Live Long and Well with Dr. Bobby
Let's explore how you can Live Long and Well with six evidence based pillars: exercise, good sleep, proper nutrition, mind-body activities, exposure to heat/cold, and social relationships. I am a physician scientist, Ironman Triathlete, and have a passion for helping others achieve their best self.
Live Long and Well with Dr. Bobby
#18: Can We Reduce Our Risk of Heart Disease? Good News and Better News!
Heart disease is the number one cause of death in the US; we understand the risk factors for it, and there are 7 key steps you can take to reduce that risk. Here is a risk calculator that will give you your 10 year risk (and test how that might fall as key problems are addressed).
1. Treat the treatable causes like hypertension, high cholesterol, smoking, diabetes, and obesity.
2. Get exercise: the most powerful way to reduce your cardiac risk based upon key studies. And more exercise leads to additional benefits.
3. Optimize your sleep. Studies show benefit from getting 7-8 hours/night, and having sleep regularity (similar sleep times each night).
4. Think about your nutrition. weight control impacts risk of diabetes and risk of heart disease. The story on type of fats is complex with no differences shown in studies of low vs. high fat diets.
5. Add some mind-body work to your life. Although there are no long term studies demonstrating that yoga/breath work/meditation lowers mortality, short term studies show that yoga reduces blood pressure (an important cardiac risk factor)
6. Consider taking a sauna: studies are pretty clear that taking a sauna (perhaps 3x/week for 20' each time) is associated with lower cardiac risk of sudden death.
7. Build and maintain strong social relationships. Large differences in mortality between those with and without strong social relationships.
Hi, I'm Dr Bobby, and welcome to Live Long and Well, a podcast where we will talk about what you can do to live as long as possible and with as much energy and vigor that you wish. Together, we will explore what practical and evidence-supported steps you can take. Come join me on this very important journey and I hope that you feel empowered along the way. I'm a physician, ironman, triathlete and have published several hundred scientific studies. I'm honored to be your guide. Hello everyone, and welcome to episode 18. Can we reduce our risk of heart disease? The good news and the better news. Well, I'd like to start a little differently with a quote by Hunter S Thompson, who's a writer and wrote this about 60 years ago, but it really typifies some of what we're going to talk about today, and I just love this quote. So here we go. Life should not be a journey to the grave with the intention of arriving safely in a pretty and well-preserved body, but rather to skid in broadside in a cloud of smoke, thoroughly used up, totally worn out and loudly proclaiming wow, what a ride. Now, to have that ride is what I want for all of you, and to do that, we need a healthy heart. We need a happy heart to make that happen. So today we're going to talk about how you can keep your heart healthy and reduce the risk of a heart attack or dying from something related to your heart. Now, if you're in your 60s, you might already be thinking about this topic, and certainly there's a lot of good stuff I hope you can add to what you're doing. But even if you're in your 30s or 20s or 40s, now is the perfect time to start doing this, to be aware of what causes heart disease, so that you can get ahead of the problems and take care of them. So I hope there's something for everyone here. Well, why do I care about this topic? Well, it's pretty easy because cardiovascular disease is the number one cause of death in the United States, and it has been for over 100 years. And it affects men and women, and it's the number one cause of death in both genders. So it kills. Heart disease kills about 600,000 people each year. Now I am hopeful. Of course, I'm generally an optimist or person, but I'm very hopeful because since 1950, the death rates due to cardiac mortality have declined 60%, which is tremendous. Now that's likely due to our much greater ability to treat blood pressure elevation or cholesterol that's high, and a greater and greater awareness that smoking causes heart disease. Now, on the not so good news that trend, the lowering trend of mortality, has started to work its way back up again. Why? Because of obesity, which then relates to diabetes. So there are lots more than we can do to help us reduce our risk, and that's what we're going to talk about today.
Dr. Bobby Dubois:Well, I like to begin with a story. So my dear wife Gail and I decided to do a vow renewal and have another wedding after 25 years of marriage, and it was a wonderful experience. We had a great time and we decided we were going to do a ballroom dance at the beginning, like most people do a dance. So we did a tango and we had a ballroom dance teacher, sharon, and so she came to the wedding, of course, and she brought one of her students as her date and he was in his, I think, early 80s. And the ceremony was great. The reception was wonderful, we had a band, it was just lovely. We enjoyed ourselves thoroughly. But late into the dancing, sharon's date collapsed on the floor and died. Now we had a lot of doctors in the room, but that didn't solve the problem.
