Everything You Need To Know About Heart Health With Dr. Keith Ferdinand (Video)
Dr. Keith C. Ferdinand: I'm Dr. Keith C. Ferdinand. A Cardiologist at the Tulane University School of Medicine. I'm the general is VeriSign endowed chair of preventive medicine at the Tulane Heart and Vascular Institute. Here in New Orleans, Louisiana.
While there are many types of heart disease. But if you look at the number one cause of death in the United States across all populations men and women; whites, blacks, Hispanics, Asians, and others. Cardiovascular disease cardio for heart vascular blood vessel stats heart attacks and strokes is the number one cause of death. While the reasons are multifactorial. Genetics plays some part of it. But, if you look at societies where people don't have a lot of processed foods, a lot of high sodium food to consume large amounts of animal fat. For instance, rural China, rural Africa, the Amazonian basin they don't have the same rates of heart disease that you see in the United States. So clearly environmental factors what we do or don't do appropriately leads to heart disease in many cases. I don't want to go too much into genetics because I think people use that as a fallback position. But for instance, there are genes that in the West African environment may be protective for instance against African sleeping sickness. And those same genes in modern American society may cause an increase in cardiovascular disease and kidney disease. But that's only a small point to make. The most important point is that African-Americans tend to eat foods that are high in sodium more processed foods and higher animal fat as Malcolm used to call it living low on the hog.
Or diabetes and heart disease kind of played dual parts in the increase in cardiovascular disease in African-Americans the rates of diabetes are higher than that in the general population. Now, remember there are two types of diabetes there's Type 1 diabetes which is often seen in younger persons. Who are born with a defect in insulin or have an inflammation of the pancreas and don't make enough in. Most adults and we used to call it adult diabetes we don't use that term as much anymore. Have type 2 diabetes and that along with most forms of cardiovascular disease and hypertension are related to consuming too many refined carbohydrates, an increase in obesity, and overweight status. And what we call a sedentary lifestyle. Big words meaning a person who is not physically active.
And before we came on I even made it sounded like a joke. But I really use it when I see patients. The Fred Sanford syndrome because the comedian read Fox did a great example of describing how a person could have a heart attack suddenly feeling fine a minute or so before that happens. So it's difficult sometimes to predict who is going to have a heart attack or stroke and when it's going to happen. One of the ways we try to predict that is to accumulate risk factors. Risk factors are things that increase your chances of having a heart attack or stroke. Some of the risk factors, of course, is age.
Older people have more heart attacks and strokes than younger people. We've already spoken about the causes of diabetes. Most people know that cigarette smoking is clearly a risk factor but especially in the African-American community, an elevation of blood pressure also defined as hypertension is a powerful risk factor for heart disease and strokes. So you can actually go on to the website and look for heart risk calculation or ACC Age risk calculator and it will show you if you plug in your age, your sex, whether you have diabetes, whether you smoke, whether you have hypertension, and what your blood pressure is, and your cholesterol numbers it will calculate your risk of having a heart attack stroke or dying over the next 10 years.
The way we calculate risk is by looking across the population and people who plug in certain numbers will have a risk that's reflective of people similar to them in the general population. Once you calculate risk it's not a permanent thing. You can modify a risk. For instance, you can control your blood pressure by decreasing the amount of sodium in your diet, losing excess weight and becoming more physically active. You can control diabetes by avoiding refined carbohydrates again. Physicians have big words we're talking about white bread, white sugar. Those forces will go into the body and increase the risk of diabetes. No one should smoke there's nothing good about cigarette smoking. And of course we can't do much about age but you don't want to modify that risk. We hopefully can age gracefully.
You know I mentioned earlier the Fred Sanford syndrome and Red Fox did a great job of depicting someone having a heart attack. But a heart attack is an equal opportunity killer. In fact, there are more women. Then men who have heart disease. Now, why is that? That is because as we age our risk of heart disease increases there are older women and older men in the society. So if you took all the people in the United States. And you put women on one side and men on the other side. There would be more women with heart disease than men. February is Heart Month. February 1st was to raise red dress day. And that's why I have a little red dress. No, I'm not wearing a red dress. This pin. Is a sign to allow us to remember that heart disease in women is a real problem.
