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Great to be on with you all today! Looking forward to a great discussion about a very important topic.
Excited to be with you all! I'm looking forward to a great discussion!
Let’s start with some questions from readers.
Great question! The best way to lower mildly elevated triglycerides is to focus on low fat, high fruit and vegetable dieting and increasing the amount of cardio (aerobic exercise) you throughout your week. A diet with ample omega 3 fats is an important part of a triglyceride lowering diet. We get our omega 3 fats mostly from fish (salmon, tuna, mackerel, etc). But not all fish have a high amount of omega 3 fats. In people with very high triglycerides, you should see a physician to guide management.
Hi Rick! Another great question. Exercise has several benefits, including cardiovascular fitness and calorie balance. If you are walking 15000 steps a day you are doing a great job on the calorie balance part. However, if you are not getting your heart rate to move much with that activity, chances are high that you are not building up much cardiovascular fitness. So adding that extra half hour of more strenuous activity would be a good idea.
Here’s what we know about krill oil supplements: They are a rich source of omega 3 fatty acids which have been shown to 1) improve your cholesterol by reducing triglycerides and LDL (so-called bad cholesterol) and total cholesterol 2) decrease inflammation throughout the body and 3) decrease blood clotting which are all known to improve your cardiovascular health over the long term. In fact, krill oil supplements likely affect your cholesterol in more ways than other fish oils.
That’s a really good question. All stress tests are indirect evaluations of your heart arteries. They are able to detect whether significant blockages are present, but not if minor/mild coronary artery disease is present. So even if your stress test is normal (which is a good thing obviously) it does not mean you should ignore any risk factors you may have. Stress echocardiograms (or any stress tests for that matter) do not look at veins in the legs.
Kudos to you! If we could get more people exercising, event to the extent that you are, we would be a healthier nation. The recommendation for optimal cardiovascular fitness is 20-30 minutes of moderate intensity cardio (aerobic exercise) 5 days a week (100-150 mins total per week). So, it really matters just how intense your workouts are. You’re probably doing moderate intensity if given how you’re feeling after you workout. Ask your doctor if you should do less strength exercise and more cardio.
This is a very timely question. The US Preventive Services Task Force just put forth draft recommendations that Americans between the ages of 50 and 69 years old consider taking daily low dose aspirin (81 mg, “baby” dose) to prevent heart disease and colon cancer. So this may be a good preventive step for you. However, even though aspirin is sold over the counter and even though only a low dose is recommended, no medication is without side effects. So before you embark on daily use, review the balance of risk/benefit with your personal physician. And remember – taking a medication as a preventative measure is only a small part of prevention efforts. No drug or supplement has been shown to be as powerful as lifestyle change (and especially dietary change) in reducing risk of heart disease and cancer.
This is a great question! While we haven’t quite figured out how to completely unblock arteries that have cholesterol blockage that has built up over time, we know that the best way to keep blockage stable is with a heart healthy diet and regular aerobic exercise. But all of these things MUST be discussed with your cardiologist to help you understand the severity of your blockage and whether exercise is safe for you.
Hi Sylvia! High cholesterol is one of the major recognized risk factors for heart disease. The significance of elevated cholesterol depends on which values are elevated – because there is good cholesterol (HDL), bad cholesterol (LDL) and triglycerides. So if HDL is high but LDL is low, that’s a much different scenario than if your LDL is high and HDL is low. In general, we like to see most people’s LDL cholesterol below 130 and HDL above 50 in women. There are risk calculators which your doctor can use to determine if your cholesterol elevation should be considered for treatment with medications. Please remember that what you eat can have tremendous impacts on your numbers so never forget to discuss what you could be doing to help improve your cholesterol values.
Believe it or not, brisk walking is a fantastic way to get back into exercise. But don’t just stroll along ☺ Really do a brisk walk. You’ll notice that your blood pressure, cholesterol and weight will all improve by doing this 5 days a week.
Hi Martha! The presence of coronary calcium does indicate that you have some underlying atherosclerosis, so you are correct that you want to be maximally preventative going forward. Attending to all your “numbers” is important – you want to keep your blood sugar normal (fasting below 100), your blood pressure normal (well below 140/90 and ideally probably closer to 120/80), and your cholesterol numbers really low (LDL (bad cholesterol) well below 100 and ideally below 70). Eating a whole food plant based diet is another thing that you can do to really help yourself. There is lots of data that a plant rich diet is helpful in preventing heart disease and even some studies showing reversal of heart disease with this type of eating plan.
A murmur is simply the sound that blood makes when it passes certain parts of your heart. Many murmurs are ‘innocent’, meaning that they are not due to significant abnormalities. This is usually the case in young healthy women and is a frequent finding in pregnant women. In other words, not all murmurs are necessarily bad and getting the echo is the best way to decide which is which for you. Good luck!
Hi Jo! Home blood pressure monitoring is really useful and I use it frequently with my patients. In general, since you live at home and not in the doctor’s office, home readings can be much more useful in determining whether you need to be on blood pressure medications, and how much. The one caveat is that you have to make sure that your home monitor is accurate. So if you have never brought in your monitor to be checked against office readings, you should do that. After all, if we are going to be using your home data to make treatment decisions, we have to make sure the data is valid.
Thanks for asking this question Jagdish,
There are many benefits to having more omega 3 fats, including the antioxidant and anti-inflammatory effects. We believe that one of the biggest benefit from eating 2-3 servings of fatty fish a week is its ability to lower your tendency to clot and to positively affect your cholesterol—whether you have heart disease or not. For those who don’t consume this amount of fish, for whatever reason, a supplement is a great way to get the omega 3s!
