Is Your Heart Healthy?

Heart disease is the number one killer of women worldwide. South Asian women are at higher risk than almost any other group — and most of us have no idea.

Dr. Ambreen Mohamed joins us this episode to talk about what's actually happening in our bodies, why South Asian women are so uniquely vulnerable, and why we keep missing the signs until it's too late.

This is not a scary episode. It's an honest one. Because the most powerful thing you can do for your heart is understand it.

Auntie Please content is for educational purposes only and it is not medical advice. Please consult with your own doctor. 

Transcript

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Welcome to Auntie Please, where today we'll be talking about heart health for us. And we have a very special guest. I am so excited. I've known Doctor and Ambreen Mohamed for many years now, and I've kind of peripherally and in the moment seen her career built. We met in medical school, we lived together, and I remember one of the first questions I asked you, Ambreen is what do you want to do?

I think we're sitting in our Park Slope apartment with the Real Housewives in the background. And which one is the pulmonologist? I think that was Beverly Hills. Pretty sure it's really good. So really good. Still really good. And as a pulmonologist, I'll say this, but with the hookah in front of us and Mo's hookah, right?

You still have that, by the way, it was one of our friends Mo. Because he never used this. So we just took it. And he's like, oh, we'll keep it for you. And then it was lit every night. And I remember asking you what you wanted to do. You were doing your internal medicine residency and you said, I want to be a cardiologist, and I think you had a McDonald's Coke.

But that's okay. We don't do that as often. We babble. And I'm so proud of you for doing exactly that, for chasing every dream and going through all the challenges, whether it be professionally, family. It's been really nice to see you and you do a lot. You do Ambreen is a board certified cardiologist.

She has a fellowship in advanced imaging. And what I love about your social media and the content you put out in your message is heart health is preventative medicine, which is absolutely true. And you really emphasize us on community and educating us on knowing what we don't know, what we need to do and making sure that we're taking care of ourselves.

Yeah, so it's an honor and I'm so happy that you're here. Thank you. We have a lot of questions, and I am happy to answer to the best, to the best of my ability and the knowledge that I have up here. But I think you have it all. I think you do. You love the heart, I must say, to a very important organ.

So we'll just get right into it, because we really want to emphasize this to the women out there listening. What are the symptoms women miss when it comes to their heart health? Oh my God. So much so. I think that this is a really interesting topic because, you know, heart disease in general. So first of all, I just want to start off with heart disease.

In South Asians is much more prevalent than probably any other ethnicity out there. So we tend to develop heart disease 5 to 10 years earlier than any other ethnicity on average. Okay. It doesn't mean that other ethnicities don't have heart disease. Clearly heart disease is the number one killer globally and in the US for men and women alike. However, in South Asians it's just much more prevalent.

However, you guys know the community, it's just not it's not discussed enough, but there's a ton of stuff that's going on there and people are just not that well informed. And so the reason that I even started on social media, because I have a loving relationship with I really wanted to inform the public because I go to all of these like auntie uncle parties with my family.

And I have a lot of, you know, family, friends. I have a lot of, you know, family in general that are always asking me questions like, you know, what about my cholesterol? What about this medication? You know, what about diabetes? And why is this happening? And so and so family member has this. And so it really just led me to think like, we just need to be better educated in general as to what our risk factors are.

And so in terms of heart disease in women, I think it's really interesting because I think the classic presentation of what heart disease is in general is I have the elephant sitting on my chest. I have crushing chest pain. Right? That's what we learn in medical school, crushing chest pain. And then at the same time, I'm getting nauseous and I'm sweaty and I'm significantly short of breath and my left arm is hurting at the same time that I have chest pain.

And, you know, maybe my jaw is hurting and, you know, this isn't going away. This is just getting worse and worse and worse. And it can happen when I'm exerting myself. It can happen at rest. But that doesn't happen in everybody, unfortunately. And so we know like for diabetics, for example, they might present differently. But for women especially, we can actually have very subtle symptoms that oftentimes are dismissed.

