GLP-1s: More Than Just a Weight Loss Drug—How They're Transforming Cardiovascular Care with Dr. Simin Lee

Heart disease is the leading cause of death for women, fueled by the growing obesity epidemic and complex cardiometabolic issues that often fall through the cracks between primary care and specialists. The simple truth? Many women aren’t getting the support they need to protect their hearts.

Today’s guest, Dr. Simin Lee, is here to change that. A Harvard-trained cardiologist and behavioral scientist, she’s paving the way for a new kind of care with Systole Health—a first-of-its-kind virtual clinic focused entirely on women’s cardiovascular health. Through innovative group care sessions, Systole Health combines expert medical guidance with the power of community, empowering women with the knowledge, support, and personalized care plans they need to thrive.

In this episode, Dr. Lee explores how GLP-1 medications are transforming treatment for cardiometabolic health, why you need to ask about testing for lipoprotein(a), and how menopause-related hormonal shifts increase heart risks and what women can do to stay ahead of them. Don’t miss this eye-opening conversation about empowering women to take control of their heart health and bridging the gaps in traditional care.

References

https://www.systolehealth.com/

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Audio Stamps

00:36 - Today’s guest, cardiologist Dr. Simin Lee shares her journey into cardiometabolic health, her focus on women’s heart health, and the creation of Systole, a virtual clinic using group care to empower women.

08:10 - We learn how GLP-1 medications improve cardiometabolic and kidney health by reducing blood pressure, cholesterol, and inflammation

22:05 - Dr. Simin Lee explains the cardiometabolic changes during menopause, the potential role of hormone replacement therapy, and why early, informed conversations with doctors are essential.

30:30 - Find out how to connect with Dr. Simon Lee’s practice, Systole Health, which offers virtual women's heart health care through group-based support.

Quotes

“In the early diabetes studies, GLP-1s were showing significant heart health advantages, reducing the rates of myocardial infarctions or heart attacks, strokes, and cardiovascular death in patients with type 2 diabetes, as well a

All of the information on this podcast is for general informational purposes only. Please talk to your physician and medical team about what is right for you. No medical advice is being on this podcast.

If you live in Indiana or Illinois and want to work with doctor Matthea Rentea, you can find out more on www.RenteaClinic.com

