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With age comes an increased risk for heart disease Broadcast Retirement Network’s Jeffrey Snyder discusses how to prevent cardiovascular disease at any age with Cone Health’s Mary Branch, M.D., M.S. Jeffrey H. Snyder, Broadcast Retirement Network Good morning, welcome back to the broadcast Retirement Network. This is BRN AM for Wednesday, July 31st, 2024. And our top story today, ways to prevent heart disease. Joining me now to discuss this and a lot more, Dr. Mary Branch is a cardiologist with Cohn Health. Dr. Branch, it’s so great to see you. Thanks so much for joining us on the program this morning. Mary Branch, M.D., M.S., Cone Health I’m happy to be here. Thanks for inviting me. Jeffrey H. Snyder, Broadcast Retirement Network Yeah. And we’re going to talk about heart health and hypertension and all the, all points in between. I want to start with some, maybe some basic, a basic question, which is heart disease. How do you, how do you just, how do you define heart disease? Mary Branch, M.D., M.S., Cone Health Yeah. Heart disease is a spectrum. So I think it’s challenging when folks think about their heart health and heart disease in general, because there’s many different facets to it. So your heart is kind of like a house. So there’s plumbing, there’s electricity, there’s pipes. So things might be going wrong with the pipes, which is your arteries that bring blood flow to the heart muscle. So they can have blockages sometimes that have to be fixed with a stent or a surgery or medications. You can also have electrical problems. So electricity helps the heartbeat and function. And so if there’s a disruption in that electrical circuit, then that can cause problems as well. That’s considered heart disease. Or if you have a fast heart rhythm, that’s abnormal, like atrial fibrillation, that’s an electrical problem. And then pumping, your heart’s a pump. So if there’s something that goes wrong with the pump, if it gets weaker, that’s more in line with heart failure. And so that’s that sort of facet of heart disease. So it’s a broad spectrum of problems, and there’s still more than that. You can have cancers in the heart. You can have many different issues with your heart, but those are kind of the broad categories. Jeffrey H. Snyder, Broadcast Retirement Network And what I know, just as a regular person, even without seeing my practitioner, my primary care or another physician, what I know if I have heart disease or have a problem, I would imagine like shortness of breath. My breath might be a symptom, but are things that we should be thinking about as we’re kind of walking the streets and going about the course of our lives? Mary Branch, M.D., M.S., Cone Health Yeah. So it can be tricky because these symptoms can be a sign of heart disease, like you mentioned shortness of breath, but it could also just be deconditioning from not exercising as much. It could be COPD. So it’s hard to, because when you Google a symptom and everything comes to the list, it’s hard as just being a human being to know how to differentiate those things. So that’s why it’s helpful to have a partnership with a primary care physician to kind of work through what might be going on. So thinking about yourself, you want to think about, well, what is my risk for heart disease? So if you’re thinking about blockages, if you’ve had family members who under the age of 60 have had multiple heart attacks, then that might be one indication that there may be a genetic risk. If you have risk factors like diabetes, smoking, those are also signs that you may be at higher risk for heart disease. So if you’re having the shortness of breath, it may be more likely that it’s related to heart disease if you have those risk factors. So it kind of depends on what we talk, we say sort of someone’s pretest probability. What’s the likelihood that you actually have an issue? And also age. If you’re older, it’s more likely that it can be related to heart disease as opposed to if you’re, say, in your 30s. Jeffrey H. Snyder, Broadcast Retirement Network And when it comes to heart disease, and again, I’m going to lump it all together because I’m a lay person, I don’t have your expertise. Where does that fit in in the diseases in our country? I mean, is it at the top? Is it in the middle relative to other diseases such as cancer, diabetes? And how is it trending? Is it trending up or down? Mary Branch, M.D., M.S., Cone Health Yeah. So cardiovascular disease overall is the number one killer, and cancer is certainly a close second. So it’s extraordinarily prevalent. And as I mentioned, a lot of that risk just comes with aging. And so unfortunately, that’s not something that we can necessarily prevent. We’re all going to age, our vessels are going to get more plaque, they’re going to get hardened, and we’re going to be at risk for heart attack and stroke just as a process of aging. So when folks say, oh, my grandparent had a heart attack, so it rose to my family, well, it’s just common in general, so that’s not necessarily a genetic predisposition. But if somebody was younger, under the age of 50, then there may be some genetic factors there. Jeffrey H. Snyder, Broadcast