitely increase your LDL, lower your HDL, and cause problems down the line.

Eli: Well, I’m glad you brought that up Dr. Abrams because I think I’ve been a victim of a lot of that “partially hydrogenated oils” because I didn’t know at some point in my life to start checking those labels until very, very later on. It is a little bit confusing for the average layperson because those trans fatty oils are actually called vegetable oils and we’re all trained to think that vegetable is a good thing, but in oils, I suppose it takes on another different meaning. Can you address that a little bit? The term vegetable oil?

Dr. Abrams: I can. So some… again it really gets quite complicated when you break it down, but some vegetable oils are actually not bad for you necessarily. In the processing of a lot of foods and cooking at high temperatures, they become chemically modified to change into these trans fats. And you know, with a lot of vegetable oils, they contain other types of good fats – what we call polyunsaturated fatty acids like the omega-3s or omega-6s – which have actually been shown to be good for heart health. So it really does get complex and that’s why a lot of people need some help in figuring all this out.

Eli: So what oils should we use and what oils should we avoid?

Dr. Abrams: What I tell people is if they’re cooking with things like butter or lard to change that out for olive oil, which has a certain kind of fat – a monounsaturated fatty acid – which is actually good for you with the evidence we have from studies about Mediterranean diet which has been in the news a lot and also in the research.

Eli: So when I go to my doctor, generally I get a blood test that shows 3 things: it shows the HDL level, it shows the LDL level, and it shows the overall level… and it usually actually shows a fourth thing. It shows triglycerides. What else is there? Is there anything else that you look for besides those 4 things?

Dr. Abrams: Those are good things to know and actually our guidelines in terms of treating or not treating cholesterol with medications are really based on those numbers, but there are other considerations for people who may be at higher risk. Just in terms of cholesterol alone, there’s also something that’s been more in the media, but really in research since the 1990s about the LDL particle size. And what that comes down to is how big or small those particles are with the thought being the smaller particles can get to more places in the body and cause more problems even if the total amount that total number of LDL is the same or normal.

Eli: So, We want our primary care physician then to also check for particle size as well as just the numbers?

Dr. Abrams: Well, I think it it needs to be individualized and I hope that people out there don’t think that everything I’m saying is something they need to run out and do because everybody is different. In general, I hope that some of these tips will get people thinking about their heart health. People should really discuss with their doctor what tests individually they need. In terms of particle size, I think that people who have other risk factors, or who maybe had a symptom or an event like a heart attack, but their tests are completely normal otherwise: their LDL is normal, their HDL is normal, and we’re left questioning why this happened… for those people, it can certainly be useful. It’s not in the guidelines so a lot of people aren’t doing it yet, but there is evidence that it does increase risk.

Eli: So we have heard this very popular drug called “statin.” When should someone actually be put on a statin? And what do statins do?

Dr. Abrams: Statins are often called the wonder drug by a lot of doctors and the reason is because they’ve done so great in terms of helping people avoid heart attacks, strokes, and even death. The question of who should be on them is an individual decision. Our guidelines say that the numbers in terms of cholesterol matter a little bit, but we really should put people on them who are at high risk, or even at a moderate risk, depending on their other risk factors. So the number that the guidelines give us is a 10-year risk of having an event, like a heart attack, more than 7.5%. That’s kind of a generalization, which is based on some calculators out there that doctors use, but everybody is different. The most important thing I can tell you about statins or any medication is that preventing the need or the decision to be on that medication, in other words Mother Nature, is almost always going to be more powerful than the effect of the medication. Of course, in people that have already had a heart attack or a stroke, the decision is clear that statins benefit those people. For the people who are at lower risk who haven’t had anything wrong yet, it’s hard to to argue that they should be taking a medication instead of doing lifestyle changes like diet, exercise, and controlling the other risk factors. So when I counsel patients about starting a statin, I always tell them that

there are risks and benefits of every decision we make together whether that’s a medication, a diet change, or anything else. Taking the statin is just one of those things, but I never want it to replace them doing those lifestyle changes.

