Jeff Scott, CEO of Section 810 communication, interviews Dr. Nero on ways to improve cardiac health. The cover a wide range of topics, from diet and exercise to medical therapy and advanced testing. Some future research topics are also discussed. Section 810 Communications is a training and development company based in Greenwich, CT. The interview was recorded on January 18th, 2024 and is also available on YouTube.
Jeff Scott, CEO of Section 810 communication, interviews Dr. Nero on ways to improve cardiac health. The cover a wide range of topics, from diet and exercise to medical therapy and advanced testing. Some future research topics are also discussed. Section 810 Communications is a training and development company based in Greenwich, CT. The interview was recorded on January 18th, 2024 and is also available on YouTube.
[00:00:00] Jeff: . Thank you everyone for joining us today. It's a pleasure for me to have Dr. Nero with me as we talk about improving cardiac health. For those of you that don't know me, I'm Jeff Scott. I'm the CEO of Section 810 Communications. We're a training and development company based in Greenwich, Connecticut.
And while a lot of the work we do has to do with communication skills, leadership, team building, today's a little bit different as we focus more on health and wellness. I'm really fortunate to have Dr. Nero with me today. So Dr. Nero, thanks again for spending the time. I'm so glad that you're with me.
[00:00:33] Tom: My pleasure.
This is going to be fun.
[00:00:35] Jeff: It is going to be fun. So by way of formal introduction, Dr. Tom Nero. is a clinical cardiologist, and he's the director of cardiovascular research at Cardiology Associates in Stamford, Connecticut.
I'm really fortunate to have him as my personal cardiologist as well. He leads one of the largest private practice research groups in the Northeast. And their trials run the gamut, everything from treatment of obesity for primary prevention and advanced diagnostics, to acute therapies for heart attack and strokes.
And they're also active in interventional trials with aortic, mitral, and electrical disease. In addition to running a large practice, uh, Dr. Nero is also very active working with a number of athletes and is himself a retired and reformed triathlete. I am still trying to understand, Dr. Nero, what it means to be a reformed triathlete.
Maybe you can share about that when we get into the exercise
[00:01:30] Tom: portion. Sure, but the real answer is my wife asked me to stop.
[00:01:36] Jeff: Okay, well that makes sense. That was a simple answer, I didn't even think about that one. So, with that, thank you again. What did I miss? What else would you like to share with the audience as far as
[00:01:46] Tom: your background?
That's about it., I went into medicine. Um, a long time ago, and as I sort of continue to progress that there were always more questions that I had that could be answered by what I was doing.
And that's how I ended up doing critical care, cardiology, interventional cardiology, and how I ended up doing more research now, because I'm finding that as I. As I get older and as my hair gets grayer, , I'm getting more questions than I have answers and , one of the wonderful things about medicine is that the more that we know, the more that we realize we don't, and that you have to really continue to ask questions, revisit the old questions and go through and Thank you.
And try to get new and better answers. And a lot of the stuff that we're going to talk about today, um, I may sort of lean back and say, you know, 20 years ago, we thought one thing, but now we think something else. Um, and sometimes what we thought 20 years ago is correct. So it's, it's, it's been quite interesting.
It's been a fun ride.
[00:02:45] Jeff: Awesome. And it's, I'm looking forward to discussing some of that. One of the things I enjoy about having you be my doctor is I'm learning a lot, not just because. Only because I'm not a cardiologist, but you're on the cutting edge of clinical research and some of the things you've shared with me, Dr Google, which is probably the worst doctor in the world doesn't give me those answers.
And so you've been really enlightening to me as we talked about that. And just a very quick background. The reason we're conducting this session today is I was both unfortunate and fortunate enough. believe it or not, to have a heart attack about eight months ago, I say unfortunate because it was one of the most difficult experiences I ever went through.
Completely unexpected. Woke up in the middle of the night with very unusual symptoms to find out I had 70 90 percent blockage was having a heart attack had stents placed It closed a week later and it had to be redone. This journey over the past eight months, the fortunate part is I've learned a lot and I've made some really drastic lifestyle changes and it's improved my health dramatically with my cholesterol, my A1C, my sugar levels, my health, my weight, so many things have improved and from that standpoint.
It's been a really big blessing and months ago, Dr. Near, you and I talked about this and I said, would you be willing? I had no idea at that point. You did your own podcasts and you really enjoy educating, but we talked about this because my goal in today's session is to help people avoid what I went through.
Maybe learn some things and not be as stubborn. I was with not listening to my doctors in the past and ignoring some of the risk factors. So with that, let's jump into the first topic I wanted to discuss. And that is symptoms. So many people talk about hypertension, high blood pressure, cholesterol, diabetes, which were my nemesis and obesity.
Talk about that from your perspective a little bit. How much emphasis should we put on those risk factors and what should people
[00:04:40] Tom: really be looking for? Well, yeah, I think that there are, there's a number of ways of answering it.
, but the, the most important things that we know about cardiovascular disease come out of basic risk factors. And we've known these risk factors since the original Framingham study, which, which came out in 1948, or they looked at, I want to say it was about 5, 000 people in Framingham, Massachusetts that were mostly white, mostly men.
, and they said, okay, in this population who ended up having a heart attack, and they went back and they found these main risk factors. Like you said, smoking, hypertension, high cholesterol, diabetes, obesity. They added in things like, sedentary lifestyles, , bad diets and family history.
, and that's been the basis of how we've been looking at this for Decades. It is still true. These things really are those risk factors. They really are important. And we always, we will always look at them. And I think that that's an important piece as the background. Um, I think there are going to be better ways of looking at heart disease and better ways of identifying risk than these, but these are cheap and easy.
Everybody knows it, right? You already, you know, most of the people who are listening know what their cholesterol is, know what their blood pressure is, and we can do a risk factor analysis. Okay. Now, one of the interesting thing about risk factors is that it's a risk over a 10 year period of time of whether you're going to have a heart attack or not.
It isn't telling you that you're going to. If you're at 2 percent risk, there's still a 2 percent risk that you will have an event regardless of these other things. So, you know, yes, it is important. And yes, you should know this. And yes, if you are at higher risk, you should be being evaluated and be under somebody's care so that you can.
Um, but it doesn't mean that you're at zero risk and we can go in a little bit about what other things we can look at that will identify people as being
[00:06:33] Jeff: that makes sense. And so when we talk about the risk factors, I knew that for years, I personally, I was type two diabetic. I had high cholesterol in the mid 200s range.
Nothing seemed off the charts. My diabetes wasn't good. And we're going to talk about tests in a moment. But all the other tests I was taking showed that it seemed it. Yeah. that I was good, but you had me do one cholesterol test, which is, I think, LP little A's as my primary care doctor called it. And you said that was, in your opinion, the smoking gun.
