VCU Health
Men’s Heart Health
June is Men’s Health Month.
Did you know heart disease is the leading cause of death in the United States? According to the American Heart Association, more than one in three adult men have heart disease, a term that includes heart failure, coronary artery disease, arrhythmias, angina and other heart-related irregularities. Knowing the early warning signs for heart disease can increase positive treatment outcomes and prevent more serious heart issues.
Dr. Jeremy Turlington and Salvatore Carbone, Ph.D., discuss the importance of men's heart health and ways to avoid heart disease including tackling risk factors by recognizing and reacting to symptoms, as well as how lifestyle, diet and physical activity can impact overall health.
Hello and thank you for joining our educational webinar tonight with Doctor Jeremy Turlington in Salvatore Capone, Doctor Salvatore Carbone, who will discuss the importance of Men's heart health and ways to avoid heart disease including tackling risk factors by recognizing and reacting to symptoms as well as how lifestyle diet and physical activity can impact overall health. I'm Pauline Jankowski, VCU Health Poly Heart Center marketing communications manager. Before we in the presentation, I would like to first make notes that we will hold all questions until the end. Please feel free to drop in any questions you may have in the Facebook comics comment section throughout the event and we will address them during the Q and A portion Now, a bit about our speakers, Doctor Jeremy Turlington is a cardiologist at VCU Health specializing in Echocardiogram cardiac critical care. He received his medical degree from Eastern Virginia Medical School and his residency in internal medicine followed by a fellowship and cardiovascular cardiovascular disease and critical care medicine At VCU Health, he currently sees patients downtown Stony Point and virtually profess Salvatore Carbone obtained his BS in nutrition and dietetics at University of Rome then completed AMS in Cellular and Molecular Nutrition at University of Oro. Carlos be in Italy and AP in a molecular medicine and metabolism at University of Rome. His research investigates the role of different dietary interventions and body composition, video and types and cardio respiratory fitness and energy metabolism and patients with obesity and heart failure. With a focus on heart failure and preserved ejection fraction. Thank you Doctor Turlington and professor Carbone for joining us today. I will now turn the show over to you Thank you, Pauline and thank you Salvatore for working with me tonight and thank you everybody for watching. Um my name is Jeremy Turlington as as Pauline, I'm one cardiologist here and we're going to start talking about heart disease mainly as it affects men because June is Men's heart health Month. Um before we go any further, I have no disclosures, anything like that to go over um objectives. you can read the objectives and I really want to bring up that um excuse me here that um one of the issues that we have is I some of my predecessors have talked about some very kind of trending Cool topics. How COVID is related to the heart and such and when Pauline asked me to give this talk, I was like, oh, that's really interesting. It almost doesn't seem very exciting but I think this is really important because as we've been bombarded with COVID, and all the things over the past year, I think some of the chronic issues that we deal with in America such as heart disease has been put on the back burner and it's really important that we talk about what heart disease is. talk about the actual definition because it's not necessarily crystal clear. We're going to talk a little bit about uh heart disease affects Americans and especially men. You'll have to bear with me for a second. I love the idea of a little bit of historical nuggets that go along to set this up. So, I have a little bit of a story to tell. Um we're going to really focus on risk factors. what it means to you and the public, what your risk factors are and how we can try to control those. We're briefly going to talk about the symptoms of heart disease and how you know, when you really should talk to your doctor and then I'm going to finish up by discussing how you can understand your own risk for heart disease. So, or cardiovascular disease or heart disease. There are a lot of terms that are used interchangeably. As you see, even on the slide and from the American Heart Association, really heart disease in and of itself is a collection of diseases of the heart and their blood vessels. They can start with a heart attack. You can also be a stroke which is actually, you know, extra cardiac. It's not from the the hardest of the brain but the blood vessels there are to be concerned with heart failure, abnormal heart heart called arrhythmias and then heart valve If you'll take just a second and this is kind of lame but I have an analogy of heart that I think it's like a house and I use this with patients a lot. You know, the house that has walls, if the walls aren't working well, then, you have heart failure. If the doors or the valves aren't working, that's a foul disease. If you have an electrical problem, that's an arrhythmia and if you have a plumbing problem that's uh that can lead to a heart attack of blocked arteries. So, I think when we break this down, it helps patients think about it and what realize is that all of these are intimately related and one can be yet another problem. We have to talk about how they are interacting with each other really when it comes down to, you know, there are forms of arterial sclerosis and atherosclerosis again, turns you hear from your doctor in the media and really artery sclerosis is any blood vessel over time can become hard and stiff arteries by nature are very elastic and almost rubbery. They can move. They can become larger and smaller. help propel blood but as people get older, theoretically, those arteries become hard and stiff. A subset of that is atherosclerosis and that's when you start getting as you can see on the slide deposition of what we call plaque um cholesterol and and other fatty build up in the in the artery and have a hard artery that can't relax, can't dilate, can't get bigger and then it starts becoming closed in from the inside with this plaque and that can lead to narrowing of the arteries and eventually to a heart attack which can lead to more problems down the line. Now, first of all, some of this, I'll tell you, like I said, this isn't a really cool trending topic but these are big deals and y'all are going to know some of this but I want to bring some of this to light heart disease as of 2021 is still the most common cause of death in America. One person dies every 36 seconds in America from heart disease. So, by the time we go to the slide, two people have died in America. You know, it's 655 thousand, almost 700 thousand um Americans die every year of heart disease. Now, I don't want to make light of it. It's a serious issue that we've had with COVID but think about in the past year, you know, at about a year, we had about 400 thousand Americans die of COVID at the year mark, which was huge and we had almost 300 thousand more people have heart disease and die that every year This is still in our country where we have so many medical advances, a big issue that we need to stay on top of and really pay attention to This is a great map because and this is for Men's heart health. So, I