Eli: You know, I like what you just said because I think so many people will go to a doctor and they kind of want what they think is it kind of easy solution: “Write me a prescription,” “Give me a pill.” and this way I can get away with not exercising 4 days a week… cheat a little on the foods and the oils… smoke and drink a little bit. They feel like they can kind of get away with that a little bit, but you counsel obviously to get that lifestyle thing in order first, right?

Dr. Abrams: Absolutely, yeah… and don’t get me wrong, statins are a great group of medications for the right people, but I agree with you completely. You have to do everything…

you can’t replace the lifestyle changes or the bad things that you do

with the medication.

Eli: So we talked a little bit about oils and probably when people think of blood pressure, they’ve heard of one substance that we use almost every day that has an effect upon our blood pressure. That’s this thing called salt! So can you tell me a little bit about salt’s effects upon the body and alternatives that people might use instead of salt?

Dr. Abrams: Sure! Salt is not good when it comes to heart health, to be quite honest. A lot of people do just fine with it, but for those who are at increased risk based on the other factors in their history, it’s really important to cut back on salt and that’s been shown to have better outcomes in terms of avoiding heart disease. The way it works in the body is it basically directly raises blood pressure by causing you to retain more fluid and it adjusts certain hormone levels in the body that also help to increase blood pressure. It’s not really your body’s fault. It’s just doing the best it can with the salt that you gave it. The natural response to salt is for the blood pressure to go up.

Eli: Hm… So are there any so-called “good salts” that might be heart-friendly such as say, Himalayan salt, which you hear about a lot these days?

Dr. Abrams: So any kind of salt… when we refer to salt or table salt, the type of salt that we put in foods, it’s sodium which is causing the problems. There are other salts out there that use other ions like potassium, but really what it comes down to is whether it’s Himalayan salt, or salt from the Jersey Shore, or salt from the grocery store, those are all going to raise your blood pressure. What we recommend to people who are trying to cut salt from their diet is to replace it with other flavors and other spices that won’t actually cause those problems such as using garlic – not garlic salt, which also contains, you know, regular table salt – but using garlic powder or fresh garlic, or using other spices in your cabinet that don’t contain salt.

Eli: So now that we’ve covered fats and salts, I’d like to get a little bit into the other one that I consider part of the big three: something that pretty much every American is probably eating way, way too much of and that’s sugar. Tell me a little bit about sugar, it’s impact upon the body, and what your recommendations are.

Dr. Abrams: Sugar, I think, is definitely not as bad as cholesterol, but we have to remember that when we talk about sugar, that can mean a lot of different things. Sugar is just really the end result when it comes down to the breakdown of sugars or carbohydrates and your body treats all of that the same way. So people who think that they’re not eating a lot of sugar because they cut out all the candy and junk food, but are having a lot of white breads and pastas and things like that, their body doesn’t know the difference because their sugar levels will be just the same as if they took spoonfuls of sugar instead. That’s very important to realize not because sugar in and of itself is immediately dangerous, but overtime high levels of sugar in the blood can lead to things like diabetes, nerve problems, heart problems, and cause a lot of issues later on down the road.

Eli: So do we continue to take our two lumps of sugar with our coffee in the morning, or do we find a substitute, or do we drink it black?

Dr. Abrams: I think it depends… you know a couple of teaspoons of sugar for most people is probably not dangerous. It’s interesting you say coffee because coffee has been shown to have some benefits for heart health, but the sugar in and of itself, I think, in small-to-moderate amounts is not dangerous. Again remember that includes carbohydrates, which are found in a lot of foods.

Eli: Well you just probably made a 95% of Americans happy who drink coffee. Tell us a little bit about the positive effects on the body that coffee provides.

