 So welcome back. We have spent the last hour learning about what the research evidence of community practice says about cardiovascular aging. And now, this part of the program is hearing from you. Before we get into the question answers and discussion here, I already have a question from Twitter. How important is genetic predisposition in developing heart disease? I'll direct that question to Sonny. Grave in her mouth. Should I just answer? So that was just a question I was asked at the break as well. So it's not a simple answer. As most of you know, there is not one gene that is associated with heart disease. There are now realizing that heart disease, the polygenetic, has a polygenetic basis. So you may have some genes that are associated with your cholesterol, other genes associated with your lipids, etc. So definitely genes are associated with cardiovascular risk factors. Up until now, the studies have shown that the percentage of the risk factor explained by genetics is actually quite low. So it's about, you know, maximum 10% for lipids. It's definitely not 90%. Now, if I had some pure geneticists sitting here, they'd say, but we haven't sequenced everyone's genome, so it's too early to say that. But at least we've done some very good genome-wide genotyping studies. And I'd say at this point in time, 10% of coronary artery disease would be explainable by genetics. So I'm going to open up the questions to the floor. Please feel free to ask your question. There are people standing around the room with mics in their hand. Any questions from the crowd? There's a question up front here. This address to, I've forgotten your name, the Y person. Genevieve. You may have addressed that, but I might have missed it. I considered taking some of these programs that you cited earlier, out into the community or the rural communities. In other words, to churches or community centers where the cost would be less and it would be a requirement to be long-kilow-wide, which for a rural person is usually quite far away out of the question. Yeah, I think for sure we're trying to look at how to challenge the rural communities. For us, well, the challenge always is to deliver programs externally to have, we don't necessarily have the equipment, and then program delivery actually becomes much more expensive taking everything out. While we are testing, I'll give you an example of something we're testing right now. We've got a program that's funded through U.S. fields called Wyand Wheels. And what we're finding is that there's a community in need or a need that they, whether it's for kids programs or seniors programs or adult programs, they can go through Wyand Wheels and request a program to be delivered. So for example, we've done it in some local communities around here to test some things. We've done some walking programs, done some zoom programs and brought them out straight out to the community. So the staff and equipment goes. We're trying to test that model a little bit. We're trying to get a better understanding right now. We've got the facilities there that's trying to bring things on site. We've got the expertise of the health professionals coming in and all the equipment to get that underway. But for sure it's been identified. We want to do some things to support that model. Find out about it in this program. What you could do is if you go on to the Wyand Save Hamilton Burlington-Brandford website and look up the Wyand Wheels program, you can submit a request there. So it's something local in your community that would be a great way to test it. And the staff will train that team to come out and actually deliver that program to your community. Genevieve, the people who don't have access to the web or don't use web is there another way to find that information? Twitter. You can see me before you go and I'm happy to share a phone number. Can they phone someone? They want to know why I'm saying this to get information. Sure. They want one of the local YMCA's. I'm happy to give you, before we get you tonight, a direct effort for the Wyand Wheels program. Thank you. Any other questions from the... There's a question back there. Hi, my name is Mae. I'm asking, I think perhaps Sonja. We've talked about genetic disposition and so on. I'm wondering about people who have been in early life, some sort of, I guess, social thing or something that led to them being poorly nourished in early life. And I'm thinking that a lot of people who went through the Second World War, I believe there have been some studies of people from Holland or from count survivors. I'm also thinking that people came out of the uterus sometimes malnourished. And what effect does that have in their later life in cardiac and other events? That's a great question. And you've touched on a really important association. So babies who are born low birth weight, small for their gestational age, have a higher risk of developing what we call the metabolic syndrome. Which is abdominal obesity, type 2 diabetes, sometimes hypertension and cardiovascular disease. So the first observation came from the United Kingdom by David Barker, who demonstrated this association. And then researchers looked around the world at other populations where pregnant mums experienced hardship during pregnancy. In particular, femme and so in the World Wars, there was a Danish famine and pregnant mums who were exposed to famine, their offspring have a very