And yet no one had ever tested me for that previously. So what about the different types of cholesterol that sometimes go undetected? So
[00:07:11] Tom: when you're talking about cholesterol, not just cholesterol, so there's a, there's a cholesterol number. that we all know this is your total cholesterol. But that doesn't really tell the story.
Um, first thing you do is you go into LDL cholesterol and HDL cholesterol. And we always talk about the LDL cholesterol being the bad cholesterol. The higher your LDL is, clearly the higher your risk is. HDL cholesterol unfortunately is not a good Indicator of health. We used to say that if you have high HDL cholesterol, you're protected.
And now we know that that's not, no longer true. Um, low HDL cholesterol is a high risk factor, significant risk factor. Very high HDL cholesterol is also a risk factor. Uh, so, you know, I think that the total cholesterol number is very misleading and the ratio is misleading and we sort of have to move away from that.
In the LDL, there are different kinds of LDLs as well. And You know, there's a whole bunch of research that's going into the different kinds of LDLs, those different kinds of HDLs, but in general, a high LDL is just bad. And I say that anyone whose LDL is over 100 baseline, and 130 is worse, 160 is worse, 190 is for LDL.
Beyond that, There's something called particle numbers and kinds of particles. Um, I don't know whether everyone has to get that, but when I'm trying to find the granularity, I will often find, look at the kinds of LDLs and are they big or small and those kind of things. The one though that everybody should get once in their lifetime is the lipoprotein little a.
Lipoprotein little a is a kind of LDL cholesterol that has a special protein on the outside of the cholesterol molecule. So if you think of this as all your cholesterol, And that the outside is defining the LDL cholesterol. There's a special protein out there that increases the risk that you're going to have a plaque in your arteries.
It increases the risk that you will have clots if that plaque ruptures. And it also increases the risk of inflammation. And I like to think of those as being sort of the three pillars of why, um, unstable disease. occurs. And this molecule hits all three of them. It increases the clotting, it increases the inflammation and increases the plaque.
So we think that in general, LP little a is about six times more aphrogenic than LDL and it amplifies the bad LDL cholesterol that you have. So in many patients who are who have events earlier in life, family histories, but really anybody, we should be looking at their LP little a's. And that's a very nice thing to sort of say, yeah, you're higher risk than we would think, even though you look perfectly normal, you got this thing.
The problem with LP little a is that you can't treat it yet. We're involved in a couple of clinical trials for treatment of LP little A, and we will have the answer sometime in 2025 2026. Um, with a medication probably being available around 2027. Um, but right now. Um, if you have an ILP, little, what do you do?
And the answer is that you're going to get your LDL cholesterol even lower than you would otherwise get it. And this is one of those key things that now physicians are starting to hear about. Um, I was actually listening to a lecture recently and they said only about 3 percent of patients in the country are getting this test, although everyone should probably have it once in a lifetime.
And with that, if their LP is higher, And we can go with the numbers, but if it's higher than they should be on cholesterol medication, getting their cholesterols lower. be taking an aspirin every day. And if they already have coronary disease, maybe multiple blood thinners as well. So it's an important one that a lot of people haven't been talking about.
We've known it for decades, truly, , but now we have sort of a pathway of how we're going to treat it now. And then we have potentials of treating the Lp(a) itself. And
[00:11:17] Jeff: that's an interesting one because when you first told me about that, I said, is this caused by a bad diet, lack of exercise?
And you said, no, and you can't fix it with better diet and more exercise. It's taking the other, the other risk factors like the LDL. I mean, I'm so happy. My LDL came down to 17. I've had other doctors say your total cholesterol 65, not just the LDL. And yes, because of some of the meds you put me on and the diet.
Okay. And the exercise routine I'm in, but it's because that LP little a, it can't be affected other than by medication. So I think that's good advice. Everybody should get tested once in a lifetime. I think that makes a lot of sense.
[00:11:55] Tom: Yeah, and if you have it, then your family should be taking it as well because it's genetic Um, and there's clear GWAS studies that looked into the genetics of this and that it's, that it's inheritable.
Although there is some wild type where it can just be in you and not be in other people. But, um, if you definitely, if you have it, kids should be tested, um, in order to see if they have it. Because maybe that will help them to decrease the risk over their lifetimes. And a lot of what we talk about now is decreasing risk over lifetime, not just waiting until you're 55 or 60 to get treated, you know, and in many ways we missed some great opportunities here where we should have been treated much earlier.
[00:12:33] Jeff: Yeah, it's easy to think when you're younger. I don't have to worry about that. I'm young. Why do I have to think about that? I look back on my own life and think that for sure. That's a good segue into the next topic, which is some of the medical tests, the predictive tests that exist today and some of those limitations.
I knew I was high risk with diabetes and cholesterol. I've had stress tests, sonograms of my carotid artery, I've done the, uh, the calcium heart test, all those different things, and everything kept coming back saying, you're good, thumbs up, and yet, they weren't really finding it, and specifically , the calcium test that is It's supposed to be indicative if there's a problem.
I know they told me in the Widowmaker, that LAD, it had a little bit, but it was really low, and yet that's where I had 90 percent and 70 percent blockage. What are we supposed to do with that?
[00:13:23] Tom: I recently did a podcast , with the guy who helped develop coronary calcium scoring, a guy named Dr. Matt Rudolph, who's at UCSD. He's brilliant, brilliant guy. Um, and, but he admits and we all know that there's limitations to every test and the coronary calcium score is really super cool because it's cheap.
It's easy. It doesn't give you a lot of risk. And it gives us a nice way of identifying people that are at higher risk than we would otherwise assume. It can miss people who we think are at lower risk because it's showing calcium. Calcium isn't the problem. It's the plaque that's underneath the calcium.
So the calcium goes there and sort of goes into where the plaque is. So the more calcium, the more plaque you have, the more calcium you have. But early on, you can have a lot of soft plaque and it won't be calcified and those patients can be missed. Because they didn't have an opportunity to be calcified.
So younger people, you won't see the calcium there yet. If you have a lot of soft plaque, you won't see the calcium there yet. So, calcification isn't everything. But as a cheap and easy study, it's a really good study. So, In patients who have high family risk and who have absolutely normal lipids, I will often just say, okay, get a calcium study, and then we'll decide whether we go forward.
Patients who are at high family risk and whose calcium studies come back normal, I'll then go forward for something called a CT angiogram. CT angiograms are like a super coronary calcium score, where we look at the arteries itself. Not just the calcium on the outside, but when we look at the whole artery, we can see the plaque, we can see soft plaque, we can see hard plaque.