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Transcript

0:28

Welcome back to another episode of the podcast. I am so excited to have you all back. And today, this episode has been months in the making. We are so incredibly privileged today to get Dr. Simmi Lee. She is an expert cardiologist who specializes in cardiometabolic health, which is really an umbrella term for things like obesity, type two diabetes. And I have learned so much from all of her online education. And I have a lot of coaching clients that have participated in the medical world. group program that she has. And so I want her to talk about all that as well. But can we start Dr. Lee with you just introducing yourself and letting everyone know what you do? Because I'm just such a fan. Absolutely. And thank you so much for having me on the podcast. I also am, am such an admirer of the work that you do and the way that you connect with patients. So I was sharing with you earlier. I am from a big medical family. I Was inspired by my parents to, pursue a career in medicine because, I just saw how how fulfilling it was for my parents to come home from a regular day's work, having connected with other human beings and having worked towards making their lives better, being just so enriching and rewarding. But, as time went on, I could really see that there was this whole crazy healthcare system around the practice of medicine that really was working against both doctors and became curious about that. You know, pursued a different kind of pathway, getting both a business and a medical degree at the same time. So I could kind of get a more of a toolkit for thinking how to solve some of the problems that both doctors and patients were facing. And then pursued my training in cardiology, which was like my soulmate, specialty. I just loved it from day one and, really felt like, even The most boring of problems to the average cardiologist were just fun and fascinating for me. So, you know, became a cardiologist and timing is everything. Like I started my training right at the pandemic was kicking off. It didn't feel like I was a cardiologist on a lot of days that I showed up at the hospital. Cause I was working in the COVID ICU, but once things started to return to normal, we were back to clinic. I was so excited to see patients coming into the office again. But it was such a shocking time. Women that I had known, I saw this affecting women more than men for years were physically unrecognizable after gaining weight during the pandemic and all the stress and being cooped up. And with that, a whole bunch of heart disease risk factors had gotten completely out of control, blood pressure, cholesterol, some had new insulin resistance, and some had had their first heart attacks. chest pain episodes or heart failure episodes. We know that 80 percent of women tend to delay their care. They're putting their loved ones ahead of them. And I saw just heart health suffering as a result of that. And there just aren't a lot of people in my specialty who are really actually trained on the unique issues that play for women's heart health. So I became very interested in this and, just organically started, really trying to address more of the issues I was seeing affecting women to their heart health. So clinically, medically speaking, I became a little bit of a local expert on women's heart health, but then outside of my day job, wanted like you to build the thing that I wish I'd been able to send my patients to, to really help them at their moment of need. And so You know, realize, look, there's just not enough doctors to help with women's heart health. We're really trained in those issues. There are more and more women who are at risk for heart disease, honestly, in part because of the rise of the obesity epidemic., and all these cardiometabolic issues that are kind of in between primary care, they overwhelm a lot of primary care docs, but the specialists don't have the time to deal with. And so, decided we just need a way to use the doctors that we have more efficiently and realize that there was such a thing as. Group care is what it's called. And, that essentially means seeing more than one patient at a time. It's really been around for a long time. It's something that insurance companies recognize. It's something that patients enjoy and that improves all of their clinical metrics, their medical metrics, but that's really hard to pull off in a normal hospital and health system. So I decided to jump out and build a virtual clinic that just focuses on women's heart health or cardiometabolic health. Through group care. And so that we're calling it systole because that's the moment that all the heart cells beat together to send blood forward to nourish the body. And it felt very analogous for what we're doing in a typical group visit where women are working together to uplift each other. So that's a little bit about me and and Sicily and everything. But I know we have so much to talk about and so many shared interests around cardiometabolic health and helping women be healthier. I never knew the name behind it. I mean, that makes total sense when I'm hearing. I'm like, why did I recognize that? Your message, I find women are so underserved, right? We've been, no one has done research on us. No one understands us. It's always, Oh, you're depressed. You're this or that. It's like, no, there's actually not a thing going on. Yes. Okay. So thank you for giving us that context. And when I brought you on, I know that we could talk about. So many different things, but