want you to look. This is men over the age of Fifty-five by thousands. The number of people that die on a year to year basis and I want you all to take a snapshot of this in your mind and look at where the deep red means. More people are dying and look at kind of the the the pattern where it kind of to the Sunbelt here in the southern States. I want you to remember that because we're going to talk about that with risk factors later Now, the epidemiology of heart disease again in the end, men are more likely going to have heart disease and have big complications of heart disease such as death, more than women. Of course, that happens with cancer and other accidents too. If you look at this, we're talking about in this study and this was from uh II said Veronica. It was a study that was done um in in circulation You know, there are more men that die of heart disease than women every year. If you look at this, this looks like over the past decade or actually the past century, that heart disease starts to really pick and it peaked in the 80s and then we start having a decrease in the number of people that die of heart disease every year which seems somewhat beneficial or reassuring but you look in the past 5 years or so, those numbers are creeping up again and that may have to do with obesity and diabetes and physical activity. Some of the topics we're going to hit on a little bit later and then if you look here, I honestly don't understand what's going on with Romania but in America, compared to other developed countries such as Israel and Norway, the risk of death from heart disease is much greater than men and women. So, again, not only does it affect all Americans, it really affects men and I think we should all be aware of this so we can try to control our risk factors and reduce our risk for heart disease. So, on the history in the 1940s heart disease, as you remember from that slot I just showed was the number one cause of mortality in America caused almost half of all deaths. Now, granted, it doesn't cause half of all deaths. Now, it's still the leading cause but as cancers have increased, the proportions have changed. What's interesting is in 1932, when uh President Roosevelt was running for election, he's going to have a blood pressure of 140 over 100 which we all know we'll go over a little bit later is considered high blood pressure, hypertension, and and by 1941, his blood pressure increased to 188 over 105 when he was in office when he came into office, he actually got an ole an ear, nose, and throat doctor to be his primary care physician as a as a as a president because he was more worried about throat issues from speaking and headaches which may have been related to his blood pressure. all this while while he's, you know, working as president as we know it would end up being almost four full terms Winston Churchill was a contemporary that know that he always looked very fatigued and was worried about him in 1944 while we were planning the invasion of Normandy to free Europe. His daughter actually was so worried about him that she admitted it had him admitted to Bethesda Naval Hospital for shortness of breath and examines of an abdominal distinction and then there's a cardiologist there, a young cardiologist and he looked a little cynic, a little blue and was worried that he had at the time called hypertensive disease. There really were no treatments for it at the time. Uh besides lowering the sodium in his diet and a medicine called deux which we still use every once in a while but he sent him home on that and he felt a little better but then a year later at the Altar Conference, the war is over. We're trying to figure out how we're going to rebuild the world. Winston Churchill again saw him and spoke with his his doctor, his personal doctor and Churchill's doctors that I think Roosevelt is a very sick man. He has all the signs and symptoms of hardening of his arteries a few months later, only the age of of Sixty-three. He died of a cerebral hemorrhage. Again, stroke blood vessels. This is all interrelated at the time. He was a men's blood pressure was 300 over 190. Those are stunning, stunning numbers. Now, while he was president, the National Institute of Institute of Health was founded and because of his death in 1947, the uh National Heart uh the National Heart Act was passed by Truman and it actually it developed um Heart Institute and then it really wanted the point of the National Heart Institute was to study the expression of heart disease in normal people to try to figure out what factors they are that predisposed or to developing heart disease and they're going to follow them over a long period of time with clinical exams and laboratory findings and it's always beneficial to have Harvard Massachusetts general on your side but they actually argue to get it brought to Framingham which is a small city of about 20 thousand people farmers to become more industrial. to study the risk factors related to heart disease. Now, the Framingham studies lasted for over 60 years and we look at that first group look at their kids and their kids, kids. We've got a ton of data that we use. This is one of the original papers and the cool thing, if there's a cool thing about this is the term risk factor was coined by the Framingham Group. Now, you're about risk factors for heart disease and car accidents, whatever it may be, that term didn't exist before this paper but I want you all to look at here is down here. We're looking at the group Framingham. This original study and young men aged thirty to Forty-five which I think is a significant proportion of this group watching tonight of that group of a thousand patients Twenty-five had heart disease. Well, those numbers are terrible but look at women the same age two heart disease is very prevalent in men back in the 40s, 50s, 60s, and much more prevalent at younger ages which is why it's so concerning that men are getting heart disease We really need to figure out why. As people age, women do eventually catch up but not to their really their 60s or 70s and you look at this group, this was a younger group, Forty-five to 62 men still outnumbered women with heart disease two to one So again, what it showed was in the young group under the age of 45, young men were much more likely to have heart disease than women and at the time when they were also finding is that there were some quote unquote risk factors. High blood pressure was much more common than the younger men as well as elevated cholesterol and we're seeing that happens and then people are having heart disease. So, we're seeing a temporal relationship that these disease processes may be leading to heart disease in young men and then and then as they get older, So, what are our risk factors? Risk factors unfortunately are advancing age as we go. We're more likely to develop heart disease as I've said a couple of times now and that's why you're listening. Being a man increases your risk and we'll talk about why that may be high blood pressure also known as hypertension, high cholesterol, especially that LDL or bad cholesterol, high cholesterol, Amia, obviously, tobacco use. We're aware of this this in 2021 and yet, there are still quite a few people smoking. We're learning more about how physical inactivity causes problems with the heart and how being overweight, overweight, or obese or even other measurements within that category. Obesity might affect heart disease Now, before we talk a little bit more, we