high risk of type 2 diabetes and cardiovascular disease. So we're actually a number of groups around the world who are examining this. And in particular, within Canada and the South Asian populations, people originating from India, the babies are born low birth weight and relatively more adipose. And we're trying to understand why that is because it's likely that in-utero exposure programs the baby to be high risk as an adult. So it really brings home the point that prevention may actually begin in pregnancy. And there's also some evidence related to that. It is not the mother's health, but the grandmother's health actually can also impact what happens to the child and how the child ages. Other questions? I just wondered how much regular exercise compensates for having a very sedentary desk job. Could you repeat that question? A very sedentary desk job, so nine plus hours a day you're sitting. So regular exercise, I do that, but does that compensate for having a job when you sit? I'll just weigh in, but that's your business too. The attestation is an important point as well, because just last year was a study demonstrating that even though you're sedentary during the day and then go to the gym at the end of the day and work out on the treadmill, that doesn't compensate for the impact of sedentaryness. So exercise can compensate fully for your being sedentary during the day. So there are lots of changes happening in the workplace. Some people, at least in the Netherlands now, they're using the standing desks or the treadmill desks. And certainly we recommend if you do have a desk job to get up at least once an hour, go for a five-minute walk around your office and sit back down. That's the best I don't know if you want to add to that. But sedentary itself is a risk factor, even when you account for exercise done later. The only thing I might add in relation to that is, and you can correct me if I misunderstood this, but I also understand that there is the greatest relative health benefit of exercise from people who go from being sedentary to beginning to exercise and having modern exercise. So even a moderate change can have a lot of impact despite the overall issues that Sonya talked about. There's our Fitbits, those things. And we typically say try and get 10,000 steps in a day. And if you wear it and you get home at the end of the day after sedentary job, you may only log 2,000 steps. So that's a real motivator to get out. I just do laps in my kitchen until I get 10,000. Thank you. There's another question. Terri, you're all formed. It has to do with early family mental health. So in some ways it's akin to the epidemiological question that we've asked about, or nurtured deprivation. We're in the 21st century, and there's so many adults still smoking. And I ask myself, don't they get it? The message is there. It's on every cigarette package. And I'm wondering to what extent do they know about or have they thought about linkages between early family mental health, either dysfunction or abuse that would let people to be not wanting to take care of themselves very well. Because smoking in the 21st century is obviously a sign of, it's a cause of suicide, energy. It's not about smoking, I'm asking. Just that's the thing that triggered my thinking. It's a very good question. And again, I see people towards the end of life sometimes looking back. We try to spend several hours with these folks. We've been trying to understand all the different issues that contribute to their current health and current health problems. And when you go back to their life story, that may certainly have something to do with it. Obviously there are family histories of mental health issues. So if there's family history of mental health, this person is more likely to have depression or anxiety or even behaviors that are addictive and intense. Really what happens towards the end of life is something called frailty, which is this vulnerability that some people get from earlier than others. One of the ways that people get there if you kind of think the issue of an RSP, we tell you the money and the thing to save it for when you retire to have enough to last year's retirement, you can say the same thing about health. And that's where this diabetes epidemic is quite frightening in children. There's a lot of activity in all of that. In a sense, if you were set behind in terms of your development, in terms of your opportunities, in terms of your self-esteem, in terms of opportunities, support from your parents, if that isn't there, then you don't realize the full potential of what you could have achieved. In a sense, you don't put enough in the bank. And so when you get older, you tend to have problems for the year. So yes, there's the genetic aspect of if someone in my family had mental health issues, I'm more likely to have them myself, which, again, can lead to poor health. Those less tangible things are probably very important as well. There's a question at the back. Why do you have a question? Is it Q10? Does it really help when you retire to the last year? Yes. So whenever people who are on staff take coins on Q10 to counteract the effect of the statin on the muscle metabolism to prevent or treat the muscle cramps that they might feel, there's not strong, large-scale evidence. There is smaller-scale mechanistic evidence, so 100 subjects, et cetera. So I don't say, no, don't try it. Patients on