Episode 5: How can your heart beat heart disease?

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You are listening to the Beyond Age podcast series.

Jennifer Botterill:

Hi, and welcome to Beyond Age, a Manulife exclusive podcast. Manulife cares about the physical, mental, and financial wellbeing of Canadians. And during this podcast series we chat with industry experts to uncover the truth about holistic health and aging to keep you living healthier for longer, no matter your age. I'm your host Jennifer Botterill, and today I'm joined by Dr. Beth Abramson, a cardiologist at St. Michael's Hospital from Toronto, Ontario. We'll be discussing how your heart can beat heart disease. Welcome Dr. Abramson.

Dr. Beth Abramson:

It's my absolute pleasure to be here. Happy to chat about heart health. Our leading health threat is Canadians and people all over the world, so we want to reduce that risk.

Jennifer Botterill:

Oh, we're so honored to have you today. Thank you. Very important to have these discussions. So can you tell us to start off a little bit more about yourself and how you got into this field?

Dr. Beth Abramson:

I'm a cardiologist at St. Michael's Hospital and the only thing I wasn't going to be was a heart doctor, like my late father. And I saw him working really hard helping care for patients as a young girl, and I knew I wanted to be a doctor. And I am very privileged and blessed to have been able to care and still care for people for two decades now as a cardiologist who has an interest in prevention in women's health. And so although I spend some of my time translating complex medical issues for the public, I've volunteered for the Heart and Stroke Foundation for many years and do a lot of work in that regard because I want people to be proactive and educated. I'm a doctor, I'm a clinician at heart, so that's a little bit about me.

Jennifer Botterill:

Wonderful. Thanks for sharing and for all of us to begin with, what does it mean to have a healthy heart and what can you do in your daily life to take care of your heart?

Dr. Beth Abramson:

Having a healthy heart means having a healthy blood supply to the heart. The heart's a pump and we have pipes, so to speak, that supply blood flow to the heart and those pipes can become rusty as we age or have risk for heart disease. The commonest cause of heart disease is atherosclerosis, or junk in our arteries, which can cause heart attack. And that same disease of the arteries can cause a problem related to stroke or blood vessel disease in our legs. So to maintain a heart healthy lifestyle, we can reduce our risk by making sure we are eating well, living well, checking our risk factors for heart disease and making sure that those risks are lower. There are some things we can do such as regular activity to start living a heart healthy life. And so we also want to, and it's really hard as we live in a toxic environment, to maintain a healthy body weight. If you're rushing around and grabbing fast food, or now back in a food court and grabbing lunch, that may not be the healthiest choice. But making some lifestyle changes takes a little bit of time in your everyday routine, but it can have lasting impact.

Jennifer Botterill:

And so as you think about some of those steps that we can take to lead a heart healthy life, what changes could you expect to feel as you age?

Dr. Beth Abramson:

If we aged in a healthy manner, the evidence suggests that it's not age itself. It's because as we get older we have risk factors for heart disease. So there are many people out there who I don't see in my office, thank goodness, who are leading healthy long lives into their late eighties and nineties, but they have actually heart healthy behavior and low risk factors for heart disease. It's the age that's associated with a lot of risk factors we have. And as I joked, we live in this toxic environment where we have a tendency for high blood pressure and high cholesterol and diabetes. We're not the same people that cave men were, where we went out after our food, right? We're calling a "someone eat's" app. You don't even walk to the store or prepare our food, let alone hunt and gather our food. So I think we have evolved as humans, but if we actually aged in a healthy way, heart disease may not affect us as greatly.

Jennifer Botterill:

Is there anything about tracking or measuring whether your heart is healthy over time?

Dr. Beth Abramson:

Well, the one thing about heart disease and risks for heart disease and heart attack and stroke is a lot of the risk factors are silent. We need to get them checked out and talk to our healthcare providers. High blood pressure is checked by getting your blood pressure checked. Go to the local drugstore, get it checked, talk to your healthcare provider. If the numbers are off in the machine, go back and talk to someone. And a very simple measure, not everyone wants to do it, but it's a waist circumference measure. So take your tape measure and wrap it around your waist. And we know that the fat around the belly is actually dangerous fat that puts us at risk. Extra weight around the waist, that is dangerous inner fat. And so that extra little belly fat that actually changes, it's a male pattern of gaining weight.

We call it an android or apple shape, versus the gynoid or female pear shape. So when women are younger, that weight tends to gain on their hips and that pear shape is not as dangerous for our weight as that apple shape. Actually as women age, they go from pear shape to apple shape. You can be a pear, but not a big pear. It's the weight to cross the waist. So the measurement that we should all be watching indirectly towards our heart health is making sure that we maintain a healthy weight and waist circumference. You don't need the total body CAT scan if you're feeling well, to have your risk factors for heart disease checked out.