need or non modifiable risk factors and what are modifiable, non modifiable. You can't change. We all get older. We are our gender. We are our parents, children. So, if you have a family history, you're kind of stuck with that but modifiable risk factors. Dr Kerr and I are going to talk about what can we change to help make you healthier or what can you change about yourself to make you healthier and there are these contributing factors, things that we're still learning about that may be related or associated with card disease but we don't know exactly how they're related if they're truly causal at this point in time. So, looking here, this just shows what are, you know, non modifiable and modifiable risk factors we can have. What can we intervene on to reduce risk of heart disease? So, you know, there again, I'll say this over and over. I'm trying to hit this point on manner. an increased risk of heart disease when compared to women based on these studies. More Framingham and other studies, we found out that women develop heart disease approximately 10 years later than men. So, women have their first heart attack later. Um the other thing we find is men have an earlier incidence of heart of other risk factors such as hypertension, high cholesterol, diabetes, etcetera, etcetera that can set them up for heart disease. Another interesting fact, Framingham. Unfortunately, when men get heart disease, what we come to find is their first presentation. A lot of times is a heart attack. We're back in the 60s 50s when they were doing the study was actually death was sudden death. Women usually present with symptoms. they're having chest discomfort or shortness of breath. It's almost a way to intervene upon it sooner. Now, things have changed over the past 6 years but that still is the case Now, there is some thought estrogen, what women have the hormone for women is that a somewhat cardio protective. It can reduce epinephrine levels which is a hormone that stimulate your kind of fight or flight response. It gets the heart rate up, gets the blood pressure up so there may be some help there and also, can we call down, regulate, or suppress genes in the heart so they don't react to those stress levels. So, maybe they're protected from some dysfunction. The men don't have some of these innate protections but a lot of studies have happened over the years and this 1 may be a little dated going in 1997. but they say that that though we think this and we see this, this hasn't been well worn out. What we can tell is that women catch up to to men post menopausal when they're estrogen levels drop. that's when they have have more high blood pressure, high cholesterol, heart disease but we haven't quite made that positive factor yet and figured that out. So again, remember that's that slot I showed you earlier about death and man of 35 or more from heart disease and where the most deaths work. This This is looking at uh hypertension in 20 year olds and older. It's roughly the same distribution when it comes to high cholesterol roughly the same distribution when it comes to smoking, you know, saying who smokes roughly the same distribution that kind of seems to the outlier out west when it comes to physical inactivity. People over the age of fifty who say I don't exercise that much and we'll define that much later. Roughly the same distribution and then when you look at When you look at obesity, we know if you look at these slides over the years, America becomes more obese but it's roughly the same and what I'm proposing is that these risk factors we see affect both men and women but men, it's in that same area, Virginia, we've always been seen to be a little bit safer compared to some of the other southern states but you know, the risk factors are there and probably lead to some coronary disease. So, how do risk factors affect the heart and that's what I think People know high blood pressure is bad. They know smoking is bad but how is it bad hypertension and physical activity reduces that elasticity that that um you know, rubber effect of the blood vessels and allows them to get harder when the blood vessels get harder, that higher pressure, the blood pressure is a way the heart is a muscle. It increases the workload on the heart and unlike your biceps where you want them to get bigger by lifting more weight when you lift more weight in the heart The muscle gets thicker but it has to work harder because that's the pump. More blood eventually over time. This is not a sudden finding. This is over years, the heart starts to dilate and become larger to make up for that that pumping mechanism and eventually, it starts getting tired and weakens some when that high blood pressure is exerting its effect on the blood vessels. it actually causes damage to the of the blood vessels which allows cholesterol to get into that lining or under the lining and over time, the body attacks the uh the cholesterol and for what we call these bone cells. You don't need to know that You just have the cholesterol gets in there and start swelling kind of underneath the the layers of the arteries and that further narrows the heart. The artery is is firm. It's distended and now it's starting to close in from the reducing um reducing blood flow through the arteries to the heart Furthermore, people aren't active when they're obese this. that's exacerbates that stiffness. the arteries and on the muscle itself, there's more work on the heart causing further stress. It's a real diet cycle or one problem to get to another and it kind of cycles through patients who are obese usually have higher sodium levels and they retain more fluids. So, now is a hard time to work hard to pump against the high pressure. It's always having to pump harder to move that fluid that blood through the body and it's another kind of whammy hitting the heart at the same time and then, you know, when patients are obese and this is a lot of uh Dr car's studies. this is what he works on. And we've worked together some over the past decade together. Obese patients have more inflammation in the body that can destabilize those plaques of cholesterol in the arteries and once that plaque destabilize and ruptures, that's when heart attacks occur. Finally, I haven't talked about smoking. We all know it's bad. why smoking multiplies the effects of everything I've just told you about the arteries become even more heart, heart rate increases increasing that workload on on the heart, the good cholesterol HCL drops on the bad cholesterol increases and blood actually becomes more viscous and it's more sticky and so when blood becomes more sticky, you're more likely to have problems with heart disease and down the line, So, when it comes to these risk factors, you know, you have to go back and it's hard Now, II just turned 42 myself and II. I'll be free to admit that but you go back to puberty Boys, young men are starting to notice have high blood pressure starting in their teens to 20s. Is that slide show? so they're already your arteries are having a chance to be harder at younger ages. Women don't catch until post menopause which is roughly 60s to your 60s or 70s. So they have years we're playing catch up before it really has an I talked about the sex effects or the effects of the sex hormones, estrogen, androgens, testosterone. There's a thought that testosterone can be deleterious too and then as you get older, your testosterone drops, that means the blood pressure can go up further and it can cause that