Statins, Calcium Score & Cholesterol: What You Need to Know About Preventing Heart Disease

In Part 2 of this powerful conversation, Dr. Chhaya Makhija sits down with preventive cardiologist Dr. Sourbha S. Dani to discuss how we can identify and prevent heart disease before it becomes a life-changing event.

Together, they break down the screening tests, lab markers, and imaging studies that can help uncover cardiovascular risk years before symptoms develop.

From ApoB and Lipoprotein(a) to coronary calcium scores, insulin resistance, statins, and lifestyle interventions, this episode provides a practical roadmap for anyone looking to take a proactive approach to heart health.

Dr. Chhaya also shares her perspective as a preventive endocrinologist, highlighting the metabolic factors that often drive cardiovascular disease and why early intervention matters.

If you have a family history of heart disease, elevated cholesterol, diabetes, or simply want to optimize your long-term health, this episode is packed with actionable insights.

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Dr. Dani is a non-invasive cardiologist with a special focus on prevention and premature heart disease at Lahey Hospital and Medical Center in Burlington, Massachusetts. He serves as the Program Director for the Cardiovascular Fellowship, Director of Inpatient Cardiac Services, Director of the Adult Congenital Heart Disease Center, and Co-Director of the region's first South Asian Metabolic Program.

He is also an Associate Professor at the University of Massachusetts Medical School and Tufts University. In addition to his clinical and academic roles, Dr. Dani is a cardiovascular outcomes and healthcare economics researcher, collaborating with the Smith Center for Outcomes Research at Beth Israel Deaconess Medical Center in Boston and the Center for Cardiovascular Research (CVER) at Tufts University.

Disclaimer: This podcast is for educational, informational, and entertainment purposes only. It’s not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider for personalized guidance.

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Transcript

SPEAKER_01 0:00

Worried about dying because of a heart attack? Worried about, you know, your family member having a heart attack and what's going to happen to you? What are the screening tests? You know, what are your goals? Especially for LDL, for apolipoprotein B. Should you be on statin? Should you not be on statin?

SPEAKER_00 0:15

If they're coming to me at 30, I said, congratulations, you have uh really achieved greatness by understanding that it is a need for South Asian individuals to start their screening in their 20s, late 20s, or early 30s. I use a proverb, uh it's a Chinese proverb, which says that the best time to plant the tree was 20 years ago. The next best time is now. So if you did not do that then, this is a good time. Why do I say that? Because the fatty streaks uh were seen as early as at the age of 15 in many autopsy studies in young kids. And by the age of 25, the abnormalities in the endothelium of the blood vessels was discovered. By the age of 35, many of these individuals were seen to have calcification or soft plaques in their coronary arteries. And that's why it's important to start in the 20s or early 30s.

SPEAKER_01 1:09

Welcome to Hormones and Hope, a podcast where we bridge science and wellness to help transform your health. I'm your host, Dr. Chaya Makija, or you can call me Dr. Chaya, a triple boat certified endocrinologist and lifestyle medicine physician and founder of Unified Endocrine and Diabetes Care. Each week we dive into the powerful intersection of clinical medicine and real-life lifestyle strategies to help you feel stronger, live longer, and show up as your most vibrant self inside and out. So let's get empowered. Worried about dying because of a heart attack, worried about your family member having a heart attack and what's going to happen to you? What are the screening tests? You know, what are your goals, especially for LDL, for apolipoprotein B? Should you be on statin? Should you not be on statin? Because there's a real craze about GLP1 receptor agonist. Beyond diabetes, beyond prediabetes, beyond weight loss, you're going to learn about is this helpful for your metabolic health? So joining me today is Dr. Saurabh Dani from Massachusetts. And if you haven't tuned in to our last week's episode, go watch it, pause this episode because you really need to know the basics about heart disease, what are the risk factors, why are we worried about uh heart disease, premature heart disease, especially in South Asian population? And then tune into this episode because it's going to be a wealth of uh knowledge that you'll learn as your foundations and then build on strategies to improve your metabolic or even cardiovascular health. So welcome, Dr. Dani.

SPEAKER_00 2:44

Thank you so much. I'm I'm delighted to be here and uh excited to talk about things which are close to my heart.