Jennifer Botterill:

Important for everyone to remember and to keep in mind about how we approach our lifestyle on a daily basis. We've often heard the phrase sitting is the new smoking, may you please expand on this?

Dr. Beth Abramson:

Yes, it has to do with our lifestyle and risk factors for heart disease. Many years ago the Heart and Stroke Foundation put out a statement that fat is the new tobacco, and that's blood fat and cholesterol. There is no doubt that when we are sitting and not active, that puts us at risk for heart disease indirectly being related to being overweight and out of shape. There fortunately are people who are smoking less frequently in North American in society, but there is still a percentage of the population that smokes and it's an addiction. We can't make people feel bad about it, but we can offer them help.

But smoking is the largest risk for heart attack. If you are young and coming into the emergency room, I'm not a betting person, but I can bet that when I take a history of this person they may be a smoker, and smoking adds up to other risk factors. Less people are smoking, but there are still smokers out there that we need to help "butt out", but smoking is bad for our heart.

And sitting is bad for our heart in other ways, and we need to make sure that especially in an era where we're work from home and at our desks and on Zoom and doing things electronically, that we're getting out and not sitting as much. Because if we sit less, we are more active, and our risks for heart disease will come down.

Jennifer Botterill:

Could you speak to other factors that could contribute to poor heart health today?

Dr. Beth Abramson:

So traditional risk factors for heart disease, or junk in your arteries that lead to heart attack and stroke, are high blood pressure or hypertension, high cholesterol and diabetes. If you have a family history of heart disease, and it goes man to woman, woman to man, if you're a woman whose dad had a heart attack in his fifties or sixties, you're at increased risk of a future heart attack and stroke. A family history is also a risk factor for heart disease. We need to be able to be aware of our risk factors and check our risk factors because you can't feel any of those risk factors. High blood pressure runs in families. So I always tell people, to try and have a healthy conversation with loved ones about nice things in life, but get a feel of your family history for high blood pressure, heart disease, and who has high cholesterol, as it tends to run in families.

So I have patients who are sent to me with high blood pressure and when I take a history, they have a lot of family members, parents and siblings with high blood pressure. There's a genetic or familial component and we can't feel our blood pressure. We need to get it checked. And then what we need to do about that then is work on lifestyle, and when appropriate, needing medication.

And you know, I'm just going to focus on blood pressure for a minute, because it's a risk factor for heart disease that we don't feel and we can take some charge of. In addition to medications that many of my patients need, regular walking and activity and getting sweaty and short of breath for 15 to 20 minutes three times a week. So I say 30 minutes because we need to warm up and cool down, but I'm not going to talk to the athlete here about that.

But anyway, we should be having at least 30 minutes a week of walking so you're sweaty and short of breath three times a week. So that will lower blood pressure through lifestyle, to some degree. And trying to maintain a healthy body weight; so if you're a few pounds overweight, lowering your weight.

Alcohol actually increases blood pressure. So watching and cutting down our alcohol intake. We are all finding out now that a lot of guidelines are suggesting that alcohol puts us at risk for cancer, and does put us indirectly at risk for heart disease because it raises blood pressure, causes us to gain weight and when you gain weight you're at risk for high cholesterol and diabetes as well. So if there's some lifestyle changes we can make if we are at risk or have high blood pressure and then talking to your healthcare provider and getting on the right medications is important.

There's some other risk factors for heart disease that are very associated with lifestyle and one of those is diabetes, or the diabetes that develops as people are older, related to being overweight and out of shape. Diabetes is a really serious risk factor for heart attack and stroke. And so we know that if we are more physically active and fit and we work towards a healthy body weight, again, I'm not expecting people to be skinny-minis and I think there are unhealthy body image expectations out there. But lowering your weight if you're at risk or have a tendency to diabetes, and being physically active makes all the difference between a diagnosis of diabetes and not. Most risk factors for heart disease we have control over; we don't have control over our genes. I make a joke that even the best plastic surgeon can't change the inside of your coronary arteries.

If your mom or your dad or your sister or your brother had heart disease, you can't change that. But you can be aware of it and be more attuned to your risk. But if we watch what we eat and how we eat, we can watch and keep our cholesterol levels by and large into a healthy range. We should be out there walking, getting in our steps and being physically active to help our cardiovascular system and to help our heart. And cholesterol is a risk factor for heart disease. If you're at high enough risk with high cholesterol or if you have heart disease, you need to be on a cholesterol medication; these are safe and well tolerated medications. Watching what we eat, watching labels in terms of food and caloric intake, sugar intake, those sorts of things. So these are the things that we have control over and in some patients we need to magnify that control with medications.

