Is fat always bad for you? Can you be at risk for early heart disease because of your parents? What are good foods and lifestyle choices to reduce your risk of a heart attack or stroke?
These are some of the topics we discuss with Dr. Yasmeen Golzar below, in our feature on your heart health.
Can you describe your clinical practice?
I work at John H. Stroger, Jr. Hospital of Cook County in Chicago, IL, a public urban teaching hospital. I am a general cardiologist, director of non-invasive imaging at Stroger Hospital, and assistant professor of medicine at Rush Medical College.
What is the incidence of heart disease in America? Is it more prevalent in certain demographic groups? How about in women?
Heart disease is still, unfortunately, the leading cause of death in the U.S.—that is 1 in 4 deaths. This is true among most ethnicities. Heart disease affects men and women equally and is the leading cause of death in women. That being said, women tend to be underdiagnosed or there can be delays in diagnosis due to atypical presentations of heart disease.
Heart disease…is the leading cause of death in women, [yet] women tend to be underdiagnosed.
Let’s talk numbers – what is the ideal blood pressure and cholesterol level we should aim for as an average healthy adult?
Recent data suggests that the lower the blood pressure, the less the risk of stroke, heart attack, or death. Generally speaking, an average adult should have a goal blood pressure of around 120/80.
Cholesterol is made up of different types of cholesterol, including “good cholesterol” (HDL) and “bad cholesterol” (LDL and triglycerides). A high HDL (women > 55 mg/dL, men > 45 mg/dL) and a low LDL (< 100 mg/dL) are optimal.
What are some of the atypical symptoms of a heart attack that people may not be aware of?
This is a great question because not recognizing atypical symptoms is one of the most common causes of delays in seeking treatment for heart attacks, particularly in women. Many people, instead of typical symptoms of chest pain, may have left arm numbness, upper abdominal pain, or left-sided jaw or throat pain. Any symptoms which are new and limit exertion, such as shortness of breath or fatigue, are also concerning.
Can you describe a balanced, heart healthy diet – and how important is it for us to start this as young adults? Any particular foods that are cardio-protective?
This is a topic which still sparks a lot of debate. Some of my colleagues support very restrictive regimens such as vegan diets while others argue that we put too much emphasis on diet in relation to heart health.
I am a big believer in moderation and looking at lifestyle rather than diet alone. When it comes to food, existing evidence points towards the fact that mostly plant-based diets with a healthy balance of whole grains and a modest consumption of fatty fish, such as tuna and salmon (2 or more servings per week), are the most heart-healthy. Food that is refined, highly processed, or high in sugar content should be avoided. One of my favorite rules comes from Michael Pollan, author of An Omnivore’s Dilemma—he said something to the effect of: If your grandmother would not recognize it as food, you shouldn’t be eating it. As an exercise, next time you are grocery shopping, think of this rule with every item that you pick up. Considering all of the additives we put in food and the highly processed foods we consume, you will be shocked by how little food actually passes this rule.
With the growing epidemic of childhood obesity and the early onset of conditions which we normally consider “adult” diseases, such as hypertension and diabetes, the development of coronary artery disease has been seen as early as the teenage years. We should start our children on healthy diets from the moment they begin to eat table food. Not only does this allow children to enjoy a healthy palette from childhood, they will continue to make good food choices through their lifetimes.
Let’s talk about fat – I know that we should avoid saturated fats, but are there “good” fats we should try to include in our diet?
Fat is the most misunderstood macronutrient. We used to think that limiting our fat intake was compatible with heart health, but over the past two decades, we have come to better understand how complex dietary fat is.
All fat is not created equal. For instance, trans fats, which are found in deep fried food or packaged snacks, are known to adversely affect heart health. This is also true for diets high in saturated fats which are found in red meats, dairy products, and tropical oils.
On the other hand, foods high in polyunsaturated fats, such as fatty fish, soybean, walnuts, and flaxseed, have proven to be beneficial for the heart. Increasing dietary intake of these foods may decrease LDL and triglycerides and help to increase HDL. In some trials, replacement of carbohydrates or saturated fats with consumption of polyunsaturated fats has been shown to be anti-inflammatory, decrease insulin resistance, and lower cardiovascular risk.
