 And joining us now to talk about your health is Dr. Abed Fakri of the University of Maryland, Baltimore Washington Medical Center. Dr. February is American Heart Month. Heart disease remaining the number one killer. But it is also a preventable disease. Is that right? Yes. Thanks for having me on today. It's a pleasure to reach out to the community this month to raise awareness of heart disease. The number one cause of preventable death in the United States. So you know, there's certainly a lot of room for improvement. And we've seen that highlighted more so even during the pandemic as we've seen the a disproportionate number of heart heart disease deaths throughout the United States. What else have you seen during the pandemic? I'm curious about either heart issues that may have resulted from somebody's infection with COVID or secondary to their respiratory issues, or maybe something involving the vaccine. Are you seeing a lot of any of that coming across your desk? We see a little bit of everything. Certainly during the pandemic related to COVID-19, we did see a fair number of heart rhythm issues and weakening of the heart muscle or congestive heart failure directly from the infection itself. So the first year of the pandemic, that was really the story was the direct impact of COVID, but also we saw a disproportionate number of patients who were coming in with delayed presentations of heart disease. Basically, patients who were not accessing the healthcare system early on for preventative care and presenting very late into the stages of their illness. So direct COVID related cardiovascular illness, but also cardiovascular illness that was independent of COVID. Both phenomenon were witnessed during the pandemic. When we talk about cardiovascular illness, is there a group of Americans that maybe gets overlooked in the conversation that could use more attention? I think it's appropriate to bring this up during February, which is we call it go red for heart, because not only is February home to Valentine's Day, but it brings to root that women are often overlooked when it comes to preventative care for heart disease and also in our delivery of healthcare for heart disease. Preventative care is accessed less by women and patients who are presenting to the hospital for cardiac illness, whether it's a heart attack or a stroke, often gets underdiagnosed or present late in their illness. We see this phenomenon disproportionately greater in women of color. We have a greater percentage of heart disease risk factors in women of color, where we see a higher rate of high blood pressure, physical inactivity and diabetes, all known to directly correlate with their risk for heart disease. Well, and the issues that are on the screen, somebody's weight, their blood pressure, their activity and whether they have diabetes, that's something we all need to pay attention to, right? Absolutely. What we've seen, especially over the last three years, is less engagement in the preventative care that leads to heart disease. We're seeing more people die at home from their heart disease, from heart attack, from stroke, from congestive heart failure. Patients have over the last three years, we've really seen a disengagement in cardiovascular prevention and cardiovascular treatment. Addressing these risk factors is, I think, the building block for good heart, for awareness and for good heart health. That first step of engaging with your primary care doctor to look at your risk factors, to understand your numbers, whether that's your blood pressure, your cholesterol, your blood sugars, all of that is an integral part of preventative health. We really want to reach out to the community to re-engage, not only as cardiologists, but as a medical community in general. Are there any specific screenings for heart disease that you advise when somebody hits a specific age or maybe they have some symptoms? What do you want people who either don't have heart disease or are unaware that they have heart disease? What do you want them to know? Well, first and foremost, when you hit the age of 18, I recommend having a lipid profile done as a part of your routine screening, minimum at every five years, and some patients will do it every year. Starting at 18. At the age of 18. Yeah, I think it's an older person's thing. No. Well, heart disease prevention starts at a young age. The sooner the better. Addressing those building blocks for heart disease, such as high cholesterol and high blood pressure is something you should engage with from the time you hit adulthood. Annual screenings for blood pressure and blood sugar are also part of that, preventative care. You mentioned some of the differences in heart disease with men and women. One thing we think about often is, when do you get help if you have some sort of symptoms? And I've heard that the symptoms can be different for men and women. Absolutely. We see a lot of women present late in their illness because they don't recognize the symptoms. Well, men may have typical symptoms such as heaviness or tightness in their chest. For a lot of women, the symptoms may be more vague. They may feel more tired than usual. They may have difficulty with exertion, shortness of breath, symptoms that may not clue them in that it's their heart. Oftentimes, people attribute it to getting older, being out of shape or being overweight, when it may in fact be their heart that's