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Heart Disease

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SARA LOMAX-REESE: We are back and we are into the second half hour of the program.  Right now we are switching gears to talk about another really critical issue in the African American community.  February is American Heart Month and heart disease is a huge issue.  We know that heart disease is the number one killer of all Americans.  We know that high blood pressure and high cholesterol and all kinds of issues are disproportionally affecting the African American community so this is a very important topic.  To talk about this we are joined with some folks at Einstein Healthcare Network.  We are here in studio with Dr. Donee Patterson who is a family physician and the Director of Medical Community Outreach for Einstein and also we also have Dr. Vince Figueredo who is the Director of the Cardiovascular Diseases Fellowship Programs and Associated Chair of Cardiology at Einstein Medical Center. Welcome to you both.

DONEE PATTERSON, MD: Welcome, thank you.

LOMAX-REESE: Dr. Donee, why don't you set things up.  You selected this as the topic for today's program and I'm sure it is because it is American Heart Month but tell us why this is really important to you.

PATTERSON: At the end of the day, this is all about educating people about how to be healthier and we really honestly want people to be healthier and save lives.  We know that heart disease is the number one killer of US people today but also African Americans.  That means that 1 in 4 people, we are not just talking about something that affects 1 in a million or 1 in 500,000, this is 1 in 4 people are affected by heart disease.  That leads to a heart attack every 33 seconds.  In the span of this show, there will be 60 people that have a heart attack.  In the span of this show there will be 30 people who actually die from heart disease in the US.  There are things that can, not to be someone who is pessimistic because I believe I am an optimistic person, we believe that there are definite things you can do to save your life; to improve your life; to make yourself one of those people that says I have never had a heart attack.  We want to educate people today.

LOMAX-REESE: I want to turn to you Dr. Figueredo.  I know that there are differences in terms of how the symptoms of heart attack in particular present for men and women.  I wanted to see if you could maybe talk about what people should look for if they are actually thinking they might be having a heart attack.

VINCENT FIGUEREDO, MD: Unfortunately most people don't have the classic crushing or heaviness in their chest.  This is especially true in women, diabetics and older patients.  It can be really bad indigestion, it can be pain in the jaw or the neck or a numbing kind of feeling.  They could feel really sick in their stomach.  The point is, it is a new symptom that they have not had before.  It is a surprisingly nerve wracking symptom that has presented itself and it is new, that is the important thing.  That is something that, even if you are not sure it has anything to do with your heart, seek medical attention right away.  Call your primary care physician and if you don't have one go to the emergency room and get assessed.

LOMAX-REESE: I have a question because I have had, I have kind of witnessed from afar two people who have died from heart attack or heart disease recently and one person was complaining of pain for a few days and I'm wondering if, that seems like different from a heart attack that just comes on you all of a sudden.  Can you be walking around with physical pain for days on end and just not really realize and that too could be a heart attack.

FIGUEREDO: That is something called unstable angina or acute coronary syndrome.  What is happening is the person is intermittently blocking off the blood supply to part of the heart.  They are having episodes of discomfort and then it is relieved, they kind of go along their way and then they notice it again and these can become progressive.  They can get worse; they can get longer until they ultimately result in a heart attack.  Those are warning signs and those need to be addressed right away.

LOMAX-REESE: Is that a cause to go to the emergency room?  Is that something that you should or could you go to your family physician and say look, I'm walking around feeling a little uncomfortable.

FIGUEREDO: I think if you are having discomfort in your chest that is new you need to seek medical attention right away if this is something you have not experienced before.  If it is something you think you had before, you think it might be related more to indigestion or something, it is appropriate to call your primary care physician but I would do it right away and if you can't reach them then you should seek medical attention at an emergency room.

PATTERSON: Sara, we just wanted to make sure that we emphasized to people what heart disease is.  A lot of people say I don't have heart disease because I have never had a heart attack.  Heart disease, it spans many different things.  If they have had high blood pressure or is they have had congestive heart failure or if they had a stroke, these are vascular diseases, all blood vessel diseases.  They are kind of lumped in one thing.  You don't just have to have had a heart attack to be considered to have heart disease.  It is a group of different disorders.  Those disorders are symbolized by clogging of the arteries.  If the arteries are clogged, then if there is decreased blood flow to the heart, a part of that heart dies and that is when someone is considered to have a heart attack.  That is what we are trying to minimize.  We are trying to minimize the clogging of these arteries; to keep the blood flow to the heart.  Time is of the essence.  If someone's heart is clogged just for just a brief moment that is when we say someone had a small heart attack.  If that clogged artery is clogged for minutes or longer, then that is when someone is considered to have had a massive heart attack.  We need people to know that time is of the essence and that is what Dr. Fig  was saying, you absolutely need to seek medical attention right away so if you can not reach your primary care doctor or you get an appointment for three weeks, you can't wait three weeks, you immediately have to go.  If you have new symptoms you break out in a cold sweat, you have chest pain, you have severe indigestion that is not going away relatively quickly, that is something to seek quick medical attention.