So what is that. So sometimes it can just be that you know what doctor like I'm feeling like I'm more short of breath than usual. And I used to be able to walk like maybe 30 minutes. And now I can only walk a few minutes and I start to get really short of breath, or I am just feeling kind of dizzy and lightheaded.

And that is something I'm not really used to. Or you know, I know that I've just been having this, like nagging left arm pain and it's not going away. I don't have chest pain, but I have this nagging left arm pain, or I have this pain in my jaw, you know, or I have this pain in my back.

I had this pain in my neck all a lot of times it's I feel really, really bloated or I feel like I have a lot of indigestion, did I eat something badly, like, I don't know, maybe my diet has changed. Like, I'm not sure, but this isn't going away and it's not something that will, you know, just happen all of a sudden, maybe in some people, but more often times than not, it's something that is kind of gradually occurring over time.

And, and then, you know, you start to think like, what is this? Right? Like, why is this happening? Like, why do I feel different? But then to kind of carry on, you know, are we actually getting it evaluated? Are we really thinking like, why is this happening? Or are we kind of just like dismissing it and putting it to the side because, you know, I think that women in general, especially Pakistani women, and we know this we have a lot of hats that we wear.

You know, we can be partners, right? We can be mothers. We have to be caregivers not only to our children, but also to our parents, to other family members. Maybe we immigrated from a different country, and we're here and we're trying to learn a new culture. So now we just have a lot on our shoulders, and it's not easy to be able to carry all of that responsibility and then also have to then pay attention to what's going on, because you have so much other stuff that you have to deal with.

So I always tell women, and I emphasize this all the time, if you feel something isn't right, you're intuition as a woman is always spot on. If you feel like something isn't right, please, please, please get it checked. And oftentimes, unfortunately, and we see this a lot, women tend to get dismissed because of their symptoms. So it might be from your provider.

It might be from the emergency room. It might be, you know, even yourself. Yeah right. That's true. Just like saying like hey like I don't brush it off with dealing with it later. Yeah, but if you feel like you're not being able to have your symptoms being taken seriously. Please get a second opinion. Because more often than not, I have seen instances where people wait too long and then actually have an event, and that is something you do not want to deal with.

And that's why prevention is so incredibly important. The biggest thing we have is the biggest tool we have in medicine is not used enough, is preventing before it actually happens. And right, we're better at it in medicine, but we're not where we need to. I absolutely agree, but thank you so much for sharing that, because I'd like to bring to surface this whole discussion on Pakistani women in Pakistan living in Pakistan, because unfortunately, they don't have all this available to them.

And sadly, they get dismissed more often than anything else. Yeah. Thaki ho. Stress hai. You're too young for this. Don't worry about it. Come back if it happens again so they don't even know where to start. So my question for you, for our view is, is could you help us understand what is the first thing they should be looking at or talking to their doctors about in Pakistan if they don't know where to begin?

Yeah. So I think going to the doctors, probably the first and foremost important thing, right. Like I think a lot of times we even ignore doing that, you know, like we should be going to the doctor once a year to be getting our labs done. I know I've ignored it. Yeah. And I don't even live in Pakistan, but I know that that is very easy to do.

So just go to your doctor for regular like preventative exam and then say... Can you can you describe prevention? Yeah, yeah. Because we've got two different types of audiences, right. Women, Pakistani, living here in the US. And they have access to everything, right? Right. Then you have women living in Pakistan who have who don't even know where to begin.

So I'd like for you to describe to them what prevention really means. So what does that look like? Prevention is assessing what your risk factors personally are. Right. So maybe that means that you personally don't have diabetes or high cholesterol, but it runs in your family. So I want you to start talking to your family members, Mom, right...

Hey, dad. Hey, grandparents. Nana. Nana. Daddy. Dada. Right. Hey, cousins. Hey, you know, you know your aunts and your uncles. What kind of medical events did you have? Did anybody pass away suddenly at a young age and nobody knew? Why do we have heart attacks or any type of heart disease or heart related something? Sometimes they don't even know it's a heart related condition.

So it's like something to do with the heart. Did anyone have that type of condition? Do we have diabetes or sugar that runs in the family? Right. Does anybody take medication for sugar? Are people on insulin? Are people on other diabetes related medication okay. How many of those people are those people closely related to me? Okay.

