Episode Transcript

What is the secret to a healthy heart? This week Dr. David Majure, a cardiologist at NewYork-Presbyterian and Weill Cornell Medicine, walked us through the American Heart Association’s eight key measures that promote heart health.

Dr. Majure helps us connect the dots to show how these measures are more than just a checklist. He explains how these factors are all interconnected and that reducing the risk of heart disease will require both individual effort to live a healthier lifestyle and systemic change to support it.

Faith: Hi, Dr. Majure. Thank you for joining us.

Dr. Majure: Hi, Faith. Great to be here. Thanks for having me.

Faith: Let’s start with the basics. Can you explain the role the heart plays in our body?

Dr. Majure: The heart, it’s a pump and it’s basically moving blood through your body to deliver oxygen to help remove carbon dioxide, to allow the cellular processes that our organs and tissues do on a second to second basis.

The heart is allowing those chemical interactions to occur so that we can continue to live. It’s the pump that provides those nutrients to all of our tissues.

Faith: Now, the heart is a vital organ. What are the ways to keep our hearts healthy?

Dr. Majure: Yeah. Maybe the thing to think about here are the things that lead to heart disease and how they impact you because of the things that could impact the likelihood of a person developing a diseased heart, what are the things that we can prevent?

I can even point to one easy tool that the AHA put together, which is this idea of “life’s simple eight.” The ways that we can have optimal cardiovascular health.

Faith: I’ve got my fingers ready.

Dr. Majure: Yeah. Right. You ready? Okay. So number one: don’t smoke.

We’ve known this for decades and fortunately had to go through a huge battle to actually get anywhere in terms of limiting cigarette consumption. But we’ve perhaps made some progress.

I’m fearful that we’re going to lose the progress that we’ve made because of the growth in e-cigarettes. Especially as it relates to young people using flavored cigarettes.

Dr. Majure: Number two, healthy weight. It’s a real big issue in the United States. And we are approaching 50% of our country being obese, meaning having a body mass index of greater than 30.

So in 2017, the last real statistics that we have from one of the large databases that we use to track these things in the US, 41.9% of the country was obese.

Faith: Not overweight? That’s obese?

Dr. Majure: That’s not overweight, that’s obese. So we’re already talking about in a pathologic state. And that actually increased from 30% two decades prior. So 30.5% up to 41.9%.

You know, unfortunately from a healthcare perspective, we are usually dealing with this after the fact. Now we can certainly advise people about obesity. We can talk to them about healthy diets. We can talk to them about exercise, but ultimately this is a policy level problem. We don’t have policy in the U.S. to really address obesity in a meaningful fashion.

Being overweight in and of itself directly is not the problem. Quite simply being overweight and obese predisposes to diabetes. It predisposes the tissues to being insensitive to insulin, and diabetes is the primary mediator of many of these problems.

So as people develop diabetes, the high levels of glucose in their blood leads to damage to blood vessels throughout the body, such as in the eyes, in the heart, in the gut, elsewhere in the body, in the legs.

The high inflammation in the body can predispose to arterio-sclerosis or damage to the blood vessels. People that are obese are more likely to suffer from high blood pressure, which also damages the blood vessels throughout the body. When you think about the most common causes of kidney failure, they’re very similar to that of heart failure. It’s diabetes and hypertension.

Dr. Majure: So physical activity, which is an obvious next one, right?

The current recommendation for exercise is 150 minutes per week.

Faith: A week, yeah.

Dr. Majure: Of moderate exercise. This is the baseline. Or 75 minutes per week of vigorous activity.

Faith: And of course these are all related because if you are walking, you are going to be creating a lifestyle that’s better for your heart.

Dr. Majure: Right and it’s not just your heart, you know, fortunately, all these things point to just an overall wellness, healthfulness, and holistic approach towards being healthy.

If people don’t start these activities at a young age and they get behind, it is extremely difficult to adopt them later on.

If we don’t find ways at a systemic level of making people more active, and you try to only address these things in a doctor’s office when the person is already suffering from high blood pressure and diabetes that maybe wasn’t even noted but had been going on for five or 10 years, well, it’s difficult to catch up.

And what’s particularly sad about this is that a lot of our kids at very young ages are becoming overweight, coming in with high blood pressure and developing diabetes. That creates complex behavioral changes that are very, very difficult to remedy later on in life.

Faith: So number one, don’t smoke. Number two, healthy weight. Number three, physical activity.

Dr. Majure: And then there’s eating healthy.

We didn’t talk about eating healthy And these all kind of fit in, right? I mean, they’re all in the same rubric.

