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Heart Disease with Drs. Paivanas and Dooley on Facebook Live

September 5, 2019

– Hello, and welcome to another
MedStar Health broadcast on Facebook Live. My name is Caryn Zengel and I’m here today with cardiologists Dr. Nicholas Paivanas and Dr. Daniel Dooley from MedStar Health
and Vascular Institute. It’s heart month so we’ve
been coming to you live with various heart related topics and today, we’re discussing
another important one which is heart disease. So if you’ve been wondering
what is heart disease, how can it be prevented,
then stick around, please share this with your friends and ask your questions
in the comments below. Doctors welcome, thank
you for joining us today. – Thank you.
– Thanks for having us. – Of course, so before we get
started into some questions, could you tell the audience
a little bit about yourself. – Sure, so my name is Nick Paivanas. I’m a cardiologist here. I grew up in Virginia. I went to undergrad down at William & Mary and then moved up to
GeorgeTown for medical school, and up to upstate New York in Rochester for all my training after that. Settled back here in Annapolis
and I’m loving it here so I’ve been with the group now
for about a year and a half. Yeah, growing up, little kids and a dog. – Awesome (chuckles).
– Excellent. And my name is Dan Dooley. I’m also a general non
invasive cardiologist here at MedStar Cardiology Associates. And I’ve been here for,
still within my first year. Been loving it so far and I
did all of my actual training, medical school, residency,
and my fellowship all in one place actually at
Georgetown in Washington, DC. And had a great experience there and am happy to be here now and working at MedStar
Cardiology Associates. – Great, thank you. So let’s get into some discussion. Let’s first talk about
what is heart disease. – Sure, so when we talk
about heart disease, I think there’s generally
a few different things that can be incorporated into that. There’s obviously a lot of
different parts of the heart that we talk about but I
think that generally speaking, what we’re referring to is
typically coronary artery disease or blockages or plaque build up in the arteries of the heart as well as potential for heart failure which sometimes in many
cases can be caused by that coronary artery disease. So those are the more common
things that we talk about when we’re referring to prevention and talking about risk
stratification for heart disease. So I think that’s kind of
the general understanding. – Thank you, so can it be prevented? – Oh, absolutely, so there’s a lot of things
that go into heart disease and actually going from
someone being healthy to having heart disease. There a lot of things that
can increase your risk so blood pressure, cholesterol, and a lot of different lifestyle things that can make it more likely for you to develop heart disease. By controlling those risk factors, we can really see a dramatic reduction in your risk of developing heart disease. – Okay, so let’s talk
about the age factor. Why should someone in their 20s or 30s care about heart disease prevention? – Yeah, I think that’s a great question. So when we think about
prevention for heart disease, we think about a disease process that’s really starts
early on in a lifetime and takes oftentimes a
lifetime to build up to a point where it causes symptoms or problems. So from a prevention point of view, it’s really critical to be
thinking about that early on so that you are on top of
treating or modify risk factors. So as Dr. Paivanas was just mentioning, there are risk factors that
are modifiable risk factors and there are risk factors that are non modifiable risk factors so those things that are
modifiable like diet, like exercise, smoking status, those are all things
that can be focused on really early in life to prevent
heart disease later in life. – Thank you, so let’s get
into that a little bit more. Let’s talk about exercise. Why is that so important and what do you recommend
to your patients? – So I tell people that unfortunately, there is no alternative to
just getting regular exercise. There’s no shortcuts with that. Regular exercise just does
so many fantastic things for your body, heart disease prevention, keeping your blood pressure
under control, healthy weight, and it just helps in so many other ways outside of the heart as well. And so unfortunately,
there’s no shortcuts here but getting 30 minutes
a day of some brisk, physical activity I would say is one way to keep the heart doctor away. More activity is good, at
least 15 minutes a day, I would say is that minimum amount where you start to see a benefit. But usually when I’m talking to someone, I’m saying, you know what,
five days out of the week, we should be getting your
heart rate up a little bit for about 30 minutes at a time. Sometimes people will say
that they don’t have time to do that, they don’t have 30 minutes. And then we’ll say, well
you’ve got a step counter, maybe get 10000 steps in a day. That’s another way to make sure
that you’re staying active, you’re moving around. So those are the general
guidelines I tell people. – Yeah, I think that’s a great point because as we learn more about this, there’s more and more evidence that sedentary lifestyle is a risk factor that’s significant for heart disease, probably even as much as
some of the traditional risk factors that we think about like high blood pressure, like smoking, so making sure that you’re