Dr. Bobby Dubois:Well, after the shock, I obviously reflected on what happened and wondered might it have been prevented? And there are some things in his story that it might have been preventable, and of course, that affected me and I want to help others to prevent something like that. But he was in his 80s and we had a chance to meet his family afterwards and they were upset, of course, because he was a beloved father and grandfather. But he died doing what he loved. He was the Hunter Thompson and he might have said wow, what a ride. And so I think we need to keep both of those perspectives in mind as we talk about this.
Dr. Bobby Dubois:After that event, I thought carefully about heart disease and what I can do in my own life to reduce the risk of it, and then, obviously now with you, my audience, how I can do in my own life to reduce the risk of it. And then, obviously now with you, my audience, how I can help you. Well, let's begin with take-home messages. Although heart disease is the number one killer, there's so much we can do to reduce your risk of heart disease, and for some of you, you might be able to reduce the risk by 90%. There's almost nothing in healthcare that's that impactful, and so I want to help you to understand that. And there are seven very practical and tangible steps you can take to help your heart live long and well and for all of us, hopefully, as we get older and older, to say, wow, what a ride. Well, before diving into the seven steps, let's do some background, because I think that's very important and it'll provide, I think, a springboard for what we're going to talk about.
Dr. Bobby Dubois:There are many known risk factors for heart disease. This is one of the best studied areas of the human body. I'm going to touch on eight of them Now. Three of these we don't have any control. So as we get older, the risk of a heart attack or death rises, so not much we can do about that. Men have a higher risk than women. That's just a reality. That is very, very clear in the data. And the last is a family history. Now, a family history isn't defined as oh well, my father died at age 75 with a heart attack. No, family history means that in someone in your family, first degree relative, typically the mortality or the heart attack happened at a very young age, you know, 50, 55, 60 years old. That's what we mean by a positive family history. So not much you can do about most of those, but there are five that you can do something about and they can be amazingly life transforming.
Dr. Bobby Dubois:So one is your blood pressure. Blood pressure is a critical risk factor and it is highly, highly treatable. There's so many medications. If one doesn't work, something else will. Also cholesterol, ldl cholesterol and other cholesterols Again, get that under control. That makes a huge difference and that's something that we want to pay attention to. Our weight is important as it relates to diabetes and, as we've talked about in previous episodes. Probably 70% of the US population are either overweight or obese, and so this is really, really important. And the final of those five risk factors is smoking. Now, the good news is, I think we're down to about 11 or 12% of the US population. It used to be twice or more than that in the past, but there are a significant number of folks who still smoke, and maybe some of you on this podcast as well.
Dr. Bobby Dubois:Well, everybody who's listened to me at least a little bit knows that I love data and I love assessing things in myself. So there is a cardiac risk calculator. Actually, there's a bunch of them out there. I'll have a link to one of the most well-known ones in the show notes. So by all means, go to it and take a look. And what it does is you put in various characteristics of yourself, like your blood pressure and your cholesterol levels and your age and gender and those kinds of things, and it then tells you what your 10-year risk is. And the beautiful thing is you can do what-ifs. You can say well, my blood pressure today is on the high side, but what if I got it under control? My cholesterol is elevated or I smoke. What happens if those change? So I went and did some basic calculations and came up with somebody who did have high blood pressure, elevated cholesterol and was continuing to be a smoker and they had about a 20% 10-year risk of cardiac mortality. And I recall I believe this was somebody in their early 50s, so they might die at a pretty young age. But if you changed in the calculator that, oh, we got the blood pressure under control, great, we got the cholesterol under control, great, no longer smoking. That 20% risk dropped to 2%, 90% reduction with a couple of lifestyle changes. So amazingly important.