SPEAKER_01 2:50

Yes, you know, I was uh so intrigued by the stats and the studies that you were mentioning and how you're breaking it down as a preventive cardiologist and all the work that you're doing in the South Asian metabolic program that you just shared with us. You really touched on I have eight to nine risk factors from the previous episode, South Asian ethnicity being the largest, and then you talked about females or autoimmune diseases, the other metabolic factors, including obstructive sleep apnea, and almost one in four individuals in the clinical study or trial of Masala study, where one in four technically had untreated or undiagnosed obstructive sleep apnea. I love that you touched based on pollution and microplastics, because that's also in our world as endocrine disruptors affecting the hormone signaling. Now, this is where we get into action, and uh we would love to learn from you as to you have anyone who is coming to you saying that I have strong family history, it could be a male or a female with that South Asian ethnicity or background, that I have strong family history of heart disease. They don't have it personally yet. They're mid-adult or maybe in their mid-30s. How are you assessing their risk factors other than the history taking and the questions that you're already asked them during your clinical discussion? What are the labs, imaging or tests that you look for and how do they support you for the implementation strategies?

SPEAKER_00 4:18

Great question. So uh if they're coming to me at 30, I said, congratulations, you have uh really achieved greatness by understanding that it is a need for South Asian individuals to start their screening in their 20s, late 20s, or early 30s. I use a proverb, it's a Chinese proverb, which says that the best time to plant the tree was 20 years ago. The next best time is now. So if you did not do that then, this is a good time. And the idea is to catch these individuals in 25s and 30s is that because of the premature heart disease, which is very common, and we don't want to hear that, hey, I've seen that 45-year-old patient who had a sudden myocardial infarction. Because his disease did not start when he was 45 or 44 or 40, it started almost 30 years ago. Why do I say that? Because the fatty streaks uh were seen as early as at the age of 15 in many autopsy studies in young kids. And by the age of 25, the abnormalities in the endothelium of the blood vessels was discovered. By the age of 35, many of these individuals were seen to have calcification or soft plaques in their coronary arteries, and that's why it's important to start in the 20s or early 30s. Again, a good history taking always helps. Uh, why does that help for South Asian, as you mentioned? Is uh is there a pattern? Is there only males in the family getting affected, women in the family getting affected, or is there a pattern where both maternal and paternal sites have had history of sudden cardiac death as a result of heart disease? Is there a history of young individuals in family presenting with heart disease? And by definitions, we say premature heart disease is when a male in the family has heart disease before the age of 45 and a woman in a family having heart disease before the age of 55. And these are better numbers than the previous numbers, which were 55 for men and 65 for women. So that's important. That history is important. And again, like we said in our first episode, that we haven't heard a single South Asian family with some family history of high blood pressure, or diabetes, or peripheral arterial disease, or for that matter, stroke, and all these are important risks to uh uncover. So that's the first part of it. So I say to my patients that congrats, uh, we have achieved the history, you are here. So, what are the basic blood tests which are available for these individuals? So, as simple as starting from hemogram to check their hemoglobins, uh, because many of South Indians, uh, South Asians have thalassemia minor, so that's important. Are the platelets okay? Then is their sodium and potassium and renal function okay? Those are important starting points. I always get liver function tests in South Asian individuals because if I'm going to put them on medications such as statins, I want to see what their baseline was. And more important than that is the metabolic associated fatty liver disease, which is again a marker of metabolic syndrome or marker of inflammation or marker of insulin resistance, is very common. So to have a baseline of that, that's an important thing. Then comes your fasting lipid level, which should check the direct uh LDL as well as the calculated LDL because LDL is a marker of how much cholesterol it's carrying and how much atherogenic cholesterol it's carrying. And I tell my patients what is LDL is a on a busy street, a single car with five patients is LDL. And I tell them that we also want to look at all the cars and all the passengers in these cars on that busy street, and that is epolipoprotein B, because it will calculate all the athrogenic particles, including lipoprotein A. But I separately also order lipoprotein A in all South Asian individuals because, as a result of the latest guideline change in American College of Cardiology, that uh as a result of increased understanding of risk associated with lipoprotein A, a lifetime once measurement is a must for every individual, including South Asians, where there is