Retirement Network Yeah. And last question before we go to a commercial break, how much does food and what we consume play a role in heart disease? And I’m thinking, if I go to Chick-fil-A, they’re not a sponsor, by the way, but if I went to Chick-fil-A and had a grilled chicken breast sandwich versus if I went to, had some fried food every once in a while, how much does that play a role in some of the challenges that we’re talking about this morning? Mary Branch, M.D., M.S., Cone Health Yeah. So food is really, I would think of it as a medicine. So the American Heart Association is really trying to push the initiative of food as medicine. So food is extraordinarily important in terms of what you put in your body. So if you’re eating a lot of high cholesterol, that can increase your cholesterol burden, your burden of plaque, and your risk of heart disease and heart attack and stroke. If you’re eating a lot of calories that are unhealthy, then you’re going to have a risk of obesity. Obesity has a lot of associations with sleep apnea, atrial fibrillation, heart failure. So what you’re putting in your body is extraordinarily important in terms of how you can try to reduce your risk of cardiovascular disease. So keeping your weight down and really being cognizant and intentional about what you are putting in your body is important in terms of being able to try to prevent heart disease. So medications are helpful, but they only have kind of a marginal benefit. What really helps the most is really your diet and your physical activity. That’s where you’re going to get the biggest bang for your buck, is what you’re consuming and your activity during the week. Jeffrey H. Snyder, Broadcast Retirement Network Let’s talk about prevention. And you talked a little about this at the beginning, visiting that primary care physician at any age. How important is that to detecting early onset of heart disease? Mary Branch, M.D., M.S., Cone Health Yeah. So it’s extremely important. One, because it’s about establishing a relationship with a physician early so they can get to know you. What are your typical symptoms? How do you respond to different things? So it helps to have somebody who knows you at baseline so that if something changes, they’ll know, oh, so-and-so usually doesn’t complain about X, Y, and Z, but now they’re saying they’re short of breath. So it really helps to establish that relationship and have that advocate physician who knows you when there’s an issue, someone who, say, you go to an emergency room, they can reach out to that primary care and try to get a better sense of how to better help you because everyone’s different and everybody’s going to present differently. So in terms of age, I typically recommend folks at least by 40 establishing with a primary care doctor, not just for your cardiovascular health, but your overall health in terms of as women, we start to need mammograms and colonoscopies are starting earlier. So we’re seeing a lot of comorbidities just in general in younger folks. So it’s really important to start early so that by the time you’re 50 and 60, you’re not dealing with cancer that could have been prevented or a heart attack that could have been prevented. So it’s really important to start early. Lab tests that can be done initially are looking at your lipid profile, so your cholesterol. Is your LDL very high? Do you have a genetic predisposition to high cholesterol and can that be targeted and treated so that that can prevent your risk of cardiovascular disease? So again, it’s just good to just kind of establish a baseline with someone so that if anything changes, they’ll know, OK, this is how this person’s labs were at baseline. This is what their EKG was at baseline. So we’ll know if anything changes what to do. Jeffrey H. Snyder, Broadcast Retirement Network And you mentioned, you know, insurance, a lot of people have insurance, either they get it through their employer or they get it through one of the exchanges or they just go out and buy it. The insurance insurance typically covers what we’re discussing this morning, does it not? Like going to the primary care physician, getting basic blood workup. So it’s not like it’s that big of an out of pocket expense or a huge expense. It’s really just a function of you just got to do it. But but it just seems like I would do it. I’ve done it and I visited the primary care physician since I was like 18. It just seems like that because it’s covered. Why not do it? Mary Branch, M.D., M.S., Cone Health Yeah, I think that’s a great point. So if you think about it, let’s say there is some, you know, small amount of out of pocket expense that is allowing you to save a lot of money on the back end. If you did develop a stroke, think about the cost of being in the hospital. If you had to take an ambulance, that’s very costly. Rehab, all of those things cost a lot of money. So if you’re going to the clinic, let’s say the copay is ten dollars or there’s something that you’re thinking, I don’t think it’s worth it. Just think about you’re saving a lot of money on the on the back end, because as you get older, this may be the only thing you do pay as opposed to an extended hospital stay or more medications or