Now that I kind of have an idea, what other things do I need to do? I need to make sure I get my blood pressure checked. I need to make sure I had my labs checked at least once. But in the labs, what do you want them to check, right? So there are several things that you can check in labs.

But when we are looking at heart health specifically we are looking at cholesterol. So that's like a general lipid panel that we say here like a general cholesterol panel. So that has four different components. So that's a total cholesterol. That is an DL which is the good cholesterol. That is an LDL which is a quote unquote bad cholesterol.

That's where a lot of our guidelines are kind of supported here in the US. And, you know, European society and all of those other types of guidelines probably support that as well, because LDL is a main contributor of plaque formation in the heart that causes heart disease. So we really focus on that and then triglycerides. And so what's abnormal in South Asians specifically we tend to have higher triglyceride numbers, lower HDL because their DL tends to be dysfunctional.

So that ratio actually matters. And actually our LDL, which is the bad cholesterol doesn't always tend to be elevated. Really interesting. Yes, you were never taught that. And you actually thought that. That's interesting. But why are we still high. Yeah. Why are we? One is that we tend to be insulin resistant and we develop diabetes at earlier ages.

And even if we don't tend to have diabetes, we can have pre-diabetes. And we can even have an elevated fasting glucose, for example, and not even be diabetic, but we're still insulin resistant, right. And then also we can have other factors in our lipid profile that are not always checked. And this is where it starts to get interesting because people don't know to ask for this.

And I can tell you, even coming up in training, I didn't even know as a cardiology fellow and even early on in my career that these factors mattered. Not until I started doing my own digging and I was like, wait a second. Why am I hearing about South Asians getting heart disease earlier? There is something that's going on here, right?

And now we have like a lot more research and stuff that's going into it. But one factor is called lipoprotein a or LP little a okay. So actually 1 in 4 and 1 in 5 people globally and I'm not just talking about specific ethnicity globally will tend to have an elevated LP a. But within South Asians that's 1 in 4 just within South Asians.

So that's 25% of our population. Yeah okay. Why does that matter? Because the LP little A is actually stuck to an LDL particle. And if it's elevated, that actually can make the LDL more sticky. And now I just told you guys that LDL actually contributes to plaque formation. So you say... Doc. You're going to have to translate that into layman terms.

There are basically if this LPA is high, it can make our cholesterol more sticky. That can increase our risk of developing plaque in the arteries, which increases our risk of developing heart disease. And this occurs earlier on in life. So this is not going to be something that can happen later. This is when we start to see heart disease present in our 30s and our 40s in early 50s is because of this.

So that's the emphasis on prevention is basically getting these annually screened at every visit before this plaque build up. Well, the nuance to that is that LP little A is a genetic marker. Oh okay. So it's a genetic markers. So if it's going to be elevated, it's going to be elevated all of your life. And it's not going to tend to change throughout your life.

So I'll bring you back to my earlier question is what type, what particular test should they be asking for? But how should they be asking their doctors? Because generally we know they get dismissed by Pakistani doctors. They don't have the option of second opinion either in Pakistan sometimes. Right. So how can we better educate our women to be ready to ask for these things?

So I mentioned the family history. So definitely go through that. And then when you do go to your doctor I want you to ask for a general lipid profile. So that's those four markers total cholesterol HDL LDL and triglycerides. So that comes in a general lipid profile. Your additional markers would be advanced lipid labs. Now here in the US this could be like a cardiac IQ panel cardio IQ panel that you get at like Quest.

Or you can get at lab core. Obviously in Pakistan I don't know what that is, but it's advanced lipid markers. So what does that consist of. It's going to be your LP little A. So you have to ask for that specifically. Can I get my LP little A screened. It only needs to be done once in your lifetime because the level typically is not going to change very much.

You can go up and down a little bit throughout your life, but for the most part, if it's elevated, it's elevated. If it's low, it's low. And unfortunately we don't have any medication right now that's really going to change that. So that's kind of the other like, you know, crazy part here. The other marker is apolipoprotein B or ApoB.