increased prevalence of presence of lipoprotein A. Then comes the specific test for these individuals, and I put two of them there, which is the fasting insulin level, which also helps us to understand the insulin resistance or the homeostatic uh HOMA-IR insulin resistant test. I also order C peptide as a baseline for these individuals and homocysteine specifically for South Asians, because I see a lot of South Indians with elevated levels of homocysteine, which is associated with stroke as well as uh coronary artery disease. A baseline ECG is a plus minus depending on their age or depending on their symptoms. Electrocardiogram will give you the underlying electrical activity of the heart. An echocardiogram will be an ultrasound of the heart. On top of that, uh, I've started ordering lipoprotein-associated phospholipase A2, which is a new marker of inflammation. Again, we don't know what to do with the inflammation, but I we get that for our registry basis here so that we can collect information. Uh, we also order HSCRP. It's a high-sensitive CRP, which is a marker of inflammation. And many times I see that that is elevated in South Asian individuals, even before they have hair coronary artery disease. In the physical examination, a simple but not so popular test is checking the west circumference and uh ratio of west to height circumference. That's an important make or break test with regards to understanding the newly upcoming CKM syndrome, which is the cardiac kidney metabolic syndrome. And the cutoffs for South Asian individuals are different, and it is very important for our viewership and patients to understand that we cannot put our ourselves in the same bucket as the Caucasians and other ethnicities, because the studies never had a lot of South Asian representation. Take it a study from the United States or take a study from Europe or for that matter, United Kingdom. So it's also important for us to understand that the numbers for the BMI, the numbers for the weight, the numbers for the hemoglobin A1C, which is an important additional blood press that I send for all these individuals to understand where they stand for, uh, are totally different for South Asians, should be different for South Asians. And again, there's no consensus about where they should be, uh, but it's important to keep them lower. Uh, with regards to coronary artery calcium, uh, it's an important test, and I consider that test for any individual who's 35 years and above of South Asian origin and has had a premature heart disease or has had two or more risk modifiers if they have had high blood pressure or pre-diabetes, or if they have some other inflammatory disorder, or if they're a smoker, or if they have elevated lipoprotein A, I usually end up ordering coronary artery calcium test. It's an important test, and there's a lot of controversy surrounding it. Should you use it, should you not use it? But it is a break or mech for many of my patients when I talk to them about a statin. So coronary artery calcium is going to determine the calcium around the heart arteries, in the heart arteries, and these are hard plaques. So a lot of controversy is that you're going to miss out on the soft plaques, and there's still a risk of having coronary artery disease and the event associated with it. It's on the lower side, but still 1 to 3% individuals may have uh situations where they have had coronary artery disease despite having a coronary calcium score of zero, which is the ideal most important score. But I use it to tell patients that look, uh, you're 36, your LDL level is 110, which is quote unquote in black in your medical records, means normal, but your epolipoprotein B is 130. You have had family history of heart disease. This is the right time to start that statin to lower your risk of having coronary artery disease. Uh relative risk is lower, but the lifetime risk of you and us preventing a heart disease is very higher. So I give them a lifetime picture that let's not talk about 10 years, let's talk about 30 years. That I'm not talking about 10 years from now. You're young, but I don't want those 10 years to be painful. But look at 30 years, I want you to live for your son's graduation or son's kids, naming ceremony and whatnot. So that helps. That's where the coronary artery calcium score comes into picture. There's a taste called City coronary angiogram, and I usually keep that reserved for patients who have had symptoms of angina or chest pain, or who have had atypical symptoms of chest pain, or who have too many risk factors, or if their calcium scores come out to be 2700, 2800, 500, 800 with risk factors, with symptoms, CT coronary angiogram would help us to check the anatomy of the coronary arteries and understand if the blockage is uh proximal or distal, or is the blockage hemodynamically significant because we can also do a test called FFR, fractional flow reserve on a CT scan, which can help us understand if the blockage is significant or not.

SPEAKER_01 13:39

Yeah, very robust. So that's the the coronary angiogram. It's not for everyone, but you would assess the risk based on also the ACOR.

SPEAKER_00 13:48

Correct. So it's a CT coronary angiogram, still non-invasive, but gives you the anatomy of the coronary arteries. I also checked TSH. Uh, thyroid function test is very important in all these individuals because uh higher levels of TSH, meaning hypothyroidism, usually elevates lipid profile.