Fish oil is a type of polyunsaturated fat. Data has been very promising in showing the benefit of fish consumption on heart health. In fact, studies have shown that by regularly consuming non-fried oily fish, such as salmon and tuna, you can decrease your risk of dying from cardiovascular causes by up to 36%!
Do you have any opinion on the role of meat in our diet? I have heard some postulate a plant-based diet as a means for reducing heart disease?
Yes, when looking at existing study data as well as studying populations which have the lowest incidence of cardiovascular disease, a mostly plant-based diet with limited consumption of lean meats is the most heart healthy. We know that consumption of omega-3 fatty acids, which is found in fatty fish, is beneficial for heart health as well.
Though some individuals are willing to make drastic changes in their diet, most who enjoy an omnivorous diet would find that very difficult. Try to start off by keeping certain days of the week “meatless.” I, for example, bring very little meat in my home but allow myself to eat meat when I eat out. Again, the key here is moderation.
If I am an otherwise healthy adult – non-smoker, normal cholesterol – do I have an increased risk of heart disease if my parents had CAD?
Unfortunately, yes. Genetics is a powerful player in the development of coronary artery disease. I had a patient who was a vegan marathon runner and had to have bypass surgery in his late 30s because, despite his extremely healthy lifestyle, he had developed severe coronary artery disease because of a very strong family history.
That being said, even though a genetic predisposition can put one at a higher risk of development of coronary artery disease, it is important to not add to that risk by additional risk factors that one can control, such as smoking, an unhealthy diet, or having a sedentary lifestyle.
Let’s talk exercise – I know that you value this in your own life, and ran a marathon last year. Can you describe some simple activities that are great for heart health?What about for older patients who may be limited in mobility – are there modified exercises you would suggest for them?
Exercise is such an important component of heart health. I tell my patients to participate in aerobic activity for at least 30-45 minutes, 3-4 times per week. Additionally, being more active in everyday activities is extremely important–take the stairs instead of the elevator, forego the closer parking spot so that you can walk further to the store, take a sunset walk as a stress-reliever and a lovely and meditative way to end your workday. These are easy ways to build in more exercise during the course of an average day.
For my elderly patients with limited mobility, getting as much activity they can get in with their activities of daily living is the goal. In addition to trying to be as independent as possible by doing their own laundry, cooking, etc., I encourage patients to walk around the house for 10 minutes during the morning, even if it is with the help of a walker or cane. While they are watching TV, I ask them to do bicep curls and arm extensions while holding soup cans. If they have access to a gym or a senior center which provides classes in water aerobics or senior dance classes, these are great activities to participate in which are easy on the joints.
For older patients, is there a certain age at which advanced screening measures should be implemented routinely to detect silent heart disease?
Our current guidelines do not support routine screening for coronary artery disease. We generally decide on further testing based on the development of symptoms.
What are some of the greatest barriers you see for Americans in preventing heart disease?
Unfortunately, our lifestyles are not very encouraging of heart health. The western diet is filled with processed and refined foods, we generally lead sedentary lives, and the stressors of a competitive and stress-filled work culture are all working against our health. As a society, we have become more cognizant of these detrimental factors, and there is a movement to incorporate more healthy lifestyle choices which I find encouraging. We have to make those choices as individuals and on a daily basis.
What do you find most rewarding about caring for your patients at County?
The rewards are so many! I care for a mostly underserved, under-resourced population. Many of my patients do not have health insurance or are underinsured; they come from all over the world and belong to a myriad of races, religions, and ethnicities. To be able to care for patients who otherwise may not have access to healthcare is so gratifying. I also have the opportunity to train future generations of physicians which keeps me energized and inspired.
Dr. Yasmeen Golzar is a cardiologist on staff at John H. Stroger, Jr. Hospital of Cook County in Chicago and director of non-invasive imaging. She is also assistant professor of medicine at Rush Medical College.