And then, if we see a lot of soft plaque, you're still at high risk for having cardiac events and much higher than the calcium scores is adding it. So very often, I'll move forward to that. In Europe, they're using that a lot more often. There's reasons why we don't use it quite as much in the United States, they're mostly historic.
But I think that within the next two years, maybe three years, we're going to see that the majority of people are going to be doing. This kind of study to look at their coronary arteries and to reevaluate there. Here's one of the cool things or interesting things I'm not sure it's cool It's interesting is that stress tests do not show you this because if your artery is open And you have a lot of soft plaque, but you're really high risk.
There's a lot of plaque that can rupture But it's open. Your stress test is going to be normal. Because stress tests only show you when you have a narrowing. And so it's only that part that you're going to identify. And that narrowing may not even be important to you. The soft plaque, though, is super important.
And so, again, we may be moving away from stress testing, , for patients who are asymptomatic or talk about risk factors. We might use stress testing only for patients who are symptomatic, but probably we'll move over to CAT scans. And then there's yet another new thing that's coming down the line called fat attenuation indexing, which is looking at these plaques and looking to see whether there's inflammation in the plaque.
And that hopefully will be available in the United States probably in the next year and a half. , that's available in Europe right now and they're trying to bring it over to the United States , but it's super cool. Super interesting stuff.
I'm looking at more of the morphology or the kind of plaque that's there and whether that plaque is going to have a problem in the future. And that's really what we need to find out, right? Is what your risk is. , what your risk is in the future and are you at high risk and could there be something that we could look to see that the risk is attenuated by our therapies?
And just to give you an insight on to me, I have an LDL of 100. I do not have any other significant risks. , eat pretty well, I think, , mostly vegetables and fruits and whole grains and whatever. Um, Yeah. Yep. Yep. And yet I had some inflammation in there in that artery, no plaque, but I had an inflammation there.
And based on that, I started myself on a statin with a goal of getting my LDLs really, really low. Um, and I do think that that's going to end up being an important piece . So do
[00:17:33] Jeff: you think it's advisable for the audience, those that have a cardiologist to speak to their doctor or those that don't speak their primary care and say, Hey, what about these other tests?
Should I be tested for LP little a, or should I have this other type of a calcium
[00:17:48] Tom: test? Yeah, I think that everyone should get an LP little a once in a lifetime, just get it. It's one test. Um, and. It may not be easy for your primary care doctor to understand that test, but if it's, if it's elevated, then that's a good reason to be referred to a cardiologist.
They can then talk to you about the risks and benefits of what we do beyond that. Um, as far as the coronary calcium score and CT angiograms, I leave that up to an assessment of our underlying risk and trying to understand, are you at higher risk than what we think? And I'll often use those tests. to determine whether or not I'm going to be more aggressive with statins or less aggressive with statins.
Statins are the main treatment that we're going to give right now. Um, in the future there's going to be other options, uh, beyond statins. We actually have four different treatments first for cholesterol right now. Uh, but there's going to be even more things coming down in the future about treating inflammation, treating different types of plaques, treating different types of lipids.
So, we're going to be much more nuanced. And hopefully that diagnostic testing will allow us to determine which way we're going to go with our therapies.
[00:18:59] Jeff: Okay. Very good. I see some questions coming in. Let's talk or tackle the third topic. And then we'll come into some of those questions in just a moment.
But the third thing we want to talk about it and you mentioned diet. And I know that you've. It's been very encouraging of me to get more into a vegetable based diet and it's one of the things that we talked about early on, but when we look at that trifecta, diet, exercise, and medication, let's talk about that a little bit.
I haven't cut out meat completely, although I pretty much am turkey, chicken, and fish, and that's pretty much it. Pretty much all I do from that standpoint, just to get adequate protein, but talk a little bit about those three diet, medication and exercise, how they all interact with each other and your thoughts on that as a reformed triathlete.
[00:19:46] Tom: So, diet and exercise are clearly the most important intervention that we can do. And when you look at population studies and you look at people who have good diet and exercise, they have a, they have a 50 percent decreased risk. versus the rest of the population. 50%. That's enormous. You start on a stat and decrease your risk by about 20 to 30%.
So it's, it's that, it's, it's so much more powerful and it's cheap and it's easy. Well, it's not easy. It's cheap. It's available. Anyone can do it. It's not easy though, because it's, it's a daily thing. You have to make that choice over and over again. , and , you have to try to be consistent about it.
You can't just do it one day and not another. But it is important, , if I had to say as far as diets concerned, , I'm changing a little bit the way that I'm trying to approach it because I know that I talk when I tell people That they should go on a plant based diet and a whole grain diet, like glazing. So, I'm actually changing what I'm doing this year in order to see whether I can be more successful. By telling people, you need to be on a high fiber diet, high soluble fiber, and the things that give you high fiber are Plants, vegetables, whole grains, that's going to do it for you, right?
Those are going to be the big three that are going to help you. In order to get up to 30 grams of soluble fiber a day, you have to eat a lot of that. And by doing that, you're going to eat less of those other things because , you'll be full. So part of that will be decreasing animal proteins and animal fats, especially animal fats.
And then a lot of it should be decreasing processed carbohydrates. So, um, flour, sugar, and those are the big ones. There's also a lot of information coming on about, uh, flour and sugar increasing inflammation and maybe it's the inflammatory piece that becomes important. , so a lot to be figured out there and I, and we can't go into this today because it's such a big topic is on the microbiome.
, this is something that I'm really super interested in, but I don't know whether there's a way of really accessing that information well enough, but there's, there's gonna be more stuff coming out. , a lot more questions are being asked than are being answered yet, but we'll, we'll get there.
And that
[00:21:49] Jeff: makes sense. One of the things after speaking with you, and then I met with the nutritionist and one of my sons is a very big in fitness and his wife is a nutritionist and personal trainer and they were very instrumental in helping me get on a. major change from a diet standpoint. And while I didn't cut out meats, I wasn't a big meat eater to begin with, but I would eat fish and chicken and ground turkey.
But I added a lot of vegetables, added a lot of fiber. So I eat vegetables three times a day. I have egg whites with spinach and scallions every day. And typically lettuce and tomato with lunch and vegetables at night. And that's been a major benefit just to add the good things, not just get rid of the bad things to process carbohydrates and the sugars, but doing a whole grain with oatmeal.
And I was trying to figure out how to even spell quinoa when I had my first heart attack. What am I supposed to do with this stuff? And so, uh, but at the end of the day, it's been really instrumental. I mean, losing 35 pounds in three months and four inches on my waist, it wasn't a goal. But I did, and a lot of that was just changing the diet, but then also the exercise.