but no studies have been shown at least for my reading that low testosterone and actually increasing your testosterone. go to your doctor and oh, oh, I heard about Low Should I take testosterone that is not been shown to lower blood pressure in men. Men also have behavioral differences. whether they don't exercise as much or they eat food, whether they increase their sodium intake, they smoke more, all those things or other behavioral differences for men that can increase the blood pressure and cause increasing heart disease. This is just another slide and again, I say this two to three times but I think you should know when you hear it, you'll hopefully stick starting in your 20s. Men are more likely to be hypertensive percent of the population and you know, a quarter of all men twenty to Thirty-five have high blood pressure. Uh only about 10% of women and it keeps going up and you can see here not to the 60s do women actually catch up and overtake Men for heart disease or excuse me for high blood pressure This is looking at smoking clearly the risk of death from heart disease when you're younger is a much higher as you smoke. what we actually see is as get older than the actual death rate just continues to climb. I don't know if I can really explain this little blip in the mid 70s but extra deaths due to smoking, causing heart disease goes up throughout people's lifespan. So, stopping smoking earlier has a much bigger effect and reduces your risk and then obesity. So, obesity for years, the body mass index the VMI has been shown to predict heart disease but are there better measurements, waist circumference but actually waist to hip ratio is actually better at that. predicting the risk of heart disease. There are people who defined as normal weight obese, and normal weight. Your BMI is not that elevated but if you carry that weight around your middle, the quote unquote dad bod that we've all heard of, you're and you can see the slot here. You're at risk of low good cholesterol, higher, bad cholesterol, inflammation resistance to insulin. You can't use sugar glucose, intolerance, etcetera, etcetera and that can increase your risk of disease. and then this actually goes to look at this. A body mass index can show predict in the manner of the dark squares. Women are the gray diamonds. If it can predict heart disease as people's BMI goes up. Look at their body, their waist to hip ratio. really sure that you can really tell by weight ratio when it gets above .95, it starts to really take off here and that can predict your risk of heart disease. So, what are the symptoms? I only did one slot. I think we know this but chest discomfort, chest pain, not everybody reads the textbook but the idea that you're having chest pain and pain, that is a squeezing pressure sensation comes on with exertion, goes away with rest, maybe radiates up to the jaw down the left arm. That's a real warning sign for heart disease. I always joke if I got a dollar for every patient men, male patient that said, oh, it's just, it's just reflux. It's just indigestion wouldn't make a lot more money but I get one or two patients a week our coronary intensive care unit Come in for heart attacks like oh, it's just indigestion. I sat on it for a few days but you're having those symptoms or any chest pain that worries you. you should talk to your doctor, shortness of breath also known as dispute. You can't exert yourself without getting short of breath. That's a sign of maybe blocked arteries or weakening of the heart. Fatigue is a general symptom. We all get tired from time to time but what I really want to hit on is if you can't do your activities, if you go to cut your grass and you push that mower, you good. But a few months later, like you need to sit down midway through to catch your breath or you can't walk the stairs of your house or whatever it may be. That's the fatigue I'm worried about when you're having symptoms that's reducing your ability to your activity. That's what I'm worried about. How is your heart functioning? Swelling of the legs when the heart gets weak, fluid backs up, can back up into the legs, palpitations be an irregular heartbeats, fast, slow, whatever it may be. If you notice your beating, irregular beating, You should let your doctor know you could be having abnormal heart rhythms and passing out Also known as syncope is a sign of abnormal heart rhythms. So, knowing your risk is the first way to reduce your risk knowing your risk factors and once you know your risk factors, you can those modified risk factors look at lifestyle, look at medications. I'm not going to go into a great detail. I want to save time for questions and sessions. definitely Dr Carbone but we need to talk about this a little bit. Blood pressure. How do you do it? What do you do? You know, it consists of the cyst, the top number is when your heart is squeezing the bottom of the numbers. when your heart relaxes, you really should be sitting comfortably with your arm at heart level, sitting on an armrest, uncrustables a manual cuff, an automated cuff, whatever you have, do it. Be consistent. You know, even when you come in the doctor's office, you may be rushed. You may have run up the stairs. That's probably not the ideal time but we check it because that's what we do but you can be smarter at home. Keep a log. Let your doctor know about that. Blood pressure really should be less than 120 over eighty. It's now. This is by the American Heart Heart Association in in 2017. This is controversial. Some people have high blood pressure. Now, 130 over eighty used to be 140 over ninety but it really is especially at younger ages. We need to intervene sooner to potentially reduce your risk of heart disease and if you get to 180 over 120, that's a crisis. Your doctors probably sends you to the hospital. This is what FDR was walking around with while he was serving our country as president. So, that's something to think about. High blood pressure medicines. There are more blood pressure medicines than any other class of medicine other than antibiotics. There are tons of subs, diuretics like HC Tzu. This is not an all-inclusive list. It's just just to give you some examples in case you're on these medicines Calcium channel blockers and Lowe's term aces Ang tens and uh ace inhibitors or what we call them ants receptor blockers, Lucero Lorin Beta Blockers. I'm Carla Dils. Hydroxy. These are all medicines that your doctor may use to help control your blood pressure. You should really see your doctor on a yearly basis even if you don't have heart disease to check your risk factors as to check your lipid panel to know your cholesterol, a hemoglobin, AoneC, It's an average of your blood sugar so we can see if you have diabetes. This is a really busy slide and I realized that I don't expect you to remember this when you're talking to your doctor, that bad cholesterol LDL is greater than ninety. You really need to start talking about being on medications if it's less than than your doctor through a a risk calculator looking at blood pressure, smoking, diabetes, etcetera, etcetera. Can talk to you about what your risk of heart disease is and whether you should be on medicines. Medicines include statins like a satin or stain absorption inhibitors eczema also called Zyia or the newest medications. PCS Knine inhibitors, aroma or or injectables that really drop that cholesterol and then knowing your BMI but really that waist to hip ratio, you get a tape measure breathe out and