A Top Doc on Cardiac Health
It wasn’t so long ago that the only medical conditions associated by mainstream medicine with what we ate were indigestion and gout. A failure to be serious about maintaining a healthy lifestyle was not cautioned as being the harbinger— or cause—of a multitude of diseases. Today, as we all are aware, that link is irrefutable, and the connection between lifestyle and optimal health is both universally accepted and much better understood.
On a personal note, let’s talk about my husband, The Lawyer. You would think that having a wife who is a health and wellness expert, an author, columnist and talk radio host with a show that is beamed around the world, would make him the avatar of healthy living! And I’m pleased to say that in many ways he is. BUT even with all I know, and all he knows, he still has six coronary stents and had a mild (“ischemic”) heart attack ten years ago. Go figure! One answer we only learned recently— a genetically high Lp(a)— is one topic of today’s interview with a world-renowned cardiologist.
In The Lawyer’s defense (since he will probably read this), I’m happy to report that since his coronary “event,” he has been carefully avoiding foods that give him any pleasure at all. And almost religiously doing something he hates—go to the gym. Indeed, he’s lost 30 pounds as a result, and more importantly, kept it off. This man, who would rather starve than eat anything that tastes like a bitter green (I’m talking to you, kale), now usually eats a Mediterranean style plant-based diet that is heavy on whole grains and beans. Still, he has added three stents in that period. So being vigilant and careful hasn’t made him invulnerable to heart disease, although it probably has kept him alive and extremely active, professionally and otherwise.
There is a plethora of information out there about our hearts, especially in February which is American Heart Month. (Not that every month shouldn’t be dedicated to the importance of heart health.) To fill us in on the latest information on cardiac well-being, I sought the advice of Dr. Keith Ferdinand, MD, professor of medicine, Gerald S. Berenson Chair in Preventative Cardiology, Tulane University School of Medicine. He was kind enough to answer my questions on everything we should know to keep our hearts on the beating path.
Below, my conversation with Dr. Ferdinand:
JWM: Doctor, given what we know—or should know—about heart health, what are we as a nation doing wrong to cause such an uptick in coronary disease?
Dr. Ferdinand: There is a general lack of awareness of what coronary disease is—it’s a type of heart disease. Research from the American Heart Association (AHA) shows that more than 50% of U.S. population isn’t aware that heart disease is still the leading cause of death. Other diseases, like cancer, tend to be more top-of-the-mind, since it lingers, while coronary disease is too often sudden and immediately fatal. But taking care of your heart needs to be equally prioritized as heart disease rates continue to rise. There are still more deaths from heart disease than the #2 and #3 causes of death—both cancer accidental deaths—combined!
JWM: Does this apply to women as well?
Dr Ferdinand: This is especially true regarding the under recognition of heart disease in women. We all know breast cancer is a serious and important concern to address, but it’s also important to recognize that ten times more women die of heart disease compared to breast cancer.
JWM: Which brings me to… what should we be doing on a daily basis for our heart health?
Dr. Ferdinand: To help improve your heart health, you should incorporate healthier foods and more exercise into your daily routine. While you can monitor for certain signs of a heart event—like shortness of breath or chest pain—there are other signs that you may not notice yourself, especially if you are relatively healthy. That’s why it’s important to know your risks and talk with your loved ones about your family’s heart health history. You should also schedule annual check-ups with your health care clinician.
JWM: I always say that genetics loads the gun, but lifestyle pulls the trigger. Given that, what are the best foods for heart health? And what are the worst? Does the ultimate heart-healthy diet exist?
Dr. Ferdinand: There is no one best diet, but in general, eating foods rich in fiber and low in saturated or trans fats, such as fruits, vegetables, whole grains, nuts, broiled or baked lean poultry or fish may lead to improved heart health. I also suggest limiting red meat and all processed foods. You should also avoid high levels of salt and sugar.
JWM: Let’s talk for a minute about genetics here. What role do they play?
