Participants: Christine Salter
Series Code: WM
Program Code: WM000340
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00:01 The following program presents principles
00:03 designed to promote good health and is not 00:04 intended to take the place of 00:05 personalized professional care. 00:08 The opinions and ideas expressed are those of 00:10 the speaker. Viewers are encouraged to draw their 00:13 own conclusions about the information presented. 00:35 Welcome to Wonderfully Made. 00:37 Our topic today coronary artery disease. 00:40 Hello, my name is Dr. Christine Salter. 00:44 I am a board certified family physician 00:46 and I am a medical director of Vibrant 00:49 Health Family Medicine St Louis, Missouri. 00:52 Coronary artery disease, why is this so important? 00:56 It's number one killer in the United States 01:00 affected over half a million people annually. 01:04 What are the risks factors for coronary artery 01:07 disease? First, we want to establish that there are 01:12 conditions called coronary equivalence. 01:16 They are not risk factors, they are if you have 01:21 these you are assumed to have coronary artery 01:24 disease. What are those; diabetes mellitus 01:28 and chronic renal disease. If you have either of 01:32 these you are considered as somebody who already 01:35 had a heart attack. But if you do not have 01:40 these what are those risk factors? 01:45 Physical inactivity that's a risk factor for heart 01:48 disease, high cholesterol that is also a risk factor 01:52 for heart disease. The male gender is a risk 01:57 factor although women are also dying of heart disease, 02:02 in fact more women greater than the age of 65 are 02:06 dying from heart disease. So, we have high cholesterol. 02:11 We have physical inactivity. 02:13 We have the male gender and then cigarette 02:16 smoking, a big risk factor for heart disease. 02:20 In fact, recent study showed that tobacco 02:24 smoking was the number one risk factor for the 02:29 cause not only for heart disease, but also of stroke. 02:34 So it is important that you as an individual assess 02:39 your risk for coronary artery disease and 02:43 how you are going to do that? 02:45 You need to see your physician 02:48 so that he can or she can look at these particular 02:52 risk factors. In addition, risk factors that I did 02:55 not mention initially is also high blood pressure, 02:58 so we want you to go to your physician 03:01 and your physician will take your blood pressure. 03:04 Is it greater than 140/90? We want to know that 03:11 or do you already have established high blood 03:14 pressure that taken medicine for this that is a 03:17 risk factor. Your physician will also draw some blood 03:22 to check your cholesterol levels. 03:25 Now you need to be fasting when you do this blood test 03:28 and as a 12-hour fast, nothing to eat after 03:31 midnight and get the test done before breakfast. 03:35 Twelve hours of fasting and will access your 03:39 total cholesterol, your good cholesterol otherwise 03:43 known as HDL you remember the H by 03:46 saying happy cholesterol that's the HDL, 03:50 we will also look at your bad cholesterol otherwise 03:54 known as LDL cholesterol or lethal that's the good 04:00 ways to remember that happy for HDL 04:03 and lethal for LDL. We will also check your 04:08 triglyceride levels. This will give an entire profile 04:13 that will contribute your risk for coronary artery 04:18 disease. So your physician will check your blood 04:22 pressure, do some blood tests and will also access a 04:28 fasting blood glucose to see if you are diabetic. 04:32 Again if you are diabetic, we will assume that you 04:36 already have coronary artery disease 04:38 and we will automatically advance 04:40 you to the high risk category. 04:44 Your physician will also access your level 04:46 of activity, are you sedentary or do you have 04:49 an active lifestyle. What else will your physician do? 04:55 Your physician will take your weight 04:57 and check your height. The measurements of 05:01 these two together with the certain calculation 05:04 will give us a body mass index and determine 05:07 whether you are overweight or whether you are obese. 05:10 The ideal body mass index is between 21 and 23. 