345 - How to Lower Your Risk of Heart Disease Naturally (Dr. Ankur Vyas)

Dr. Ankur Vyas, cardiologist with St. Luke's Heart Care Clinic, joins Dr. Arnold to discuss simple, natural steps you can take to protect your heart and reduce your risk of heart disease.

To learn more, visit unitypoint.org/cr-heart. 

If you have a topic you'd like Dr. Arnold to discuss with a guest on the podcast, shoot us an email at stlukescr@unitypoint.org.

Transcript

Dr. Arnold: 00:08
This is LiveWell Talk on how to lower your risk of heart disease naturally. I'm Dr. Dustin Arnold, Chief Medical Officer at UnityPoint Health, St. Luke's Hospital. Joining me today on the podcast is Dr. Ankur Vyas, interventional cardiologist with St. Luke's Heart Care Clinic. We'll be talking about simple, natural steps you can take to protect yourself from heart disease and reduce your risk of heart disease, as well as it applies to cerebrovascular disease as well. Dr. Vias, welcome to the podcast. Your first podcast. Yes. I could have sworn that we'd done one before.

Dr. Vyas: 00:41
Yeah, thanks for having me. Yeah, no, thanks for joining me.

Dr. Arnold: 00:45
How long have you been here now?

Dr. Vyas: 00:47
Uh, almost eight years. Eight years, yeah. Yeah, like over seven, I guess. It's somewhere between that range. Yeah.

Dr. Arnold: 00:54
Um, and prior to that, you were at Mercy in Iowa City.

Dr. Vyas: 00:58
Correct. When were you there? I was there for three years. Three years.

Dr. Arnold: 01:01
Yep.

Dr. Vyas: 01:01
And then um, yep. I started there right after my training at the university.

Dr. Arnold: 01:07
Okay. All right. Well, you've established yourself as a well-respected and reliable, uh competent interventional uh cardiologist. We're glad you're here.

Dr. Vyas: 01:16
Thank you. I'm glad to be here.

Dr. Arnold: 01:18
Let's talk about heart disease. Uh-huh. Um what take us through what risk factors can I control to prevent heart disease?

Dr. Vyas: 01:27
Great question. Yeah. So we know there are risk factors for heart disease. And as you said, you know, there are risk factors we can control and factors we cannot control. The factors we can't control are age and genetics, basically. The risk factors we can control include diabetes, high blood pressure, smoking, um, our diet, exercise, um, you know, all these things are things we can focus on to try and reduce our cardiovascular risk.

Dr. Arnold: 01:59
You know, one that I think doesn't get mentioned a lot is quality sleep. And I mean, there are a lot of studies out there. You and I have seen these studies because as a resident and even as an attendee, and you're up all night, you know, and like how third shift workers have more heart attacks. What what what's your experience with that sleep, poor sleep? Beyond sleep apnea, you know, sleep apnea they get low oxygen, strains the heart, that makes sense. Sure.

Dr. Vyas: 02:28
But just poor sleep. So it is, it I would say it's more a risk factor for increased levels of inflammation, and that is a risk factor for heart disease. So, you know, to the best of my knowledge, that's more the accepted mechanism behind it. Uh, the American Heart Association recommends seven to nine hours of sleep for most adults, you know, so um that would be what what's recommended. And uh so quality of sleep does affect uh our cardiovascular risks.

Dr. Arnold: 03:08
I always personally and that I must not get enough sleep because when they take away my that hour in the spring and then give it back to me in the fall, I'm always so much happier when I get it back. So I must not be getting enough sleep. But uh, but but you know, I think the average American sleeps like 6.5 hours, which uh when I was younger, I probably could run on that. I as I've gotten older, I need eight uh just uh be grumpy. Um but do do you isn't there like an old wives tale that most heart attacks uh occur like in the early morning hours? Is that true?

Dr. Vyas: 03:54
It is so the the rates of um of uh MI higher around that time, you know, statistically by a little bit. I mean, we're you're not talking dramatic changes, but yes. And um often it's to do with other things that go on in our body. You know, our bodies work on a diurnal rhythm, there are uh neurohormonal changes and and other things going on all the time. So I suspect a lot of that has to do with that. There is a diurnal variation. Again, when you are um you know on studies that basically look at ERs and and uh uh what times patients show up. Yes, there there is a slight. Does anyone do we know exactly why that is? We don't, but my guess is that's probably what the mechanisms are.

Dr. Arnold: 04:48
Yeah. Sleep uh that knits the raveled sleeve, unraveled sleeve of life. That's a quote from Macbeth. So sleep is important. Um, it's so easy to throw out exercise. We've had other podcasts about exercise, and I think the main thing that I always stress to people is you don't have to be a crossfit uh ultra athlete to exercise. Simple things. But how does exercise reduce your risk for heart disease?