Now apolipoprotein B or ApoB b is a marker that is attached to every LDL particle. So you have one LDL. You have an APB that's attached to it. And so basically it is a surrogate for how many LDL particles are swimming around. Why do we care? Because we know that the higher the Appo B, the higher the LDL particles that are swimming around, the more of a chance you have of developing plaque.

That level can change because as your LDL particle number goes down, let's say that you're starting to get on a good diet, healthy lifestyle, or you're on a statin, for example, your ApoB can fluctuate your LP little can't. So again, I emphasize if you're going to go to the doctor in addition to your regular labs, you should be getting a lipid profile every year.

You should be getting a hemoglobin A1C, which is your blood sugar tracker. Every year you should be getting a basic metabolic panel, which includes your fasting glucose every year. That is a non-negotiable. You need to be getting those every year. In addition to that LP little layer LP sorry, LP little or lipoprotein A once in your lifetime an Apple lipoprotein B now we actually recently the American College of Cardiology American Heart Association recently came out with updated lipid guideline labs.

And they're emphasizing ApoB be even more so now than they were before. So you at least should be getting it once. But of course, if you're going to be tracking how your LDL is going up or down or whatever, then you can be getting that more than once. But at least just get it more than once. I love the lipid guidelines changing all the time, but you know, with good reason.

They're evidence based. You know, I have a question because I get this a lot. And obviously I'm not a heart doctor, but and it's kind of swimming around conversations amongst every population that's testing the heart. This is a calcium score. So what is your opinion on the calcium score and when and who do you recommend it for? When I was in Pakistan last year, it was being floated around there too.

So it's kind of, in my opinion, from my lens of medicine. Everyone's kind of looking at it as this yes or no. Like if it's fine, you're fine for life. And if it's not, then oh my God, I got to do something really quick. So what's your opinion on it? Yeah. Sorry. Just to add to the point about other things that you should be screening for.

So in addition to diabetes and your cholesterol another thing is blood pressure measurement. Yeah okay. So a really easy thing to do because a lot of our, you know, family members or extended family or whatever, we have high blood pressure and high blood pressure is a significant risk factor for heart disease. You should keep a blood pressure cuff at home.

Right. And you should check your blood pressure at home. If you don't have high blood pressure, maybe just screen yourself once or twice a month just to make sure that your blood pressure is okay. But that is another easy thing that you can do and another thing that you should be doing when you go to the doctor's office is making sure that, again, Cholesterol Labs LP, little A, apolipoprotein B or APOB, get your blood pressure checked.

Get your basic metabolic panel checked, which includes a fasting glucose. Get your hemoglobin A1C check which is the blood sugar tracker over the past three months, blood pressure I mentioned. And then, you know, we have another thing called BMI which is body mass index. Right. So you're familiar with that. So it basically averages your height and your weight. Now for South Asians we have another problem.

Yeah. So we can actually develop a different kind of fat called visceral fat. So visceral fat is a metabolically active fat that surrounds our organs. And we can actually be at a normal BMI, which we track for overweight and obesity here in the state. And it's also done globally. But we track that for overweight and obesity. But you can actually be at a normal BMI and still have high visceral fat.

So make sure you're also getting your waist circumference checked. Kind of sleep apnea gets missed all the time too. Yeah, exactly. Exactly. And so what were.

You're like a wealth of knowledge. And I also like I'm such a bad. All I'm learning is I'm learning a lot. But I'm also learning about how bad of a patient I am. I'm just going to act like you're better, okay? I'm not, I'm not. I'm really the worst. But this is amazing because breaking it down like this, and I'll be honest, like, you're absolutely correct.

We don't learn this. Yeah. So we can't even help ourselves. So how are we supposed to word it to people who ask us questions? And I've always found this challenging. So I really admire, like your passion and diving into your body to help other people too. It's really a big problem because we always are told South Asians have higher risk of cardiac disease, and it really takes a really good clinician.

I will say a very good doctor, to understand why, where we always say the lesion lies, what we're not being told, and really to do a deep dive. I know as a doctor, I can tell you, I know you did a very deep dive to really answer these questions honestly for your patients, and I appreciate this coming for you.