Symptoms can sometimes be confusing. The heart lies in the middle a little bit to the left on the chest while right behind the heart is the esophagus, a feeding tube. If you have gastroesophageal reflux. Again doctors got big words. Gastro for stomach, esophagus for the feeding tube, and acid come into the area. The pain can be in the same area as a heart attack. So if you have severe gastroesophageal reflux they call it Gerd, G-E-R-D or heartburn. It can mimic the signs of a heart attack. How do you know the difference? Sometimes you don't. And that's why it's important to have an identified source of primary care. Someone you can go to and get an EKG or be evaluated. And don't just use the emergency room as that source of care because it's expensive. It's timely and it's often not necessary. If the pain is severe and recurrent especially accompanied by shortness of breath and swelling. That may be a sign of a heart attack especially an old individual. But we don't diagnose of course without seeing the patient. And that's why it's important to have that identifiable source of care.
One of the important things that you do when you go into a hospital setting or a clinic setting is to ask the physician or the provider. It may not be a doctor could be a nurse practitioner, physician's assistant. What test am I having done and what is the indication? Indication meaning what's the reason for the test. Another important thing to do is when you get that particular test we talked about the EKG, where you run the strips to see the electricity in the heart. You can also get the echocardiogram. It's an ultrasound test. The same tests we do on pregnant women to see if it's a boy or a girl or twins.
That test and be on for it and it can show the heart pumping action you can see the valves and how the blood circulates. You may get a stress test when you walk on the treadmill similar to what you may do in a gymnasium. But in this particular case, you're hooked to an EKG machine and it monitors your heart while you exercise. So that's important. What is the test that I'm having done and why am I having it done? Another thing that I really suggested everyone do is when you get a test whether it be a laboratory blood test, an EKG, an echocardiogram, or stress test get the results. Don't assume because quote nobody called me it must be OK because many times I've seen people who have diabetes, elevated cholesterol, an abnormal EKG, and the hospital or the physician or other provider neglected to inform the person. It will come in a week later, two weeks later, a month later they say well did you know you had elevated cholesterol? Did you know you had diabetes? And your answer should be no one called me. So if you have a test done get the results.
Getting in the hospital can be difficult if you just go to the emergency room and you're sitting and you don't articulate or say exactly the magic words. They may have you wait if you call 9-1-1 and you're transported by an ambulance or emergency services. You go to the front of the line. Now you don't do that unless you're pretty sure there's something serious going on. How do you know that? First of all, know your risk factors. Know if you have diabetes, hypertension if you smoke. We didn't mention positive family issue but that also is a risk factor. In that particular case. Then you may indeed not be having heartburn or just an anxiety attack. It could really be a heart attack.
Hypertension is a somewhat arbitrary factor. We used to say 140 over 90. Now it's come down to 130 over 80 and some people will say well now they're changing the numbers. They're giving people disease. Well not really. Optimal blood pressure is less than 120 of age. As the blood pressure goes up. That force hits against the eyes, it hits against the kidney, it hits against the heart. It increases your risk of having a heart attack. 140 over 90 was arbitrary. There's nothing magic about that number. And in fact, if you wait to your blood pressure's 140 over 90 before you intervene your risk of having a heart attack is twice that of less than 120 over 80 which is normal blood pressure. We spoke earlier about men and women and I mentioned women having heart disease. The same is true for high blood pressure or hypertension. If you take all the people, the United States who have hypertension you put women on one side and men on the other side. There are more women who have hypertension than men. In the black community, this is a real problem because black women have an increased risk of having a heart attack. More similar to that seen with white men than white women. Almost to the point that being a black female removes the protective effect of being female.
The increase in heart disease risk seen in the black community may have some genetic components but I really believe that is driven mainly by what we do to ourselves. You know many people have what I call the love of slave food. Pigs feet, pig’s liver, pig’s jaws, bacon, grease, and that's good if you need it and you don't have anything else to eat. But wow this is 2019. We've moved forward and the data seemed to indicate that decrease in saturated fat. What's the saturated fat? Usually, an animal fat, something that's hard at room temperature increases the risk of heart disease. The main diet then should be what they now call a plant-based diet. Everybody has these fancy names but you're basically talking about fruits, vegetables, root vegetables, occasional amounts of meat if you desire, but they should be lean sources of protein. That has been shown to be more protective than eating a lot of fried foods. A lot of animal fats.