you should measure your waist. The waist is higher than we think. It's about an inch above your navel. You measure there and then you measure across the widest part of your hips and divide one by the other. As you can see here, if you get above, you know, .95, that's average but above that, your risk of heart disease goes up. So, you should think about what you can do to lose some weight if you have those measurements. Finally, when you have, what can you do, you can help activity, moderate exercise, walking regularly. It's a lot. it's a two and hours but averaged over a week. going to push that lawn mower working in the yard. That's a great way to burn an hour or two of time right there and that can be very helpful if you vigorous the exercise, play tennis, go running, whatever it may be, you can cut that time down. Wait, there are many gimmicks out there and I hate to say gimmicks but really it's decrease your intake and increase your output but watch those sugary snacks and drinks avoid trans fats. Talk to your doctor about what kind of food or talk to a nutritionist. I know a great one coming up. They can help you figure out the right Medicaid or the right food to eat to help you lose weight. I would like to give this to a little card. You can always print this up and put it on your refrigerator or whatever but know your blood pressure systolic, know your cholesterol, your total cholesterol, good and bad. Know that AoneC, your BMI waist to hip ratio. Write down your activities. If you know this, when you go see your doctor, you can show him or her this say, what should I be worried about? What can we do to reduce my risk? If you have that information there in front of them, it can make or hurt. It can make things so much as far as trying to figure out your wrist and what can we intervene upon and finally, about 2 years ago, the American Heart Association created this path to improve your cardiovascular health and it's simple life simple Seven, they talk about smoking States, physical activity, weight diet, blood sugar, cholesterol, blood pressure. That's the website you go through and they give you some real easy, nitty gritty activities you can do to help make your heart safer while you're talking to your primary care doctor or your cardiologist. I hope that was very helpful. There's a lot of information, a small time. I'm going to turn it over to Salvatore and I look forward to answering questions in just a few moments. Thank you very much. Okay, Thank you very much, Doctor Turlington. There was a really a great overview of cardiovascular disease in men but uh I think it's really relevant to men and women and uh hopefully now with this second part of the presentation, we can find some potential strategies or at least known for a logic in this case to potentially reduce some of the improve some of the risk factors with the goal of eventually reduce the risk to develop hypertension and a heart attack and stroke and diabetes in some cases So, I only have a couple of slides with some figures but I think it's really important to show to show. I really wanted to show you this life and what is this live is essentially telling telling us is that uh over the last few years, uh if you look at the number of deaths in the United States, uh you can see the dietary risk account for the majority of the death in our country and this is extremely important because certainly that risk are modifiable so we can improve our diet and possibly recent data suggest that we can we could prevent up to of all deaths related to diabetes and stroke and heart attacks just by improving our diet. Dr Titan has shown you what life Simple seven is and I strongly encourage all of you to actually go online and fill out your life. Simple sermon. you can put your values and then you will have a score and some tips to improve some of your score and the reason I wanted to show you this is that as you can see here in both children and adult what is called a health y diet score. It's actually the risk factor that is the least achieved in the US population. We would love to have everything blue. Like for instance, as you can see with smoking, we're actually doing pretty well um uh in uh you can see that almost 80% of people are not smoking right now in the United States but when you look at diet the blues, it's very very small. You it means it's only 0.5% of the US population is actually achieving what is considered to be a very healthy diet. So, room for improvement which is on the one hand a positive because we can do so much better but on the other, it suggests that really uh we need to work hard to improve these numbers and so how do we improve our diet? Uh luckily, there is um there are the American guidelines. So the dietary guidelines for Americans are released every 5 years and these are developed by a number of experts. It takes really it takes several years and so much work to put together this guidelines that allow to prevent a risk factor in the first place. So, we always talk about high blood pressure, high cholesterol, or obesity but treating them is really hard while we could actually prevent them in the first place. So, what is called primordial prevention? So, the prevention of risk factor and uh these are free that can be downloaded online. Uh they are really good and now the newer guidelines, they also include nutrition for children, pediatrics, and and pregnancy because we know that risk factors start from the pregnancy and so we need to do something already earlier. Um you know, pregnant women what I wanted to also mention today is that when we think about diet and nutrition, we always think about restriction. When you talk about someone and they say, oh, I'm following this diet but there's it's so hard to follow and in reality, when you look at the dietary guidelines, this suggests that yes, the majority of the calories in your diet are approximately 85% of the calories from your diet should come from a healthy food uh food that are nutrient dense, meaning that they have a lot of in a small volume. They have a lot of nutrients, healthy nutrients like uh protein, healthy most of your vitamins and minerals but there's also room for approximately 15% of unhealthy calorie in your diet. So, it is okay to include some unhealthy uh about ten to 15% of calories in your diet that are not necessarily healthy as far as we're able to remain within that. this 1015 percent Now, there is also a little bit of a focus especially in the United States on calories on counting calories and this sometimes takes away the focus from quality to quantity which is not necessarily the way to go uh for our nutrition facts are actually emphasizing the number of calories of a specific serving but now in a very well for a number of clinical studies done in the last decade that quantity or a number of alone are not sufficient. In fact, you could have a snack made of nuts. So, you can have a handful of nuts which could be about 200 calories or you could have like uh uh a protein bar or a very unhealthy bar which gives you about 100 calories clearly in this case, nuts would have been the choice of the best choice but if you only look at calories, the bar would have probably been uh uh what many individuals would have chosen because they have lower calories and so we need to to read the nutrition facts and uh hopefully today, we'll focus a little bit of on sodium and a little bit of fat. Um we don't I don't think we have time to talk about sugars but if anybody has