SPEAKER_01 14:04

Yeah, I I agree because as uh for preventive endocrinology, everything that you said, everything is a checkbox, including the CAC or the calcium score, that we end up doing. I would read about the phospholipase A2 as to how you're but you're probably doing in the in the research area and also trying to collect data.

SPEAKER_00 14:21

Absolutely. There are there are more markers than that. There are markers about IL6 and TNF alphas, but again, we don't know what to do when these numbers are high. So many patients ask me that, hey, my lipoprotein is elevated. How are you going to treat me? Because there is no medication for this. Then I say that, hey, let's focus on LDL because what we know at this point is can we keep that LDL very low? Can we keep that apolipoprotein D very low? Can we keep those triglycerides very low? Versus I don't know what to do when the IL6 levels are high. I don't know what to do when the TNF alpha levels are high. I don't know what to do when lipoprotein associated phospholipase A2 levels are high. But I tell them, wait, let's focus on what we know. So that helps me to understand them the emergency, because language changes the urgency or emergency, and the results should make you work on an action. So I tell them one risk factors, we are talking about prevention, two risk factors, I'm giving you a medication, three risk factors, I'm looking at you very closely to keep all those risk factors very low.

SPEAKER_01 15:27

Absolutely. So now the the cardiology question for for you is that you know, if we've assisted all these metabolic panels, I'm not just talking about a complete metabolic panel, but all the tests that you laid out. Say if you're adult, and I feel like this is very much relevant to any adult who comes in beyond the ethnicity for all the testing that you that you suggested or recommended. But here is where the barrier is, even I talked to a lot of primary care physicians, is a statin barrier or the statin resistance to in in people's minds. It's not the statin resistance, which is, you know, another uh problem, which is more of a physical diagnosis or a medical diagnosis. So you have your young adult just with the family history, you know, you've checked all the parameters and they get a green light for the fasting insulin, the glucose, A1C, and so on, even the CAC score or the coronary calcium score, but the LDL is elevated, apolipoprotein B is elevated, and you just told me about how you approach 10 years versus 30 years, and you're giving them that trajectory. What is the actual fear of statins that you've come across in a general population? Forget about any ethnicity, but why is that fear? And if you, because you're a stats person or the data person, can you give us that the fear of myalgia or the muscle aches that people read about or they look at social media misinformation versus what is the actual real data in humans in relevance to statin-induced myalgia? Because that's the fear which uh makes them not go on statins most of the times.

SPEAKER_00 17:04

It's real. In clinical practice, it's real, right? So I see many patients who say that, hey, I watch this on this social media or this network or that channel where uh patient was not able to get up from his bed as a result of statins. And yes, there may be one out of 10,000 such cases where they have intense malgia as a result of statin or intense liver dysfunction as a result of statin, but that is rare. It does happen. But more common are the muscle aches and pains of daily life, also not uncommon. I take a statin myself as a South Asian individual to keep my LDL as well as possible. I have experienced those muscle aches and pains. Uh many patients get used to them, many patients work out their way out of it. A few years ago, there was uh coenzyme Q10, which was supposed to be good to reduce the muscle aches and pains of these individuals. But is there a real statin-associated myalgia syndrome versus is there real statin-associated intolerance versus is there something as a result of what they are listening, experiencing, biased about, is difficult to tease out. I then show them the benefits with various studies and trials for the last 40 years, right? From simbastatin to pravastatin in the older days to atorvastatin and now rosevastatin, and how they will reduce the LDL and how the long-standing effects of LDL persistently elevated are really bad. And if you lay that out to a patient in the language they understand, and there's it takes a lot of reinforcement, it takes a lot of understanding. And many times it takes multiple meetings, it many times it takes you to print out all these things and give it to them. And that's where I discuss that the coronary RT calcium can also come into picture because many people like to see. If I tell them that, look, you're 37, 38, your LDL is borderline, but this is how your coronary arteries look like. A picture can speak louder than the words. At this point, there is some calcification already there. That means this has been going on for the last five, ten years as a result of these risk factors. In their case, I lay out what are the number one, two, three things that we can take care of. And then I say that the latest that we can focus on, the earliest that we can focus on is your LDL. And the best medication that we have is a statin, and usually a Roswa statin or atorastatin. Many times it helps for us to increase the dose slowly and gradually and to see what happens. But I tell them that in the next three months you would have lost three months. So if there is time to sow the seed and grow the tree, it is now, uh, that helps. Or many times when they say that I'm having muscle aches and pains, in that case, I tell them that have you tried ezetymib? This is not a statin. And they're like, okay, really, it's not a statin, it does not have the same side effects as that. So they are very at that point approachable in that way. When uh they don't want to take a statin, I start ezetimib and see if that helps. But then the next follow-up visit is quicker in about six to eight weeks to check the lipids and say, hey, nothing has happened, or only 15 to 20% injection has happened as a result of ezetimib. So let's start you on a low dose this and low dose that, or is the next step to go to the bempodic acid, which is uh again a 13% uh relative risk reduction in the clear trial? Can we use that medication? Or do you want to take injections? There's always a fear of injections. So for the fear of injections, many patients are ready. So that's my option three or four. The behavioral aspect of it, uh, the nudge uh aspect of it, the pictorial uh evidence to say that there is something wrong, or for that matter, sometimes a CT coronary angiogram helps me to say that, hey, look, there is a soft plaque here that we did not see on the coronary artery calcium. So soft plaques are the most deadly ones to cause a heart attack. So this is the best time for you to take a medication. But in my practice, I would say 60 to 70 percent agree, and those 20 to 30 percent who don't want to agree, don't agree.