So I wanted to go back to the calcium score because I get asked this often and I'm like, okay. Then like it's really a really good question and I think it's being misused a lot. Thank you. I appreciate so I have a love hate relationship with the calcium score. So let me just explain what that is in general.

So a calcium score is a very easy test that can detect calcified plaque deposits in the arteries of your heart. So what is that. And so basically it's a CAT scan of your heart that is used without contrast agent. So without IV contrast. So it's a very quick and simple test. It looks at the arteries that supply your heart.

So we have four major coronary arteries. So it looks at those arteries. It picks up the calcified plaque. It calculates a score called the AGASTIN score. It goes from zero to greater than 400. And we're able to pick up only calcified plaque. Let me tell you what it should not be used for. It is not going to assess how much total plaque you have because it doesn't pick up soft plaque.

Doc. Yes, you're going to have to go into plaque. I think we need to talk about what that cause is. So plaque is basically fatty deposit. That is I was talking about elevated LDL before. Right. So LDL is the quote unquote bad cholesterol. That's a main component of plaque formation. So fatty deposits that are deposited in the arteries of your heart.

Now we know that cholesterol doesn't just favor the heart. It also can be deposited in your brain and in the arteries and the peripheries. But right now I'm just talking about the heart. And so what can happen is that when you have this plaque formation, these fatty deposits, initially it's soft plaque. It's fatty plaque. Right. But then it's going to go into two categories.

It's either going to be fatty soft plaque or over time it can stabilize. And that's called calcified plaque. Wow. Oh. So when plaque initially deposits its soft plaque it can stay soft or over time it stabilizes and it becomes calcified plaque. Now the other nuance to this is once we have plaque, we can't really get rid of it.

What happens if plaque dislodges? Well that doesn't always happen. So plaque doesn't dislodge. So that's actually a misnomer. Plaque doesn't always dislodge okay. You can have a heart attack from plaque that is unstable. Yeah. Right. So over time maybe you do have a lot of, you know, plaque that starts to become very active. I tell people it's like a volcano that's like, you know, having pressure and eventually that plaque can rupture and that can cause a heart attack.

But that is not because plaque is dislodging, it's because plaque is actually rupturing, and it causes an immediate blockage of an artery, which causes a heart attack. And I feel like maybe that's a little confusing to people, but just to just say to people, that plaque in general is fatty deposit of cholesterol and some other inflammatory markers and such that sits in the artery wall, it can start to build over time.

If that plaque stabilizes, it becomes calcified. And that calcified plaque is what can actually get picked up in calcium like a coronary artery. Calcium score, CAC score. Now what can CAC scores be used for? CAC scores can be used for in people that are not on cholesterol lowering therapies. When you are unsure as to whether you should be starting them on therapy or not, that's interesting because it's not.

I feel like it's not used for that is your no answer for like it is not the hardest. Yeah. Going to combust or not. Like that's what I feel like it's floated around as. So again you know I mentioned earlier the ACCHA recently updated their lipid guidelines. And with that there is a score called the prevent score. Now I know this is only applying to the US but this could be applied greater globally as well.

But basically this is a risk score that assesses, you know, various parameters your cholesterol numbers. Do you have a history of diabetes? You have a history of high blood pressure, what gender are you, etc. and we can put this all into a score and we can basically assess over a ten year period and over your lifetime, what is your risk of developing heart disease.

And it's a percentage okay. Based on that percentage we can say, are you a good candidate for cholesterol medicine or not? And if we're unsure, that's called the intermediate risk. That's where the calcium score comes in. Because if I get a calcium score on you and I start to see calcified deposit, I'm going to be like, wait a second, you're LDL is kind of okay, I didn't know if I was going to start cholesterol medicine, but now I see calcified plaque deposit.

Yeah. You already have plaque. That's that's that's there. I got to start you on something. Yeah. What it should not be used for is if someone's already on cholesterol medicine, it's already on cholesterol medicine. Then, you know, they're already, they already have like. So again this is a little bit complicated. But basically the cholesterol medicine can further stabilize your plaque.