05:15 If it's greater than 25 we say you are overweight. 05:20 If it is greater than 30 then we say you are obese. 05:27 Overweight and obesity both contribute to coronary 05:31 artery disease. So these are the things that 05:36 your physician will do for you to access your risk 05:41 and also he will find out whether you are smoking 05:45 or not. So ideally, you should not be smoking, 05:51 you should have body mass index of, let's say 22. 05:55 You should be exercising at least 30 minutes a day. 06:00 You should not be diabetic. You should not have 06:03 high blood pressure. And the gender male 06:07 or female they both are dying of heart disease, 06:11 so we won't say anything about either one of those. 06:14 The other risk factor that your physician 06:18 will find out is do you have a family history 06:22 of coronary artery disease or premature death 06:25 from coronary artery disease. So did your father, 06:28 mother, brother or sister die of a heart attack 06:33 before age 50? That would put you at risk for a 06:39 coronary event. What do I mean by coronary event? 06:47 Let's consider the blood vessels of the heart. 06:50 The blood vessels feed the heart during the stage 06:57 of diastole when the heart is relaxing after 07:01 it pumped the blood out into the major circulation, 07:04 it relaxes and during that time the coronary 07:07 vessels are fed. The coronary vessels bring oxygen, 07:13 glucose and nutrients to the heart muscle enable 07:18 it to continue to pump. These vessels are fairly 07:22 thin and if you look to the lining it's very smooth. 07:27 If you can imagine going down a slide, 07:31 if you go down a slide and you just slide so freely 07:34 and smoothly that's the way it should be in the 07:38 coronary vessels, but imagine if there is dirt 07:44 and debris on that slide and as you come down 07:48 the slide you are going to hitch. 07:51 You are gonna stop, you're not gonna able to go 07:53 through so smoothly that's the problem with 07:57 coronary artery disease. The nice smooth vessel 08:02 now becomes irregular and rough. 08:06 We call that endothelial dysfunction. 08:10 The endothelium is a thin lining. 08:14 The inner lining of the blood vessel that allows 08:19 the blood to flow by smoothly and unimpeded, 08:26 so if you have high cholesterol and were still 08:30 if you have LDL cholesterol that's elevated and if it's 08:35 of the type we called the small dense type 08:39 that's small dense type likes to go and lying in 08:43 those coronary vessels. As it lines those vessels 08:49 it damages that nice, thin, delicate endothelium. 08:54 What is the body response to that? 08:59 Well, whenever there is an area of damage in the body, 09:01 the body sends platelets, little cells, 09:07 little blood cells that will go and patch up the area. 09:12 We see this when you cut yourself. 09:14 When you cut yourself you bleed for little bit 09:17 and you notice that the bleeding stops 09:19 and that is because the platelets are coming 09:22 and they are aggregating, they are clumping together 09:24 to prevent any further bleeding. 09:28 Well, that's what happens on the inside of the 09:33 coronary vessels. The LDL or that lethal cholesterol 09:39 causes damage to that nice thin endothelial lining, 09:44 it becomes oxidized and then in so doing damages 09:50 the lining and the platelets come rushing to the area 09:56 to try and wall it off and prevent any further 09:59 damage. But let's say that area was called the LAD, 10:06 the left anterior descending artery that supplies a 10:10 large area of the heart and we have that kind of 10:14 damage going on or those platelets will go to that 10:17 area and form a clot trying to wall off the area, 10:22 but in so doing it blocks off the entire vessel 10:25 and there is no more blood flow going to that area 10:30 of the heart muscle, we call that ischemia. 