I wanted to kind of silo it down to getting your expert opinion with, with some of the other functions that GLP 1 has that I don't think people understand that it goes beyond blood sugar management, things like that. And then also just get your thoughts on how some things are different for women as we go through peri or post menopause. Let me, let me start out with the first question. So one thing that you really stress a lot, which I really appreciate, cause I'm trying to like beat the drum on this all the time. It's that These medications, GLP 1, it really goes beyond just weight loss, right? So, the, the cardiac components that help, sleep apnea can improve, all these kind of things. You talked about that there are three areas within sort of the heart or cardiovascular system that are protective. And I'm wondering if you could talk about those three functions, because I think people that are on these meds are going to be blown away that these things are actually happening. Mm hmm. Absolutely. Yeah. And I mean, I know there's some of your listeners might be wondering like, what is the cardiologist doing prescribing glp ones? And it's kind of a funny story how it all started. I, trained under a master clinician cardiologist named Dr. Dale Adler. When we when we started, you know, when I started my clinic with him during the pandemic, he So many patients, as I was telling you before, we're coming back with just unbelievable weight gain that was crushing them, both emotionally, but also physically joint pain, difficulty breathing, all those heart disease risk factors that come with excess weight. And, we have a bariatric medicine and obesity medicine center, a weight loss center. The weight was two years. Two years to get a new patient in and so he said, well, that's insane. That's insane. Right? Like I talk about this with my primary care practice in the past, there was a six month wait to see me. That's not amazing. That's crazy. It's not okay. Yeah. It's not okay. But unfortunately, even now, after all these shutdowns, it's, it's, and we've kind of like returned to business as usual. I mean, unfortunately there's still patients still face. That's significant weights to access specialty care. And so Dr Adler just said, look, we can refer and wash our hands of this problem or we can actually solve the problem. And so, you know, we, we just, we studied the clinical trials. We read the data, we talked to our colleagues, we informed ourselves on how to prescribe these and also recognize that GLP ones were showing significant, heart health advantages, reducing the rates of myocardial infarctions or heart attacks, as well as strokes and cardiovascular death in patients with type two diabetes, as well as leading to weight loss, which, you know, led to all of this data on on JLP ones and obesity. But to your question, so that's the story of how I started prescribing. But, you know, your question is about what else beyond weight loss do we see That really is going on biologically under the microscope to really help with cardio metabolic health, that intersection between weight and heart health. And it is there. There's more and more that we're learning every week. So I feel like I want to just issue the caveat that this is the tip of the iceberg, but some of the most impressive things to me, and that I make sure to share with my patients are. Beyond weight loss, beyond improving, our pancreas is ability to secrete insulin and lower the blood sugar. Three things that we see are, number one, that GLP 1s can produce a reduction in blood pressure. Number two, a reduction in cholesterol. And number three, a reduction in inflammation. So let's start with blood pressure. There's a couple of things going on. One is that GLP 1s seem to actually work on The inner lining of blood vessels, which we call the endothelium helping that layer of tissue, which contains muscle cells, to relax and open up and just be a little bit more elastic and spongy. So you can imagine, more relaxed, spongy blood vessels are not going to be a tight, rigid, pipe like structure. vessels and therefore that the blood pressure will go down. That's one really interesting finding that we've learned as people have investigated this, sort of wonder drug, new therapeutic category. The other way that it acts on blood pressure is by stimulating the heart to relieve something called atrial natriuretic peptide, ANP, which is kind of like our own bodies blood pressure medication that we're just making in house. It basically, is a little hormone or signal to our kidneys to flush out salt in the urine. And with the salt comes extra fluid that if it hangs around can be putting pressure on our blood vessels and increase air blood pressure. So really interesting that it decreases blood pressure, obviously through weight loss as well, by just having less weight on our bodies, pressing on our blood vessels. That's a third layer of how we can see the blood pressure go down. But that's sort of dimension 1. Dimension 2 is cholesterol. We've seen in the clinical trials evaluating both semaglutide, known as ozempic or rigovi, as well as terzepatide, known as munjaro or zepalan, that cholesterol tends to move in the right direction for patients on GLP 1. LDL, the bad kind of cholesterol that you know, has been shown time and time again to get into little cracks in our blood vessel types, cause inflammation and ultimately cholesterol plaque leading to blockages and things like heart attacks and strokes. That goes down by around 5%. Meanwhile, HDL, which we typically think of