Hi Wendy! The significance of an “enlarged heart” depends upon how the diagnosis was made. Sometimes a heart looks large on a chest x-ray because of how the image was captured, rather than actually indicating a problem. There are multiple causes of an enlarged heart, too many to explain in this type of forum. If the cause for your enlargement is not known at this point, further testing will likely be required. Often, the first test that is obtained when an enlarged heart is suspected is an echocardiogram (heart ultrasound). This test gives a lot of information about heart function and structure and, actually, often rules out that any enlargement is actually present.
Hey Jonathan Walker White,
People can ‘out-grow’ supraventricular tachycardias (SVTs); however, if you’re still feeling palpitations or other symptoms, please see a cardiologist to help you understand which SVT (of which there are many) and what to do about it.
Hi GW! Let me actually answer this a little backwards. One of the major drivers of blood pressure is sodium, so limiting the amount of sodium in your diet is a great way to keep your blood pressure down. Those with high blood pressure should be consuming under 1500 mg of sodium per day. That’s actually hard to do. Sodium is found in processed and pre-prepared foods, so avoiding these whenever possible makes sense. If that is not easy or practical, one strategy you can use is to purposefully add in foods that are naturally low in sodium – fresh fruits and vegetables. So if you start every meal with a piece of fruit or salad (go easy on the dressing since that’s higher in sodium), you will likely eat less of the higher sodium foods.
This is so important!
Bad teeth can definitely affect your heart! I recently took care of a previously healthy 42 yo women with 2 kids that allowed a tooth abscess go untreated. She developed a heart valve infection, went into severe heart failure and was on life support for 3 weeks. She is better now, but needless to say, her life will never be the same.
Take good care of your teeth by seeing a dentist twice a year and taking meticulous care of your teeth with brushing and flossing.
Hi Barb! Statins have a clear role in prevention of heart disease and most physicians agree that individuals with known heart disease, those with diabetes and those with very high LDL (bad) cholesterol readings (over 190) should be on a statin. However, there are ways you can try to lower LDL without medications if you are not in one of those groups. Fiber and plant sterols (also known as phytosterols, a supplement) can be especially helpful. A high fiber diet and taking in 800 to 1000 mg of plant sterols twice a day with food can lower LDL cholesterol by 15%. Omega 3 fatty acids can help improve the balance of cholesterol numbers (increasing HDL (good) cholesterol, while lowering LDL). Great dietary sources of omega 3 fatty acids include flax, chia seeds, walnuts and almonds.
Many people feel your pain.
Low acting thyroid (hypothyroidism) can cause your heart rate and pumping function to be abnormally low. It can lead to changes in your electrolytes and cholesterol, as well as affect almost every other part of your body, so it definitely should be treated adequately. Talk to your Endocrinologist ASAP.
By the way, hypothyroidism makes losing weight extremely hard. But it can be done! You will need to have your thyroid function treated and you may have work a lot harder than those with normal thyroids to lose weight.
Atrial fibrillation (AFib) is a significant health condition, not so much because of its heart effects but rather because it increases risk of stroke – even if the AFib occurs intermittently. Many patients who have AFib end up being on blood thinners to reduce their risk of stroke. Factors that raise the likelihood of suffering a stroke due to AFib include history of high blood pressure, diabetes, heart failure, age over 65, prior history of stroke or mini stroke, or presence of underlying heart disease. If you have not discussed whether or not you should be on a blood thinner with your doctor, please make sure you have this conversation.
CoQ10 is a naturally occurring antioxidant, which we carry in our bodies, particularly in our heart and skeletal muscles. As a Preventive Cardiologist, I mainly prescribed it in people who take medicines that can deplete CoQ10. We don’t have a large enough study on CoQ10 in otherwise healthy people but there does not seem to be high levels of side effects. Talk about using it with your doctor.
Hi Dawn! I often see patients with a family history of heart disease in my clinic. The way I like to explain the effect of family history it to talk about the story of the Three Little Pigs. Genetics is like a blueprint, but what you do with the blueprint can result in very different outcomes. All 3 of the Little Pigs had the same blueprint instruction: Build a house. But each used very different materials – with very different results. So my best advice is, no matter what plans you were given, build with bricks not with straw! We have a lot of control over our health destinies. Genetics does not mean doom.
Brugada syndrome is a genetically inherited heart condition that can increase the risk of serious heart rhythm disorders, and exercise can bring on some of those rhythm issues. In general, patients with Brugada syndrome should avoid vigorous exercise. For more detailed advice, you should discuss your particular situation with your cardiologist or electrophysiologist (heart rhythm specialist).
Not everybody does well with medications. However, there are some scenarios where we know medications can prevent significant trouble or even help save your life. Your LDL (so-called bad cholesterol) level of 244 is extremely high and is a major risk factor for heart attacks and strokes, as you already know. Ask your cardiologist about a stress test if you’ve not had one recently. Also, there are new therapies available to people with your level of LDL. Discuss the so-called PCSK-9 drugs with your cardiologist. These work very differently from statins.
Hi Richard! Great question. When I see patients with elevated triglyceride levels I always look for underlying factors that may cause this. Low thyroid function is one of those factors, and low thyroid function is typically signaled by a high TSH blood level. Diabetes/poor blood sugar control is another common factor. In most individuals a significant driver of high triglycerides is too many processed carbohydrates in the diet (think white foods like white bread, pasta, whjte rice, cakes, cookies, etc.) as well as sugar (soda, juices, alcohol, etc.). Losing weight can also impact triglyceride levels substantially.