Dr. Abrams: Yes, it’s interesting because I don’t think that we really know the mechanism or how coffee works in the body to improve heart health, but that said, there have been several studies out there that show coffee’s benefits on heart health and other things like Parkinson’s disease, for example. The statistic I can tell you, which is what I tell patients when they ask – and I’m a coffee drinker myself, so I’m glad that this applies to me – but about 3 cups of coffee or so per day is associated with about a little over 10% lower risk of heart disease in the long-term. And now these studies are not, you know, taking some people and giving them coffee, and some people and not giving them coffee and following them over time. These are just rough estimates… and like I said we don’t really know how it works. You know, a lot of things are hard facts in medicine and this one is less so, but for now, I’ll take it because I like my morning coffee.

Eli: Maybe a few more trips to the bathroom, but it has positive effects and it keeps you happy, so there’s a lot to be said for that. Now, speaking of keeping happy, tell us a little bit about some of the mind-body relationship, you know how the mind affects heart health.

Dr. Abrams: Yes, so this comes up a lot in terms of stress and mood. Things like depression, anxiety, stress levels, and the interactions are not really worked out completely, but I can tell you people that have things like depression and anxiety and stress tend to have more heart problems.

Depression in and of itself is risk factor for heart disease.

People who are anxious or stressed have higher blood pressure. They have certain hormones that are higher levels in the body such as cortisol, which causes some issues with heart disease such as raising blood pressure. So it’s important to know that we don’t need to understand everything in cardiovascular health to understand that some things are just good for you. Finding ways to relax. Or if you have depression, get treated for it. If you have a lot of stress in your life, find ways to de-stress. Those are recommendations that can certainly apply to everyone and if having a doctor tell you that you need to find ways to relax gets you to do it, then by all means… It’s good for you, it’s good for your mental health, and it’s definitely good for your heart!

Eli: So then would you say that you incorporate some of the so-called new-age modalities in your recommendations to patients – things like yoga, meditation, massage, etc.?

Dr. Abrams: I do and everybody’s different. I think some people find that exercising causes them a lot of stress relief. Some people find that yoga, meditation, and things like that help them relieve stress. Whatever it takes for that person, I think it’s very important. I, myself, enjoy taking my dog for a walk and you know, hanging out with friends and family. Things like that are very important to your mental health and also that translates to your heart health.

Eli: So in your notes you have written a pretty sobering statistic that

heart disease actually kills more people in the United States 
than all cancers combined.

Now that is saying a lot! So what we want to do is get into the nitty-gritty a little bit. Talk about some of the things that can help people not to be part of that statistic. Tell us first about any recommended diets that you recommend for people because I think food is probably one of the most important things that will affect our body in every which way. What are your recommendations?

Dr. Abrams: I think diet gets very complicated, but the main thing that I think it’s important to realize is these fad diets or diets that are targeted at specific weight loss plans are generally for two reasons not going to be helpful long-term. The first is that they’re quick. Quick weight loss is generally not healthy. The second thing is that anything that restricts you from doing things you enjoy, whether it’s… you know, once a week, splurging and having a meal that’s not healthy. You’re not going to be able to follow that long-term and these lifestyle changes don’t just matter over the next week or month. These lifestyle changes need to be things that you can do and really stick with and be honest with yourself about over many years. That’s going to help you get the results that you’re looking for in terms of preventing that 80% of heart disease that we can. So in terms of a recommendation, I think the first step is really to understand and be true to yourself about what you’re eating. What I recommend is that people keep a food journal and write down every time they eat something for one week. That includes you know, drinking sodas or alcohol; it includes snacks; it includes other people’s food, which sometimes people say doesn’t count as their own calories. Really understanding what you’re taking in is the first step to coming up with a better plan. The next step is really to decide, what can you realistically do looking back at the past week’s journal? What are the types of things that you don’t mind cutting out or cutting down on and what are the things that you really can’t cut out because you enjoy them too much? And then after you decide that, I think the most important thing I tell people to look for in food items is the amount of fiber because high fiber foods tend to be in vegetables, fruits, whole grains, things that are generally healthier. The good thing about it is that fiber fills people up!

Eli: So we hear this new fad, that’s relatively new at least, called juicing. Now doesn’t juicing take out the fiber from the fruits?

