February is "Heart Health Month." In its honor, I spoke with Dr. David Funt who has been practicing cardiology for more than 30 years in Boca Raton, Florida. As a board-certified physician in both internal medicine and cardiology, his interests include clinical, general and preventive cardiology. Although the average age of his patients is 65 years old, they range in age from 25-100. He graciously allowed me to interview him, and I'm happy to share his heart health knowledge with you this week and next through SOULFUL Insights. –Jeanne What suggestions do you give to your patients in terms of heart-healthy behaviors? I tell my patients to create the best environment in their bloodstream, so they have the least opportunity to cause damage to their blood vessels. The circulatory system is composed of our heart and blood vessels, which help to pump blood and nutrients throughout our body. To maintain a robust heart and a flexible array of blood vessels, these behaviors are helpful:
Exercise: At least 2 1/2 hours of aerobic exercise/week or 3-4 miles/day (walking, biking, swimming). This is independent of weights. I advise my patients to start slowly so they can adjust to the new habit. Be active. Use stairs when available. Park in the farthest place in a parking lot.
Weight: Maintain an ideal body weight. If overweight, I encourage Weight Watchers. I advise my patients to limit restaurant exposure and buffets due to lack of control of what is going into their food and the quantity of food ingested.
Nutrition: Create an environment for success. Moderate portion sizes. Try to eat foods in their natural form and avoid processed foods. When at a restaurant, I advise my patients to request “no bread at my table,” no French fries, no white rice and to avoid sugar-sweetened beverages. I also suggest that everyone order a salad and share an entrée. Order fish when dining out because people often do not like to cook it at home.
Meats: Avoid all processed meats; limit red meat to once or twice a week, at most.
Fats: Use skim milk dairy products. When eating red meat, remove the excess (external) fat.
Smoking: Stop smoking and avoid secondhand smoke, if possible.
Mindfulness/stress reduction practices: I recommend yoga, exercise and meditation as great methods to relieve stress.
Sleep: Avoid caffeine in the late afternoon, avoid sleeping pills, limit afternoon napping. Exercise, because it is helpful for a good night’s sleep. Many older adults cannot sleep because of discomfort; I recommend 1-2 Tylenol at bedtime in this situation.
Can you explain a bit about vascular health? Is there a connection with gum disease? The brain and all organs in the human body get their nutrition through the blood vessels. Disease of the blood vessels anywhere in the body also affects the blood vessels of the brain. In fact, these vessels are more susceptible to damage and blockage due to their small diameter. I'd estimate that at least 50% of the cognitive issues we see in the elderly are due to vascular disease. Vascular health is essentially brain health. I encourage my patients to exercise because studies show the more a person exercises, the less likely one is to have dementia and cognitive issues as they age. Physical exercise is probably more important for your brain than brain exercises. Prevention of heart disease is the prevention of dementia. Gum disease Good oral health is essential. Inflammation anywhere in the body increases the risk of a cardiovascular (CV) event. Any infection in the body is not good for the heart. Even having the flu multiplies your risk of a heart attack in the subsequent few months.
At routine cardiac visits, what do you review? What should patients know more about concerning their cardiac numbers and health? At each visit, I review a patient’s entire cardiovascular history. I spend approximately a third of the office visit discussing lifestyle. I try to get a measure of how much they are exercising each week in minutes.
In terms of numbers, I look at:
Weight & BMI: (Body Mass Index=weight in kilograms/height in meters2; BMI=kg/m2). I compare these numbers to past visits.
Blood pressure: The definition of hypertension recently changed to above 130/80 (see post on Hypertension). If a patient's blood pressure is >130/80, I have a long talk about lifestyle. A patient’s BP is put into a global risk calculator to decide whom to put on medication.
Blood sugar: I want to see fasting sugar <100. If >100, I consider a Hgb A1C (a measure of a patient's average blood glucose over the past 2-3 months) to determine if the patient is prediabetic, has a risk for diabetes or if they might have full-blown diabetes.
Cholesterol: Each patient is unique, so I don’t concentrate much on their total cholesterol. Instead, I pay attention to:
HDL (high-density lipoprotein). I like to see HDL >50. To raise HDL, increase exercise and fish consumption (if they don’t eat fish, I advise a supplement; however I prefer food if possible) and weight reduction.
LDL (low-density lipoprotein). The lower, the better. With blocked arteries, I like to see <70, even closer to 50. There is no level that is too low now. This has changed in the past few years. It was once thought that if LDL was too low it could be harmful. Low LDL confers additional health benefits. I look at the LDL in the context of the patient’s global risk (in conjunction with the risk calculator).
Triglycerides <200. Patients with high triglycerides tend to be overweight, physically inactive, and eat too many processed carbs. High triglycerides often indicate that the size of the LDL molecules is smaller, which indicates more risk for heart attack and stroke.
I advise my patients to avoid processed foods and soups in restaurants and food in cans because they are both generally full of added salt. I tell them to exercise. We discuss ideal body weights and what constitutes moderate alcohol consumption (for females: 1 drink/24 hours; for men: 2 drinks/24 hours). I advise my obese patients to eliminate alcohol. I suggest they avoid nonsteroidal anti-inflammatory medicines (e.g., Advil and Aleve), which can increase blood pressure and cardiovascular risk. Use Tylenol for pain relief. If the pain is severe, I advise using Advil sparingly.
Next week, we'll learn more about cholesterol's role in heart health, different methods for assessing risk and additional measures we can take to promote our heart health.
Resources
"Cholesterol Guidelines: What's New?" Berkeley Wellness Letter: http://bit.ly/2USf43I
"Five Things to Do Daily to Keep Your Heart Healthy," Cleveland Clinic: https://cle.clinic/2TFPQ8z
"Hearts Get Younger, Even at Middle Age, with Exercise," NPR's Morning Edition: https://n.pr/2SBFhWO
"How Exercise Affects Circulation, and Vice Versa," Experience Life: https://experiencelife.com/article/how-exercise-affects-circulation-and-vice-versa/
"The Impact of Confounding on the Associations of Different Adiposity Measures with the Incidence of Cardiovascular Disease," European Heart Journal: http://bit.ly/2TEMa6U
David Funt, MD
Dr. David Funt received his undergraduate degree from Emory University, where he was a member of Phi Beta Kappa. He graduated from the NYU School of Medicine and completed his internship and residency in Internal Medicine at the University of Miami-Jackson Memorial Hospital. He then completed his Cardiology Fellowship at Boston University and Boston City Hospital. David is on staff at West Boca Medical Center and Delray Medical Center. He has been Chief of Medicine at West Boca Medical Center and has served on the Board of Governors. David volunteers his time at the Caridad Center for migrant workers. He was born and raised in Long Island, New York. He is married and has three sons. David Funt Davef1027@gmail.com
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