statins have that. I can't guarantee benefit. I will raise your attention to a meta-analysis, so a study of studies that came up probably last month just showing that all the vitamin supplements that people think are beneficial for their health, so vitamin C, vitamin E, even a multivitamin, that we have zero evidence that it improves health, and we have some evidence that it causes harm in the cases of vitamin E and beta-carotene. I always find it challenging trying to promote a statin medication where there's a large body of evidence being minded. It's hard to kind of convince people to take it, yet they have five or six other kind of multivitamins that they pay for it in the pocket, and they think that's better. So it's difficult. So short answer is it's worth a try, but there's not large-scale evidence to suggest that. In terms of the best the best vitamins come with food, really. That's why people who live in Crete and part of Japan do so well. They eat fresh food, they eat a varied diet, and they make their own food. So you can get more than enough vitamins in a broad array of food which do a very heavy focus on fruits and vegetables, avoiding red meats. And you'll enjoy it a lot better, too. It's really like pills. I'd rather have a nice fresh salad that will taste better. But I'm a big facetious. I think that's one of the things that we're not teaching our kids of cooking at home. And as part of this whole lifestyle issue of having a meal at home to prepare yourself, there's the enjoyment of the food but essentially the social connections that you've got with your family sitting down, relaxing after the day, don't begin. You can't achieve that with tablets and pills. There's many more benefits than real fresh food made at home than taking pills. You've heard it tonight a few times about these blue zones. We were talking about this diet, exercise, social support system. One of the other common features with all these six blue zones around the world, one of them is in Canada so that they're all stubborn people. So being stubborn is a good thing. There's a question at the back. I'm going to cry there, I want to know if in our late fifties isn't too late to change the trajectory of where this is going and if you have I have way too many of them. So what can you do to try to get rid of some of these very scary kinds of things? I know this whole thing is an easy one I think, but not so easy to make to whose weight. So what kinds of advice should you give for people who are in their late fifties who want to be on the other side of the line? I think I would just say to that start where you're comfortable with diet whether it's exercise small changes can't have an impact and they will accumulate over time and I don't think it's ever too late for someone to make change so probably the best advice is to start small and move from there and develop habits if you develop healthy habits now that you can continue over time then over time they will have a cumulative net benefit for you. No, I just, again I'll share maybe a little story but I think it's never too late we have that mindset of being never too late things can just get worse and if it means that we can maintain we had a woman that came into our program and had a lot of the significant health action she came to which she started with these whole significant bunch of things going on over the course of a year and a half lost 100 pounds is now certified fitness leader leading instructors not in her scooter anymore came off all of her diabetes medication and that's a lofty goal I think when she came in her goal was not going to lose 110 pounds it was I'm going to make a healthy choice every day so today it's about getting up and walking for 10 minutes and maybe tomorrow it'll be 15 to 20 minutes she looked at it with every meal so I'm going to eat a little bit healthier today so those small changes were extremely cumulative and it became something she could maintain was also able to when we celebrated her success and where she had gone one of her personal goals was she'd never been able to ride a bike with her kids and in terms of there's the medical conditions and all those things go with it social things that go in so when she achieved that weight loss we actually celebrated that and began the family bikes and she was able to go on her first bike ride with her two kids there's not a pressure to pay on that so although the physical health if she said it was never too late she would have not hit the physical benefit she had but also just achieved a dream that was really right there she's had to make some good choices every day you already learned a story from George talking about this from Tornado he actually his wife passed away at age 83 and he went into depression for 4 years after that he decided he was going to do something about it and he had never ran any race marathon or anything like that prior to that and here he was at age 100 running a full marathon in 8 hours so I don't think it is ever late to start so start today I'd just also add that if you're late 50's and you actually have measurable risk factors they are in pretty vast for the most part treatable so you know we can lower cholesterol we can treat blood pressure we can treat diabetes so that's great because in the area of cancer the understanding of the causes and the treatments aren't as well developed but the combination of treating risk factors with proven