Dr. Vyas: 05:17
Every study that's been done regarding this has demonstrated a benefit. You know, exercise is just such a physiologic medicine for everything in our body, it gets the the different uh neurohormonal uh responses in our body working in a positive way, so it essentially leads to positive effects on pretty much everything it's been studied with. And with exercise, whatever you can do is is great, and the more you can do, you know, is better. And but it's really about you know the recommendations are at least 150 um minutes of moderate level activity like walking or 75 minutes of strenuous activity like running per week spread out over the week. But really, that's at least, you know, if you can do more, great. And if you cannot do, you know, cannot reach that due to limitations, either time limitations or orthopedic limitations, just do the best you can. The more you do, the better our bodies do in the short term and in the long term. And plus, there are other benefits as well. We release endorphins when we exercise, it typically makes people feel better and uh it affects our autonomic nervous system, improves that in the long term. So there's really excellent benefits of exercise in pretty much everything, you know, that it's ever been looked at.

Dr. Arnold: 06:56
For my patients that I take care of, you know, mostly in the elderly population in the hospital, the the patients that are more mobile mobile are healthier. Absolutely. Or one thing I always check uh is grip strength. So you always you know shake a patient's hand. It's not uncommon for someone that has a good grip, chances of getting readmitted are a lot less. Yeah. And it's it's just simple things. I think it's that mobility.

Dr. Vyas: 07:31
It is mobility. Actually, there's recent evidence that that some strength or you know, keeping your muscle strength over time or doing some uh amount of strength training is also beneficial in the long term. Like in the past, the focus has mostly been on aerobic activity, but there is there is recent evidence that even strength training helps. And so a combination of that is probably the best you know option. But really, the general rule of thumb is whatever you can do, too.

Dr. Arnold: 08:01
You know, there's three things in life that you people are set in their ways and you really shouldn't bring up. One is religion, the other is politics, the third is what type of food to eat. Because people are very set in their beliefs and it's hard to convince them. But from your from a cardiology practice, you know, the food pyramid's been inverted, keto's fasting, you know, Mediterranean. What what do you what's your go-to recommendation for diet?

Dr. Vyas: 08:33
So, based on actual evidence and randomized data, that the one kind of diet that has been proven to be beneficial from a heart viewpoint is the Mediterranean diet. That is the one we have the most evidence for. And and all that means is a diet rich in fruits, vegetables, nuts, olive oil, um, you know, lean meat or fish. That that's the rough food groups that that uh I'm talking about. So that has been shown to reduce the risk of cardiovascular events in in people in the long term.

Dr. Arnold: 09:08
Now, I I happen to believe that the the ultra-processed foods that is a lot out there, uh, I think those are really bad for you. Um so if somebody sees me in a bag of Doritos later today after lunch, that's I'm not following my own advice. But I really think we're gonna discover as time goes on that the how dangerous those ultra-processed foods are. Um I I kind of like the simple rule that if you can't recognize what it is, don't eat it. You know, if you can't say, well, that's corn, that's tuna, you know, then don't eat it.

Dr. Vyas: 09:43
Yeah, I think that's a great rule.

Dr. Arnold: 09:45
You know, but I don't always follow it, but I do think it is. Um calories in still matter, correct?

Dr. Vyas: 09:56
Yes, to an extent.

Dr. Arnold: 09:58
Yes. Yep. I mean, some of the longevity studies have shown that lower caloric intake um is associated with longer life.

Dr. Vyas: 10:08
Correct. I mean, and I think a lot of that kind of comes around to weight and you know, and and all of that as well. But yes.

Dr. Arnold: 10:15
Yeah, well, we uh the other one that get is talked about a lot, and I and I get this asked a lot, did stress cause this problem? Um, and you had mentioned inflammation earlier, uh, which chronic stress causes inflammation. Correct. You know, um what do you tell patients? I mean, it's hard for people to say, well, I'm just not gonna be stressed.

Dr. Vyas: 10:38
I think that's the hard thing. I think it's more about finding so you're absolutely right. You know, there is a link between chronic stress and inflammation, and there's a link between inflammation and a lot of other things, including cardiac disease. And um, so at the same time, I don't think we can really avoid stress triggers per se, but I do think there are strategies available now uh to try and manage stress, you know, and that is key. I mean, in our professions and in pretty much everything these days, there is a lot of stress. And so it trying to find um relatively positive ways of managing stress, you know, uh, is probably going to be beneficial for people in the long run.

Dr. Arnold: 11:28
And there's several apps out there, there's a lot of availability. But exercise so exercise is exactly the best.