Jennifer Botterill:

And you have mentioned about the importance of nutrition. Are there other tips or recommendations that you have on how to maintain our healthy heart on the nutrition side and how can we start to make our diets more healthy?

Dr. Beth Abramson:

Well, it's actually easier to take a pill than make a lifestyle change, but the lifestyle change is probably more impactful for all of us. For many of us, the tendency for high cholesterol versus lower cholesterol is dietary to some degree. So I take a history on my patients.

And it's the foodies in my practice who like nice cheeses and french cheeses and high fat dairy products. Dairy is important for us, for our bones and calcium, but in lower fat. So I have skim milk in my coffee in the morning and eat fat free yogurt and lower fat dairy products. Eating less red meat; red meat once every one to two weeks is healthy. Not eating fried foods, broiling our food, and taking the skin off of chicken - those sorts of things will lower the fat intake in our diet. Really important. Meal plan; bring your lunch to work, when people are now back to work from being at home. I have brought my lunch bag for many decades to work, and there is a heart healthy lunch in there. I've portioned out fruits and vegetables and healthy eating and a little snack for me, but that's okay because we're planning it out. So bringing your lunch to work is one example of how you can make your lifestyle a little healthier.

Making healthy choices even though we're eating out, taking those sauces that can be full of fat and calories and putting them on the side, reading food labels, seeing what we're eating. I have my patients who are trying to lose weight, and others who are not but need to lead a heart healthy life. Just pick up an app that makes you count your calories and look at your nutritional content and put everything in for the course of a few days. You'll see in your own life what foods you should or shouldn't be eating and where there's wiggle room to modify what you might think is a healthy diet. And again, most things in moderation. So I don't eat very much red meat. I very rarely have fried foods, and I will be known to go out once every few months to a restaurant and order fancy french fries. So that's my little sin. Don't deny yourself it, but just don't have it all the time. And I think that's the balance in life that we all need.

Jennifer Botterill:

Absolutely. And I think those are so many great ideas and tools for people about thinking about making positive change for their heart health. One of the things that you mentioned was exercise, and certainly it has always been a part of my life, but as I age, I feel like my activity has changed from being an elite athlete to being a professional, and being a mom. Now in terms of those windows, how much cardio exercise is necessary and is intense cardio better or can you get the same benefits from shorter sessions or less intense to maintain a healthy heart?

Dr. Beth Abramson:

So I have never been an elite athlete and I've always pushed myself to exercise and be active. I practice what I preach. The good news is that regular activity, even in moderation is good for our cardiovascular health. And you don't have to join a gym and put on spandex and it's never too late or you're never too old. In fact, as I get older, I see my patients who come in and need to see the orthopedic surgeons for knee problems and back problems if they're running. So if you were a runner, being a power walker is just as good, getting yourself short of breath and sweaty.

So moderate vigorous activity is good for our heart health. The Heart and Stroke Foundation recommends 30 minutes of activity most days of the week, and that is a good and realistic goal. I think as we all lead busy lives, I tell my patients and friends and family that you can bunch it up in little pieces. So your activity, if you're busy and you can't do 30 minutes every day, if you go for a brisk and vigorous walk a few times a week, it gets you going and gets your body used to that activity. And there's a lot of reasons why exercise and activity is good for our heart and blood vessels. Aside from lowering risk factors for heart disease, it actually makes our blood vessels healthier. All of the experts say schedule it in. If you schedule in an activity or routine, it is more likely to happen just as you schedule in an appointment for your kids in school or go to a doctor's appointment or a work-related meeting. Scheduling an activity makes a difference. I schedule it in, I spend twice a week and I have it scheduled into my calendar so someone in my household is doing pickup or drop-off and I have time. That's "me time" on the weekend for an hour to be active. And if you pencil it in or type it into your electronic schedule, you are more likely to follow through with that activity. So the good news is you don't have to be a competitive athlete. And if your lifestyle has changed, just being active is good for our hearts.

Jennifer Botterill:

I always find for me I do like jogging or a brisk walk. I find this a way to clear my mind. So important to manage our time in the best way possible for our health.

We're going to take a quick break and we'll be right back after this message.

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Jennifer Botterill:

Welcome back to Beyond Age.