10:34 If it's completely blocked off we say that the person 10:38 has a heart attack. There is death of the myocardium 10:44 or the heart muscle and the person may die on the spot. 10:50 It is unfortunate that for some people their 10:55 first symptom of coronary artery disease is sudden 11:00 death. Other people have different symptoms 11:06 and we would like to talk about those symptoms now. 11:09 Symptoms such as chest pain, 11:14 chest pain when you are running up the flight of 11:17 stairs. Chest pain when you are coughing, 11:23 chest pain when you are eating, 11:27 what's so common to nominate of those three 11:29 activities. The heart is having to work harder, 11:34 it's having to work harder and if there is an area 11:39 of clot buildup or plaque, the blood is not gonna be 11:45 able to get through as well and so it's gonna 11:48 be manifested as some chest discomfort. 11:51 Sometimes it may be manifested as discomfort 11:54 in the jaw or it may be manifested pain in the arm. 11:59 Most people think of the left arm as the area of pain, 12:03 but I've seen patients where they presents 12:05 with pain in the right shoulder or the right arm. 12:10 The point is chest pain or discomfort, jaw pain, 12:15 arm pain is occurring with exertion that is 12:20 considered ischemia until proven otherwise, 12:27 so sudden death, chest pain can be manifestation 12:35 of coronary artery disease. So, the signs and symptoms 12:41 we say can be asymptomatic or they can be symptomatic. 12:47 We want to try and find people when they are in 12:51 the asymptomatic stage of coronary artery 12:54 disease or better still determine what their risk 12:58 factors are before they even develop heart disease. 13:03 But how we to do that, we need you to go 13:06 and see your physician, so your physician can 13:09 access your risk. It is important to find out 13:13 about your family history and other lifestyle factors 13:17 and disease factors to know where you are in risk 13:22 stratification. Once we know what your risk is then 13:26 we can be aggressive in your management. 13:33 And so what can we do to lower your risk for 13:40 heart disease, coronary artery disease. 13:46 Well, it's the same story just the different song. 13:51 Recent guidelines showed that the majority of 13:56 heart disease is due to tobacco smoking, 14:00 physical inactivity, and poor diet. 14:06 It's the same story just the different song. 14:09 Lack of physical activity, tobacco smoking, 14:13 and poor diet. Tobacco smoking, if you are a 14:19 smoker and you quit smoking right now, 14:23 you would decrease your risk of coronary event 14:27 by at least 50 percent why? Let's think again about 14:34 that endothelial lining. That endothelial lining 14:39 when it has the cholesterol plaque buildup can 14:45 become unstable. Tobacco smoke contributes to that 14:53 and makes it unstable, it makes it inflammatory, 14:57 sticky. You've seen, you cut yourself sometimes 15:02 and you've seen the blood oozing and then you get 15:05 a crust and is it's all kind of gooey and sticky 15:08 that's what happens with endothelial lining. 15:12 The tobacco smoke makes it sticky. 15:15 The high cholesterol makes it sticky. 15:18 The diabetic state with all that sugar floating 15:22 the blood stream makes it sticky. 15:25 So if you quit smoking right now and never smoke 15:30 another cigarette again you will significantly 15:34 decrease your risk for a coronary event. 15:39 What else can you do? Get up and move become active. 15:47 The Institute of Medicine recommends at least 15:51 30 minutes of moderate intensity exercise, 15:54 optimally up to 60 minutes on most days of the week. 16:02 And so quit smoking, start moving. 16:06 Now if you been a couch potato for the last 10 years 16:11 we do not want you to jump up and run out there 16:14 and start exercising for 60 minutes. Now if you are 16:20 greater than age 40 it's important that you do go 16:23 to see your physician as I said earlier assess 16:26 your risk, determine if you have any symptoms 16:30 of coronary artery disease, the chest pain, 16:33 the jaw pain, your physician may then order something 16:37 like a stress echocardiogram to determine 16:40 if they really put your heart under stress, 16:43 does it show any evidence of ischemia. 16:49 But we always want you to stock low and go slow, 16:54 but do something everyday, stock low and go slow, 16:58 but do something everyday. Plan when you will exercise. 