SPEAKER_01 21:16

So that's prevention in and uh well explained in in the scientific world. Like you've simplified the science of why uh a specific medication can be very meaningful in improving the outcomes basically for that particular individual. That's the pharmacological world, which is simplified, and I love the data and how you're explaining it, including the concern. If I had to come on the second aspect of prevention, which is you know, you talked about all the risk factors in your approach or in your program, how is that being approached with patients? Is it let's focus on your weight loss, or let's focus on your body composition or your visal fat, or is it let's help you with you know the nutritional changes? I know you were mentioning this before we started recording. About your dietitian or nutrition programs. So the entire approach of lifestyle, how is that being discussed with patients?

SPEAKER_00 22:08

It's difficult, right? It's difficult to sell the lifestyle because you have seen that cartoon where there are thousands of people lining up to take the GLP1. And on the second window, which says lifestyle, there's a single person there. It's difficult to change people's behavior unless you show them that there are good reasons for you to change it. And uh having a very candid conversation with these patients helps. And many of them ask me, so what do you do out of this? You're a South Asian yourself, and I candidly tell them that uh I do all of these things. So I'm trying to lose weight. I'm trying to remain very physically active. I do exercise every day. I try intermittent fasting. So I eat every day or every other day. I avoid milk, dairy, I avoid any empty calories or any processed carbohydrates. How is that possible? So then when they are curious to know that I'm practicing what I'm practicing, then I put it on a plate saying that, okay, what is the first goal? Because if I tell them 10 goals in our meeting, which is 30, 35, 40 minutes at the most, it is not going to happen. So uh seeing these patients and giving them bite-sized goals that okay, charting down or journaling will help you. So let's start with exercise. How much exercise are you doing? And this is the best time to practice medicine. That's what I feel. The technology that we have is so good with art intelligence helping us, so many apps helping us to do the calorie counting, the step counting, the exercise of the day. So let's be honest and document how much you're doing. And you and I know that we tend to overestimate our exercise by 15%, and we tend to underestimate how much we eat by 20%. So by having that uh compulsion to document that on a daily basis that this is what I'm doing, and this is what I'm charting, and this is what I'm eating, and this is how much exercise I'm doing, is that an atomic habit to change what you want to do? And then the first goal is okay, you are at BMI of 27 at this point. In next three months, is it possible to go to BMI of 26 or 25? And then they ask me, okay, but is that definitely going to change me? So I have many wealthy patients who are ready to pay out of their pockets to find out where their visceral fat is. So DEXA scan is one of them, which I reserve for patients because DEXA scan is routinely not covered by insurance here in the United States unless you have osteoporosis. So I use that to those patients who want to find out their fat stores, and then I show them that, hey, look, this was the DEXA scan showing us visceral fats in these proportions last year, and you have made efforts, so let's check it out in a few months from now or next year or whatnot. So the first target is can we reduce the weight by some? Then the next target is can you increase the exercise or can you show a steady exercise? Then the third target is what is your diet? Can you make micro changes or small changes in your diet? At least start counting your calories. Are you eating more? Alcohol is a big deal, especially in South Asians. And I know many of my patients are good alcohol drinkers, and it's the history, if you don't elicit that, it does not come out. So asking that in that sensitive matter, so how was Diwali? So, what did you do for Diwali party? How much did you drink? I don't ask them, do they drink? How much did you drink? And then the real truth comes out. Uh, many of these patients are not just the cigarette smokers, so it's the BD smoker or eating good car, even in the United States is very common. So asking that history and can you cut down on that is very important steps. Those who are very much motivated, are you joining a gym? Are you going to a gym? What are the exercises are you doing? And is it 30 minutes every day for seven days of the week? And do you have two days of muscle strengthening? That's an important part