questions, we can address that in the Q and A session why it's important not just to count calories are important, right? Because if we eating more calories than we burn for a for a long period of time, we will gain weight. On the other hand, if we eat less calories than we burn, then, would lose weight. So, that's a strategy to lose weight but not everybody needs to lose weight um and some people also if they have a normal weight, they can still be unhealthy. They can still still have risk factors such as high cholesterol, high blood pressure, uh um impaired glucose or prediabetes. So, we're going to need to be careful not just about calories but uh all the nutrients that the food can provide and so that's everything that we eat of calories and are all low calorie food necessarily healthy So, this is a little old nutrition facts but I wanted to show you to compare these two nutrition facts and the one both are frozen peas and you can see that they provide the same amount of calories, sixty calories, and sixty calories They provide a certain amount of total that same amount of cholesterol, same amount total carbohydrates and pretty much the same amount of protein. So, if you were just to look at calories and macronutrients and nutrient that provide calories, if you would say that these two products are equivalent but when you actually look at sodium content, you can see that the frozen one, they only had 125 milligrams of sodium while the um 11 they had 380 milligrams of sodium. So, three times the amount of sodium that you can find in this in this uh in the frozen version of this of this piece. So, we need to be careful because sodium as we know does not provide any calories but it does affect your blood pressure sodium intake. It's one of the major risk factor for high blood pressure and we know well that if we reduce sodium from our diet, our blood pressure can improve and by improving all about pressure. We can reduce your risk for stroke but also heart attacks. Now, just a little bit of salt. We are often we confuse salt with sodium which are not necessarily the same thing. Uh salt is uh well, technically it's called sodium chloride and this is just because there is sodium and chloride uh but typically when we ask for salt, we don't ask for sodium chloride which is a salt. um but how do we convert sodium into salt? Very simple. Very easy. You just take the amount of sodium in a specific product and then you multiply by 2.5 and that's when you get the amount of sodium chloride or man. And what is the recommendation? How much sodium should we eat to reduce for hypertension or improve blood pressure and those who actually have hypertension in the United States, we consume approximately 2000 2400 milligrams of sodium per day which equal equal to about 8.5 grams of salt and just to look at teaspoons, we're talking about almost two teaspoons of salt but the guidelines are actually very different. The recommendation from the doctor guidelines are that we should consume no more than 300 milligrams of sodium per day and if you actually have hypertension or high blood pressure, this number should be even lower than 1500 milligrams which equal approximately one teaspoon of salt. So, we're actually in the United States. We can't. we're eating almost double the recommended amount of sodium that we should with our diets. and so, it's really important that if in case you're not doing that already is that when you go to your grocery shopping, you start looking at the nutrition fact and you don't focus just on calories, you need to lose, start looking at other nutrients, particularly especially if you have hypertension or if you have a strong family history of hypertension. So, you're at an increased risk for it and need to be very careful about the amount of sodium that we're eating because this we don't often we think that sodium is only containing the salt and so by cutting the. So from our diet, we fix all the issues Uh certainly that's uh that's helpful but we need to look at the amount of sodium in in some of the food we buy very interestingly, often when I talk to our patients eating, they think that's or even myself before I thought that, you know, sandwiches could be a healthy choice uh to potentially just as a substitute for a meal In reality, that major source of sodium in the United States are actually sandwiches. So, sandwiches can very unhealthy and I'll show you in a minute how we can actually make it a healthier choice uh and then of course, there are so many different sources of sodium but sandwiches remain the number one and just to give you a little bit of perspective when you two slices of thick, thick crust pizza with pepperoni, that is accounting for almost 2300 milligrams of sodium. That's actually the same amount of sodium that we should eat throughout the day and remember that it doesn't matter what so you're eating, if it's a table salt, uh any salt, it could be the fancy salt in the world. Uh the amount of sodium is exactly the same. So it doesn't matter if it's a very very expensive. So, they will still have the exact same effect on blood pressure and risk for cardiovascular disease. So, here at the sandwich, you can see here that we have two sandwiches with the exact same ingredient and uh in in this part, we have a higher sodium choices and here we have the lower sodium choices. So, you can stick that at the end of the day, you can have the exact same ingredients except you can choose for the you can choose the lower sodium versions and save approximately 600 milligrams of sodium per half. In this case, half a sandwich that you So, extremely important to start choosing the right food. Start looking at sodium when you buy food and look for the ones that have a lower amount of sodium Here's a little more detail. This is a full day of a full diet for 24 hours and on the left in gray, you can see this is a more of a typical American diet and uh at the end of the day, we are approximately we have approximately 4600 milligrams of sodium and so in this slide that uh you will be able to to look at later Um you can see how by making a healthier choices, you can have a diet and it's lower than 1500 milligrams of sodium. So, extremely important and and one of the major suggestion recommendation I would give you is to avoid pre-made meals. Um a lot of food meals especially the microwave microwavable meals. They tend to have a very very high amount of sodium uh and so my recommendation is to try to cook or prepare your meals as much as you can uh because you can really control the ingredients and the amount of salt or that you're actually including in the food But why do we have why are these? We have sodium Well, for a number of reasons but generally speaking, for when we go from a less process to a more processed food, we have an increased a dramatic increase in here of sodium and a decrease in potassium, Potassium is another micronutrients. so it's a that really doesn't provide any calories or has a very strong effect on blood pressure while so it increases blood pressure. Potassium reduces blood pressure and why do do we, where do we find potassium in our diet? The major sources of potassium in our diet are fruits and vegetables. So that's why one of the recommendations to all increased consumption of fruits and vegetables to four to five, at least four to five servings per day. non starchy vegetables and you can see that when we are processed, there is a huge increase in sodium. look at roast beef with