Dr. Abrams: If the pulp is still in the juice, then there is still fiber in it, but a lot of the times it’s drained or people don’t drink the pulp and then the fiber is not in there.

Eli: So we should have the fiber and we should have the whole fruits. That’s better than just the juice, is that correct?

Dr. Abrams: Exactly!

Eli: So what are heart friendly foods that you recommend that people consume?

Dr. Abrams: So I think the most important thing is to be varied in terms of the foods that you do take and as you just said to try to eat them as Mother Nature gave them to us… with not that much processing. If you’re eating vegetables, eat the vegetable and not a pureed or a processed version of it. If you’re eating a fruit, rather than drinking the juice, eat the fruit, which contains the fiber and all of the vitamins and nutrients. In terms of whole grains and carbohydrates, if you ever have the choice, try to avoid white things that contain carbohydrates. So avoiding white breads, white pastas, and substituting that for things like brown rice or whole grain breads, whole grain pasta, because those will have more fiber and that translates to less sugar in your body.

Eli: So we want to get it a little bit into this controversial thing called red meat. What is your take on red meat and its effect upon the body?

Dr. Abrams: So the disclaimer is that a little bit is okay so I don’t want people to get mad at me telling them they can’t have any…

Eli: … You don’t want those associations to send you letters, right?

Dr. Abrams: Yeah…Exactly, but the reality is for a lot of reasons that we’re really coming to better understand now – although we don’t have all the answers – is that red meat, for a variety of reasons, causes bad effects on heart health. A statistic I can give you is that

one additional serving of red meat per day is associated with a 16% increase of dying from heart disease based on research studies.

And that’s… a serving size of red meat is a 4-ounce portion, which is not typically what Americans are eating when they have their, you know, “serving” of red meat. The reason for it is probably because of inflammation that happens as a result of digesting red meat and the interaction with the bacteria that help us digest it in our gut.

Eli: Interesting… so tell us a little bit about this diet called the Mediterranean diet, which we hear so many doctors touting these days. What are your thoughts on that?

Dr. Abrams: The reason the Mediterranean diet has become so much in favor, especially at least talked about among cardiologists, is because of a very large research study that came out a few years ago that showed that

the Mediterranean diet could reduce
the risk of dying from heart disease by 30%!

So a third… which is pretty incredible for just one intervention, one lifestyle change, which is diet. So you may ask, “Well, what is the Mediterranean diet?” It sounds like, you know, the best kept secret in terms of heart disease. It’s really more of a lifestyle in terms of cooking and eating rather than one change, but it involves eating more fresh, unprocessed foods. So if you think of laying on the beach in Greece or going to a Greek restaurant, often you’ll have fresh salads with vegetables, maybe fruits. They use a lot of olive oil instead of other oils, which we mentioned before contains monounsaturated fatty acids, which are good for heart health. And they eat a lot of fish and lean meats, such as chicken, rather than red meat. The last thing, which we haven’t talked about yet, is that they eat a lot of nuts… Specifically things like almonds and walnuts, which also contain a lot of those good fatty acids that are good for heart health.

Eli: So what I’d like to find out about is… I have a lot of friends who are pretty skinny. They’re on a vegan diet. There’s a lot of controversy about vegan diets: are you getting enough protein or other things in your diet? Tell us what your thoughts are about being on a vegan diet?

Dr. Abrams: Sure! Well, I guess I’ll start by telling you that you can’t always judge a book by its cover. So your friends that are skinny doesn’t mean that they’re necessarily healthy. Vegan diets on the other hand definitely lower your risk of heart disease. It doesn’t mean that if you’re vegan, you’re healthy, but if you’re vegan you’re more likely to be healthy because those people tend to eat a lot of vegetables, a lot of whole grains, a lot of unprocessed foods, and they avoid a lot of the meats. Now they do lack some nutrients, some vitamins that come from animal products such as Vitamin B12, which is the most talked about, and so they should under most circumstances be supplementing themselves if they’re truly not getting any animal protein. Vegans, in general, do have better outcomes and it’s because they avoid a lot of those things in the Western diet that are so unhealthy.

