Heart health 101

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MYRNA BROWN, HOST: Up next, a bit of a turn here… to heart health.

It’s hard to believe it, Mary, but it’s been a year now since you were hospitalized with heart problems.

MARY REICHARD, HOST: Yeah, that’s right.

BROWN: So we thought on this one year anniversary would be a good time for an update, and what you’ve learned.

REICHARD: Learned a lot! A crash course in cardiology 101 really. First thing I learned is that heart disease is the number one killer in this country.

I started listening to Dr. Joel Kahn, recommended to me by a listener, in fact. Dr. Kahn’s a preventive cardiologist, also a clinical professor and an author.

JOEL KAHN: Every 34 seconds in America, somebody dies of heart disease. That’s number one by far. Every year for over 100 years number one. Equally shared between men and women.

Those numbers land personally, because I’m one of those statistics. I had a heart attack last spring.

KAHN: The body has an amazing ability to hide disease and that’s not just heart disease. 

I think you just shared with me that there was a period of time before you had your cardiac history that, in retrospect, you think you had symptoms. And many people think it's heartburn. Think it's, they've strained the muscle and all that, but a lot of people literally have no symptoms til the day they have a heart attack, or occasionally the day they drop dead, which is obviously so tragic.

Truth is, I had symptoms for years. And I have a terrible family history of heart disease. But my then-cardiologist said all was well.

He asked if I was having chest pain. I said no. What I didn’t mention was the neck and jaw pain I would get just sitting at my desk. And he didn’t ask me that.

Then one night, I woke up around 3 a.m. with excruciating jaw pain—I mean, I thought my teeth would explode out of my head. First, I remembered that doctor telling me I was Type-A personality and probably just needed to calm down.

But… I’d been asleep. So how uptight could I have been?

Then came the second thought: maybe I’m dying. I braced for that and imagined heaven. Instead, I fell back asleep. And the next morning, I got up, went to work, told not a soul. Queen of denial!

Months later, I switched to a functional medicine practice. My nurse practitioner ordered a heart calcium CT scan. You want a zero score on that. Mine was in the high 400s.

Dr. Kahn says my story is all too familiar.

KAHN: There is a test that’s the equivalent of a mammogram for breast cancer and the colonoscopy or ColoGuard for colon cancer.

So don’t wait for symptoms. Everybody—I use hashtag, ‘test, not guess.’

It turns out, I had an 90% block. One thing led to another and I received two stents last August. I’ve been in exercise therapy, taking medications, and eating better ever since.

The test Dr. Kahn wants everyone to know about is that heart calcium CT scan. Randomized studies show better outcomes with that known score.

Now, some people with high scores may not have significant disease and in the wrong hands, it could be used to promote further unnecessary testing. But it’s noninvasive and relatively cheap—especially considering the risk.

KAHN: There’s no needle, there’s no injection, there’s no allergy, there’s no kidney damage. You are exposed to radiation, typically less than a mammogram. And you do it maybe once, or maybe once every five to 10 years based on the outcome.

That test has been widely available for 30 years, 10,000 research studies. And I don’t think 5% of primary care docs order it. I don’t think 5% of cardiologists order it. Almost every hospital in America offers it.

His point is clear: ask about the test.

Back in the 1960s and 70s, researchers identified the “Big Five” heart risks: smoking, diabetes, high blood pressure, high cholesterol, and family history.

But Dr. Kahn says the list is a lot longer than that.

KAHN: Most of them are testable. Some are hugely important, and one is actually—we now recognize—that air quality and air pollution triggers heart attacks.

I hadn’t known that, either. I’d been shoveling mulch around and breathing in dust all day around the time I had my heart attack. Live and learn.

He also wants people to know about a cholesterol particle that is rarely checked:

KAHN: The one that I want everybody to know the name of: It’s a long name: lipoprotein, little a. And if you notice that’s not a capital A, it has to be a lowercase a. It’s a terrible name for a cholesterol particle that 25% of people inherit from mom or dad… Primary care doctors don’t check that darn box.

While genetics matter, lifestyle matters more.

KAHN: Well yeah, we always say the genes load the gun, the lifestyle pulls the trigger. There's no doubt if you got a bad family history of cardiovascular disease and you love your coke and cheeseburgers and french fries and your recliner watching TV all night, you're in trouble, particularly if you smoke.

Dr. Kahn’s top five prevention steps are straightforward, almost like mother always told you:

KAHN: Quit smoking. You know, there’s still about 10 to 15% of Americans, way down from 50%, but 10 to 15 is still too much.

Get enough sleep:

KAHN: Seven to eight hours quality sleep. If you’re snoring, get tested. There’s things called home sleep studies.

Yea, I also had sleep apnea. Some people need a C-pap machine, but a mouth device worked for me.

And the third prevention step:

KAHN: Nutrition, nutrition, nutrition. Again, I'm not here just to promote, but read my book, The Plant Based Solution. It's a couple years old, with beautiful blueberries, beautiful recipes. The science, you know, yeah, carnivore and keto and paleo and Mediterranean. Of those, the Mediterranean is clearly the best choice.

Fourth step: move.

KAHN: Walk, get your 7000 steps a day. That’s the new number. Do some strength training. Do some balance training. You don’t have to do a marathon or triathlon, in fact, some data, those create as much harm as good.

And fifth step: manage your stress. He strongly recommends things like meditation and controlled breathing as tools to help patients relax…also going to church or synagogue ...

Dr. Kahn is a proponent as well of ECP therapy (extra corporeal pulsation). I’ve been doing that myself. You lie on a table, there’s a Velcro cuff around your pelvis, thighs and calves….

KAHN: …calves, connected to a computer console… and it goes boom, ba-boom, externally. And it really helps circulate blood. Some people call it exercise lying down…

A doctor named Peter Cohn studied it:

KAHN: He saw people that were having chest pain, shortness of breath, had a bypass or had a stent, but they didn’t.

The therapy, which takes 35 sessions one hour each, was FDA approved in the 1990s. Insurance sometimes covers it, and it can help some patients avoid bypass.

Dr. Kahn leaves patients with two reminders:

KAHN: Test, not guess. And number two, I say all the time, ‘A person with good health has 1000 dreams. A person with poor health has only one dream—of course, getting their health back. You don’t want to wait. You want to get checked.

Heart health isn’t something people think about very much, until they have to, like I did. I’d also convinced myself I didn’t have the time to deal with it.

Trust me, that’s a mindset each of us should change. I’m Mary Reichard.

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