doing regular exercise is really important. – Great, thank you, so let’s talk a little bit about smoking. How does that contribute? As being a smoker or even a former smoker, how does that contribute
to getting heart disease? – Yeah so smoking is definitely one of the biggest again
modifiable risk factors that you can have for
developing heart disease and it has several effects and obviously can be a risk
factor for other things besides heart disease. But the way that it affects the heart so it can certainly raise blood pressure and it can cause damage over time to the lining of the blood vessels which can lead to plaque build up and in a lot of cases, can lead
to heart attacks and strokes which at the end of the day is
what we’re trying to prevent when we talk about heart
disease prevention. So really there’s
different mechanisms for it but no question, smoking
one of the main risk factors for developing heart
attacks and heart disease. – I would say piggy backing
on that, unfortunately, it’s not just regular cigarettes. All the other alternative
e-cigarettes and vaping, unfortunately we’re seeing more and more that they’re filled with
the same garbage stuff that increases your
risk for heart disease. Sometimes people will
use other things, vaping, to get off of cigarettes which is great but then getting off the vaping, getting off the e-cigarettes
too is very important. – And last thing to say is quitting smoking can be really
hard and it’s something that, if you’ve struggled with that before, definitely something to
talk with your doctor about because there are
options that we can offer if you’re having trouble
quitting on your own so I think that’s something
that’s really important to keep in mind. – Great, thank you. So let’s talk about check
ups with your physician. So how important is it
to have regular check ups with your physician and how
often should you be discussing these type of issues with them? – So a lot of this depends
on the individual patient. So your age, your other risk
factors, your co-morbidities, these sorts of things will help to dictate how often you need to see your doctor. For someone who’s young and healthy, it might just be checking in once a year. For someone who has high blood
pressure, high cholesterol, maybe it’s checking in
a couple times a year. For patients that have
developed heart disease, heart failure, heart attacks,
sometimes we’re seeing people even more frequently than that. So it has to be individualized but I would say at least
checking in once a year to make sure that there’s nothing going on that we need to adjust, we
need to tweak going forward. – Thank you, so let’s
talk a little bit more about high cholesterol. What are some ways that people
can manage high cholesterol? – Yeah so that’s a great question. So really, there’s two
general categories of ways that people can manage high cholesterol and I think it’s important to keep in mind that cholesterol’s affected
by several different things one of which is genetics too so certainly it can be
hereditary among families. But dietary changes and making sure that people
are eating healthy diets which often include high fiber, certain specific foods
have been shown to maybe have an impact on cholesterol
such as red yeast rice and medication is the other
major category of things that we can use to control cholesterol in cases where diet and
lifestyle modifications like adding exercise as
we’ve been talking about doesn’t do enough of a job to get that cholesterol level down to a reasonable and acceptable level. So from a medication point of view, certainly we have several
different classes of medications that we can choose from if we need to use something like that. – Great so how do medications work? – So I lump the cholesterol
medications into big categories either they reduce the
amount of cholesterol that you’re absorbing from your diet or they change the way your body is metabolizing
cholesterol internally. And your doctor can help you to select which one is right for you. Most common medications we use, the ones with the most
evidence behind them, are gonna be statins. It’s something that people
will read a lot about and I would encourage you to
really talk with your doctor about the evidence behind them if your doctor feels that’s something that’s appropriate for you. – Okay, thank you so let’s
get into blood pressure. So how does blood pressure
contribute to heart disease and what numbers should you be looking for when you’re looking at
your blood pressure? – So blood pressure also is
one of the major risk factors for developing heart disease and again, as we’ve talked about in the beginning, that includes things like
coronary artery disease or plaque build up in the
arteries as well as heart failure which can develop from
having high blood pressure that’s not well controlled. And of course strokes also can result from not adequately
controlled blood pressure. So oftentimes, people
feel no symptoms at all from having high blood pressure which is why it’s so
important to make sure that you’re following up with your doctor and keeping on top of that. And the goal numbers
that we tend to target usually recommend that we
try to keep blood pressure with medication in the 120s
systolic which is the top number or the 80s or less, or less than 80 in that diastolic blood pressure
which is the bottom number. So 120s over less than 80
would be the target numbers. I think that for most patients are gonna be the best results. – Okay, why is obesity a risk factor? So obesity does a lot