an intervention like a heart catheterization or surgery. So I would just think about it as actually saving yourself some money if you’re on the preventative side. Jeffrey H. Snyder, Broadcast Retirement Network Yeah. And proactivity is certainly better than reactivity, at least when it comes to disease and diseases like heart disease. Dr. Branch, let’s talk a little bit about treatment in the closing minutes of our time together. Let’s just say I’m diagnosed with heart disease. I have a high LDL. I bloodwork and I’m showing signs. How do you what has been developed? What has been the evolution of treatment? Science is amazing, especially in the last decade. So there’s probably a lot we can do to recede some of this this disease. Mary Branch, M.D., M.S., Cone Health Yeah. So the medical management has been has been there’s been a lot of great strides and in terms of one cholesterol lowering medications. Now you have injectables that are a lot more effective in dropping your cholesterol and reducing your risk for cardiovascular disease. So or if you have heart failure, there’s a lot of new medications now that really help improve the heart pumping function, like in Tresto, for example, that really makes a difference in patients. And I’ve really anecdotally and through the data have seen the improvements that these medications can make. So, you know, so from that perspective, they’ve done very well to the point where you haven’t needed as many interventions as you may have needed in the past on both on medication. So if someone comes in, they have these risk factors or they have documented coronary artery disease, say from a CT scan, a lot of folks may get a CAC score if they’re concerned and they have a high family history of coronary artery disease. So if your CAC score is high, the first question is, are you having symptoms? Are you having chest pain? Are you having shortness of breath? Is this something that’s progressive? If there’s something that’s progressive and there’s a concern, then there’s an indication to maybe go in and take a look with the heart catheterization. But if you’re not having any symptoms at all, you actually can just manage it with medications. So what we typically do on a preventative side is hit certain targets. Target number one is your cholesterol and that LDL. If you have a lot of plaque, you want the LDL to be less than 70. Another target we try to hit is weight. So having a healthy BMI can certainly help prevent your risk of heart disease and disrupting plaque to cause a heart attack. Next is lifestyle. So if you’re smoking, got to quit smoking. That’s the worst thing that you can do for your health. And if you have diabetes, a lot of these medications like HDLT2 inhibitors can be very helpful, again, in preventing cardiovascular disease risk. So those are certain targets that we aim to to treat. And then aspirin as well. If you have, again, a really high sort of coronary artery calcification. So we start with medications. We aim to hit those targets. And then if you’re developing symptoms, then that’s an indication to go in and try to fix it. But otherwise, again, it’s lifestyle and prevention management. Jeffrey H. Snyder, Broadcast Retirement Network I mean, it just seems the way you lay it out just seems so easy in the earlier start. It’s like I was likened to compounding, compounding interest. You start early saving. You’re going to have a lot more if you if you start early because the power of compounding, if you start early with your visits, getting things, you know, getting basic information, you’re going to be a lot better off long. Mary Branch, M.D., M.S., Cone Health Yeah. So I say, you know, the best way to treat a disease is actually to prevent it. So if you don’t have it to begin with, then, you know, you don’t need to worry about how do I treat this disease now on the back. And once again, there’s some things you can’t help. So, you know, after the age of 80, your risk of atrial fibrillation goes up or coronary artery disease after the age of 70 or so goes up. There are some things that we can’t mitigate. Aging is one of those things. And I think nowadays it’s been hard with a newer baby born population. They want to you know, it’s hard to kind of conceptualize that the body is just aging. And unfortunately, we can’t always change that. But certainly starting young and being as healthy as you can to give yourself the best benefit in terms of if things do go wrong, that can be helpful as well. So it’s always a good idea to try to prevent. Jeffrey H. Snyder, Broadcast Retirement Network Yeah, absolutely. Well, Dr. Branch, so great to meet you. Thanks so much for joining us. And we look forward to having you back on the program again very soon. Absolutely. I hope this is helpful. That wraps up this episode of BRNAM. Have a topic of interest, someone you think we should talk to? Drop us a line. And don’t forget, for all the latest curated news and lifestyle wellness, finance, tech, so much more all in one place. Check out today’s edition of our daily newsletter, The Morning Pulse. Want to search our archives, check out our latest content? Well, then visit our website. 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