as the good cholesterol. which play the role in combating inflammation as well as sort of picking up loose LDL and returning it to the liver. That goes up by around 5 percent and triglycerides, fatty acids that are increasingly recognized, especially in patients with type two diabetes or just high heart disease risk because of other risk factors like obesity, high blood pressure, family history. That goes down by like 30%. So you know, all the numbers move in the right direction and obviously this can come with weight loss of any kind, but it's just, weight loss when it's not medication assisted we know is really hard to achieve beyond, 5% over a lifetime. So we're really excited to see. That people can, can unlock some benefits and reduce their heart disease risk through lowering cholesterol. And then the final thing is inflammation. We know that obesity is an inflammatory disease. The other thing that we know is that, heart disease, you know, that blockage formation and ultimately destabilization of cholesterol plaques in any blood vessel, whether it's in the brain, the heart, you know, somewhere in the aorta, that is often driven by inflammation. It was investigators, researchers at my, my home hospital, the Brigham and Women's Hospital that really are responsible for that knowledge, that understanding that it's not just about the cholesterol, it's also about inflammation for heart disease. And what we've seen in these clinical trials, looking again at semaglutide and trizepatide, is that C reactive protein, which is sort of like a general marker of inflammation in the, in the body that's measured on a blood test, that goes down by like 35 to 40 percent when patients take these drugs. So, This is why, you know, this is just part of why we see for patients taking these GLP 1s that they're having fewer heart attacks, fewer strokes, and fewer deaths from heart related causes. It's very encouraging and I'm sure we're only going to learn more as time goes on. This is absolutely incredible. I mean, I think about how diverse the function is of everything that's happening, right? And it's so encouraging because I have, I wonder if you see the same thing with patients when, if someone's really going to be a responder, they start on the meds and they'll have a lot of weight loss initially. Now they're not, they're not going crazy, not eating or not having any carbohydrates, things that might artificially make the weight go down really quickly. I just think that their inflammation is going down. So some of them, it's so clear, so fast. And some of them even, joint pain will decrease and it's disproportionate to the progress of weight loss that they've made. Right. And so the cardiac things, along with what we see on some of these other fronts, it's just so encouraging to be able to put some of the physiology behind it. I just think it's really fascinating. Absolutely. Absolutely. And I think we probably don't talk enough about what's going on with the kidneys, right? Like so cardi, you know, the American Heart Association is trying to not let us, you know, You know, get away with what already is a ridiculous term cardio metabolic. Like it's ridiculously long and it's something that feels very hard to ask patients to say or understand. So the American Heart Association is asking us to consider cardio kidney metabolic syndrome. Okay. You know, CKM. You know, recognizing the role of kidney impairment in heart and metabolic disease and risk for heart disease and these glp ones, have been shown to really improve kidney function to slow down the rates of kidney disease, which often is is tangled up with inflammation and. Some of these issues. And so, you know, I think you're right. Like we, we see people having benefits sort of out of proportion to just the weight loss. And it's because it's not just a weight loss drug as it turns out. And so obviously we're waiting for the kind of like cultural discussion to catch up to that. But we are so lucky to be practicing in this time when this tool is not as available as we'd like it, but at least exists. And is introducing a whole new wave of innovation. Yeah. I like that you brought that up because I often say, I know with time, this will be much more accepted, but unfortunately we're just having to overcome a lot of bias and people not being willing to look at studies or what's actually evidence based. So, okay. Everyone's going to love what they just learned. Now, another thing that you really dig into online, I know my listeners are very familiar with sort of routine lab work that should be done, you know, like a. Fastening cholesterol panel, hemoglobin A1c, a three month average blood sugar, things like that. But you also talk about an additional cardiac lab. I'm going to call it a cardiac lab, cholesterol lab. And can you speak more about, I'm going to call it LP little a, but I know there's several names for it. Can you talk about what it is, why it's important and should people get it checked? Yes. Okay. Ladies, men, whoever you are listening today, The lab to put on your 2025 checklist is just as Dr. Rentea said, LP little a, that is the cute little nickname, a mouthful of a nickname for its longer name, which is lipoprotein little a and what is it? It is a Type of cholesterol that looks a lot like physically it or structurally it looks a lot like LDL cholesterol, which we were discussing earlier is, you know, simplistically the bad kind of cholesterol, the kind of cholesterol that gets into our artery walls and forms blockages. Lp little a behaves in a similar way, it