LOMAX-REESE: That is Dr. Donee Patterson who is a family physician and the Director of Medical Community Outreach for Einstein and also we also have Dr. Vince Figueredo who is the Director of the Cardiovascular Diseases Fellowship Programs and Associated Chair of Cardiology at Einstein.  Let's talk about risk factors.  I also want to talk about age, because one of the things that have been absolutely devastating and stunning tome is recently I've seen two 50+African Americans, one Fatimah Ali, who was one of our dear hosts who recently transitioned and we think it was a heart attack, we don't know for sure, but we think it was a heart attack.  Another was a gentleman who was 52, who is a dancer; we thought he was very healthy.   He actually went to the emergency room; it was too crowded and left and went home and ended up dying.  I just am baffled about what seems to be prime time in the middle of your life, 52, 55.  Talk to me about risk factors and age.

FIGUEREDO: Age is obviously not a modifiable risk factor.  The older you are the more likely, especially in this country, you are to have heart disease.  Modifiable risk factors unfortunately, especially in the African American populations, a lot of these risk factors, hypertension, obesity, inactivity, cigarette smoking, these are all presenting earlier in the African American community.  We are seeing hypertension in 20s and 30s and no one is getting treated for it until they start having the complications related to it.  Diabetes is becoming epidemic; it is twice as likely in the African American patient compared to their white counterpart.  Kidney disease is a major risk factor for heart disease, 16 times more likely in African Americans compared to non-Hispanic whites.  Hypertension, it presents earlier, it is more severe and has more devastating consequences in a younger population when we are talking about the African American population.  It really behooves us to perform preventative medicine here.  See these patients while they are supposedly healthy and younger and jump on it quickly if they have things like hypertension or abnormal cholesterol or they are obese and address that with them directly.  

PATTERSON: We know that more than 80% of people who have heart attacks, they are older than 65.  That still leaves a percentage of people that are younger than 65 and what Dr. Figueredo was talking about modifiable risk factors that means risk factors for heart disease that we cannot change.  We can't really change or age, even though we might want to and we really can't change our sexual orientation, well being a male or female, our gender and we can't really change or family history, but what we can change is cigarette smoking.  Cigarette smoking increases your risk of developing heart disease by 4 times.  It changes the blood vessels, it changes the arteries, it changes how we clot.  That is the number one thing to do to improve your health.  Of course if decreases cancer, we can have a whole show on that.  Cigarette smoking is huge.  So high cholesterol, diabetes again and high blood pressure.  Often in our African American communities, like Dr. Figueredo said, we are seeing this at younger ages but what I see in some of my patients is they say well I'm only 30 or 35 so I don't have to take care of it right now.  It is often that these medical conditions aren't being fully treated.  We know that these patients have it, but they don't take it serious enough to come in and actually get it well managed.  It is not enough to just be on one blood pressure medication if your blood pressure is still high.  It is not really about taking medicines, it is just making sure you decrease your risk factors.  We are not here pushing medicine; we are saying that if you have high blood pressure you need to get it under control.  If you have diabetes, you need to get it under control, etc.

LOMAX-REESE: I want to invite callers.  If you have a question for Dr. Donee Patterson or Dr. Figueredo both of them from Einstein Medical Center, we are taking questions. 215-634-8065, toll free 866-361-0900.  It is American Heart Month, the month of February.  We are talking about heart disease, heart attack, high blood pressure, diabetes.  All of these things put incredible pressure on this amazing muscle that keeps us alive.  We don't think twice about it unless it is not working right.  We have to take care of it. We have to take care of our heart.  One of the things you both mentioned I think was obesity.  Dr. Figueredo I want to see if you can kind of project into the future because we know that there is a growing obesity epidemic in children and there are public policies that are being debated that are very controversial in terms of whether or not people on food stamps should be able to gt potato chips and soda as part of what they have access to.  There are lots of questions about what this current childhood obesity epidemic is going to look like in 20 years when these young people are mid 20s, early 30s.  How is that going to impact the heart disease issue?

FIGUEREDO: Well it is only going to make it worse.  Obesity has become epidemic in this country and it has particularly affected the African American community.  I think education starts with the children.  I can't believe we don't have public health policies in place where we are educating children at school about healthy diets and physical activity.

LOMAX-REESE: We don't even have gym; gym has been eliminating.