17:02 If you to say to yourself oh I think I should 17:05 exercise 30 to 60 minutes a day and then just 17:08 trying to work it in somewhere it's probably 17:11 not going to happen. We want you to look at 17:14 your schedule in the same way that you plan 17:17 when you are going to eat and when you go to bed, 17:20 when you're gonna go to store and do shopping 17:22 we also want you to plan when you will exercise. 17:26 It takes about 30 days to build a habit and so it 17:30 will be better if you spend those exercising for 5 17:35 minutes everyday at the same time build that habit 17:41 and then thereafter you may add more minutes 17:44 until you reach your goal of 30 to 60 minutes. 17:50 So right away, you can decrease your risk 17:55 for coronary event by quitting smoking, 17:58 by planning to exercise, and then improving your 18:04 dietary habits. What all those dietary habits that 18:08 can be so detrimental to the coronary vessels. 18:14 Let's talk about trans fatty acids and 18:18 I'm sure you've heard of those. 18:19 Trans fatty acids, when you read your labels 18:23 and we hope you all reading your labels 18:25 when you go to the store. You don't want to eat 18:27 food blindly unless you know it's an apple, 18:30 you see this is an orange, that's pretty safe, 18:35 otherwise, read your labels so you know what you are 18:38 ingesting into your body. Trans fatty acids otherwise 18:43 known as partially hydrogenated oils. 18:46 When you read your labels, it will say partially 18:49 hydrogenated soybean, corn oil 18:52 or whatever oil that has been partially hydrogenated. 18:55 It changes the structure and those trans fatty acids 18:59 when they are ingested and they get into 19:02 the cell membranes all over our body including 19:06 the coronary artery cell membranes they cause 19:11 a distortion that is more likely to attract those 19:15 clots, those platelets causing more damage to that 19:19 endothelial lining. Read your labels, avoid trans 19:24 fatty acids like the plaque. Where do you find them? 19:29 Cakes, pastries, baked goods those things that 19:32 can sit in the shelf for 50 years without going bad. 19:36 Those have the partial hydrogenated fats in them 19:39 and those you want to avoid. What else in your diet? 19:43 Well, of course, fruits, vegetables and whole 19:47 grains give nutrients that cause health 19:52 and regeneration to the endothelial lining 19:56 and to the coronary vessels. We want you to eat fruit, 20:01 vegetables, whole grains. Ideally to be a vegetarian 20:08 you would have less heart disease than you would 20:12 if you a meat eater. What is in meat that is so 20:16 damaging to the vessels not trans fatty acids, 20:21 trans fatty acids we find them in vegetable products 20:25 and they are damaging. And meat we find the 20:29 saturated fats that you find in the stake in the 20:35 marveled meat in the skin. You know, of chicken, 20:41 these saturated fats are damaging to the blood 20:46 vessels. The Institute of Medicine as said, 20:51 there is no safe upper level of normal for trans 20:58 fatty acids basically avoid those. 21:01 For saturated fats depending on your risk assessment, 21:06 if you are at high risk it may be that you have 21:09 to completely avoid them. If you are at low risk then 21:13 occasional use, you know maybe permitted without 21:16 detriment. Ideally again we want you to be 21:22 or want you to have a plant based diet, fruits, 21:28 vegetables, whole grains. So the things that we eat, 21:35 toxins that are ingested such as caffeinated 21:41 products can also affect the heart 21:45 and the nutrients. If your diet consists of chips, 21:50 soda, crispy cream donuts or that is a vegetarian diet 21:58 and I have to say it's also plant based, 22:01 but it's not gonna give you healthy coronary arteries. 22:05 So, we do have to look at the big picture. 22:08 We have to avoid things that are bad and include 22:11 things that are good, fruits, vegetables, 22:15 whole grains. Lean meats if you are going to eat meat 22:19 depending on your risk assessment. 22:24 So coronary artery disease is a marker not only 22:31 for conditions in the heart, but in other areas 22:34 of the body. You may suffer from cramping in 22:38 your legs when you walk that tells you that 22:43 the same process that maybe going on the heart 22:45 is going on in the legs. Erectile dysfunction in 22:51 males can also be a marker for coronary artery disease 22:56 and so if you suffer from this condition do not 22:59 simply get a medicine to mask the condition. 