preventing them from doing the things that they want to do. So those classic symptoms of chest pain when it comes to a heart attack may not be there for a lot of women and also for diabetics. That's many of our diabetic patients actually don't present with typical symptoms of chest pain. It's easy to understand how smoking results in lung cancer. How is it that it increases somebody's risk of heart disease? So smoking increases levels of inflammation within the blood stream. And if you have plaque that's been building up that is vulnerable to causing a heart attack or a stroke, smoking may make that plaque become more inflamed and potentially rupture. That's the basic root cause of a heart attack is the rupture inside a coronary artery that closes off the blood supply. So smoking is like putting fuel on the fire. How about salt, sodium? How big a role does that play? Salt is salt draws water with it and where water goes the blood pressure of the blood volume expands. Expansion of blood volume puts more pressure on the heart leading to congestive heart failure. Salt also for those who may have a normal heart may have normal heart function. Salt promotes higher blood pressure. The higher blood pressure over time leads to increasing inefficiency within the heart muscle and thickening of the heart muscle. A bigger thicker heart is less efficient and more vulnerable to heart damage. Everybody advises getting more exercise from a cardiology standpoint. What sort of exercise and how much? The American Heart Association recommends 150 minutes of moderate intensity aerobic exercise per week. That can be divided up into half hour blocks, five days a week. So basically they're telling you to take a half hour walk, five days per week. Saturday, Sunday you get to take a break. The level of physical activity should be enough that you get mildly short of breath and a little bit sweaty, but enough that you can sustain it over a 30 minute period. What's happening with medications in the cardiology field? I'm thinking about statins as a well-known treatment for cholesterol. Well, the interesting thing about statins is we're recognizing cholesterol numbers in and of themselves may not tell us who benefits from treatment. What we're taking now is a risk-based approach to patient. In other words, if you have identified as a patient who is at risk for heart disease based on, for example, we use a 10-year atherosclerotic risk calculator in our office, if you have a high 10-year risk of heart disease, even though your cholesterol numbers may be modest, you may still benefit from preventative treatment. So we take a risk-based approach to patients' blood pressure and cholesterol management. Those patients at higher risk, for example, are diabetics or patients who may have a strong family history and other risk factors such as smoking. Those are the patients that benefit even more from taking preventative therapies. How much of a general cardiology practice involves things like cholesterol and clogged arteries as opposed to other issues with heart rhythm, congenital defects, things like that? That's a great question. So I think that basic preventative care starts with your primary care physician. They're kind of the quarterback for your healthcare. By the time you get to us, we hope that it's not too late. That's really not where you want to be starting the preventative care. A lot of times, the patients that are coming to us often are manifesting symptoms of disease and are requiring further work on. So I think the basic primary preventative care starts in your own backyard with your primary care physician. You know, the last thing I want to ask you may sound like it's out of left field, but we have this incredible technology coming along with, I just read something about the Apple Watch may eventually be able to check somebody's blood sugar or glucose. But it can also apparently do heart rhythms and, you know, pulse and all that. How often are you telling somebody to get something like that? Some sort of monitoring device? I think that's a great question. So there's two types of point of care technology that is accessible to patients. One is heart rate monitors, and the other is pedometers. Pedometers have been around a lot longer than heart rate monitors, and you probably have heard of Fitbit. So heart rate trackers are actually a very good indicator, and I actually screen a lot of my patients who are using heart rate tracker or who are using pedometers on their activity level when they come to see me in the office. As I alluded to earlier, a decrease in exercise tolerance can sometimes be the first sign that somebody's not doing well. So I actually pay attention to my patient's step counts. When it comes to the heart rate monitors, for our patients who have heart rhythm disorders or may experience symptoms of palpitations, I think that the wearable technology with the iWatch for heart rate tracking can be helpful. The important thing is to share that data with your doctor, not try to self-interpret, because there may be nuances in diagnosing heart rhythm conditions where your doctor needs to be involved. Dr. Abed Fakri practices cardiology out of the University of Maryland, Baltimore, Washington Medical Center. Doctor, thank you very much. You're welcome. It's been my pleasure. Your health segments are a co-production of Maryland Public Television and the University of Maryland Medical System.