again, because South Asians traditionally will have more fat and less of muscle. And studies have repeatedly shown that the longevity is dependent on the muscle strength. So are you able to strengthen your muscles by core exercises or other isometric exercises? Will that help you? And then the nutrition and the diet is okay. Do you need specific help about understanding? Because you cannot tell that we see South Asians in various patterns. You will see meat-eater South Asians, and you will see strict vegetarians who don't even eat an onion in their diet, for that matter. So, how do you cater the diet for those? So that would be the step to refer them to the dietitian who understands background, who understands how the food is cooked, who understands how in which proportion things will be better. And to the point of GLP1, I've been telling them about foods. I tell them, do you know that there are certain foods which increase your GLP1 receptor agonism? They're like, okay, I don't know this. I've never heard it. I've only heard about medication. So have you heard about chi acids? Have you heard about oats? Have you heard about fibers? And if you do that for the breakfast, it automatically can naturally secrete GLP1 in your system, which will give you the feeling of satiety, which will prevent the downstream effects of antagonism of GLP1, which is not just obesity and diabetes, but the other inflammatory or pro-inflammatory things. So I think it's it's not just the one size fits all type of a suggestion. It's the catering to the needs of the patient. To a female, it's also very important to understand that what are the responsibilities here? Do you have enough help? And then I come down are you sleeping enough? Are you stressed at work? Because South Asian traditionally in the United States are a high-earning, high-income category individuals, highly achieved individuals. So are there enough stressors? Are they controlling those stresses? Is there a role played by meditation? Is there yoga that they can incorporate in their day-to-day practices is also very important. And these are not just the fancy words that you throw at them, but there's scientific evidence about music therapy or meditation or yoga, which will help in not just the risk factors, but prevention of combination of these risk factors causing coronary artery disease.

SPEAKER_01 28:17

Yeah, absolutely. Very robust. So, as uh, you know, with having the lifestyle medicine specialist a diploma, which I started, I think when I turned maybe 38 or 39, I was like, girl, you gotta do this.

SPEAKER_00 28:31

I thought you were 27.

SPEAKER_01 28:33

Yeah, I'll take that compliment too, because my patients tell me they think that I'm a medical student, but I'm 45, out and loud. So here it is, you know, I love that you shared your personal experience of how you're working on a prevention. And same thing before we started recording the episode, I was sharing that I have a strong family history of type 2 diabetes, premature coronary artery disease, not my parents, but everyone else in my family. And um, you know, that awakening call after I finished my endocrinology fellowship, I was like, oh my gosh, I better start working on my health. Check, check, check on everything, especially the strength training and you know, the dietary modifications. I also wanted to share that, you know, personally, that you know, I have an in-body composition machine. I check those parameters. But also for insurance purposes, there are lots of DEX centers now. You can pay 100 bucks and get a very robust body composition as baseline. That's been very convincing for our patients to work on metabolic health. The second thing is insurances are covering bone density. It's just, you know, if we are putting in the risk factors, especially for our women patients. So even if they are in that age of 40, I've had my bone density tested three times. So just for the audience, so that they can talk to their clinicians about it. The last one I wanted to touch base was in women, right? So we have this advocacy for hormone replacement therapy and not just for hot plashes or for prevention of uh low bone density, but now we have active interventions also, like trials, to see that, okay, is it directly cause and effect that starting initiation of HRT can prevent heart disease? We don't have good data in terms of yes and no, but definitely leaning towards the positive impact on heart disease or prevention. What's your take on that? Or what does your clinical approach for these women who are experiencing symptoms, especially heart flashes correlated with increased heart disease, or if they're untreated? How is that being approached in your program? Or, you know, I know it's yeah, not prescription-wise, but just a discussion-wise.