forms blockages, but it does so very aggressively, and unlike LDL, it has nothing to do with what we eat or don't eat. Or our lifestyle or anything. It is almost completely genetically determined. And that's because it has this outer shell, that with a protein that is determined by how many, you know, gene, how many genetic copies you have, what your, what your genetic makeup is for this LP little a gene. And so as I was saying, LP little a, it drives blockage formation. But it also is much more, we say it's sneakier and it's stickier. So it's sort of can drive all the blockage formation without people realizing it's there. And it's also a lot more likely to cause clotting, the kind of clotting on top of an unstable cholesterol plaque that can lead to the catastrophic events. that we don't need in our lives, like heart attacks and strokes. And so the reason that beyond this interesting sort of biology discussion of what it is and what it does and how it can lead to heart disease, the reason that it is so important and why we in cardiology are really pressing our profession to move towards universal screening at least once for this This test, which is not included in the routine cholesterol panel is because it is so commonly elevated one in five adults have a high LT little a level, and most of them don't know it. You know, we've, we've had a number of studies looking at patients who already have had heart attacks and strokes, right? They're already a higher risk group. bunch who are hospitalized at various health systems. And the rate of screening for this in those people, the people who've already sort of are at higher risk for a second heart attack or stroke is less than 1%. And among people who have been discovered to have a high LP little egg, the rate of referral to a cardiologist or an expert who can really make sure that they're Treatment is as aggressive as it should be, as proactive as it should be, is strikingly low it's definitely under 50%. So, we're trying to encourage our colleagues and our patients, honestly, a lot of the times we should just be talking to the patients themselves about, you You know what should be on their checklist what they what what they might want to bring up with their doctors And that's a conversation I have frequently with with people that i'm meeting on social media where we're doing a lot of our education ask your doctor about it ask about lipoprotein little a it's a simple blood test can be done with any of your other routine blood work and if it's high Then it's just a reason to, if you think about it the way you would a big family history of heart disease or having diabetes or having some other risk enhancer or like, you know, really high triglycerides or something like that. And you just take it very seriously and you try to work on lowering your LDL cholesterol as much as you can. So that's a little bit about LPLA. The other thing I'll say about it is that we've come to understand that levels fluctuate a little, and this might be a seg or good segue into your next topic, but levels tend to fluctuate a little bit over the course of someone's lifetime. And we do see in women. That levels do seem to uptick during the perimenopausal period, and that menopausal transition. We don't yet know as, as, as fundamental and basic as this sounds. It's crazy to say this out loud. We don't yet know if a high level of Lp little a is definitely worse and higher risk than a low level. We just know that high is bad, and low is better. LDL, on the other hand, it's very clear. It's what we call a linear relationship, where the lower the better, down to an LDL of zero. LP little a, we're still trying to learn if that's the case, but we do see that the levels go up during menopause. So, very interesting new area of research. We're learning more every single month. And just trying to educate both patients and our colleagues to make sure that at minimum, people are getting screened, so that they can then be connected to specialists who can help them with their cholesterol and their risk. It's, I think it's good that we're talking about this because I know for sure that my primary care colleagues are not ordering this, and I bring this up because it's like, oh, you bring it up to your doctor and they don't know what you're talking about. Sometimes they just are not familiar with that area yet, right? It's like GLP 1s a few years ago. I was writing them, multiple primary care doctors were not. Now it's very common, right, that many of them will be managing that. So I think it's good that we're talking about it. And I always think it's very empowering when we can know something that might be headed at us and maybe change the trajectory. I'm always looking for where's the empowerment moment, not just I'm, I'm helpless to these genetics or family history, right? Like, okay, what can we do that can help this? And I think we do have a lot of tools, right? That can help if, if we see this relationship. Yeah. Absolutely. So many tools. I think obviously a lot of patients who get referred to us for cholesterol have been through hell with, various statins and side effects. But we're always so excited to share that, you know, statins work for a lot of people and we now have So many other options in addition to statin. Some people are scared to look under the hood because they're worried about various medications. But I think we're definitely in an era where knowledge is power. I love what you just said about empowerment and there's a lot that we can do together with patients to help them and find