One of the things you told me, I used to think exercise, that means, all right, get your heart rate up to 155. My max heart rate according to my age is 160 beats per minute. But yeah, you said, no, you don't need to get your heart rate in that really intense, high aerobic zone. Talk about that a little bit.
Exercise can be walking, right? Just doing a simple,
[00:23:14] Tom: consistent walk. , the amount of exercise that you need to do in order to get the most cardiovascular benefit is approximately 150 minutes of walking a week or 75 minutes or 60 to 75 minutes of jogging or something above that a week. , And, you know, the hardest thing about exercise is putting your shoes on, um, and getting out and doing it.
Anything that you do will benefit you. Doing a lot doesn't necessarily help. It's interesting. We found that patients who do excessive amounts of exercise, more than five hours of really, really high aerobic exercise per week, actually have more events than we would predict. Versus people who do just modern exercise, not as high as people who don't exercise, still higher.
And that's actually one of my research interests is trying to figure out in that group why that happens. But all of that being said, , just doing something, anything that you like, but doing it and doing it consistently is really, really, really important. , I had one patient who I keep on thinking back on who had a heart attack in his 40s.
He changed his diet and he exercised every other day, moderate levels, and just was , was consistent at it. And he didn't have his next event until he was 85. Wow. And this was a guy who, , when I first met him, I thought this could be bad and he was great. , he did wonderfully.
, it doesn't, he didn't eliminate his risk, but it markedly, markedly decreased him.
[00:24:42] Jeff: I, I believe that and that is encouraging. I love hearing those encouraging stories after I went through my event at 59 and one of the things they had me go through was, and you asked me to go through, was cardiac rehab, where I went three days a week to a gym where I was monitored with an EKG.
And it was walking bicycles, some resistance training, and it felt good to know that at the end of that period, I was never really a runner, but I was able to run a mile and a half just because of going through little by little, little to make those changes. And for me, with my diabetes being a risk factor, my A1C had been as high as 10.
7. It was 9. 4 at the time of my heart attack. In three months, no additional medication, everything was still the same. But just by diet, exercise, , my A1C went down to 5. 5. And I look at that and say, nothing to do with meds. Not that meds were bad. My endocrinologist took me off a medication. He said you're going too low, but it was the diet and the exercise that made that profound
[00:25:43] Tom: Like I said, it's it is an incredibly powerful drug these two things and maybe we should be looking at the more as a drug I am I used to many years ago give people I take out the prescription pad and write a prescription for Exercise, you know, and I should probably go back into doing that, but we should think of it that way.
, and , I say this very frequently that I could save the country 100 billion a year in health care costs. by getting them to stop eating Big Macs and putting on a pair of sneakers. I, I, I
[00:26:13] Jeff: believe that. And, and, excuse me, as a quick note, with, with diet, a lot of times we don't know really what we're eating.
I know when my son came up after my second heart attack, he came up to spend some time with me. And I, he said, what do you have for coffee in the morning? I said, I have some flavored creamer, but it's only a little bit. It's only like five grams of carbs. He said, how much do you put in your coffee? I said, I don't know.
He said, I want you to pour into an empty mug what you normally use in your coffee. I did that and he said, now measure it. One, two, three. There were seven tablespoons in a typical cup of coffee. And I'm like, okay, that's 35 grams of carbohydrates. And I would have four cups a day. Two decaf, two regular. And he said, Dad, you're getting Your daily dose of carbohydrates just in your cups of coffee before you even eat that Big Mac or that sub and that was really drastic for me to realize I need to make changes in everything because the little things add up in a massive manner and that was really eye opening for me.
[00:27:10] Tom: Yeah, no, no, you're absolutely right. 100%. Yeah, it's amazing.
[00:27:15] Jeff: No, I was just going to say, let's take, we've got some questions coming in. We're going to jump into the other factors we want to talk about, uh, but let's take a look at some of the questions that would come in. One ties with that coronary calcium score.
. When you talk about the coronary calcium score, is that the typical calcium test that comes back in a regular blood test or is it something different?
[00:27:34] Tom: So, yeah, the calcium score is actually a CAT scan. You have to do a CAT scan. , it's a very quick CAT scan. It takes about five minutes to perform. , and they'll look at the calcification in the arteries itself.
, it's a low radiation scan. It's about the equivalent of being on an airplane for about 15 minutes. So, it's not. A very super high risk for, , increasing adverse events for by doing the scan. And those scans usually cost around a hundred dollars. , so it is worth getting, a hundred dollars is not going to break anybody's bank to be able to get this information.
So I think it's, it's a, it's a very reasonable, um, initial study to do. The blood test calcium is not related to this at all, and your serum calcium is not related to your coronary calcium. Um, supplementation of calcium pills does not affect your coronary calcium. This has to do with the physiologic effect of how the arteries are being healed by something called smooth muscle cells, and I can get in the pathophysiology, but, but it, , essentially there, as your plaque increases and becomes more or less stable over time, you'll have spicules of calcium that will deposit in them.
And that way we see that. The CT angiogram, on the other hand, is a little bit more involved. It's again, then another kind of cat scan. It's a noninvasive test. They will give you an IV, um, uh, contrast agent to look at the arteries coming closely. Um, but the problem for that test is that it's often not, covered by insurance.
And so. It will often cost us approximately 1, 200 to 1, 500 to perform. , I've had two of them done on myself, one was because I was having chest pain while I was training for a triathlon. And, , I was also lecturing at the time about sudden death in triathlons. I didn't want to be the guy.
Um, and it was completely normal. It was super. Reassuring to know that my arteries were so that's that's a helpful thing. It was for me. It was it was worth the money to do that. , it would be nice if it was covered more by insurance. But right now we're fighting through that in Europe. It's a lot less expensive.
[00:29:30] Jeff: Okay. , here's a couple that are coming in regarding drug coated balloons. Uh, the adoption of drug coated balloons in lieu of drug coated stents, I read this is being applied in Europe. Do you see this as a treatment option that may be coming to the U.
S.? And along those same lines, for the treatment of small vessels, I understand they're now small balloon and micro stenting options versus medical options only. What are your thoughts on those? .
[00:29:53] Tom: Those are really cool questions. , and the person who asked that question just opened up a big can of worms.
So I'm sorry. Uh, so the simple answer is drug coated balloons will be coming to the United States. They do have a role. Um, their role is extremely, extremely the time when you're going to use drug coated balloons or two when you have something called instant restenosis. So you've already had a stent and then the stent Closes back down.