Dr. Vyas: 11:38
Definitely, and it has other benefits as well. But yeah, and you know, as mentioned before, it um it you release endorphins, it makes most people feel better. Yeah, except there's an actual physiologic mechanism by which exercise makes people better. But yes, there's other ways of reducing or managing stress as well, you know. Um, and I think whatever you can do, however you can do it, is is just recognizing that this is there and trying to work on it is really the first step.

Dr. Arnold: 12:10
You know, I you know what I recommend to people, I recommend reading Marcus Aurelius Meditations because it has that stoic philosophy that basically says the little things really don't matter, neither do the big things, right? That in the end none of this really matters. Yeah. Uh so that's one of my go-to's for myself as well as recommend patients. That I think those meditations for Marcus Aurelius are just good. You know. Uh my favorite one is like if if what you're doing at this time you fear death less than that, then quit doing it. You know, I mean, if you're if you're willingly die as opposed to get out of what you're doing, then why are you doing it? You know, and I think that's uh good advice for all of us. What are some, you know, this I'm older than you, but there is a time like when I'm early in practice, that still about half of heart disease presented with a heart attack. You know, and that's dramatically reduced advanced imaging and better access to health care. But what are some early signs that someone might be having concerns related to their heart that they may or may not recognize?

Dr. Vyas: 13:26
So you know, heart disease is a broad term because it encompasses a lot of different things and you know, from heart failure to A-fib to like coronary artery disease and heart attacks. So just coming around to the heart, coronary artery disease, which is what's what most people you know associate like a risk of heart disease with, um uh, there's two kinds of symptoms to really pay attention to. So for chronic symptoms that occur over time, you know, when you're talking chronic coronary artery disease or even other structural heart disease, um, it's really symptoms with activity. So symptoms with exertion. And uh usually these symptoms reliably occur with activity and then resolve with rest. You know, the classic symptom would be chest pain or pressure uh that would occur with activity or and go away with rest. Some people it can just be shortness of breath, some people can have pain going up to their jaw or arm, again, occurring with activity and going away with rest. So um it's another benefit of exercise. If you aren't active, you know, you'll probably miss uh early warning signs of these. So if you have any symptoms like that, you know, that's one that's a time to talk to your regular doctor, seek cardiology consultation. The other kind of symptoms are more of acute uh coronary syndromes or acute heart-related issues. So if, and the general rule of thumb is anything severe, take it seriously. So severe chest pain, severe new shortness of breath, you know, severe pain, uh again going to your jaw or down your arm, anything that is significant, severe uh and uh not resolving, take it seriously, go to the ER. Um, it is important to recognize signs of heart attack and uh and seek care right away, because if it is a heart attack, the sooner we can uh identify it and the sooner we can fix it, the less heart muscle damage there would be.

Dr. Arnold: 15:37
I my experience, I don't I'm curious to hear your response to this. My experience has been that women more often have fatigue uh as they're presenting, that they just don't have the capacity they had previously, and then they tend to like quit doing something. Like if let's say they went for walks, never developed anginal symptoms, you know, but all of a sudden they quit doing it, you know, and you ask them why I just didn't, you know, feel good. I mean, for me, I I I think women can present a little bit more sublimely.

Dr. Vyas: 16:06
Sure, I I think there are there's evidence to back that up that women do have more atypical symptoms. So again, I think you know it's a good thing to listen to your body and and not to ignore uh things. Uh you're absolutely right that sometimes you can just try and avoid things because you know, because uh and not really recognize that the reason you're avoiding it is because you're having issues with it.

Dr. Arnold: 16:32
Also, uh patients with peripheral vascular disease. Seldom do they have symptoms of claudication when you see them, but you taught really dig through their history and they quit doing what they were doing because of claudication. It's always kind of a sublime presentation. One one one last question about cardiac from a cardiac standpoint coronary calcium score. That's advertised a lot. Uh, you know, you get flyers in the mail, uh, get screened for coronary. How do you integrate that in your practice?

Dr. Vyas: 17:03
I think that's a great question. I think it's a great tool. I personally use it a fair bit. In my mind, it is best uh used in people at you know intermediate cardiac risk when you want to risk stratify them into either high risk or low risk. So for people with a family history who want to know their own risk, uh, you know, because we have good tools like the the ASCVD risk calculators that can give us a population-based risk, but tools like calcium score can help us individualize it to you. So um, and uh so I use it in people who have uh a strong family history of heart disease, um, especially premature heart disease. I use it in people who have uh hyperlipidemia, who are hesitant about going on a statin, you know, uh basically in identifying people um who will benefit from more aggressive risk factor modification. And really the most important risk factor modification that we can do from right now for these uh for these patients is put them on aggressive lipid lowering therapy, like statins. You know, you were saying earlier about how the the rates of acute events has come down with C AD. One of the big things is is we are getting better at at uh at treating uh people uh for their risk factors, especially dyslipidemia. So statins have really that that's been, I think, the one change that has really lowered the risk of acute.