compared to corned beef. there is a great increase, a significant increase in in sodium content. Uh look at cucumbers versus pickle, you have a huge increase in sodium and so these are uh uh reasons why every time we eat it especially processed food. we are increasing the amount of sodium that we that we are eating in our diet. How can we reduce sodium? How can we reduce salt in our diet? Often patients say that if they don't have sodium, their food doesn't taste as good, right? And so, we need to be smart and we need to find solution alternatives that can still make our food taste good and yet uh reducing the amount of sodium that we're eating. Um typically, I recommend to cut on sodium or salt a little by little. Don't just cut all your soap from your diet from 1 day to the other but just start doing it slowly and hopefully within a couple of months, you might not even need to add any salt to your diet. In fact, you can start using more herbs. You can start using more pepper and you can use uh salt alternatives that can definitely be helpful to reduce the amount of sodium in your diet. Now, let's switch gear and talk. Let's talk a little bit about uh that we know that sodium does not provide calories but if it affects blood pressure, what about that? We know that uh that can it's not all the same, right? And so we have healthy fats in our diet and unhealthy fat, Unhealthy fat is the fat that is typically uh mostly coming from animal sources for the most part and that's called a saturated fat. um and trans fat trans fat actually coming from industrial processing but regarding saturated fat. look at what is the major source of saturated fat in the United States. Again, we find the sandwiches here that everybody thinks that are healthy choice, a healthier choice. In reality, again, we need to be very careful about our sandwiches because they can become very healthy but they can be very very unhealthy as well. and what are the foods that are rich in saturated fat and the reason why we really want to cut saturated fat from our diet Is that because they increase the cholesterol in our body. Unfortunately, the bad cholesterol, what is called the LDL cholesterol and saturated fat can be found in mostly in red meat and when I talk about red meat, I'm including not only beef but also lamb and pork. Those are considered red meat because they have a very high amount of saturated fat and for their typical chemical composition, but also when you eat white meat like for instance, uh chicken, you need to make sure that you're not eating the skin because the skin is actually the product that contains a higher amount of saturated fat and you can see here a list of food that are unfortunately including a butter which is also another major source of saturated fat in the United States as well as cheese and dairy and for this reason, uh when you eat dairy, the recommendation is to use the low fat dairy because they we're carrying on the amount of saturated fat that we are eating see Too saturated fat but actually even worse. Trans fat trans fats are used particularly in the industry to uh uh for the processing of their food and if we have some limit amount of saturated fat that we can eat to 10% less than 10% of calories from our diet. There's really no recommendation for trans fat other than eating zero. We don't we should not eat trans fat in our diet because with trans fats have been strongly associated with the risk of cardiovascular and so that's why when you look at the nutrition fact, you should choose for the ones who have the lowest amount of saturated fat and the lowest amount of trans fat So, but if we don't eat saturated fat. what what what what kind of fats you eat And uh remember that when we looked at for instance that that we use in our diet such as uh um butter or olive oil or canola oil. Those foods are composed of a number of different uh fatty acids so they can be healthy or unhealthy. For instance here, I wanted to show you all some of this fat like coconut oil, butter palm oil that are actually very very popular because often we think that those are healthier choice in reality. in green here you can see that coconut oil but they're pretty much almost completely made of saturated fats. So, the bad fat. So, we should not eat those fat. Well, we should try to switch to this to the right part of this uh of this figure to the fat that are actually reacting mono and polyunsaturated fat. So, the fat in the lower saturated fat but such as olive oil, canola oil, uh peanut oil, and those are the ones that really we should uh we should use in our diet and uh possibly really news at all. This fat here on the last part of the of this video. So again, I love it. I use uh more unsaturated fat and these are found in olive oil, canola oil, uh fatty fish. Remember, when you eat fish, you should eat for we should eat the fatty fish and not the ones because the fatty fish is the one that contains what is called omega three fatty acids which are beneficial for a number of reasons. cardio, cardiovascular disease but also tree nuts possibly unsalted or lightly salted tree nuts but avoid it. Avoid this one avocado is another source of healthy fat and then these are the ones that we should limit and completely lose it. The ones who are um reacting trans fat Oh. Why is that? Well, we know very well that if we switch saturated fats for monounsaturated fat and polyunsaturated fat, there's been a strong data suggesting that we might be able to reduce the risk for cardiovascular disease but overall mortality. So, we should increase the consumption of this healthier and reduce the consumption of these other ones. the American Heart Association updates uh periodically the their website where you can actually go online and for a free download, hundreds, really hundreds of recipes and those are healthy recipes that still taste really good and so I just want to encourage you to go on their website. Uh not only that, they also have videos that you can learn how to cook if you're not necessarily uh uh a proficient cook and then something that I think is very important and many of my patients benefit from is to track your food intake because it's really hard especially at the beginning to understand how much you're eating and so you can download apps from if you have a smartphone or like an iphone or Android one app that I often recommend to use is free is called Myfitnesspal and you can just download it and you can include all the food that you're eating and at the end of the day, you have um um the result, a report that tells you how many calories you ate, uh how much How many saturated fat and how many proteins. So, that's extremely helpful and if you were able to fill that out for a few times a week and when you go to talk to your doctor, actually show them what you were able to do. that's extremely, extremely helpful because then we can make some adjustments to your nutrition, to your diet based on what you typically do And then lastly, Dr uh Turlington mentioned about the importance of moving more and yes, we need to move more. We know that by increasing physical activity and reducing sedentary behaviors. this is another risk factor that is emerging in the last few years. Uh by using for instance, standing desks right now, I'm presenting here but I'm actually standing um and then you uh you can increase physical activity and you can potentially reduce the risk for cardiovascular disease and so the 2019 guidelines developed by the American College