SPEAKER_00 30:33

Absolutely. It's a great question. Again, I'm you have all great questions. So the big endocine group that we have uh as part of the South Asian clinic, I tell them that this is what I know about heart disease dating back to the 1990s, where there was women's heart study which say that, oh, maybe there is a signal towards uh harmful effects until now. There may be thromboembolic effects, but no definite direct uh effect on coronary artery disease. And if you do need it, then yes, uh it's okay. But talk to the endocrinologist, make sure that the risk factors are kept under control and we don't want the risk factors to get worse. Uh the again, the traditional risk factors. But I'm uh absolutely open for them to talk to the endocrinologist and go ahead with okay, that's wonderful.

SPEAKER_01 31:16

One specific tip before, like one word of wisdom that, you know, because you gave us a lot of gems, like as mentioned. But one thing that someone can start after listening to this episode, be it a South Asian, be it any any adult, that is it empowerment, is it knowledge, is it one intervention or one habit change, just leave us with one word of wisdom or action step that they can take along before we end the episode.

SPEAKER_00 31:41

Go to your doctor, ask them that I need the screening. If you're South Asian, if you have not had screening and you're 40 years old, you've already lost 10 years, if you're 50 years old, you've already lost 20 years. Second uh general advice: keep walking. Keep walking, remain active. The more active you are, the better are the neurotransmitters, neurohormones, uh, better are the mentalities, and life will be better.

SPEAKER_01 32:06

That's so, so amazing. Thank you for sharing that. Get the right medical expertise. And uh, Dr. Sarabdani has already given us a list of tests that you can literally write down, print it out, and then go talk to your clinician because they're all legit, they're all evidence-based, they're all recommended by American Heart Association. I practice the same in our clinical world of endocrinology, and it's really going to be the best gift that you can give yourself. You've given us a lot of gifts, Dr. Dani, and I'm so happy that uh we were able to cover two episodes with you. Delighted to have you maybe again in the future for another topic and for another discussion on this cardiometabolic world. Before I say goodbye, I wanted to say thank you. And also any way that we could reach out or learn about your program, because you know, this episode is definitely hosted in California. So we have most of the listeners or the YouTube watchers from California, but also internationally, I'm actually getting more audience from India on our YouTube channel. So, how can they learn more about this program or prevention in cardiometabolic health from your standpoint?

SPEAKER_00 33:14

Yeah, first of all, thank you for the chance for me to come here and share uh my two cents on your uh podcast and the platform here. And I hope many, many uh viewers see this, get motivated and understand their health better. Second, the way, easiest way to reach out to me is on LinkedIn or on uh Twitter or X for now. And I'm always happy to share the way that we build this program, always happy to share the way that we do things here and collaborate because uh disruptive collaboration is what is going to take the things ahead for all of us as a community. Always delighted to collaborate in research activities if anyone is interested in research. Uh, happy to come talk to any one of you in person or on Zoom platform if somebody wants uh more knowledge shared uh with multiple people. So thank you.

SPEAKER_01 34:01

Absolutely. Reach out, people. He's an amazing physician and cardiologist. Thank you so much. If you've loved this episode, which I'm pretty sure all of you did, please like and subscribe to our YouTube channel, share this podcast with any South Asian you know, because you're really going to get a lot of wealth out here. And thank you so much. Thanks for hanging out with me on Hormones and Hope. If you've loved this episode, do me a favor, hit subscribe, share it with someone you care about, and drop a review if you're feeling generous. Want more tools to support your hormones and health? Head over to unified endocrine care.com. We've got free guides, resources, and more waiting for you. Until next time, stay curious, stay kind to your body, and keep your hormones happy.