Dr. Abramson, there is some recognition that men and women can experience heart health and heart disease very differently and that women at times are not always receiving the care that you need. Can you help us understand some of the similarities and differences between how men and women's heart disease can present itself and what signs should women look for?

Dr. Beth Abramson:

Well, I think women need to understand as do the men in their lives, that heart disease is an equal opportunity killer and women are at risk for heart disease. So the first recognition is it can happen to me. There are some sex specific risk factors for heart disease as well. If women develop high blood pressure or diabetes that's gestational diabetes with pregnancy, we know that these younger women are actually at risk for future problems as they get older. If you have diabetes earlier on in life or have a family history of heart disease or heaven forbid you're a smoker, your risk may be even higher when you are younger in life. And as a woman ages and goes through midlife or menopause, a woman's risk for high blood pressure, diabetes, high cholesterol and heart attack and stroke increases at midlife and beyond. And so a woman needs to think, this could be my heart and heart disease tends to present actually similarly in women and men in terms of symptoms, how women describe their symptoms may be different.

And if you have a heaviness in your chest and you're suddenly short of breath and sweaty, if you're at midlife or beyond or have some risk factors for heart disease, you need to take that seriously. If something is wrong, you need to say, could this be my heart? Am I sick enough? Do I need to go to the emergency room or is something just not right? When I'm active, if I'm walking and I'm getting a chest discomfort and it goes away when I rest, I need to see my doctor and say, could it be my heart? It may or may not be, but it's important to understand that it could be. And I think one of the issues when it comes to women in heart disease is this lack of recognition even amongst ourselves as women. I have had patients over the years run errands, pick up children, deny their own health before coming to the emergency room with chest pain because oh, it couldn't happen to me. And women tend to be type A personalities. They're everything to everyone except themselves. And I tell people, if you want to be around to be a caregiver, you need to take care of your own health. So not all chest pain in women or men is due to heart disease, but it could be and we need to get it checked out.

Jennifer Botterill:

Definitely. And you mentioned the fact that we're all so busy in our lives, in our careers, and I'm curious, and I'm sure many of our listeners are as well, how can stress impact our heart health?

Dr. Beth Abramson:

Well, there's good and bad news with stress. The bad news, and I guess good news because we're not alone, is that everyone has different stress in our life. And stress is not an extreme risk factor for heart disease. It's how we deal with stress.

So if you are stressed and you decide to sit on the couch and gain 30 pounds, or run off for fast food, or pick up a cigarette, that's not good for your health. But if you cope with stress in a positive way, get out there, go for a brisk walk, deal with your stress in a healthy way. It does not contribute to heart disease per se. The only exception to the rule is that there is a little association with extreme stresses in one's life, losing a loved one, some very unusual stress where we do see a signal for increased heart attack. And that's where we all need to get support for extreme stress in our life. Having said that, stress, which we all have, doesn't kill us.

And that's the good news. It's more than it doesn't kill us, it does not traditionally lead to cardiovascular disease.

Jennifer Botterill:

Great to know. And when we talk about heart disease, I'm wondering, does it affect our other organs too? So what exactly is the link between heart disease and our other organs?

Dr. Beth Abramson:

That's a really excellent question. When we talk about heart disease, heart disease is a constellation of several diseases. The most common disease is a disease of our blood vessels, and a heart attack comes when there's a blockage of blood flow to the heart from junk built up in your arteries. That's actually a disease of the arteries. So when your arteries are sick in your neck and your arteries lead blood flow to the brain, you can have a stroke.

If you have artery disease in your legs, people sometimes have something called claudication, which is a pain in their legs with walking, and that can even lead to blood vessel problems and amputation. So the heart pumps blood to the rest of the body, and that's an important factor in looking at our other organs. But the main association is that the blood vessel disease that affects the hearts can affect blood vessels to other organs as well.

Jennifer Botterill:

Yes, absolutely. And so we've talked about, I guess different phases of our lives. And does age put you at risk for heart disease or how big of a factor does good or poor heart health have on our longevity and our quality of life?

Dr. Beth Abramson:

So those are two great points. First of all, age does drive cardiovascular risk. So the older you are, the more likely you are to have risk factors or have developed heart disease or cardiovascular disease over years of being exposed to a little bit of blood pressure or cholesterol. So the older you are, the higher your risk for heart attack and stroke. But healthy activity and lifestyle and being well at all stages of your life protect you from developing heart disease as we get older. So if you're older, certainly you need to talk to your healthcare provider about risk factors for heart disease, but it's never too late to make a lifestyle change, go for a walk, start changing the diet a little, making sure that we do our best to try and enjoy life, but not too much. So we maintain a healthy body weight.