Eli: I think you just made a lot of skinny people happy!

Dr. Abrams: Perhaps! It’s a good day for them, I guess!

Eli: Yes. So you touched upon vitamins there and can you tell us a little bit about what vitamins or natural supplements you would recommend for good heart health?

Dr. Abrams: I can. This is honestly one of my favorite questions that patients ask me because everybody’s looking for that natural or miracle pill that they can take.

Part of the problem is they turn to the internet instead of their doctors,

but that’s a culture change that’ll take some time to address. When people ask me the best vitamin or whether they should be taking a vitamin, for most people, the best vitamins or supplements are the ones that you find naturally in food. I don’t mean that you should be taking a whole host of pills that contain various vitamins. I mean that you should be finding foods that are healthy enough to contain those vitamins. If you do that, that’s the best thing that you can do for not only your diet, but probably weight loss, avoiding diabetes, and also for your heart health.

Eli: This may or may not be within your domain, this question, but are there any vitamins that you know of that can actually be dangerous for somebody if they’re taking those vitamins in high dosages or if they’re not supplementing the vitamin with something else that they’re supposed to take along with it?

Dr. Abrams: The answer is I don’t know for all of the vitamins and the reason for that is because a lot of these vitamins that are being sold… and I don’t want to take sides here because everybody is different, but a lot of the vitamins and natural supplements that are sold are not approved by the FDA. What that means is that perhaps not enough research has gone into their development to decide whether they’re safe, or dangerous, or beneficial. So there may be some out there that are fantastic for heart disease and keeping people healthy, but I don’t know that just the same as I don’t know that most of them are not dangerous.

Eli: So most patients are probably not familiar with cardiac calcium. Who should be tested for cardiac calcium? How do you test for it? And why isn’t everyone screened for it?

Dr. Abrams: First off, I guess I’ll just describe what it is and maybe then why it’s there in the first place. What coronary calcium is is calcium that deposits into the arteries – the walls of the arteries – in the heart. Those arteries are called the coronary arteries and so coronary calcium just refers to the calcium deposits that occur there. Why they’re there is because of fat that gets deposited from those particles that we talked about before, the LDL particles. After they drop off fat, it creates inflammation and overtime that inflammation causes basically scar formation, which results in dead cells and calcium. That calcium is the same calcium we find in bone or anywhere else. It doesn’t really mean that the artery is blocked if it’s there, but they’re certainly related. The blockage happens from the fat build-up, which doctors refer to as a plaque. When that plaque breaks – it becomes so big or it’s unstable and breaks – that’s what causes a heart attack. The calcium is just one part of that, which may or may not be there. So in terms of how we test for it and why not everybody gets it, it involves a CAT scan, or a CT scan, and the risk of that, which is small, albeit there, is that it involves giving radiation. Every x-ray or CT scan involves radiation and so it’s not a great test for everyone because of that and because it doesn’t tell us actual information about how blocked the arteries actually are. It does on the other hand give us an idea of how severe the disease is and perhaps how likely those arteries are to be blocked. In that respect, it does relate outcomes in terms of heart attacks. We don’t test for everyone because for a lot of people, they actually don’t need it. There are other tests that give just enough information without the radiation involved.

Eli: So for those with high cardiac calcium scores, how reversible is it?

Dr. Abrams: So this is where the distinction between the blockage itself, which results from fat, and the calcium is very important because the calcium, just like bone, is probably not reversible to an extent where really matters, if it is at all. The blockages, that plaque… there is evidence that you can reverse it with the right changes, specifically in diet. If you can reverse anything, it’s going to be that plaque – the amount of fat in that plaque – not necessarily the calcium.

Eli: So we’re hearing about this food substance that’s in so many different foods… all of our grains and breads, this thing called gluten. Tell us what your thoughts are about gluten and its role in heart health, if any.