medications and changing your lifestyle becoming more active and getting better can do a lot in terms of preventing eventual cardiovascular disease we occasionally attend to a natural path and I mean this young lady is trained in her field very sincere very well read as far as we can tell anyway are there any natural remedies out there that could be beneficial that you might be aware of I know pill form or calcium form and that but are there any out there that would be helpful for once we start on that one well I will start just thinking cardiovascular disease not all illnesses depression so we just think cardiovascular there aren't any that I can think of that have been well proven so we practice what we call evidence based medicine so we look to see has a large enough study being done with an experimental design so a flip of the coin half get the drop half don't if the study is being really well done and we think it's a valid study then we typically believe it we often don't believe it after one trial we need a few trials to really believe it so things like omega 3 and 6 fatty acids that lots of people were taking as fish oil recently large trials have demonstrated that they don't reduce cardiovascular disease so sometimes we say absence of proof is not proof of absence however if we on the other hand have proof that a lot of conventional medications work what sometimes baffles me is why patients are so reluctant to go on the prescription medications and stay on the long term yet they'll pay out of pocket to use treatments that are not as well evidence based medicine because it was it was a thousand years ago according to past projections but then it was tested in good trials and we believe it so there may be some of these things that actually have benefit but we wait for the large randomized trials before we I think the point here is that if evidence becomes available if something works it doesn't work there is no hesitation from the medical community to prescribe if there is a good evidence but if there is not a good evidence then it's a questionable practice of medicine and I think that's what Sonya was trying to get at George do you have anything to add or I think the key is evidence and it's interesting because heart disease we have to use drugs as inhibitors they're wildly effective medications and the original acid barrier was diluted by preventant and Coumadin rat poison was actually from spoiled hay but again Sonya said the difference is somebody actually sat down and studied it and made sure that it was effective and then replicated the trial I think one of the key things that needs to happen I'm sure there are things that are prescribed by an antropaths that work but there needs to be and it's somehow there needs to be more rigor in the way that these things are studied because again you are bringing out a pocket for it and if you pay for something that doesn't work that's a harm I remember seeing one patient who was taking something called Belladonna alkaloids for her bowels and some of you might know that Belladonna alkaloids have these properties that are so called energy and acetylcholine is the key brain chemical that allows your brain to function and she was mad at that literally and she was going to a nursing home and we stopped all these things and we've heard of the nursing home permission again not all naturopathic medicines are like that but you want to know the pros and cons of the drug and the only way to do that is to evaluate them previously so again it's no I the naturopaths are great people and they do provide really good advice the issue is if I'm going to prescribe something to make you pay for it at least there should be some data to support it there are questions back and then one in front here oh there's one back there my question is regarding diet specifically fats in diet I'd like to know what the latest is on the types of fats and the quantity of fats you should have I know for years it was thou shalt not have any cholesterol and eggs that have a lot of cholesterol so we worked about doing eggs for a long time is that still the case and what kind of fats basically should we have in our... weeks ago called demystifying medicine and it was all about eggs as the example that it's really confusing if you think back to all the covers of time magazine one day eggs are bad the next week they're good it's confusing I think 20 years ago the American Heart Association was really kind of anti-fat and promoted low fat diets and so what happened is people reduced all fats and then replaced those calories with high sugary or high glycemic carbohydrates and so when people looked at what happened to the lipid profile of Americans or North Americans they were not improved so now we realize that there are some good fats and typically we don't say across the board reduce all fats but we do typically say reduce animal fats or saturated fats and certainly trans fatty acids but we promote unsaturated fats or malano unsaturated fats call it unsaturated fats so will you promote eggs now? oh so eggs as a postdoctoral fellow and I reviewed the evidence about four years ago and we found there was low quality evidence supporting an association between eggs and cardiovascular disease however there is a prominent cardiologist at University of Western Ontario who is very much against egg yolk and I think that contributes to some of the confusion but what we