Um, when it closes back down, usually it's because of, um, uh, plaque that gets put into inside the stenton. So you're going to go in and open that up. You don't want to put in stent upon stent upon stent because you can imagine that, you know, that that tube is getting smaller and smaller and smaller as you put more scaffolding in there.
So. Treatment for incendiary stenosis. That is going to be one of the options. Um, I started using them actually a bunch of years ago, uh, while doing some, uh, work, , overseas and working with other, uh, labs that had them available. And so I think they're interesting. Um, but there, there's limited treatments for limited treatments that you're going to get maybe for stable disease.
You'll also be able to use drug coated balloons, unstable disease. , , if you come in unstable, you're going to want to have a step because usually that indicates that the artery itself has ruptured, that there's a, um, a flap there and you have to, you want to, uh, keep that flap, you want to open it up and so the scaffolding helps physically keep the artery open and then deliver the drug to the arterial wall.
The real question though is. Do you need to have any of these things done and and with small vessel disease, small vessel disease is not going to kill you. It's the large vessel diseases, proximal LADs, those things that are going to really cause the problem. It's the heart attack that's going to cause the problem.
So small vessel disease is best treated. by medical therapy, and I would say that one of the big sea changes that's going to occur in cardiology in the next five years is a movement away from going into the cath lab and stenting everybody. Um, we have a couple of trials that showed that stenting, except in very limited situations, Stenting doesn't change outcomes.
And if it doesn't change outcomes, why would you want to put yourself on a procedure, an invasive procedure, that itself can have bad outcomes and side effects to it? Um, and so some people will describe stenting as inducing a new disease state, rather than just treating the arterial disease. So the stent doesn't change your risk of having an event, because, you know, think about it.
The stent's a very small thing, and your artery's really long. So, you know, And so you can have events at any other stage there, and that stent is only helping one little bit of it. The important piece is going to be the medical therapy. And if you have angina, if you have chest pain that is limiting, well maybe then you stent or maybe you balloon to treat that symptom.
But you're not making you live any longer. What makes you live longer is medical therapy with cholesterol lowering, risk factor reduction, especially not smoking. , treatment of diabetes now, because in the past, even treatment of diabetes didn't make a lot of difference, but with the new drugs like Ozempic, Menjaro, and Jardians, these drugs really do improve outcomes, and we can talk about that in a little bit, because I know it's a big question, but those are the things that are really going to, and you know, exercise and diet, those things change outcomes, and those things make you live longer, and that's really where we need to be focusing on, not on the stenting.
If you're having a heart attack, if you're having an unstable event, stenting is the way to go. I'm not saying you don't do that at all. I'm just saying, for stable disease, you want to be very cautious about how you're proceeding. Um, instead of inducing a new disease
[00:33:43] Jeff: state. Okay, that makes sense. I want to go answer two questions quickly here and then jump back in because we want to talk about stress.
Uh, some practical steps to resort health and then the medical anxiety aspect. But a couple of quick questions. First, I'm going to take a layman shot at it. It's okay with you, Dr. Near, and then I'd like to get your thoughts. Uh, it says if you could go back to your twenties and thirties. What would be the one or two changes you would make in your own life with all the health information, knowledge and experience you have now?
So from my standpoint, I would have listened to my doctors better because I felt invincible. I felt I'm healthy. I've got nine kids. I live an active life overall. But I've always had a sedentary job, primarily office based. I would have taken more than meds. I was stubborn on medication, and I wasn't taking it, and allowed years of having high diabetes and high cholesterol.
I would have been more active with that. Uh, I would have listened to the doctors a little bit better and watched my diet. I've always had a high metabolism so I could eat anything. I can buy a whole pizza and eat it myself. No issues. And I really didn't gain that much weight. But looking back, I was just destroying myself with doing that.
So those are things. . I would have absolutely made changes and been a little bit wiser and not thought that I was so wise in my own eyes and listen to the doctors a little bit better. But Dr. Nero, do you have any thoughts
[00:35:02] Tom: on that question? I think you answered it. The only thing I would do differently in my 20s and 30s.
Maybe I would have married my wife earlier. Um,
[00:35:10] Jeff: but,
[00:35:14] Tom: uh, but yeah, no, no, that's it. That's it. Right. Diet and exercise. Right. That's start, start there. Start early. Um, I do believe that people that have good diets and their kids are around them, that their kids end up having better diets later. So it's not just, that you're affecting yourself.
It's affecting the other people in your family. , so if you can induce change early or, or be good mentors and role models as far as, um, lifestyle habits, that helps.
[00:35:39] Jeff: Okay. That makes sense. I've got a question here. My, , cardiac issues run granddad had multiple Angios and bypass when he was in his late seventies.
My mom had two angioplasties, four stents last year. She's 59. I'm 31. When should I start taking the cardiac tests? Like an echo, I'm a vegetarian. I eat healthy. Don't drink. Don't smoke. Please share if you have any advice for me. That's a great question. Thank you for asking
[00:36:06] Tom: that. So it's harder to identify people who are at higher risk at younger ages.
Um, and usually I wait to doing any kind of, um, advanced diagnostic testing until they're 40 at least, because you're, you're going to be misled if you do a coronary calcium score at the age of 30, you won't see any calcium because you won't have had the time to do have calcium deposition. If you do have calcium, there are 30, it's.
It's, it's important because you're clearly at higher risk, but, but that's a rarity. . So there's no testing per se that we would do outside the blood testing. But I do think the blood testing for someone like you, , who has this higher family risk and has a clear delineation, , you should get your cholesterol test.
You should have an LPA test. , and then. Knowing that you're at higher risk should stimulate you to already say, okay, I'm at higher risk. What else can I do with my diet and exercise? And that's, and, and if you can, if you can do that and utilize that as a motivation to, to exercise regularly, et cetera, then , you're markedly better off for the future.
now.
[00:37:10] Jeff: Okay. Makes sense.. Let's talk a bit. Sometimes people say gonna, you know, give you know, and the whole conce And you had indicated to me that you weren't so confident that stress had a factor in my case.
Talk a little bit about what your perspective is
[00:37:27] Tom: on that. Yeah, very briefly, um, it's hard to prove that stress is a risk factor because we all have it. And it's, so when you look at studies in the United States that have looked at it, it really doesn't really fall out. It may be that what's happening with the stress is that we're eating more poorly, we're not exercising as much.
Those things end up being, , the bigger risk factor than the stress itself. But it would be foolish for me to say, Oh yeah, stress isn't a problem because clearly it's a problem, right? I mean, you don't want to do anything that makes you unhappy. It makes you feel terrible. , but so I do think that taking care of stress is important because you're taking care of yourself.
And so it's a little bit of a nuanced answer. I realize that because, you know, you, you want to blame something. Um, but I think that maybe, um, doing things that help you, it sounds really wishy washy, but those things like self care are really important and that will decrease your stress.