23:02 You need to have thorough cause your vastly workup 23:06 or else you will first manifestation of coronary 23:10 artery disease maybe sudden death and that 23:13 would be very unfortunate. So, we want to implement 23:20 if possible primary prevention and secondary 23:25 prevention. Secondary prevention means that 23:29 we want to try and find the disease when it is 23:32 asymptomatic, we want to get that coronary artery 23:35 disease before there is an event. 23:40 Primary prevention means we want to prevent 23:44 coronary artery disease occurring in the first place. 23:49 So you can see that the coronary equivalence 23:52 diabetes and chronic renal disease already tells us that 24:00 most likely coronary artery disease is present, 24:04 and so in individuals like that we have to be very 24:08 aggressive with diet, with exercise, tobacco smoking. 24:14 We will even look for markers in the blood 24:19 stream that you can check with them by getting 24:23 blood drawn looking for something called cardio 24:26 CRP or C-reactive protein. That tells us about the 24:30 inflammatory state of the blood stream. 24:35 So it's not enough just to know the levels of your 24:37 cholesterol, although they are important. 24:40 We need to also know how is your blood 24:44 stream behaving. Is it inflammatory? 24:47 Is it likely to stick? And large study have done 24:53 actually in women show that exercise, 24:57 regular exercise decrease the C-reactive protein 25:02 to safe levels and so in my patients as part of 25:08 myocardial risk profile, not only like a family history 25:13 and a personal social history about smoking, etc., 25:17 we will check a fasting lipid profile and the 25:21 blood glucose but also we will check their cardio 25:24 CRP as well as the cardiac homocysteine, 25:28 which is also a marker not only for coronary disease 25:31 but also for cerebral vascular disease, 25:34 so we want to look at a variety of markers 25:39 to assess the risk, once the risk is assessed that 25:44 will determine just how aggressive we will be. 25:48 If you are found to be in the high risk categories, 25:54 aspirin is recommended to be taken just the baby 25:57 aspirin more is not better, taken 2 and 3 regular 26:05 aspirins simply increase your risk for hemorrhagic 26:08 stroke and gastrointestinal bleeding. 26:12 A simple baby aspirin if you are at high risk would 26:16 be very useful for you. If you are at low risk, 26:20 there is no help at all. Again medicines only 26:26 complement the lifestyle factors. 26:28 Is the lifestyle factors that are the foundation 26:33 for the management of prevention and treatment 26:37 of coronary artery disease. The recent women health 26:41 initiative study addressed hormone replacement 26:44 therapy. It was thought that this was important 26:48 for women to prevent them having heart disease 26:50 and that is found to be a false 26:53 and in fact hormone replacement therapy 26:56 may in fact increase the risk for coronary artery 27:00 disease, so if you are taking hormone replacement 27:02 therapy to decrease your risk of coronary artery 27:04 disease that is not the reason to do that 27:08 and we will suggest that you go back to your physician 27:12 and have a discussion about the reasons for 27:15 using hormone replacement therapy. 27:19 And so what are the steps for prevention 27:23 and treatment of coronary artery disease, 27:26 you need to see your physician so that your risk 27:29 can be assessed using the global Framingham scale. 27:35 Once your assessment of your risk has been 27:39 done then we can implement lifestyle guidelines 27:44 to prevent an event occurring such as sudden 27:50 death or heart attack. And so we are truly fearfully 27:56 wonderfully made. The Lord has made our coronary 27:59 vessels so fine that there are simple things that 28:02 we can do to keep them clear. I wish you have all 28:07 the things that you will prosper and be in 28:08 health even as your soul prosperous. |
Revised 2014-12-17