of things to your body. One of the things it does is it can raise that blood pressure. It can put an additional
strain on your heart and anything that’s
increasing the amount of work that your heart has to do is
going to increase your risk for heart complications down the road. So I think of it as
there’s that one aspect of just the extra effort that
your heart’s putting forward to pump against higher blood pressure, to get your body moving when there’s that extra weight onboard. The other aspect of obesity that we worry about
with heart disease risk is with metabolic
syndromes meaning diabetes, cholesterol, all getting
out of control with obesity. So the good news with that is that even small reductions in weight, even 10 pounds of weight
loss can really make a dramatic impact in blood
pressure, in cholesterol, and in the amount of effort and strain going on with your heart. – Okay, thank you, so
what would you recommend to our viewers who aren’t
at that desired weight. What would you recommend that they do to get to that weight that
they’re looking to achieve. – Yeah so it can be really
hard for a lot of people to lose weight and if you’re
successful in losing weight, to keep the weight off which is often the most difficult part. But the way that ultimately
weight loss is achieved has to do with the balance between the calories that
are taken in during the day and the calories that are burned. So really, there are a lot
of different diets out there and some may work for some people but it ultimately comes down to the number of calories taken in so you should as an individual
talk with your doctor about what’s recommended for you ’cause that’s certainly
varies based on patients’ age and gender and their
current weight as well but certainly calorie
restriction at the end of the day is gonna be the most
effective way to lose weight and to maintain that weight loss. Exercise can be very helpful
as an adjunctive therapy or adjunctive strategy but it’s
not in and of itself enough. It has to be also done in
conjunction with dietary changes to maintain and achieve that weight loss. – Just piggy backing on that,
I think it’s really important that when we’re talking with
someone about weight loss, that its’ individualized to the person because different people
will approach this in different ways. Some people want to just
totally have a clean slate and they’ll go onto a diet
that’s totally different than what they’re used to and
that works for some people. For a lot of people I would say that, the majority of people that I talk with, that’s really too hard to do because there’s so much wrapped into food, culture, social gatherings,
that sort of thing. And so it’s much easier
like Dr. Dooley was saying to reduce the calories a little bit rather than changing
everything about what you eat. Just because it’s really
hard to go on some diets depending on a certain person’s situation. So we really try to individualize
that and work with people. – Great so we’ve covered a
lot of different risk factors, smoking, obesity, let’s talk
about one more, diabetes. How does that raise your
risk for heart disease? – So diabetes unfortunately
really increases your risk for cardiovascular disease through a number of different actions and I lump it into that
metabolic part of obesity where your body’s having
trouble handling its sugars and that’s putting some
inflammation on your blood vessels and then leading to
problems with the kidneys. And it triggers this whole
cascade of vascular issues. So unfortunately with diabetes, it is something where we really
have to stay on top of it. Again the great news with diabetes is that when it’s well controlled, when we have some
medications, lifestyle things that keep diabetes under good control, it can reduce that inflammation, that injury onto the blood vessels and really let people have
normal, healthy lives. So the big thing with diabetes
is keeping it under control so that we don’t let it
really get out of control and injure the blood vessels and heart. – Great, so that’s all the questions that I have for you today. Before we wrap up, is there anything else you’d like to share with our viewers before we conclude our broadcast? – I think the only other thing that I would add to all of this is that a lot of the things
that we’re discussing are certainly really useful information in terms of thinking about
a general population level but I think it’s really
important to remember that all these things are generalities and talking with your doctor
about what works for you in all of these things and what strategies
are recommended for you is really gonna be the
most important thing to take away from all of this because everything is individualized and when we see patients in the office, I know Dr. Paivanas and myself
and all of our partners, we really tailor our recommendations
to individual patients and what’s going on with that patient, what might work with them,
and what might work for them so I think that’s one of
the more important things to keep in mind when we’re thinking about
all these recommendations for preventing heart
disease and staying healthy. – Yes, absolutely. – Alright, well thank you very
much for joining us today. We hope you learned something
today about heart disease. If you would like any more information or would like to make an appointment with Dr. Paivanas or Dr. Dooley,
please call 410-573-6480. Thank you very much.

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