Dr. Abrams: Yeah, I think gluten has actually a very interesting course in recent years in terms of what’s been talked about in the press and what it’s been implicated in, but I think what it comes down to is really, you know, patients with this disease called Celiac Disease, which is a sensitivity to gluten. Those people shouldn’t have it. I think that’s clear. For a lot of people not eating gluten though when they don’t have Celiac Disease or an allergy or sensitivity to gluten, it means that they’re cutting out a lot of whole grains, which is where gluten is. It’s not that eating the gluten is bad, but avoiding gluten if you don’t have to may result in a less healthy diet because you’re avoiding a lot of those whole grains.

Eli: Interesting. Can you get into today a little bit about the various heart disease risk factors?

Dr. Abrams: Sure!

Eli: …Besides cholesterol, which we’ve talked about a little bit.

Dr. Abrams: Yeah, just a little bit… I think we touched on it. I want everybody to really think about their family history as the first one because as we mentioned before, genetics does play a role. People who in your family have had heart attacks and strokes at younger ages certainly puts you at an increased risk and that’s something that you may not have spent a lot of time thinking about except when your doctor asks you briefly, “Does anybody in your family have any health problems?” But you should really think about it and think about what ages they had those problems because that really does change your risk. Aside from the typical blood pressure, cholesterol, and family history, which gets at genetics, things that we can’t change are things like age and whether we’re male or female because those definitely… those things make a difference. The older you are, the higher your risk. Being male unfortunately comes with a higher risk of heart disease. We mentioned mood and stress: things like depression and anxiety. Obesity, or even being overweight, is associated with heart disease. Being sedentary, meaning you don’t have an active life and you don’t exercise – what we call a “couch potato” – that’s also associated with heart disease. Your diet, smoking, and the list really goes on and on. The more we learn about patients, the more we talk, the more we can identify the smaller things, which may not in and of themselves put you at a very high risk of heart disease, but they certainly add up over time.

Eli: So what is considered the standard today for what is normal blood pressure and what is considered high blood pressure?

Dr. Abrams: I’m glad you asked. I’m sure a lot of people have heard that the guidelines for blood pressure change recently based on some large, convincing research trials.

Normal now is less than 120/80.

Before, 130/80 was considered okay and a lot of criticism for this was whether doctors or pharmaceutical companies just wanted to prescribe more medications, but that’s not actually the case. As a doctor, I actually prefer not to to prescribe medications if there are lifestyle changes we can do to avoid them, but the interesting thing which people deserve to know is that the reason the guidelines changed is because

lower blood pressure had better outcomes:
less heart attacks, less cardiovascular disease.

And again, that’s not over the course of a week or a month or even a year maybe, but over the long-term, those people did much better. So targeting a lower blood pressure is what we try to do whether that’s with medication or exercise or cutting salt out of the diet… things like that. High blood pressure is now considered 140/90 or greater. In between that 120 and 140, or for the bottom number called the diastolic blood pressure, 80 and 90, people are at risk and have what we call sometimes pre-hypertension, or they’re likely to develop high blood pressure if they don’t make any changes.

Eli: Interesting. One of my listeners has asked me to ask you a little bit about the connection between their low thyroid issue and the heart. Does that play into the heart health in any particular way and are there any particular recommendations, such as avoiding gluten or anything else?

Dr. Abrams: Yes, thyroid disease and heart disease do have things that go together and again I stress that the purpose of talking about all this is that I hope people learn something about their heart. If there are specific questions or you know, treatments that I’ve mentioned, it’s not meant to be personalized advice or medical advice for individual listeners, but I’m happy to talk about the thyroid and heart disease. The reason why the thyroid is so important is because when we talk about metabolism, or people having fast metabolism or slow metabolism, a lot of that can relate to the thyroid. So having your thyroid checked if you have certain symptoms that your doctor can ask you about, is very important. Having a normal thyroid is important for normal metabolism. When we talk about metabolism, that’s when we get into cholesterol, being overweight, and other things like that, which is why the thyroid is so important.