Dr. Bobby Dubois:Before we dive into the seven things you can do, I want to point out that there really are two types of preventing heart disease. What I'm going to talk about and focus on is what's called primary prevention, meaning I don't have heart disease now and I want to avoid that happening. Then you have what's called secondary prevention. Those are people who already have heart attacks or have heart disease and you want to prevent it getting worse or dying from it. We're going to talk about primary prevention. If you already have heart disease, by all means talk to your doctor. Not that the things I'm talking about won't apply to you, but your situation may be sufficiently unique that you need input from your doctor. Okay, let's dive in for the seven steps of how you can reduce your risk. So I might refer to the ones we talked about, like the blood pressure and cholesterol and smoking, as the good news, so things that we really, really know can help.
Dr. Bobby Dubois:Now I'm going to get to, as the title said, the even better news that these are things you could do on your own. Don't require a doctor, don't require medications after we've finished the first step. So step one obviously, if you have high blood pressure or high cholesterol or diabetes or you smoke, get those under control, treat them, because they make a huge difference and, as I mentioned in my little scenario, 90% reduction. By all means, if you have high blood pressure or high cholesterol, try diet and see if that works. Try exercise and see if that works. It's been my experience that for lowering cholesterol and blood pressure you're only going to get so far with lifestyle changes. Now, if you lose 50 pounds and that's the driver of this of course that may all go away. But for most people, if you're not really obese, changing your diet and exercising probably isn't going to get you completely there.
Dr. Bobby Dubois:So what I would do, if you aren't there, is to really seriously consider medications. I know some people really don't want to take medications. It's not what their body was meant to receive and they don't want side effects. But these are so highly effective and population-wise we've reduced heart disease specifically because of these drugs. So I don't want you to be frightened. If you need to, don't feel like you failed. If you need them. I take a blood pressure pill, I take a cholesterol lowering pill. Certainly I pay attention to my nutrition and certainly I exercise a lot. I've got an Ironman triathlon, a half Ironman, probably around the time that this will take the airway. So I obviously get a lot of exercise, but I still need medication, so don't feel bad. If you need to as well, all right.
Dr. Bobby Dubois:Step two I just alluded to exercise. Now, this topic and many of the others we're going to get to in the next few minutes are ones I've already done detailed podcasts on, so by all means, listen to some of those again to give yourself some more insights. I'm going to summarize some of the key issues here just for the purposes of heart disease, and exercise helps lots of other things. Okay, so there are several points I want to make about exercise. First, exercise lowers our risk of cardiovascular death.
Dr. Bobby Dubois:So here's some observational studies of 116 adults. One was the nurse's health study, another was the health professional study. They followed these people for 30 years, which is a really, really long time, and they compared people who met the recommended guidelines for exercise and just to remind you, that's moderate exercise, about 150 to 300 minutes a week, or vigorous exercise, 75 minutes to 150 minutes a week. So they compared the people who had that level of exercise with those that didn't, and what they found is those that were doing the exercise on that regimen had a 30% lower cardiac mortality A huge impact, probably even more than getting your blood pressure under control, so tremendously important. But there's another piece of the puzzle and that is more is better. More exercise will give you more benefit, obviously within bounds. So this was a study of Harvard alumni it's about 17,000 people and they found that the more exercise you got, the death rates fell. More exercise beyond that, the death rates fell even further.
Dr. Bobby Dubois:And they looked at people who got 500 calories a week of exercise like about five miles a week up to 3,500 calories burned a week, or about five miles a day. So this is just sort of walking equivalents. Obviously, if you're doing a bike or jogging or playing pickleball, you can work that in and figure that out. And what they found is that for people who had burned about 200 calories a week, they had a 25 to 33% reduction in cardiac mortality. So really, really substantial. So a mile a day every day, you know, will get you your 700 calories a week. Up to five miles a day might get you 3,500 calories a week. So a few miles a day of just walking can make that substantial difference. The other thing I just want to point out is that the guidelines are quite clear about how much exercise we should get, but only 25% of us get that full recommended amount of exercise each week. So take a look at what you're doing, think a little bit about what you hope to accomplish, and maybe this is an area to focus on in the future.