Exercise decreases your stress. The benefits of exercise, I don't just think, are by making your body work more. It may be due to stress reduction. It may be due to increased breathing and deep breathing. It's why maybe meditation helps. Um, so there's a lot of pieces here that we go together without, I can't say necessarily cause and effect,
but I can say that it's clearly associated and things that reduce stress seem to be associated with. better outcomes. So it's not that stress isn't the problem or is the problem. It's all those other things that are around it. I think it's the nice way of looking at it.
[00:38:55] Jeff: I think that makes sense. And unfortunately, so many of us deal with stress.
I found that just being aware of my breath of just doing some deep breathing exercises and even simple things like trying to relax and smile more. There's an ancient proverb, you know, a joyful heart is good medicine, but a broken spirit dries up the bones and a joyful heart. Just I've read that even when you smile at physical process itself, releases endorphins.
Even if it's a fake smile, it tricks our brain into releasing those, those happy chemicals. So it's sometimes the simple things really do make a difference in addition to the other things you're talking about. I'm going to
[00:39:31] Tom: steal that quote and use it. That's a great one. Yeah,
[00:39:35] Jeff: that's it's an old proverb, actually.
But, uh, yeah, and, you know, it's true. So the next thing we'll talk about, what about people like myself who've gone through an event? What are some things that people can do? Practical steps to, expedite the restoration to good health. We, you know, exercise, diet, we've already talked about that. What else? And listening to the doctor's orders, which I became better at after my heart attack, what are some practical steps you can think of that can help people along the road to recovery?
[00:40:08] Tom: That's a really, um, I mean, I know what I do. Uh, but so the first thing is to, um, is to plan things out right. First off, you don't want to get into this situation where you think, okay, it's over. I can't do anything about this, right? You have to be positive about the fact that the vast, vast, vast majority of people after a heart attack do really well, much better than when we were kids.
People died of heart attacks all the time, right? You went into the ICU, you had a 30, 50 percent chance of dying during that, that hospitalization. And now it's 1 percent or less. I mean, it's markedly better, and so we're, we're way beyond where we were, so don't become overwhelmed with it. Number one. Number two is you sort of make a plan, say, okay, I work with my doctors, obviously they're going to put me on medications.
They're going to put me on a stat and they're going to put me on aspirin. Often they're going to put me on something like Clopidogrel or Berlant or something like that as a secondary thing. We're going to get my blood pressure down. We're going to make sure that my cholesterols are controlled, my diabetes is controlled, and then you're going to take a deep breath and you say, okay, what are my lifestyle things that you're going to change?
And we talked about that. Um, but making a plan about how you're going to do it is really key. Yeah, sitting down with your spouse partner and saying, okay, what are we going to do today? Tomorrow? This week? Let's make a meal plan. What am I going to do for exercise today? Tomorrow? This week?
Next week? Um, if you can do cardiac rehab, , after heart attack, clearly there's benefit to cardiac rehab. The benefits. seem like they are markedly greater than what you could get just by the numbers of hours that you are there. But the more people do, the better their outcomes are. And it probably is that the more people do and the more consistent they are with cardiac rehab, the better that they do exercise in the future.
And that is not the initial rehab event, but it's the longterm benefit that people get from rehab. Um, whether it's, Directed rehab where we tell you what to do and you do it at home or whether you do it , in the hospital. Probably the benefit of rehab, a lot of it is it's giving you comfort that you can do the exercise without having a problem and you're not worried about it and you're doing it.
And you're supported through it and you get all this positive feedback from from the rehab itself. So there's a lot of pieces that come along .
[00:42:30] Jeff: And you mentioned something there about knowing that people have heart attacks. And yes, the survival rate is much higher than it used to be when I had my event.
It scared me because I'm thinking I correlated heart attack with death like imminent and it was really a mess would be here, which is why we have the last topic. And that's the whole concept of medical anxiety. I had both you, my primary care physician, a number of doctors said. After an event like this, pretty much everybody will struggle a bit with depression, anxiety.
I was in the hospital at one point, and the internal medicine doctor at the hospital looked at my son. He's 21. He was in the room with me, and he said, Check your dad's moods, because he's gonna go through some bouts of depression. And I was shocked to hear him say that. But I found that was unfortunately the case is you and I have talked about.
In fact, I was talking to a client. , and he had had an event years ago, and I had to reschedule an event because of something I had happened after the case. wasn't sure, wanted to go get checked out and, and John was very understanding and he said, look, when I went through this, I had about a year where I felt everything in my chest, anything that was going on.
I felt it. Talk about that. What's your perspective on that? They say it goes away in time and I'm finding in my case, it is going away over time, but it's real, isn't it? What people go through.
[00:43:49] Tom: Yeah. Yeah. It's, it's real. It's concern. It's, it's worrisome. It's concerning. And, but the, I do think that it's important not to, uh, downplay it at all.
Because you could also be having a real event and people do have real events. And you don't want to miss those. So I always tell people, don't worry about calling me. Don't worry about, , go to the ER if you need to. And we'll talk about that in just a second. But, , but get it evaluated and make yourself feel comfortable that what's going on with you is normal.
But yeah, you will have more symptoms. You're going to be focused in on your chest. It's all right. It's a natural part of that process. 50 percent of people will have clinical severe depression within a year of having a heart attack or bypass surgery. That's a big number, and I think that when you look at the bell curve of that, it's actually very rare for people not have any effect of that and just say, Oh, yeah, no, I'm, I'm, I'm good.
Yeah, I'm good. That's that would be the rarity. And so you have to accept that what was, there was a trial where we looked at trying to get people antidepressants. After heart attacks and didn't show any benefit and I don't know exactly why other the fact that , the medications don't treat everything and you I think that talk therapy is just as good in certain circumstances.
Um, and also, uh, control like you, but you've done where when you take control of your life. You will do better, right? When you take the responsibility of controlling your medical care. And that's a, that's a, that's an important one. I, um, I do have a podcast somewhere on my list about, you know, how to be a better patient.
And it goes into all of those little tricks of keeping your own records and making sure you know all the names of your medications and that you have a, you know, everyone's phone number in your pocket so that you can call your doctors if you need them and all that kind of stuff. Because, because you're, you're taking ownership.
And once you do that, you can then get through this a little bit better, just as you have Jeff. You're doing wonderfully now.
[00:45:42] Jeff: Excellent. Thank you. I, I appreciate that. And, uh, I've got, I've got a good doctor in you and, uh, my primary care. It's funny, Dr. Williams, who you know very well, uh, she had said to me, when you have an event, your brain instinctively will think that anything you're dealing with, uh, pertains to that event.