Dr. Ferdinand: While having a healthy diet is important to support your overall heart health, it has little to no impact on certain cardiovascular conditions, like those that are genetic. For example, about 80% of your blood cholesterol actually comes from the liver and there are clearly some genetic factors that affect our lipids, meaning cholesterol and other fats.
JWM: What are the risk factors that we should be aware of?
Dr. Ferdinand: Yes, one risk factor is Lipoprotein (a), also known as Lp(a) or “L-P-little a.” Despite being quite common, it isn’t something that many people know about. Roughly 1 in 5 Americans live with a high level of Lp(a). It is an inherited condition that can block arteries and increase the risk of having a heart attack or stroke. Lp(a) levels are about 90% determined by genetics and set by about age 5, staying mostly the same for life. Because it is predominately determined by genetics, unfortunately, things like lifestyle and diet do not impact Lp(a) levels. High Lp(a) is even more common in people of African and South Asian descent, and perhaps, explains some of the increased risk in those populations.
JWM: What are hidden “signs” we should look out for when it comes to our heart health?
Dr. Ferdinand: We may be aware of signs like chest pain or shortness of breath, but others aren’t as noticeable. For example, a high LDL-C, high Lp(a), elevated blood pressure or the early phases of diabetes often have no symptoms, meaning you can’t see or feel them until you’ve experienced some sort of event. So, making sure that you do not ignore an elevated LDL-C level or Lp(a) level, elevated glucose, or blood pressure readings can help keep you proactive in preventing disease.
JWM: How can we be certain of our risk?
Dr. Ferdinand: The only way to really know is to get a blood test and measure these various lipids. Ask your clinician about an Lp(a) test—it is not part of your regular check-up— especially if you or a family member have had a heart attack or stroke before age 55 (men) or 65 (women). If you discover that you have high Lp(a), ask how it affects your heart and what next steps to take. You should also talk about your family history. Knowing that history is important and sharing this with your doctor helps them understand your overall heart health and potential risk drivers. Furthermore, when seeing a clinician, make sure to organize your questions and be ready to get answers.
JWM: How often is an Lp(a) test. How often is this needed?
Dr. Ferdinand: At least once in a lifetime, you should get this test as a signal for increased risk.
JWM: And if we find out we have high levels of Lp(a)—my husband’s is high, for example, and possibly the reason for his heart issues, aside from his liking of strawberry shortcake—what can be done about it? Would it be the same protocol as for a high LDL cholesterol and triglycerides? Or is this separate from those?
Dr. Ferdinand: If your blood test shows that your Lp(a) level exceeds 125 nmol/L (50 mg/dL), your Lp(a) levels are high. Finding out you have high Lp(a) may come as a surprise, and it’s normal to be concerned. But it’s important to remember that there are things you can do now to help manage your risk.
JWM: What would you suggest we do, if so?
Dr. Ferdinand: Work with your doctor to protect your heart by managing diabetes, high blood pressure, or cholesterol, staying active, eating a heart-healthy diet, and getting seven plus hours of sleep. At the present time, since there is no approved drug for Lp(a), it is especially important to control what we can, including the regular lipid profile.
JWM: Doctor, in nutshell, what message do you hope readers will take away from our interview about how we all can feel Better Than Before, heart-wise?
Dr. Ferdinand: Maintaining healthy lifestyle habits such as a good diet and exercise is a lifetime endeavor when it comes to mitigating your heart disease risk, so your heart health always needs to be a priority. Being aware of your personal risk for cardiovascular disease is also key to determining your need for treatments and preventing complications such as sudden death, heart attack and stroke. The net net is that taking care of your heart can help you live a more active, productive and even longer life.
JWM: Thank you so much, Dr. Ferdinand. It is my deepest desire to help my audience become Better Than Before in 2025, physically, mentally and spiritually. And your valuable insights and advice will go a long way to improving the shape of their hearts.