observe when we plot out all the studies that are funded studies side with you know eggs aren't bad for you and the other extreme people say they are we don't have enough data to know but there is not strong evidence that they are bad for you what about bacon? bad in addition to the question I had back there what percentage of our diet should then be fat? it depends again on who you ask but I think and you can tell me what heart stroke promotes we have less than 30% of your calories consumed by fat do you say anything? I say less than 10% saturated fat but less than 30% level yeah I don't think we describe it in those terms we recommend that people follow the Canada food guide as the guide to all the diet it's more about having a balance and with an emphasis on food and vegetables so let's go with less than 30% right? there was a question back there then one question up here and another one here recently there have been some studies emerging I was wondering if you're aware of studies connecting statins so statins for cardiovascular but on the other side, lower cholesterol is associated with increased risk of Parkinson's and Alzheimer's and that seems to be more different so I don't think you have any comment on that George you wanted to I think the cholesterol story needs to be interpreted in terms of the overall fitness of the individual and also the kind of study that was conducted so there are studies that are out there that suggest that having low cholesterol is associated with bad outcomes but these studies are often done with people who have already pre-existing disease maybe they are in the process of developing Alzheimer's disease or they are malnourished or there is some sort of malignancy or they are already sick in which case low cholesterol is just a marker that you are sick and so that's going to be very important and a lot of these studies are done where they basically do what is called a cross sectional study so if you were to do a cross sectional study today I would go and measure all your cholesterol and look at your health and I might find that those with low cholesterol have poor health the kind of study that the CLSA is, they are starting with people at a certain point and they are going to measure all sorts of things and measure them through time and so that's a stronger study design because you know what the risks or what the exposures or what their characteristics were and then you measure something more firm as you know later on so the thing about Alzheimer's disease and cholesterol there is a lot of science that is based on non or quasi experiments and some will suggest that actually going on statins prevents Alzheimer's disease some of them say that having high cholesterol leads to Alzheimer's disease the bottom line is we are not sure if you do have Alzheimer's disease there have been a number of randomized controlled trials again that will flip with the coin one with describing a statin from cholesterol lowering does nothing to alter the course of Alzheimer's disease but one of the problems with the studies is that death usually happens quicker than the developmental dementia so when someone does a large clinical trial they start to measure outcomes like death and heart attack the study gets stopped because obviously you don't want to wait until everyone has died and so the dementia never fully develops so we are not really sure whether starting with cholesterol will in a younger age prevent dementia if you have it cholesterol lowering agents still affect it either way dementia is a very key one and I think what we do know is that blood pressure control may certainly prevent dementia but more importantly getting back to the exercise there is a lot of good evidence now that when you exercise you are actually getting more blood flow into your brain your cognition actually improves so it is not just an exercise or delay of the red dementia we should move on to the question is there any information or evidence around meditation and its effect on cardiovascular disease there is it seems to do positive things from the perspective of lower blood pressure lower the epinephrine stimulation of your heart so you have a lower heart rate and there has been some nice studies sent by a cardiologist named Dean Ornish he may have seen some of his work so he had this healthy lifestyle intervention that combined diet with also exercise and yoga meditation and his initial study his healthy lifestyle intervention was able to help a bypass graft surgery in individuals with significant coronary disease that is one example and I think from the studies I have read there is an increasing evidence that meditation is certainly effective in lowering one's stress response to stressful situations and we do know stress is associated with cardiovascular events so emotional stress in the 24 hours before a heart attack is clearly correlated with the heart attack there was a question here and then there is another question here 8.5 years ago 9 years ago now I became the primary caregiver for both of my folks they were poaching when they were over 85 they had health care issues at that time my mom developed cancer my dad had a serious heart attack so anyway my mom is now 96 she will be 97 pretty soon and the thing that I came to understand with both my mom and dad is that as they naturally they became something happened and they started to naturally lose interest in life and I