In other words, she said someone who survived cancer, if they have a pain in their pinky, they think they have pinky cancer. There's no such thing. But in your mind, it always goes there. And for me, I have a pain in my chest, my back, my toenails, itch, everything feels like, okay, am I going to have another heart attack?
So I think it's normal to feel that. And I agree. Talk therapy, whether it's speaking to a counselor, cognitive behavioral therapy of just self talk of just managing the process through that, Okay. And having a support system wherever you can, the people that will encourage you and motivate you, I think, are really important.
You said you want to mention something about going to the ER,
[00:46:35] Tom: Yeah, the quick one was, um, the symptoms that you're gonna be worried about. If you do need to go to the emergency room. Unfortunately, I can't tell you one symptom, but I also often tell people you're gonna have a symptom in your chest, whether it's in the front of your chest, top of your stomach, middle of your back that you have a difficult time identifying and say, Hey, this is just not right.
It will often be, although not always, it will often be associated with shortness of breath or nausea or radiating down the arms. It could be either arm. Women have more atypical symptoms than men, but there's no specific symptom that women have that men don't. It's just that there's tend not to be the classic Redd Foxx.
Hey, Elizabeth, I'm coming to join you, honey. It could be a bunch of other things. And the, when you're having a symptom like this, I say, , If it lasts for more than five minutes, that should stimulate a phone call to a doctor. If it lasts for more than ten minutes, you should be going to the emergency room and getting assessed.
There'll be times, there'll be times when you'll have that and it won't be anything. And I've had patients who've had classic symptoms of heart attacks and we've treated them a couple times and we realized that's not their heart attack symptom. And then you learn, you learn biofeedback and you realize, okay, this isn't as bad or as important, but that's sort of an important sort of thing about when to go to the emergency room and when not to.
And I think that's an important one to know.
[00:48:01] Jeff: , you know, I've been back several times when there were no issues, but I was feeling something that just felt off, whatever that was. But they would do the blood test for the troponins and everything was fine, and it was good to go.
But when I first had my heart attack, I had pain in my back. I didn't have the, the pain in the chest. I didn't have the proverbial elephant sitting on my chest, didn't have shortness of breath. I had sharp pains in my back and a sense of, of just panic, severe anxiety was, and it woke me up at two in the morning from nowhere, out of a sound sleep.
And I said, out of abundance of caution, I'll go get checked out. And that's when I found it. So, and everybody I've spoken to, you included, has said, if you feel something, do something.
There was one question, . My wife had a couple of heart attacks five years ago. And when she has systems, including pressure in the middle of her chest, difficult breathing, she takes a nitro pill and was told five minutes later, if it doesn't go away, take another one, another five minutes.
If it doesn't go away, get in an ambulance, go to the hospital. At what point should we go to the hospital and bypass the nitro? If it's more severe than usual, but what are your thoughts on
[00:49:04] Tom: that? Nitroglycerin doesn't make heart attacks go away. So the nitroglycerin is going to make you feel better, but it's not going to eliminate your heart attack.
Unfortunately, um, but the same 5, 10 minute rule probably applies that if you have it for 5 minutes, you should call someone and have them help you decide because you don't necessarily want to go in every single time if you're having chronic angina where it's coming back over and over again. That's that's a certainly different problem than if you're having an acute issue.
But if you've already had a heart attack, if you've already had a problem and it's the same symptom and it's severe, Yeah. Go get it checked out, but don't, you know, the fooling around waiting, it doesn't really help you out too much. Unfortunately. Makes
[00:49:48] Jeff: sense. . You mentioned supplements don't work Then do you not need a multivitamin? So yeah, you feel
[00:49:53] Tom: like no. Yeah, no multi, but
you have saved your money eat vegetables. Stop the multis. It's
[00:49:58] Jeff: exactly what dr. Williams had said Here's another one on food. What's your take on intermittent fasting? I feel light on my feet when I do the one meal a day diet But some people feel it's unhealthy for your heart What are your thoughts?
[00:50:12] Tom: I actually think it is healthy for your heart.
Um, there is, but I don't know about every different kind and there's not a lot of good, you can't do a placebo controlled study of intermittent fasting. You know whether you're eating or not. Um, and the people who do it tend to be healthier. Uh, so there's a little bit of uncertainty. Uh, there's a very nice review article in the New England Journal of Medicine, December 26, 2019.
And the only reason I know it is right before, right before COVID. Um, but they, going over the data that we have on the intermittent fasting, and then there was one in the British Medical Journal about three months ago. And both of those are available online. Okay. I, I personally do intermittent fasting about five days a week, four days a week where I don't eat.
I'll, I'll take about a 16 hour break where I eat dinner. I don't need anything till lunch. I need a reasonable lunch and I actually feel pretty good with that. Um, but on the weekends I sit down with my family. We have breakfast together or whatever. And every time I can't have a meal with other people, I try to do that.
Um, and so. Yeah, there's, there's pluses and minuses to everything, but I don't think it's necessarily unhealthy. I don't like the idea of people fasting for multiple days. Um, okay, that's just me
[00:51:25] Jeff: and I know for me as a, as a diabetic when I eat, I eat more now, I think than I did prior to my heart attack and yet lost weight because I'm, I'm eating healthier foods.
I'm spreading it out through the day and I eat a lot. an abundant amount. But again, healthy items. But when I don't eat, if I skip meals, sometimes that can really mess with my sugar levels. So I think some of it depends on if someone has a diabetic issue as
[00:51:47] Tom: well, right? Diabetes, you can't do intermittent fasting.
you should not do it.
[00:51:51] Jeff: What are your thoughts? I'll answer this. My thought first. What are your thoughts on statins? I used to hate them. They provided cramps in my legs. My mom couldn't take them. I said, I'm never going to take statins. And yet, if I had, that possibly could have prevented me from having the heart attack because statins, like the other medicines you mentioned, Dr.
Nero, They can have ancillary benefits that are not necessarily just cholesterol reduction, but they can provide some heart benefits. What are your thoughts on statins?
[00:52:19] Tom: Oh boy, we could do, we could do hours on this one. Um, but I'll answer it in 30 seconds. Statins are good. Uh, statins get a bad rap. I think that for about 5 percent of people, statins are not a good medication, about 5%.
Okay. There was a, there was a placebo controlled trial where they looked at side effects from statins and 20 percent of people who were taking placebo had side effects and 20 percent of people on statins had side effects. There was no difference. So we do believe that there is a nocebo effect. from these medications where people are afraid of them
I do not think they're perfect. I think that 30 years from now, 40 years from now, we're not going to be taking statins and we're going to move over to better drugs, but we have them right now and we have about 30 million patient years of clinical data from trials. That's a lot. I don't think there's any class of drug that is as well studied, but it's not, but it's not for everybody.