Dr. Bobby Dubois:All right, step three optimize your sleep. Now, this may seem a little odd. Why is sleep going to help me with my heart or prevent heart attacks or cardiac mortality? Well, there's three lines of data that I'll walk you through which are really important and speak to this issue. The first getting too little sleep is a real problem. So in the nurse's health study, which had about 7,000 adults in it, they looked at people who had less than six hours of sleep on average per night and what they found is they had a 70% increased mortality relative to people who got seven to eight hours per night, to people who got seven to eight hours per night. Now, let me point out that this was not the mortality, wasn't specifically cardiac mortality. They looked at and measured and reported overall mortality. But since, as we've talked about, half of all deaths are due to heart disease, I suspect a lot of this was mediated through heart disease. So huge impact if you had less than six hours of sleep.
Dr. Bobby Dubois:Second, which you may not have thought was the case actually too much sleep can be a problem too. So a much bigger study they looked at 70,000 women. They followed them for 10 years and they observed that there is a U-shaped curve. Now what do I mean by that? It means if you got very little sleep, your risk was high. Five or six hours sleep was not good. Seven or eight hours of sleep was good and the risk went down. But if you got more than nine hours of sleep, all of a sudden the risk went back up again.
Dr. Bobby Dubois:Like a lot of things in life, you don't know where the chicken is and where the egg is. Was it the less sleep that caused the problem? Or was it that they were already ill and felt the need to sleep a very long time? We don't know. Certainly, on the low end, we know that's a problem. On the high end, I would say it's still somewhat of an open question. Would say it's still somewhat of an open question.
Dr. Bobby Dubois:Second aspect of, or third aspect of, sleep sleep irregularity is a problem. Now what does that mean? A regular sleep pattern is every night you get roughly seven to eight hours of sleep. You roughly go to bed at 10 o'clock at night and you generally get up at five or six in the morning and this is your routine. Irregular is obviously the opposite of that. That you don't get the same number of hours of sleep at night, and when you go to sleep, when you get up, is varying from day to day. So here was a study with the UK Biobank, which is a large database where they've been following people for a long time and it was about 61,000 people and they had Fitbit data long time and it was about 61,000 people and they had Fitbit data the things that you wear and they had that sleep data. So they then looked at how much people were exercising, how much they were sleeping, and then they looked at what happened to them, whether they had a higher or lower risk of a heart attack and death and they followed these people for around six years and what they found is those people who had a regular sleep pattern meaning roughly the same every night they had a one quarter to one half reduction in mortality, cardiovascular mortality a huge difference. And again, that's something you might not have thought that sleep has a tremendous impact and it does.
Dr. Bobby Dubois:Okay, I'm a little hesitant or frightened or uneasy to do the next one. This is step four. Think about your nutrition. Okay, some of this is pretty obvious. If your weight is above what it could be or should be, that is a risk factor for causing diabetes, for increasing your blood pressure, affecting your blood lipids, your cholesterol, and related to death and mortality. You might listen to my episode 15 on what we know about weight loss, what the evidence really tells us, but this is very clear that if your weight is above what it could be, should be, this is a risk factor. Now it starts to get a little bit complicated and that is fats good fats, bad fats, much fat, little fat. Here is where I believe the data are not convincing one way or the other. Now I'm old enough to remember that.
Dr. Bobby Dubois:Not that many decades ago, egg yolks were bad, egg whites were okay, but egg yolks were bad. Shrimp was bad. Basically, cholesterol eating cholesterol was bad, and for a long time that's what we were told. Of course, it turned out that the cholesterol in our body is manufactured by our body and that cholesterol intake wasn't an issue. So eggs are bad, okay, now eggs are good. Then there was a progression, because when they said don't eat eggs and don't eat butter. Then they said margarine, margarine's good, and so those have trans fats. Well, that was supposedly a good thing in terms of having margarine, but then we learned, nope, that's not good. Trans fats are bad and for all intensive purposes most trans fats now are not available and people don't get exposed to them too much. So now we're down to the next issue, which is saturated versus unsaturated fat.