the right treatment for the right patient. So, definitely would encourage anyone who hadn't heard of this before to just Talk about it at their next appointment, and try to make 2025 a year of great health and less risk. I love that. Okay, so along those lines, you kind of alluded to this. One of the last, I know I could talk to you all day, one of the last things I wanted to make sure to touch on is that I think women are in a very unique situation when they start to go through peri and then postmenopause. The physiology really changes a lot. And. I'm wondering if you can say, obviously it's a huge topic, but are there any sort of main things that you're looking for or any sort of top advice that you give women? And realizing when we say this, that obviously we're just doing a few minutes of talking here. So I'm acknowledging that any, pearl that you think is like really helpful for a woman to understand during that time. Yes, I think there's a lot to say. I think there's two, the two big buckets, of sort of useful information that occurred to me in response to that question is one is like, what is going on? What actually happens with cardiometabolic health during the menopausal transition, which like it is a transition. It's not a moment. It's not like there's not a light switch that goes off and boom, you're in menopause. It's usually like a prolonged transition. So what actually happens that women should be aware of. So that they're not feeling like they're on their back foot, trying to make sense of numbers and changes and new information as they go to their appointment. And number two is sort of this big topic around hormone replacement therapy and, you know, what, what are the things to really consider if there's any curiosity there about the potential role for that in a woman's case. So first is the cardiometabolic changes of menopause and perimenopause. What we see estrogen actually plays a very helpful role for cardiovascular health, right? It helps relax blood vessels the way we were talking about GLP 1 doing earlier. It helps keep our cholesterol in check. It helps with insulin sensitivity. And obviously, during perimenopause, estrogen starts to go down, and so all of those things tend to move in the wrong direction. It's a little, it can be very kind of, honestly, emotionally, complex for women to, to sort of be experiencing all of these things biologically that at their root have to do with no longer, Being of reproductive use, they're no longer reproductively active. And so what happens? Estrogen goes down your body because you're not like, going to be having babies just doesn't need as much energy as it did before to carry on. The amount of energy that you're just burning in a regular day, doing whatever you're doing. goes down. Therefore, if we do not change what we eat or how much we eat, and essentially really decrease our caloric intake proactively, what tends to happen is weight gain. Where does that weight get distributed? It gets distributed in the center, the midsection. A lot of people call it like menopause belly or whatever and that's because one of the things that's going on with estrogen reduction, the reduction estrogen levels or withdrawal of estrogen is that we tend to shift our body composition from lean muscle to fat. So we don't burn as much energy, setting us up for weight gain, and that weight is going to be stored as fatty tissue, adipose tissue, instead of lean muscle. That, having more adipose tissue on board, sets us up for insulin resistance, which is already something that's happening because of decreased estrogen anyway. And then on top of that, without estrogen, as much estrogen as we had before, our blood vessels become stiffer, setting us up for high blood pressure. take care. Our cholesterol goes up and this is why a lot of heart disease risk factors and heart disease itself seems to pick up and accelerate after women have started to go through menopause. So that is what is happening. Now obviously on top of that, there's a lot of what we call vasomotor symptoms, horrible hot flashes, brain fog, fatigue, or sleep disruption that really crush a woman's quality of life. And this is the kind of thing that. You know, like anything else in women's health, it's something that a lot of people roll their eyes, at inside or outside or just kind of cognitively dismiss unless you're going through it or unless you're, you're a man and your sister or your daughter, your mother, your wife, somebody else is going through it. Obviously, when someone in our lives is going through this, we know how horrible it is and how much it affects them. The question naturally arises, well, what about hormone replacement therapy? And so what that is, estrogen of various forms. Sometimes it's progesterone, another type of hormone can be administered, in a patch, in a pill, in a vaginal cream to just try to help women feel more normal and less symptomatic. And this used to be given out as standard of care. But then there was. Study the Women's Health Initiative that, revealed a possible relationship between estrogen based hormone replacement therapy and heart attacks, strokes, and, you know, what we call venous thromboemboli, clots in the leg veins or in the lung, lung arteries. And so suddenly everyone under the sun with a medical license stopped prescribing hormone replacement therapy. And a lot of women have been suffering through menopause since then. Unfortunately, it's taken us a while to sort of absorb data that has come out subsequently, but there have been analyses, re analyses