Yeah. So once you're on cholesterol medicine your calcium score can go up. So there's no benefit. The other thing it should not be doing is just tracking how much plaque you have in general. Because we don't know. Right. Like aside from calcified plaque you could have non-calcified. And where it comes in with South Asians is that you can have younger South Asians who can have a calcium score of zero.

But let's say they have other risk factors. You might actually have plaque there and we wouldn't know. So I don't recommend calcium scores for everybody. I think it's an individualized discussion. I do think it could be beneficial in patients that are older than 40 or 45. I think that if you have borderline cholesterol, you're over the age of 40 years old.

You need to have a discussion with your doctor, either your primary care doctor or your cardiologist and say, hey, is this something that could be beneficial for me? I have heart disease that runs in my family, or I'm a diabetic or have diabetes that runs in my family. My cholesterol is borderline. And you know, I want to see if I have any, like calcified plaque deposit in my arteries to see if I could be a good candidate for cholesterol medication.

Outside of that, not a good, not a good test. And what are your thoughts on GLP1s? I have to ask my own personal interest. I actually love GLP1s, but only used for the right reasons. Now we know that a lot of studies over the past I would say five years, maybe a little bit more have shown that GLP1s are not only a great medication to lower weight in patients that are over, I would say more so obese, but even overweight and have diabetes.

But we actually have seen a reduction in cardiovascular risk in patients that are not only diabetic and overweight or obese, but also without diabetes. So if they're overweight and obese, even without diabetes, we have still seen an increase in reduction of cardiovascular risk in those patients. So I think it is a great medication, but only when used appropriately.

Now we know we live in the era of we want to look thin and fabulous, and it's the Hollywood medication and it's the perfect, you know, thing. And there are newer and your medications coming out like Eli Lilly, you know, is studying a medication called Retatrutide, which is a derivative, of Mounjaro and Zepbound, which is supposed to be phenomenal right now.

It's kind of used off market for weight loss, you know, as one of those peptides. Yeah. And it's not being regulated right now. And Eli Lilly doesn't seem to be very happy about that. But I think that that's kind of like the next generation because we're seeing really great results with that. But that's not out yet. So to answer your question, you know, I do think a GLP one is fantastic.

And for diabetics I think it's fantastic. And obese, maybe even overweight patients, but it needs to be used in the appropriate way. And in these patients we can definitely see a reduction in cardiovascular risk as well. So sorry. Go ahead. And I wanted to touch base a little bit on what you see in your patients the South Asian patients. And you know we talk a lot about our podcast about mental health and how much we aren't even given the opportunity to acknowledge what that is and how to express it internally and externally.

Have you seen any relationship between mental health and cholesterol and heart attacks, whether it's in one person or what they see in their family? And is there a relationship? Yeah. I mean, you know, I'm a huge mental health advocate, you know, they know that. And, you know, I am very passionate about that. And I always have wondered about like the interplay between, you know, mental health and heart disease.

And there actually is a huge interplay. And if we talk about South Asians and we'll talk about South Asian women, specifically Pakistani women, and I kind of already alluded to this before. But, you know, we are we wear so many hats as Pakistani women, right? We are caregivers to our families. We are you know, a lot of us are professional working women.

You know, we could be partners to our husbands, we could be mothers to our children and so many other things where maybe we're dealing with the stress of adapting to a new country like the US, like a lot of our parents have. Right? Or, you know, maybe it's that we're dealing with the sick family member or whatever the case might be.

A lot of this, over time, can increase stress in your body. And we know that increased stress in your body over a period of time is not good for you. You know, one of the things that I've heard from Pakistani women living in Pakistan is like when they go to doctors with those symptoms and they were dismissed, then they carry that weight of the emotional.

Yeah. And then they started out. Yeah. So, so like, what can we do or what can we say to help them understand that this is not their fault and that you how they can how what what you have agency right. Like at this time. Like, you know, we are really fortunate at this day and age that we are able to have multiple resources.