Eli: So in your notes you had another pretty sobering and almost alarming sort of statistic here. You said that

early evidence of blockages in the arteries of the heart
is seen in as many as 85% of adults age 21-39!

That’s pretty young! So I want to know and I want my listeners to know a little bit about your practice called Heartbeat and what Heartbeat does to help people not get down the road 20 years later and learn some things that they may have learned in their 20s and 30s. Tell us a little about Heartbeat.

Dr. Abrams: Absolutely! Let me just start by saying that statistic should shock people, but it should also motivate people. I think what people may or may not understand is that that’s why a lot of heart disease out there is preventable… because it starts decades before the actual problems develop.

At Heartbeat, what we’re trying to do is refocus and modernize cardiology by combining a great team of cardiologists, educators, engineers, data scientists, and more to get people easy access to specialist-level knowledge about heart health so that we can have people seeing cardiologist not after they have a symptom or a diagnosis like their first heart attack, but get people to see a cardiologist when they can actually make changes to prevent that heart disease.

That’s what we’re passionate about and we feel that this philosophy and this paradigm shift can really help prevent heart disease.

Eli: I want to make it clear to my listeners, you know, that I do not have sponsors on my program and I do not advocate or make recommendations. The people who I have on my program… that’s simply their point of view and our listeners can choose to engage with the guest on my program or not. That’s strictly up to them. I do want my listeners that are interested in what you have to say… I want them to know a little bit about where you’re located and how they can get in touch with you if they would like to.

Dr. Abrams: Absolutely! We’re located here in the lovely Columbus Circle at 60th Street and Broadway in New York, New York and the best way to get in touch with us, which you may not be used to in communicating with your doctor, but it’s through our website, which is

hiheartbeat.com

or “h,” “i,” “heartbeat dot com.” On there you can take your own risk assessment, which will give you some recommendations about coming in to see us and about your own heart health. You can also text us from the website. You can email us from the website. You can learn more about what we’re doing. Going to our website will give you a lot of information about what you can do to get in and see us quickly. We’re here 7 days a week. We’re here for our patients. We love for people to come down, check us out, and as a team, let’s get healthy together!

Eli: So, a lot of my listeners are from other cities, other states, even other countries. Is there a way for out-of-towners to engage with your services?

Dr. Abrams: Well, you can certainly contact us through our website and we’ll be happy to communicate with you by texting and emails, things like that. You can also follow us on Facebook and Twitter and communicate that way. You know… We’re creating a culture change, not just a cardiology practice, so you can expect to find us in the years to come in other areas around the country… hopefully quickly so that we can really help as many people as possible. The first step is definitely knowing your risk and contacting us, asking for help, because we can help you. Now’s the time… when you’re feeling good, not after you have a symptom or a heart attack.

Eli: Dr. Abrams, when I go to a doctor or cardiologist, that can be very stressful for me. There’s a lot of fear in finding out things that you sometimes… I would prefer almost not to find out, but obviously, you know, an intelligent person knows that they have to be checked and preventive is better than certainly finding something out when it’s too late. How does your practice and how do you personally would put patients at ease so that they don’t exhibit what I probably have exhibited when I visit a doctor, something called the White Coat Syndrome? Tell us a little bit about what White Coat Syndrome is and how to avoid it.

Dr. Abrams: So it often refers to high blood pressure that people have in the doctor’s office and I agree. Even when I go to a doctor, it involves a lot of anxiety, a lot of anticipation about what’s going to happen and what the doctor is going to ask. By coming and trying to attract people when they’re healthy and feeling good, we really want to encourage people to do that so they can learn more about their heart health. A lot of people nowadays when they have a question about their health, they either turn to friends and family or they turn to the internet. That may or may not provide good information, but hopefully knowing that you can come in, be greeted directly by your doctor at the door who will sit down with you, answer all your questions… It won’t be a rushed visit. You can ask them questions afterwards or beforehand through texting or email. You’re really engaged in the entire experience and part of the Heartbeat team in terms of getting healthy. Hopefully that takes the edge off so-to-speak in terms of being motivated to come down, get checked, get some good advice that’s based on evidence that really helps you live for many, many more years to come.