While perhaps the earliest sign of heart disease is knowing what your risk factor is. Your mother, your father, your sister, your brother, your nuclear family, and you may even extend that to your aunts and uncles. Why is that? When we talk of an instance about elevated cholesterol I mentioned the impact of diet. But 60 to 70 percent of the cholesterol in your body is actually manufactured by the liver. So here genetic factors may come into play. If your father died with a heart attack at 50 which is premature. Your mother's had a heart attack or stroke and she's only in her 50s then that increases your risk. That being said I go back to lifestyle modifications again doctors, unfortunately, use big words. Exercise, losing weight if overweight, avoiding excess salt, or sodium.
Avoiding processed food, fried foods, and animal meats. Those things appear to be as protective as anything else we can do to avoid heart disease. The rest of the story is that heart disease doesn't suddenly manifest itself when you're in your 20s, 30s, or 40s. It probably starts in childhood. So we should take a look at what we're doing with our children. Taking physical activity or exercise out of the school curriculum. Increasing the amounts of fatty foods and high sodium foods in school meals. Not educating children about how to avoid processed foods and refined carbohydrates as sugars. Those things would really be protective in childhood and would help protect this epidemic that we see later in life. Diabetes, obesity, and heart disease. Especially in blacks, Hispanics and disadvantaged populations.
Heart failure is a specific type of heart disease and I'm somewhat sorry we don't have a better name for it than heart failure. It's when the heart pumping action starts to get weak. So if you look at the heart it's a pump, it circulates the fluid. We're here in New Orleans, my hometown. We have pumps to keep the water out of the streets. When our pumps fail, we flood. Well, the same is true with the human being. If your heart starts to get weak and doesn't circulate the body's fluid, it builds into the lungs. You get shortness of breath. It goes into the legs you swell. It goes into the abdomen. You get an increase in abdominal girth. You get a decrease in exercise tolerance because as you try to do the activity the heart can't push the oxygen in the blood forward. This also, unfortunately, is seen more in black patients. Probably related to poorly controlled hypertension but also related to an increase in cholesterol. Heart failure for anyone who is 65 years or older is the number one cause of being admitted to the hospital.
Yeah, that's why I said the term was a little bit unfortunate. You can have heart failure and still maintain a good life. In that particular case, you probably need to take a diuretic. A fluid pill to remove the excess fluid. You may have to take medicines to lower the blood pressure. There are medicines called ACE inhibitors and angiotensin receptor blockers that block the constriction in the blood vessels and allow the blood vessels to have the fluid circulate. There are beta blockers. They slow the heart because when you're in heart failure you don't want the heart beating rapidly, it makes the heart work more. So, you want to slow the heart so it can be more sufficient. Especially in people of African descent. There is a medication and I did some research on with others that combine a basal dilated.
Known as ISIL saw by don nitrate hydrologyzene. I apologize for the big doctor names, but that particular medicine has been shown to be lifesaving in persons with heart failure. So there are things we can do. But the main thing that I would like to know is what you're doing to prevent heart failure because even when we treat it we can't reproduce the vigorous life that you had when you were young.
It's a little bit unfortunate that we don't recognize in many cases that heart disease starts in childhood. If you think about it children can die in car accidents, and trauma and quietness are one of the leading cause of death in children. So certainly we wait until a child doesn't wear your seatbelt and don't worry about daily speeding and intoxicating alcohol we're going to be OK. You would take steps to protect the child. I think the same is true with heart disease in many cases the scourges of heart disease, hypertension, diabetes that we see in the black community start in childhood. Taking a lot of processed foods eating a lot of fast foods not having adequate fruits and vegetables. Not having children do activity and it's not just our perception of their national data now that children spend more time in front of the computer or playing video games than previously.
That increases your risk of heart disease. So what I would suggest is that if a parent especially if that parent himself or herself has a history of hypertension diabetes or heart disease. Look at your children and what you can do to teach them early in life how to live a more positive lifestyle.
If you have heart disease your quality of life may really be affected. Let's go back to heart failure. We talked about the pumping action of the heart and I suggested to you in New Orleans when the pumps failed the city floods. Well if you look at your own heart if it starts to get weak you're going to be slowly short of breath with activity. You can't walk upstairs if you go to a shopping mall or large store you can't complete your task. So it really can affect your quality of life.