I'm not going to say it is. And if you can't take them and you need to take them, there are now other therapies, including Ezetimibe a group called PCSK9 inhibitors, um, Inclisiran, Repathin, Praluent. There's another new medication called B Ampedoic Acid. , and then there are other things, Icosapendethyl, there's a whole series of things that are coming down the pipeline that are going to be beneficial for those patients who can't tolerate statins.
, it's one of those situations where , people should stop looking at the internet and reading things on blogs because it can be very, very misleading.
[00:53:50] Jeff: Yeah, I, I can see that and, and know that, uh, I see a comment here about your podcast. Can you provide the information?
I guess we'll, we'll provide that if not here as a followup, we will provide everybody with information on Dr. Nero's podcast. And there's a, another question regarding medicine. I'm on an anti inflammatory medicine, a thousand milligrams a day for joint arthritis. Does that help with cardiac inflammation?
[00:54:12] Tom: So unfortunately, no. So you're probably taking methotrexate, um, or some variant of that, uh, for, uh, rheumatoid arthritis is the most common. And, um, unfortunately, methotrexate was studied and it did not benefit cardiovascular disease. And this is a really sort of cool, interesting, but, but we have a medication that was tried initially as an anti inflammatory up the chain.
of inflammation, something called an IL 6 blocker. The first one showed a decrease in cardiovascular event rates. It was called Canankinumab. Um, there was a little bit of increased risk of infection rate, but what happened was there was a decreased risk of 50 percent of cancers. And so it's being developed as a chemotherapy agent.
But it did decrease heart event rates as well. So there's another drug called zilvecumab, which is now being studied out of Harvard. Uh, we're involved in two of their trials for this. It's another IL 6 blocker, and we're very excited about the possibilities that this is going to improve cardiovascular outcomes.
Finally, there is an anti inflammatory that is available called Colchicine. It's an old drug. We use it for gout. But now we have data, really strong data, that it decreases cardiac events in patients who've already had coronary artery disease instead. I'm smiling
[00:55:29] Jeff: with that because I, I was just going to mention that, that some drugs have ancillary benefits.
When you put me on colchazine and I, and I started looking up, I said, gout? Why am I taking a medicine for gout? But again, you, you're saying that they're finding it has Other ancillary benefits that can benefit us from a cardiac perspective. Yeah,
[00:55:47] Tom: the trial is, LODOCO and LODOCO 2 were the two big ones. Um, and, uh, there's going to be a few more that are going to be coming out on Colchicine.
, getting my podcast. There's a guy named Mike Richter who we have a nice discussion about, , inflammation in coronary artery disease and how we're going to be approaching in the future.
[00:56:05] Jeff: Excellent.
[00:56:06] Jeff: What's the benefit, if any, for COQ10 with statin?
[00:56:10] Tom: Oh, God, I wish I knew the answer to that because we've never proven it. There were a couple of trials that looked at it and it didn't seem to benefit. So we've never proven it. They make about a billion dollars a year selling COQ10. There's never been a trial that showed.
That it worked. So I'm intrigued by that. I know what we do know, though, is that we're not seeing people dying. They're not falling off the face of the earth by taking cookie 10. So my, my sort of general feeling is, if it works for you, go ahead and take it. I don't start anyone on it, but if they come and they ask me about it, they said that having some symptoms They're not sure the tricocutane.
It makes it feel better. I said, okay, that's fine But I don't initiate it in myself, but I also don't stop people from doing it.
[00:57:01] Jeff: Okay.
All right. Very good. And then one more question here. Uh, I want to hear about SCAD. S C A D. It's uncommon.
It happens to young women like myself. I was healthy, no meds and active, but yet had a heart attack. Only to hear there's still research out on it, whereas you can't pinpoint what causes it. Uh, I have two stints because of this. Is there any way a person can see signs at all or prepare for this? I'm sorry to hear that you went through that, by the way.
Thank you for sharing that.
[00:57:27] Tom: It's, so SCAD is one of the more. Worrisome and concerning things that, uh, and worrisome from a patient standpoint, um, that we deal with because it comes out of the blue in younger people, mostly women, 95 percent women and it just happens and then it can come back, but the recurrence rate. , it's usually down around 4%. And I've actually done work and research in SCAD and been involved with the folks that run the SCAD databases for both the UK and, , and the US. , but the problem is we can't pinpoint why it happens. We can't predict who it will happen in.
It is not familial. It is not genetic. , there's no clear way of treating it. Other than to support patients through it, sometimes you do have to stent, we try not to. What's interesting about SCAD is that statins don't work in SCAD because it's not a plaque based thing. It's just a breakdown of the arterial wall.
So it's a completely different entity. It looks exactly like a heart attack. It acts like a heart attack, but it isn't. And then if you look back at that artery after it's healed, you go back in three months later, six months later, it looks completely normal. It's healed itself, but they can have scab in another territory later.
Again, very, very rare, but they can have it the patients who've been the most concerned have been some of my SCAD patients, because it's really difficult for me to reassure them when I don't have the data to say, yes, and this is why, and this is how we're treating it, and you're going to be okay.
Other than say, you're going to be okay, but be aware you're going to be okay, but if you have a symptom, don't blow it off. It's not that you can't ever have another event. It's just, it's highly, highly, highly unlikely for you to have another event. Um, but you know, the SCAD research is. It's ongoing, we're really working on it, um, and there's a bunch of people out there that want to make a difference in SCAD, um, and I think that there's, there's going to be some cool things coming out about this, but it's going to be, it's going to take years because it's such , a relatively rare event.
[00:59:25] Jeff: Okay. Okay. Interesting on that one. Dr. Neer, we're past the top of the hour. I appreciate you staying out a little bit longer and to the audience, , that was able to stay a little bit longer. Thank you for that. I hope and trust that the conversation today has been beneficial, that you've been able to find some things that you can tangibly apply in your own life to increase your health and to those around you.
Maybe you've been through an event or someone you love has been, that you can support them. Listen to your doctor. Uh, there are great doctors like Dr. Nero that are available that have a wealth of knowledge. Uh, don't be the stubborn ones like I was. Listen to your doctors and , maintain that path to health.
Dr. Nero, any parting thoughts before we conclude the session?
[01:00:06] Tom: No, it's been really great. This has been fun. Thank you for having me. .
[01:00:08] Jeff: Thank you so much, everybody. Thank you for joining. Have a wonderful and a healthy rest of the day and new year. Thank you very much.
Bye bye.