Dr. Bobby Dubois:When they've compared these two sets of diets, here's an example of a study, the Minnesota Heart Study 9,000 people, and they compared people had high saturated fat diets, that's typically animal fats, butter and the like. Yes, of course there are saturated fats and coconut oil, but in most people that was sort of butter related versus low saturated fats, polyunsaturated fats. What they found was there was no difference in cardiac outcome. High saturated fat low saturated fat, didn't seem to matter. Now, there's some reasons why this might've occurred, but that was the findings. The World Women's Health Initiative randomized diet trial 48,000 people. Again, they compared a reduced fat diet to a typical diet. Again, no difference in cardiovascular outcomes.
Dr. Bobby Dubois:Now there are some people that say well, the reason that the low fat diet didn't work better, because they believe a low fat diet is the way to go is that those people then ate more sugar. They had to eat something, since you lowered their fat, so they ate more sugar, and the sugar is actually the, and actually low fat is better for you. That's a theory. That isn't what the evidence said at the highest level. Also, there are people that say plant-based is better than animal-based. I don't think we know. So in general, I kind of eat what I want. I will be doing a podcast very soon on seed oils because that's gotten so much attention and I want to figure out where we are on this topic. It's not an easy one to sort out, but I'll do the best I can for you All right.
Dr. Bobby Dubois:The third aspect of nutrition is alcohol. Now here's a little interesting question Is the alcohol damaging to your heart or not? Now, for many, many, many years, they thought a small amount of alcohol, especially red wine, was good for you, for your heart, that is, and so that was kind of the standard teaching. Now we all agree that if you're having three, four, five, six drinks a day, that's not good and your heart is going to be impacted by that in a very negative way. But the data on sort of low to moderate use of alcohol has been uncertain on your heart. Now, no question it has impacts on your brain and so I'm careful about how much alcohol I drink. But I'm not looking at it from a heart standpoint, I'm looking at it from a cognitive decline and impact on my brain. So alcohol, as a direct toxin and it is a toxin may or may not directly hurt your heart a lot, again, mild to moderate drinking.
Dr. Bobby Dubois:But where alcohol may have a really important impact is on our sleep. So maybe it's not a direct effect on our heart, but it's an indirect effect because, as we know, as we talked about in the sleep episode, alcohol impairs your sleep. You go to sleep quickly, but the quality of your sleep, the length of your sleep, is not good and so, as we just talked about, sleep increases your risk of heart disease. So alcohol, which affects your sleep, might affect your heart in just that way. Okay, the last thing about nutrition is there's a lot of interest in omega-3s as a good fat. You know that's the fat that's in fatty fishes like mackerels, sardines, salmon and certain types of nuts and chia seeds and those kinds of things. Now I think the data is pretty clear that a diet that is rich in these things, meaning foods is helpful At least it looks to be in a lot, a lot, a lot of observational studies. Where it's less clear is whether omega-3s as a supplement make a difference, and I believe this is a mixed bag because it might have an impact on your heart and heart disease and heart attacks, but it also appears to increase your risk of a heart rhythm disorder atrial fibrillation. So it may be a double-edged sword. Again in your diet. Great, I think supplements it becomes less absolutely certain. Step five add some mind-body work to your life.
Dr. Bobby Dubois:Okay, now to be clear, there is not a randomized control trial comparing people who did yoga or meditation to those who didn't and watch them forward in time in a randomized control way and say, oh, what happens in terms of heart disease. So we're gonna have to piece together some data that suggests that this type of intervention will help you. There's the British Whitehall study about 7,000 people. They followed these folks for about 18 years and what they looked at was stress. So people who had high levels of stress in the beginning had a doubling of heart attacks and death due to heart disease. So what that suggests is that stress may be a problem. Now, of course, as you can anticipate, we're going to then talk about can yoga or meditation reduce stress? Again, there isn't this perfect long-term randomized trial, but in a yoga scenario there was a meta-analysis or a summary of 49 clinical studies with 3,500 participants, and these people, on average, had about five yoga sessions per week, and this went on for about 13 weeks. Again, in 13 weeks you're not going to see a reduction in heart attacks that would take years. But what they did find is that in the people who were doing the regular yoga, their blood pressure fell a lot like five points, which is probably about as much as you get from some blood pressure medicines. So what does this all tell us? We know that a blood pressure that gets lower is good and reduces your risk of heart attack. So one way these techniques can help us is lowering our blood pressure. Then there's also this issue now of stress and whether these types of things will help us in terms of reducing stress.