We might not think so, but just imagine, like, you know, our aunties and uncles, moms and dads, you know, whatever. Like back in the day, they didn't have that type of agency. They didn't have information. Now at least like we have the internet, well, we can start to like outsource and be like, okay, you know, even just asking Google like, these are my symptoms.

Like what's going on with me using ChatGPT something that that's this is where I'm going to challenge you because like using ChatGPT internet and all, I think that's a lot of noise. And I think we need to be able to eliminate signal from the noise. Right. So how do you help them and understand that? You know, because I go and charge you to be ChatGPT.

And I always get really confused and really scared at like what comes out of it. But that's I think it's scary, but it's giving us an avenue that we can ask is my is this irritability I had this morning a problem or related to something else. So there is a lot of noise but at least gives you a strategy, an answer and a yes, perhaps.

Whereas I agree with you Ambreen, before they didn't have any of it. They didn't So then if you don't have it. How are you supposed to answer the question? So there is a lot of noise. You do need help navigating it and tailoring it down. That's where experts come in to help it. But I agree with you that there is there's there are resources to ask if the feelings are there.

And I think it's also important to implement in the population everyone that these are signs of real things. These are what you're feeling is probably a mental health issue, a real problem that needs to be acknowledged and assessed and diagnosed. So normalizing it as, oh, this is not just you or deal with, it is the biggest thing I think we need to do.

Having the like, you know, whether this was 15, 20, 30 years ago or whether it's now, you still have to be able to advocate for yourself. That's going to take bravery from you irrespective of how many resources you have. You have to advocate for yourself. No one can hold your hand to actually take you somewhere unless it's like so drastic, right?

Like no one can do that. So you have to kind of be a little bit brave and it's scary. But once you push past that, push past that fear a little bit and say, hey, I need to get this checked out, I will tell you, like, I don't have a wealth of knowledge of all of the, you know, different resources and books and but but at least as far as I know, things have started to advance there as well.

And there are more knowledgeable people there. We have more experts there, whether it's in heart disease, whether it's in mental health or other types of avenues. So it's not that the people don't exist, it's that it's the patients have to meet the providers, but the patient has to start to come towards the provider. And in the interim, if you can try to find a resource that eventually tries to get you there, you will be able to get there.

I have a question. I'm so sorry. Something you said about like, you know, previous generations is so back then our nannys and daddys, then all didn't have all the resources, right, like we have today. And they relied very much on home remedies, like how do you do then soften advice. I mean, even today when I call my mom with something, she's like, you know.

Yeah. And what you are, I've read loves me, but I'm like lactose intolerant pretty much. Now, my question for you. Do you still believe in that? Like, do those home remedies still work and how do we apply them? I like what if they work for your mental health like a like a mentor or not? I think that they're you know, this kind of gets into the realm of supplements, right.

So can supplements in general, whether it's healthy, whether it's, you know, something else, can it cure, you know, heart disease? Can it cure your mental health? No, no. Yeah, we know that, right? Can it alter your blood sugar a little bit? Can it maybe decrease your blood pressure a little bit? Sure. We've seen that in certain supplements. It should not be used to supplement what you need to be taking.

So my thing is, is that please get everything checked out. Have your doctor lay everything out on the table. And then if your doctor says, hey, I think you need to take this medication because we can't just do it without, you know, just with lifestyle changes, which is diet and exercise, then we need to think about, okay, maybe I need to take that medicine.

Right? If you also want to take other things to help you. Sure. As long as there's no harm. I'm totally fine with that. But just remember, whether it's supplements in Pakistan or whether it's supplements in the US, these things are not regulated, right? I get a lot of questions from patients almost on a daily basis as to can I take the supplement in that supplement?

And I don't like taking medication. And we're kind of getting into like the wellness like and I don't really believe in that because then you're basically telling people like, hey, you can take this and it's going to not you don't have to take medication for that. And I, I don't think that that is helpful information to people. I think that you can use it in addition to taking the things that you should be taking.

And your foundation is your diet and your exercise. Yeah, I love that. I think that comes to our auntie please moment embrace my auntie please moment man. I mean really, I really want to get my labs, to get my I need to go to a doctor. I can't be my own doctor. Like that's what we can't.