Hypertension we called the silent killer because your blood pressure can be elevated and you can feel pretty good. But I really don't think it's the silent killer especially as blood pressure elevates. The higher it gets, the tired you are. Some of the vague headaches we have often are uncontrolled hypertension. The same is true with diabetes. When diabetes first comes on you don't feel much, but with time your kidneys may fill you can retain fluid. If you have too much sugar in the body tries to eliminate it by increasing urination. So you have frequent urination. So there are signs and symptoms an educated person with no his or her body and would have a provider who would help them interpret those signs and symptoms. So I'm not making the point that every symptom you have is related to heart disease, but I am making the point that this is the number one cause of death. That is higher in African-Americans. And if you have a positive family history and you have those risk factors that we talked about then you should pay attention to these symptoms.
B12 injections are not necessarily negative. But most patients are not needed. Now if you are a strict vegan, you don't eat any animal products then there is a possibility of being low on B12 since B12 is often found in animal products. In that particular case, your provider can get a B12 level and give injections as needed. On a regular basis, either given B12 injections is not recommended for most people.
Diets come and diets go, the Keto diet is now something associated weight loss indeed that may be the case if you're eating a lot of fat and animal proteins. You have an increase in satiety of phonies and you may lose weight rapidly but it can't be maintained. Long term, the keto diet has been associated with an increase in cholesterol and there are no data that it's protected against heart disease and strokes. People will say I'm on the keto diet because that's how we lived hundreds of thousands of years ago. Well actually most people are from Africa and they do not cave men and cave women. They are hunter-gatherers. They were free-living people. Who use vegetables, fruits, they would roam and get root vegetables, occasionally maybe shoot a bird out of the out of the sky or the young warriors would go and catch a wild game. That was rare. Most of the time their diets were actually plant-based. So this idea that the Keto diet is how we lived a long time ago because we were cavemen and cavewomen are not historically accurate. And I think although it may give rapid weight loss it's not actually a healthy diet.
Well, first of all, we never treat patients over the phone and I said that before and I guess over Facebook either. But if you have consistent heartburn and you don't have a high cardiac risk, chances are it's gastroesophageal reflux versus to heart disease. It is difficult. If you have heart disease to have recurrent symptoms lasting 15 - 20 minutes and not actually have a massive heart attack and have to be hospitalized. So if the symptoms are very recurrent and the person is not a high risk then chances are it's not really a true heart attack. But I must make this caveat. We don't treat patients over the phone, or over Facebook.
Well you know we have whole textbooks it takes three to four years to become a cardiologist. So certainly I'm not going to suggest that I can cover the curriculum in one chat. But the general rule of thumb is I think we should recognize that heart disease and stroke are the number one cause of death. Also recognize that there are real disparities that African-Americans and U.S. blacks have higher rates of hypertension, heart disease, heart failure, and kidney disease which is a cousin of heart disease. The third point is that although genetics may play a part much of what we're seeing is what we do to ourselves. And as we move forward we need more information and we can modify our cardiovascular risk. Cardiovascular blood vessels. Those things are not fixed. There are things that can be changed.
Well, the kidneys are actually a group of blood vessels that sit in the back of the abdomen that filters the blood. So the postal tile pressure that we see with high blood pressure or hypertension while it affects the heart and the eyes also hits the kidneys. The rates of kidney failure are much higher in the African-American community. If African-Americans are only 12 or 13 percent of the general population.
In persons who are on dialysis, they're 35 to 40 percent such that being African-American just observing the environment every three to four times the risk of having kidney failure. Now, why is that? Again genetics factors may play a part. But much of what we see with people in their 30s and 40s even in their 20s who are on dialysis are African-Americans who have had high blood pressure for years and not controlled that post the time pressure damaging their kidneys. That along with diabetes because the high sugar also damages the kidneys leads to what we call end-stage renal disease. Dialysis can be very crippling.
Although it's lifesaving you have to spend two, three to four hours sitting in a chair three days out of the week. And most people on dialysis become disabled. So in order to avoid the death and disability religion stage renal disease the most important thing if you need dialysis to get it of course. But the most important thing is to prevent it by controlling high blood pressure and preventing diabetes.
Tuesday, March 19th, 2019