Dr. Arnold: 18:44
I think you're right. And just much like ACE inhibitors with heart failure, statins with coronary artery disease. But I always want to stress people that the it's not just your cholesterol level, it's stabilization of that cholesterol plaque. Exactly.

Dr. Vyas: 18:58
Your absolutely right. So that's what, yes, because so with you know, if you're looking at the mechanism for heart attacks, they're not uh heart attacks are by definition sudden events. They're they occur because uh a cholesterol plaque suddenly opens up, forms a clot, and that causes a total or near total uh occlusion of a vessel. So by definition, it's it's a sudden event. The vast majority of MIs of heart attacks occur from um plaques that are fairly mild in severity. Mild as in they're not significant obstructive lesions. This isn't something that slowly progresses over time and gets narrower and narrower and then causes a heart attack. The majority of this of acute coronary syndrome occurs from plaque that is relatively mild at that point in time. So one of this is the reason why, if you look at evidence and look at data, stents have not been shown to prevent heart attacks. They're great at treating heart attacks, they're great at treating symptoms, but this is the reason why prevention is actually about treating these risk factors, because all these risk factors in their own way increase the risk of this sudden change. And this is also how a CT calcium score helps. You know, I would think of it as you know, the more plaque you have, the higher statistical risk that one of them can rupture. Exactly. And so uh that's why if your calcium score is high, then it's worth being more aggressive. And with statins, it's you're absolutely right. It's not just about lowering the cholesterol, that's only part of it. In fact, the bigger mechanism by which you know they reduce cardiovascular risk is by stabilizing these plaques. That's the main way. This is the reason where big that there's other medications that we used to use in the past, you know, niacin, all these other things. We don't use those anymore because even though they may lower your LDL, they've never been shown to actually reduce hard endpoints, you know, uh, which means risk of heart attacks, strokes, or uh, or cardiovascular death.

Dr. Arnold: 21:18
Okay, gonna throw in one more question. Yeah, this is more for my practice. Aspirin for primary prevention. Here's how I've approached my patients. If they already were on it, I've kept them on it. I just haven't started it for primary prevention. What's the cardiology world doing?

Dr. Vyas: 21:38
I think we're mostly doing that. I still, you know, um, so it is not necessary to put most people on it for primary prevention anymore. Uh because uh uh there is there's good evidence now that there is no net benefit of it. And by net benefit, you know, I mean the if you combine the The small uh ischemic benefit versus the small increased risk of bleeding. So um I take it case by case. You know, most people, if they are not at increased risk, I tell them they don't have to take it. They can safely stop it. For some, for uh patients who I believe might carry an increased risk of bleeding, like you know, the elderly, um, I I tell them to just go off it. Because I think in that case, the the risks might not be worth the benefit.

Dr. Arnold: 22:38
I I guess I've been approaching the philosophy of they haven't any bleeding problems.

Dr. Vyas: 22:41
That's true.

Dr. Arnold: 22:42
You know, and do you remember the ditch study where it said digoxin, if people are already on it and you stop it, they do worse and people that aren't on it putting them on it, they don't do any better.

Dr. Vyas: 22:54
You know, so I was kind of like, well, I think actually that's a good way of thinking about it because if they haven't shown any evidence of bleeding so far and they've been on it for a while, you they probably fall in the category where they have a lower bleeding risk and might still get a little bit of benefit from it.

Dr. Arnold: 23:10
But see, I always like to probe the guest on this podcast about the way I do things so I can feel good about myself because you know one last question why cardiology?

Dr. Vyas: 23:23
Um, you know, I just it's something I connected with as a um as a med student, as a resident. It's just so that's that's part of it. You know, I have a family history of heart disease, so that's the other part of it.

Dr. Arnold: 23:39
Well, we're glad you did connect to it because you've done a great job.

unknown: 23:43
Dr.

Dr. Arnold: 23:44
Vias, thanks again for joining me and sharing with our listeners about how to lower their risk for heart disease, naturally. Once again, this is Dr. Ankur Vyas, interventional cardiologist with St. Luke's Heart Care Clinic. To learn more, visit unitypoint.org/CRHeart. Thank you for listening to Live Well Talk On. If you enjoyed this episode, don't forget to subscribe. And if you want to spread the word, please give us a five-star review and tell your family, friends, neighbors, strangers about our podcast. We're available on Apple Podcasts, Spotify, Pandora, or wherever you get your podcast. Until next time, be well.