of that same Women's Health Initiative study data that have revealed a more nuanced reality, which is that it actually matters a little bit You know, like which patients are, are you're prescribing HRT in? It turns out that if you are prescribing hormone replacement therapy in an older patient, you know, an older woman over 60, who is more distant from menopause 10 years out or more, those people are at higher risk of things like heart attacks, strokes and clot. But for other people who don't meet those criteria. younger, more recently menopausal. It's more of a risk based assessment. And we have ways of just looking at the whole history, their labs like LP little a their cholesterol, their family history, their other conditions. Have they had breast cancer? If they had radiation, do they have other inflammatory conditions? And we can sort of integrate all of that and tell the patient, Look, you're you're high risk. You're You're low risk or somewhere in the middle and you have sort of a back and forth what we call shared shared decision making conversation about what is the risk benefit of starting hormone replacement therapy for your symptoms of menopause. So lots of things can happen to affect your heart health during menopause hormone replacement treatment is out there for symptoms of menopause. It's not low risk for everybody, but it might be in the right people and having, you know, a discussion, a risk based discussion is the key in this modern era where we have a more comprehensive understanding of menopause and heart health. Well, that's really good. I feel like women are not having these conversations early enough. And so they're blowing past maybe the 10 years since menopause. So I'm really trying to get all my patients to bring it up much earlier. And I think we're starting to understand like you, you know, mid thirties and beyond, you need to start to be concerned about this. Not just once you've not had your period for a year. So I'm so glad that we're talking about this in the interconnection with the heart because everything's related and they don't occur in isolation and it's not all our fault. So we're not making all of this happen, right? Oh, absolutely not. No, I know. I think a lot of women do carry that sense of like, guilt or response that they somehow got themselves here, perhaps because it's often, tied up in excess weight. A lot of these things are correlated with or driven by excess weight. But of course you and I know, and any patient who's worked with you knows that now even obesity and the physiology of excess weight is a physiology that it's not. Something a behavioral failing or anyone's fault, so I'm really glad that you brought that up and being more being proactive really is key. Even if it's just to educate, you know, educate ourselves and form ourselves and start thinking about the issues and having those rich conversations with our doctors, it's never too early to start. Yeah. Oh, okay. I've learned so much from you. I know everyone's going to love this episode. What's the best way for them to connect with you? Yes. So, you know, our, we, Our website, we just sort of did a nice little website upgrade. So anyone who wants to work with us can, we're doing virtual care, we're focusing on women's heart health, but we're doing it in a little bit of a different way. We're seeing people in these little communities and these groups, and it's been so wonderful for women to feel like, I think they all know intellectually, but to really feel like, Oh my God, I'm not alone. with all these things. And it's just been amazing to see the kind of, support because doctors can't, we, we would love to be able to do it all, but we can't do it all. Like there's just a special kind of support and encouragement and motivation that can come from a peer as opposed to somebody in a white coat. So. where that's our model. We're seeing people virtually in these groups It's me and a health coach and the way to to explore working with us is jumping on our website Sicily health. com. I do free calls with everyone to just sort of hear about their story and see what are their goals and can we help and even if we're not a good fit? We still try to help any way we can so booking a call is very easy on our website or just sort of sifting through Our programs and then once somebody's really interested, we we do a deep dive on their history and get them into a group. So obviously, we would love to help anyone who's listening, but they're already in such great hands being part of your community and your clinic. And, it's just so important, the kind of work that that you're doing to, fill this void between primary care and specialty care, we need more people getting into that messy middle. But for now, the work that you're doing is so, is so needed and so valuable. Everyone that I've spoken to they've told me her program's amazing and they've been telling me such great things. And so I was following you for a long time, but then they were like, you have to get her on the podcast. So we always say we don't just have like random people on. It's very like selectively interview why we bring people on. So. Thank you. Your knowledge has been invaluable. We're going to make sure to link all of this in the show notes. So it's right underneath this episode when you're listening, or if you, if you go to rentia clinic, r e n t e a clinic. com, you'll see her episode and you can click on that. And again, we have all of that information in the show notes. So just again, thank you so much. Oh, thank you. And happy new year.