actually thought that was a very healthy development and we are really not designed to last forever and I think sometimes in your mid 40s and 50s and anyone younger they are not going to be able to appreciate that but what I have found is that maybe you like to comment on this and maybe you are not ready to but at what age do you think it is okay my mother is now she broke her hip in May and she had a hip replacement and I have to hear every day how she doesn't want to be here anymore and that's despite being on the antidepressants so I think that there is something sort of screwy here somewhere both my parents have had really quite a wonderful life they were born into the first world war and they went into depression were actively involved in the second world war had six kids and they really had enough of life and they have heard it all and been there and done that and I think there should be some consideration given to telling very elderly people that if they feel ready to die that that is probably okay and can't we help them do that too so yes I am very interested in being health and fitness for myself because I think it makes me more useful to people it certainly brings pleasure to me but I think that we should look at the other way sure there is the odd person who is 100 and out there learning a marathon but for most of the people that I am involved with and senior residences is just living they are already so why can't we talk about that too keep this answer short maybe we will let more men in another scientific cafe like that on that topic sometime in the near future because it's a big topic and just to add to your right we give examples of successful ages but there are people who struggle with and I think that's the 22-25% of the population we were talking about that we have to figure out one type of care to provide them to the best fashion it's a tough call because I remember having his resident here we had a patient who was 92 years old and she fell and broke on her shoulder her wrist, her hip, her ankle and she said we got into a lot of trouble by prescribing an antidepressant but after a couple of weeks she was changing her attitude now it's hard to comment on individual cases but there are issues that antidepressants don't work in a long-term care environment and it's it's easy to sort of fall into this notion that perhaps they're correct but until we have a system of that can be really good at managing symptoms and depression and pain and change the environment it's a tough one to say yeah let's go ahead and do that they tried that in Belgium they had one guy with dementia he said if I get Alzheimer's put me down he got Alzheimer's and he's happy and things change it's very, very, very difficult to answer but it's still an important topic as a society, as a community we have to have a discussion we have one last question so we'll take the last question here it looks like we can make another hour but we'll do this time if you've already been diagnosed with the buildup of plaque and your artery can it be reduced or merely maintained so that it won't get any worse so both and it can be reduced so surgery so what we typically do is we see if you've had any symptoms of stroke and we also look at the percent of the blockage that you have and again using some of these randomized trials that directs us to recommending either going to have your artery cleaned out in surgery versus being treated with medications so it can't be reduced in medication so the use of the cholesterol lowering drugs and other things etc. don't reduce the degree of stenosis sometimes they stabilize the plaque but it doesn't reduce well thank you very much for sparking such a wonderful discussion our evening has now come to a close I'd like to thank our experts here Sonia Anand Vincent Boma George Hecklin Genevieve Latish for being here and we have a small token of our appreciation for each one of them I don't get one and actually we should be giving this type of back to everyone who came here that's a good idea I would also like to thank all the staff and volunteers who helped out with the event they're all sitting walking around these people I've done a lot of work before you may please take a moment and complete the short survey which was on your chair because it's very much appreciated because it allows us to organize events like this in the future and you can drop off the information you can drop off the survey of the information table as you accept and I'd also like to mention two events that will be hosted by the MacArthur University in the large optimal aging initiative this spring on April 2nd at 7pm award-winning journalist Steve Bacon will host a public talk on aging in the workplace will extend aging in the workplace called will extend it and second careers become the normal and the following night on April 3rd there will be a second presentation called do celebrities do more good than harm with their medical advice and the evening begins at 7pm it will be hosted by Julia Williams who is a writer from the Glade magazine both events will take place here at the Western Innovation Park if you'd like more information about these upcoming events please pick up a flyer which is at the information table at the back and also sign up if you're interested in our world's committee on aging in the adult aging again thank you very much for coming thank you again to our speakers and everyone