Eli: Well, I like what you said about taking the edge off because there are so many physicians where you walk in the office and their bedside manner isn’t exactly helping your blood pressure.

Dr. Abrams: That’s true!

Eli: Great! You sound like a really friendly, easy-going guy and that’s something that I can certainly relate to. So I want to get into a real serious question here. What should somebody do immediately if they feel chest pain or any signs of something that might be a possible heart attack?

Dr. Abrams: So the first thing to do is to seek medical attention immediately especially if you know you have these other risk factors for heart disease. Whether that’s calling your doctor if you don’t think it’s an emergency or you don’t really think you’re having a heart attack, but want to talk about symptoms, or calling 9-1-1 and going directly to the emergency room. I think it’s better to be safe than to be sorry here. We have a saying in cardiology that

time is muscle

and nowadays with the procedures that we have, if you are having a heart attack, it’s important to open up that blocked artery as quickly as possible and not sit at home thinking that it’s going to go away. There is one other point that I’d like to make, which is that chest pain or what you see on the news or in the press about, you know, left arm pain and jaw pain and that being a sign of a heart attack is not the only symptom that people get. Women, more often than not, and people with diabetes, more often than not, don’t actually have that typical chest pain. They may have other symptoms like nausea, or belly pain, or vomiting, or dizziness, and so it’s very, very important that you educate yourself about what the symptoms are and if you have any of them to seek immediate medical attention.

Eli: So we have a couple of minutes left in the show and as a patient, when I go to my primary care physician, there are a lot of people in the waiting room and you’re lucky if you get somewhere between I guess 10 and 15 minutes from the doctor. Sometimes you leave feeling that you haven’t had all your questions answered. Perhaps you didn’t even get everything screened for that you should have because there’s only so much time the doctor can spend with you and address the immediate questions and the immediate issues you came in for. What should everybody be screened for at their doctor’s office that perhaps not every primary care physician screens for?

Dr. Abrams: Yeah, I mean… As we’ve been talking about, heart disease, or

cardiovascular disease, being the number one killer in our country, the number one cause of death, really deserves a lot of attention

that… nothing against primary care doctors. They have a very tough job and a very important role in our healthcare system, but heart disease is just one of the aspects of a primary care visit that needs to be addressed, which is why we’re trying to change that culture of needing to go and have a symptom or have a problem before you see a cardiologist when it comes to your heart health. I’ll give you an example. You know, you talked about the anxiety that people have for doctor’s appointments. It could have to do with on average, people have to wait three weeks for an appointment, they spend an average of about half an hour in the waiting room, and then as you said, their visit is about 17 minutes on average in this country. What we’re trying to do is really identify people that are interested in knowing their risk, doing things that they can try to do to reduce that risk of heart disease, and dedicating an entire visit to it that’s longer than 17 minutes. If people have questions before, during, or after, we’re very easy to get in touch with through texting, phone calls, email. We’re always available to help and we’re always available in person as well. I can tell you, every time I’ve been in our office, there have been zero patients in the waiting room and that’s because people don’t wait. They’re greeted at the door by the doctor and they’re taken right in, which creates a very nice environment, I think, for patients to come. It takes the edge off, as we said, and gets them the advice and the counseling that they need in order to be healthy.

Eli: Well, you have been a tremendous guest today and I want to thank you, Dr. Mark Abrams, for coming on our show. For those who are listening, go on his website, hiheartbeat, “h,” “i,” “heartbeat dot com” (hiheartbeat.com) and fill out their form. Thank you again. You’ve been tremendous.

Dr. Abrams: Thank you so much for having me. I look forward to seeing everyone here at our office!

Eli Marcus is the host of The Motivation Show on Party934 – Independent Non-Traditional Radio, which airs live on Saturdays and Sundays from 10-11am. You can follow him on  FacebookInstagramTwitter, and LinkedIn.

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