And it's sometimes hard to do when you're younger if you're not well. And I talk about physical fitness. I'm not talking about Olympic athlete physical fitness, but I am talking about just leading a healthy lifestyle. We're busy in front of our computers and exercising our brains. We need to be active with our bodies as well and try and eat healthy and maintain a healthy lifestyle. Being fitter and weller from a heart and vascular perspective when you were younger will protect you as you age. So we can change the trajectory of time by leading a heart healthy life.

Jennifer Botterill:

Yes, I think that is so intriguing. If you think about heart health or damage that may be created at some point in your life, damage to your heart, is there any other things we can do to create more prevention or to address that, or even reverse as you just alluded to, if you can reverse some of the damage that has been done over the course of a life?

Dr. Beth Abramson:

Yeah. I think getting checked for risk factors for heart disease, certainly when you're at midlife or beyond is important. All of our medical organizations recommend getting cholesterol checked at a certain stage, going out and checking your blood pressure, making sure that some of the risk factors that we think are in our control are checked. And although a lot of this risk is under our control, some of it isn't. There is a genetic component, and if we get our cholesterol checked, if we are screened for diabetes, if we check our blood pressure and even if we're leading a heart healthy life, we may need some medication to help control that. The most concerning situation arises in an individual, and I see them coming into the emergency room with heart attacks who have not seen a physician in 10 years who think they feel well, and we check their blood pressure, it's super high. They have diabetes they're not aware of, and their cholesterol is off the wall. And it's because some of these risk factors we can't feel. So even with the maintenance of a good lifestyle, you need to be partnered with your healthcare provider.

Jennifer Botterill:

And I think so many of these things are about that communication with your healthcare provider on a regular basis. And what about misconceptions or myths or misinformation that might be circulating in our society about heart health? Are there any of those that you feel need to be addressed or debunked?

Dr. Beth Abramson:

The first myth that's out there for my patients who have heart disease or who are at risk for heart disease, who need certain medications, cholesterol lowering medications in the form of statins are safe and well tolerated. And if your doctor prescribes it for a reason, it's important to have a conversation about risk and benefit with all of our healthcare providers, but these are safe and well tolerated medications. I want to debunk that myth. Firstly, the other myth I'd like to talk about is the fact that it can't happen to me, right? I have no risk factors. I look healthy, I'm fine. It happens to many people as we age and we can't feel our blood pressure and we can't feel our cholesterol level, and we generally can't feel our sugar level. So getting your risk factors checked, even if you feel that you're healthy is important.

Jennifer Botterill:

I think there has just been so much valuable content for people and our listeners to absorb. Is there anything else that you would encourage to make sure listeners are informed and educated and conscious about healthy aging and their hearts?

Dr. Beth Abramson:

Yeah, I think you need to go in this world of misinformation to sites that give you credible information. So whether it's the Canadian Cardiovascular Society, or the Heart and Stroke Foundation, I wrote a book on preventing and treating heart disease that supports the Heart and Stroke foundation. I wrote it for charity, but get your information from credible sources because there is so much information out there, there's a lot of misinformation as well. And if something sounds too good to be true, it probably is. Leading a heart healthy life takes a little bit of discipline and a little bit of effort. And the magic vitamin or the magic wand that makes you lose weight right away just doesn't exist. I think we all need to lead by example. If we have younger children in our lives, just as they're teaching us to behave with respect to the environment, we need to make sure that our next generation is healthy from their parts. And so leading by example, being active, making healthy choices, more fruits and vegetables, less junk food. It's common sense. It's hard to do sometimes, but it's common sense and it requires a little bit of discipline. But that will go a long way for our heart health

Jennifer Botterill:

And making those adjustments. And sometimes it can be small things that can create big changes in our health. And then finally, as we start to wrap up, are there one or two key takeaways or perhaps the most important reminders you would like our listeners to take away from our discussion today?

Dr. Beth Abramson:

Well, I think we're all at risk for heart disease and small changes in our everyday routine could have lasting impact on our heart health.

Jennifer Botterill:

Absolutely. Thank you, Dr. Abramson. There's been so much important and extremely interesting information that you've shared with us today, so thank you.

Dr. Beth Abramson:

My pleasure.

Jennifer Botterill:

So that's it. Thanks for tuning in to Beyond Age, an exclusive podcast from Manulife. Tune into the next episode where we talk to Dr. Alexandra Fico from Toronto, Ontario, all about mindset and whether you can change your mind on aging. Don't forget to visit our website manulife.ca/livehealthier for more tips, videos, and content from Manulife that can help you live healthier for longer, no matter your age.

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