Dr. Bobby Dubois:Okay, number six taking a regular sauna. In our episode on exposure to heat and cold, we talked about studies that were done in Finland. And why Finland? Well, because there's about one sauna for every two people in Finland and everybody pretty much does it. So it isn't just a matter of well, rich people do saunas, people who have a lot of free time do saunas Pretty much everybody does. So they follow the group of middle-aged men and they follow them for about 20 years and what did they find? They found that the risk of sudden cardiac death, typically due to a heart attack or a bad rhythm disorder, was way down in people who did routine saunas.
Dr. Bobby Dubois:Now there's two pieces of this puzzle. The first one was people who did more sessions a week had more reductions. So if you had, you know, a once a week session in the sauna, you had a certain cardiac risk death. If you had two to three, it fell. If you had four to seven, it fell even further. So more is better. The other aspect of more is better is being in the sauna for longer, and so they compared people who were typically in the sauna less than 10 minutes 10 to 20 minutes, more than 20 minutes and they found again, the more time you spent in the sauna each time, the better off you did. Now they didn't test people doing an hour or two hours, and I'm not recommending that at all, it's just that you know doing more was better. So ideally, 20 minutes at a time a few times a week would be fantastic, and I try to do it as often as I can. I can't say I'm on a three time a week, especially when it's really hot when I am in Texas. I don't generally love to jump in the sauna. When it's colder outside I tend to do it more, but it's something I need to remind myself as often as possible.
Dr. Bobby Dubois:All right, step seven, the last of the things that you can add to your regimen Build and maintain strong social relationships. Okay, so again, we don't have a randomized trial here of you know you're going to be a monk for the next period and cloister yourself and not talk to anybody and you're going to, you know, have a normal life with normal relationships. We don't know. So we have to do the best we can with the data. That begins to tell us a bit of a story. So the first story we know is that when one spouse dies, the likelihood of the second spouse dying in the time period soon thereafter is way higher.
Dr. Bobby Dubois:So in the health and retirement study they looked at people who were married and they were 50 and older, and what they found is, if the wife died, there was an 80% increase in risk for men dying and if, in the woman's case, if the man died, there was a 50% increase, not as high as for the men. I believe it's because women have more relationships in their life and when their husband passes they have others that they can depend upon and have connection with, whereas men, often we aren't as good about having really close relationships outside of our wives, and so I believe it takes a greater impact on us. Again, this was a study looking at overall death, not just heart related. But again, heart related is the most common reason, so it probably had an impact there. They've also done a number of studies looking at people who already have heart disease, and when they compared people who were married with heart disease with those that were unmarried with heart disease, they found there was a threefold increase in the unmarried mortality at five years. In a meta-analysis summary of 148 studies with 300,000 people observational studies, they looked for seven years, and again those that had adequate social relationships had a 50% greater likely of survival than those that did not.
Dr. Bobby Dubois:And when we think about it, we know that smoking is a really bad risk factor and so stopping is important. Well, the magnitude of the impact of having close relationships in your life is probably even more impactful than the risk factor of smoking. Of course, I want you to stop smoking as well, but this just brings to mind how important social relationships are. Well, but this just brings to mind how important social relationships are. Okay, it's time to wrap up.
Dr. Bobby Dubois:Heart disease is a major cause of death, the most common in the US. Now things have gotten better as we've gotten greater treatments and greater awareness, and I want you to treat the treatable the blood pressure, the cholesterol, stop the smoking and those kinds of things, but also think carefully about the other things we discussed your sleep, your exercise, your mind-body work, your nutrition. All of these kinds of things are very important Social relationships and how much alcohol you drink and how much alcohol you drink. I want you all to live long and well and for all of us and our family members around us to say, wow, what a ride. Let's continue on this journey together Until next time. Goodbye. Thanks so much for listening to Live Long and Well with Dr Bobby. If you liked this episode, please provide a review on Apple or Spotify or wherever you listen, if you want to continue this journey or want to receive my newsletter on practical and scientific ways to improve your health and longevity, please visit me at drbobblivelongandwellcom. That's, doctor, as in D-R Bobby livelongandwellcom.