FIGUEREDO: It is alarming because that is probably one of the most important things from a physical and probably psychological standpoint that we can do for children at school.  Allowing them to exercise; healthy mind, healthy body and we don't do it and they are not eating healthy and they are becoming obese as children then they are obese as adults.  That is a major risk factor for heart disease and it clumps with high cholesterol and diabetes and high blood pressure and that is a recipe for cardiovascular disaster.

LOMAX-REESE: I want to go to the phones. I have Gina from North Philly on the line; welcome to the program Gina.

GINA: Hi, good afternoon.  This is a topic that is very close to my heart.  I'm 61 years old and I've always pretty much been a healthy, active person. I've had good levels, cholesterol and everything but I found out several years ago I'm hypertensive so I'm on medication which I take every day.  I had two stress tests and the doctors are really amazed that a woman my age would do so well.  I recently had an EKG in my primary physician's office and I was looking at the report and it said I have abnormal sinus rhythm and I don't know what that is.  It says possible left atrial enlargement and I'm devastated, I don't know what that means.

FIGUEREDO: The only thing that I would suggest that the left atrial left chamber of your heart is enlarged, probably related to increase pressure from high blood pressure.  That is one of the signs we seen on an electrocardiogram that suggests that a person has high blood pressure that is not adequately treated.  The fact is, for an African American woman your age, 2/3s to  3/4's have high blood pressure and unfortunately many of them are not at goal, they are not being treated sufficiently.  That includes life style modifications and usually combinations of medicines.  That is something we can see going away on the electrocardiogram with long standing adequate control of your blood pressure.

PATTERSON: So for people that don’t know, the heart has four chambers and the top two chambers of the heart we consider the atrium, so you may see that on your report and the bottom parts of the heart are the ventricles.  Those are just doctor terms that you may see.

FIGUEREDO: The important thing is don't be devastated.  It sounds like you are a pretty active, healthy person.  Unfortunately if the African American community, on 24% of adults report regular exercise so if you are out walking most days of the week, you are doing a wonderful job protecting your heart.

LOMAX-REESE: Thanks for your call Gina.

GINA: Thank you.

LOMAX-REESE: Today we are talking about heart health.  We are talking about heart attack, heart disease, but more importantly, how to be proactive and take good care of your heart.  We are in studio with Dr. Donee Patterson, who is a family physician and the Director of Medical Community Outreach for Einstein and Dr. Vince Figueredo who is the Director of the Cardiovascular Diseases Fellowship Programs and Associated Chair of Cardiology at Einstein.  I'm curious in terms of what kinds of things you advise people, you said don't smoke, there are a lot of don'ts, but I'm curious, when you said Dr. Figueredo that if your blood pressure naturally increases with age, is that correct?

FIGUEREDO: That is correct until in your 80s.

LOMAX-REESE: Until your 80s, then does it level off?

FIGUEREDO: It levels off and actually goes down; if you make it until your 90s or past.

LOMAX-REESE: Is there anything that we can be doing now that will manage, because it seems like high blood pressure, they call it the silent killer, but particularly in the black community is epidemic.  It is in epidemic proportions and I'm curious, what are the things we need to be doing to really get a handle on our blood pressure.  

FIGUEREDO: Especially in African American, there are a couple things that promote high blood pressure, especially at an early age.  Some of those are genetically related and we can't do anything about except treat people when the time comes. Salt sensitivity is an important one.  Salt definitely exacerbates blood pressure, especially in the African American community.  Obesity exacerbates  high blood pressure, losing as little as 5 pounds can make a huge difference on your blood pressure.  I have a lot of patients who come in and they say I can't lose 50 pounds; I say you don't need to lose 50 pounds, you need to lose 5 pounds and you can do that over a month or two.  The way I recommend that is not dieting as much as eating healthier.  Eating more fruit and vegetables; low fat dairy, don't fry, bake.  Little things like that can make a significant impact on the blood pressure.  Lastly, cigarette smoking clamps down those arteries and keeps your blood pressure high.  You get off the cigarettes your blood pressure will come down.

PATTERSON: Sara you would be surprised how many people don't know their family history.  In some cases, some medical conditions are not as important but for heart disease it is very important. Ask your mother, father, grandmother what your family history is.  Even if you don't have a lot of symptoms, even if you don't have symptoms, you may have strong family history of heart disease and need some extra intervention; some extra testing.  So know your family history.  If you have had someone that has had a heart attack in their 30s or 40s, you should ask your primary care doctor to make sure you are getting your cholesterol checked, that you have a baseline EKG just an EKG on your chart to make sure everything is OK and in some cases they need referral to cardiologists just to test them early on.  Do you want to talk about that Dr. Figueredo?