of Cardiology and the American Heart Association to prevent cardiovascular disease in individuals with risk factors really recommend like Dr. Time to mention 150 minutes per week of moderate to vigorous physical activity or 75 minutes per week of a vigorous physical activity and what do we mean with moderate to vigorous? A moderate to vigorous. It's typically an activity such as walking, biking, dancing, or doing yoga, recreational swimming, and those enough to activate your cardiovascular system and possibly reduce your cardiovascular risk. Now, what is really important and this has changed in the last physical activity guidelines just a couple of two or 3 years ago is that every minute counts in the old diet, physical activity guidelines, really the guidelines suggest that you needed to do a list about at least 10 minutes to be counted in those 150 minutes physical activity per week but now, every accounts. So, if you can do 2 minutes of brisk walking, while you're at work, that's still counts within your 150. minutes of physical activity that you have to achieve at the end of the week. So, extremely important. Other things that you can do for physical activities come to your steps, count your steps on your phone, on your watch. If you have a smartwatch and try to increase that amount by 10200 steps every day. The ultimate goal would be to achieve at least steps per day but recent research suggest that if you're able to go about 4000 steps per day, especially in older adults that's already associated with the uh significant cardiovascular benefit. So, don't think that sometimes 10 thousand steps is too far from what you are, where you are right now but every few thousand steps that you can increase every month, that's really uh uh an improvement of your of your health overall. and I think I'm done right now and so um I'm happy to take any questions with Doctor Turlington and uh wonderful, wonderful job. Thank you so much. Doctor Carbone, Doctor Turlington. This has been a fascinating discussion. I've got lots of notes here that I've been jotting down that I can't wait to share with my family members and friends in that same age group. Doctor Turlington, like you mentioned like in your 40s but you know, we have some questions that have come in and you know, some good questions like, you know, you mentioned Doctor Turlington that you know, men aren't coming in for their their checkups and seeking that preventive care. How can we encourage them to get those numbers? I really like that guide that you you had that, you know, how do we get the men in our lives to take control and get those numbers? Well, you you know, I think frequency it should be at least on a yearly basis. They should go in to see their doctor and ask those questions about my cholesterol, about my blood sugar, you know, like Dr Carbone has made and show some of those you know, with with the app on your phone to show your doctor to engage them in conversation but how do you motivate them? Well, that's that's a little bit trickier, I think. Exactly. like he said, maybe taking that little sheet I gave you or having that app on your phone or whatever it is and saying, look, you're only taking 4000 steps. Maybe we should do, we should go for a walk together or or look, you know, your blood pressure was in that 137. It's good but not great and use that as a spark saying, you know, you're right. I heard these talks. We've heard this but it's not quite where it is. Maybe that would be the sport to go see your doctor or talk to a nutritionist or somebody else about what other options you may have. Yes, Doctor Carbone, would you like to add on to that? Uh no. yeah, that's uh I agree 100% Uh and sometimes if you're really uh have no idea how good your diet is and I'll just talk about the nutrition part. it might be good to see a dietitian just once uh often people think I see a dietitian just because they need to lose weight In reality, you can see a dietitian to improve your overall quality of your diet even if you're healthy. I wish I had some more healthy individuals to prevent a lot of issues that we see often, you know I get, I get referred to. I see patients very very late when they're disease and I've already progressed. So, I think the earlier the better. So, I think that's key uh prevention so we don't have to wait to see something to to act on it but um and diet is really a risk factor too. So, if you have an unhealthy diet, even if you have blood pressure, it's still good. We want to prevent that blood pressure to get worse. Yes. and that's a perfect transition, you know, because we'll hear friends. say, oh, I'm too young for heart disease. I'm too young to have a heart attack. You know, Doctor Turlington, you mentioned, oh, you know, people come in and just say, oh it's probably just um Heart reflux, you know, spicy food, you know, and so We have uh we've gotta get that message out there that we need to get our younger audience. I thought it was staggering that that twenty to 34 year old age group really we could really target in and harness that Um really appreciate that you shared that and so we've only got a few minutes left but I do want um Doctor Carbone. I really appreciated your um discussion to on salt does not equal sodium and um you know, thank you for sharing that um slide with us and you know what we can do because I didn't know II think it's just you know that's what I love about doing these seminars I always get something, something back. Uh so, before we wrap up, I know there was a question that came in um and we can go to that if we have time but is there anything additional you want to add to um like sodium and there was an app that um you guys have just mentioned in this dialogue. What do you suggest um like are there any like free apps that you can give to our viewers? mention to our viewers mention to our viewers that they could download. I mean, you mentioned the AHA um seven Life simple seven and is there was there anyone, anything else? Any other apps? Um an app that I often use myself and I use uh a lot of my patients use is called Myfitnesspal and it's free. There's also a version that you have to pay for it's use by the free version. It's more than enough uh and really at the end of the day, you can see whether you were able to be under those 300 milligrams per day uh and it really nice because it also gives you a weekly average so that you can see maybe you know, if 1 day, you eat a little more as far as with your weekly average, you were able to stay below that 2300 milligrams that that that would be good. Yeah. Uh I'm glad that you mentioned that number. I had a blank right there. I wanted to um to share that too. So thank you. Uh we are at time we have um you know just covered so many good things and of course this is going to be on demand. So if you missed it or you want to share it with a family member friend. You can do so. Doctor Turlington, Doctor Carbone. Thank you both for joining us tonight. In this discussion, you really highlighted the importance of knowing early warning signs for heart disease and how early detection can increase positive treatment outcomes and prevent more serious heart disease. For more information about heart disease, please visit VCU health.org slash and follow VCU Health Poly Heart Center at VCU Health VCU Health Heart on Facebook. Once again, thank you so much for joining us tonight. We'll see you next time. Thank you. Thank you.
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