We can't. Yeah I usually I mean, in full honesty, I usually order my own labs and I have not done it, but... It's the reason why I haven't done it is because I don't want to order my own labs. I want to go to a regular doctor and get it done. But I'm going to get my labs soon.

I mean, no one's getting younger. The risk is there. And I want to know because I can't be preaching and not doing it myself. Yeah. And also, I won't be around to preach and imagine that the world would be quieter and happening to you, I'm finding, and hard to believe. Yeah, I need to know. I need to get it on my list.

And it's the one that I just am okay removing from my to do list every week. Enough is enough. So thank you and Ambreen for reminding me that I'm a bad patient and that I need to be better. But no, I appreciate it. It's a good reminder and give me the same way. I'm not a very good patient.

I waited a long time to get my labs too, and I was really relieved once I finally did it. And again, it's just kind of like overstepping that like, oh, you know, because I know, like we know I think as doctors, it's like we also know, like the inherent risk behind things. And so we start to overthink and then we're just like, oh man, maybe I just shouldn't do it.

Yeah. But you know, I did it recently and I was like, okay, thank God. You know I'm okay. Yeah. Clean slate of health for now. For now. You see, my auntie, please moment is I have to get into my annual for this year. I am anal about getting my prevention done every year. I need to know my numbers better and stay on top of it.

Because I would like to be, you know, like teaching people. Yeah, like educating the Pakistani women about women's health, because that's the background that I come from. So I am anal about it. And I just realized I did not do it this far this year. So far I've been so busy with all that's going on. So my auntie please moment, I'm going to get my labs done.

And I just want to like kind of end with this because we didn't get to talk about this really is like is menopause. So in perimenopause and menopause our bodies are going to start to change. Why? Because our hormones are changing, right. So hormone replacement therapy isn't the answer to everything. It's definitely not the answer to decrease your risk for heart disease.

But just make sure you're starting to just be more vigilant about things like your blood pressure, your cholesterol, you know, insulin resistance. So your blood sugar, things like that, because you will start to see shifts in those things in the wrong direction. And we really need to stay on top of it. Thank you for bringing it up. I had a question for you which I forgot to ask, but when you said, you know the panels that we need to ask for, we need to order when we talk to a doctor.

Is hormone panel one of them? So we as cardiologists don't necessarily recommend that from our perspective. However, if you are on hormone replacement therapy or you are entering perimenopause or you're in the menopause era, we do recognize that your shifts in hormones are going to cause changes. So we know that if you're kind of in this certain age bracket, typically greater than, let's say, age 35, you know, going into, you know, your 50s, we know that we can see certain changes.

And, you know, we might say, like, hey, if you maybe are dealing with certain things, then maybe it's not a bad idea to speak to your ob gyn about potentially starting hormone replacement therapy. But we will not. I mean, I want to really say this. We do not recommend hormone replacement therapy as a kind of definitive reducing your risk of heart disease because it is not indicated.

Thank you. I appreciate that because that's a question that we're getting everywhere in medicine now. And yeah, I appreciate menopause is going to be a topic on its own. And yeah coming soon. Yeah yeah. No it needs to be talked about because I think it's like a lot for women.

It's a lot of taboo to, to talk about these. So I appreciate thank you so much for having us. Amazing to see you. I appreciate learning from you. I learn a lot from your content, by the way. Yeah. Do you want to tell your Instagram and your handles so people can learn more about themselves?

So Instagram is drambreenmohamed and then my TikTok is AmbreenMMD. Maybe I should all make it like the same but it's in MD. I do have a YouTube, but it's just basically like my old content that's like posted, but I maybe I'll do like it's just my YouTube and you can do, you're going to do a lot.

You're going to do a lot. I learned so much from you. And as a physician, I learned so much about where I need to guide my patients to, and having someone talk about it in the detail you do, it makes me comfortable sending, you know, that's the big one. You want someone who's going to really approach them in the, you know, educate while fighting the internet trolls at the same time.

I know I'm sure that's a fun one. Thank you so much. It was so much fun. Thank you. So fun. Thank you.