FIGUEREDO: I think one thing we suffer from in this country and it is especially apparent in the African American community is we don't practice preventive medicine.  People go to their doctor when they are sick. W hat really needs to happen in this country is people need to go to their doctor while they are still well and be assessed for cardiac risk factors.  If they have those risk factors, then seeing a cardiologist is appropriate but certainly jumping on the blood pressure early, jumping on the cholesterol early, talking to people about their weight, prevent diabetes, all of this is important and unfortunately we don't practice preventive medicine and that would be a huge life saver, especially in this community.

LOMAX-REESE: But I think you have to have insurance, you have to have access to get preventive care, to really take and be proactive and be more preventative and I think that is always the missing link in these conversations because there are still millions and millions of people who don't have insurance and even if they do have insurance it might not be adequate.  There are lots of people and I think there are a lot of African Americans who don't have a relationship with a primary care physician and everything you all are saying is that cultivate this relationship so that somebody is monitoring your development in terms of your disease processes.

PATTERSON: I think you are absolutely right.  There are programs for people who don't have a lot of money so you can absolutely come to Einstein and there is definitely different offices that are for people who don’t' have money and they are run very well.  This is something that is coming up in March, there is the Enon Men's Health Fair, we are hoping to screen 1,000 men and that is a pretty awesome task and it is absolutely free.  We are going to screen blood pressure, cholesterol, HIV, prostate testing, and it is an entire day.  It is at Enon Men's Health Fair and we ask people to register but it is absolutely free.  It is done absolutely confidential.  

LOMAX-REESE: I just hope you do one for women too because March is women's history month so we need one of those for women.

PATTERSON: It is a little bit harder to get the mammogram there and the pap smears there but we are working on it.

FIGUEREDO: Remember, heart disease is the number one killer of women in this country, including African American women so we need to screen for that.

PATTERSON: We absolutely do, we are working on it.  But the men can come out and get free awesome healthcare and information that day.  It is March 24th at Enon. 

LOMAX-REESE: I don't want to take anything away from the men because we know that African American men are disproportionately removed and disconnected from healthcare as well, so that is an amazing opportunity for men to have a way to get their screenings as well.

PATTERSON: So we are looking forward to men coming out.  Over 1000 came last year, we are looking for those numbers this year and I believe it was a very positive day for them.

LOMAX-REESE: Well hopefully in one of our upcoming Einstein Spotlight segments we will talk amore about that particular program.  We are almost out of time.  I want to get some final thoughts.  What are the things that people must, I keep saying to folks, especially after what the station has gone through with the loss of Fatimah recently, that we don't have an option to take our health lightly.  It really is a matter of life and death.  What do you all, and I will start with you Dr. Figueredo, what do you say to compel people to really make health their number one priority and to really take good care of their heart?

FIGUEREDO: Often what I will do is talk about their family with them.  Then I will say what happens if you are not here and that has a huge implication for them and it suddenly gets them sitting up in their chair.  I say well you have risk factors for heart disease and that is the most likely thing you are going to die from.  You can do it soon or you can do it later and you much rather do it later given your family so let's talk about how we can modify your risk factors and keep you around for awhile and people listen.

LOMAX-REESE: That's a good one.  Dr. Donee?

PATTERSON: It is huge.  Also I know that for a lot of people when we don't know something we tend to do nothing.  I want people to be educated.  I want people to listen and I want people to take this serious.  Exercise, we kind of poo poo it and we don't do it and say we are too tired, but make it a priority.  Make sure you are exercising, it can decrease your risk of cancer, it can decrease your risk of Alzheimer's, diabetes, hypertension.  So exercise is huge.  Make it a point to eat healthier, eat the rainbow, it things of all different colors, eat fruits and vegetables because it definitely makes you healthier.  Decrease the red meat and alcohol.  Do things that are consciously important for your health and not just go out and do the things that taste good, feel good.  I'm not saying just eat cardboard, I'm just saying it is important to really think about being an advocate for yourself.

LOMAX-REESE: Absolutely.  That is Dr. Donee Patterson and she is a family physician and the Director of Medical Community Outreach for Einstein and we were also joined in studio by  Dr. Vince Figueredo and we have been talking about heart health today.  The website Dr. Donee?

PATTERSON: If you need an appointment with a family doctor or you need a cardiologist you can call 1-800 Einstein or www.einstein.edu.  You can also get free daily health tips on Twitter at@DrDonee.

LOMAX-REESE: Excellent, we are very grateful for both of you for being here today.  We are celebrating American Heart Month, giving the listening audience tangible information to make sure healthful choices and we are out of time.  Remember to make health your number one priority; celebrate the healer within and always practice peace and don't forget to stay tuned for Al Sharpton next.  


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