So eating healthy. We’re talking about fresh vegetables, fresh fruit, nuts, legumes, lentils, minimizing the amount of meat.

Get rid of processed foods and foods that contain added sugar. That would be my biggest message by far.

So if you take those 20 ounce bottles of soda that are very popular, you know, how much sugar are we talking about? 65 grams of sugar. So that’s about 240 calories.

Faith: Oof.

Dr. Majure: And so if you figure that people may drink one, two, three of these on a daily basis. That is a lot of excess sugar and excess calories that are being consumed for nothing.

And so if people could find ways of eliminating those sugary beverages, eliminating processed foods, not only for the sugar, but for the salt, you could make some headway.

Faith: So if I’m using what everyone would consider too much salt and yet my heart’s in great shape and my blood pressure’s fine. Do I need to cut back on salt?

Dr. Majure: We do know that there is a relationship between salt intake and the development of hypertension. And presumably salt-mediated cardiovascular damage is via the development of, of high blood pressure.

And so when you take in salt, water follows the salt, you tend to have more volume in the blood vessels that imposes a higher load on the heart, higher blood pressure as a result.

And the other problem that is difficult to appreciate, back to your question, Faith, is you might have good blood pressure right now. But it’s the chronic development over time that you’re trying to avoid.

And look, the good news about salt and sugar and all this other sort of stuff is that you can train yourself. These are acquired habits, acquired traits, but that’s difficult, once again.

And back to the original supposition of all this, we’d like to create a system where people don’t have to later remedy something that they’ve become very used to.

Faith: Mm-hmm.

Dr. Majure: So you actually got on the next point on the list, which is blood pressure.

Faith: Number five. Okay.

Dr. Majure: Yeah, blood pressure.

People that don’t go to the doctor on a routine basis you might not know you have elevated blood pressure until you come in with a stroke.

When you are stressed, you release a lot of adrenaline, epinephrine, and your blood pressure can surge as a result of that.

Conversely, in certain people, if their blood pressure is really high, they might develop headaches, which might make them anxious, which might make their adrenaline surge and there could be a feedback loop there.

Your heart is working against that very tight resistance in the vessels. It’s the weight that your heart is having to lift. And your heart, let’s say it’s beating 70 beats per minute, seven days a week, every day, always. If you’re having it lift a heavier load, well, what does it do? Just like any muscle, if you ask it to lift a heavier load, it’s first going to get thicker. It’s gonna try to get stronger to accommodate that weight that it’s having to lift. But it can only do that for so long and then after a while it will start to enlarge in size and not work as well. And that’s one of the ways that people can come in, in heart failure.

And quite tragically, what we are seeing are young people in their early 30s, 40s coming in in heart failure because they’ve had high blood pressure since they were teenagers and they just didn’t even know it.

So we wanna keep that blood pressure really optimally controlled, and so a number to hold onto is less than 120 for the top number and less than 80 for the bottom number.

Faith: What’s number six?

Dr. Majure: The next one is not a hard one to imagine. It’s cholesterol.

Cholesterol is a very important substance in our body. It’s important for the membranes of all the cells that we have for various other processes in our body. But too much of it can be bad, just like a lot of these things.

We consume cholesterol, but we also produce cholesterol. Our liver is very important in the production and metabolism of cholesterol, but in two high levels it can lead to deposition of the cholesterol in the blood vessels.

And we can see this in all of our blood vessels, in our brain and throughout elsewhere. But in particular, you see it in the blood vessels that give blood to the heart, that supply the heart muscle with blood. And that’s part of the genesis for coronary artery disease.

As those blood vessels become diseased with cholesterol and they can form calcium deposits, that can really impede blood flow to the heart. And in the worst case scenario cause a heart attack and there’s a rupture of these. They’re called cholesterol laden plaques. And they can break, a blood clot can form in the blood vessel. Then you don’t get enough blood flow to the heart muscle that precipitates a heart attack.

And prior to having really effective means of treating heart attacks, say in the cath lab or with some of the other medicines that we use, people would routinely die of this. This is how people died very suddenly for much of the 20th century, especially when cigarette use was at its peak.

Faith : And what is number seven?

Dr. Majure: Well, number seven, we’ve also kind of talked about, and you can see how all of these are very much related, is blood sugar.

And so making sure that diabetes is not present and if it is present that it’s optimally controlled.

It’s something that we want to really make sure that good emphasis is placed on, in particular in terms of prevention. We’re seeing more and more children being diagnosed with diabetes, and it’s a real tragedy because the damage that diabetes exerts on the body is time dependent. So the longer they have diabetes, the more likely you are to develop damage to the blood vessels, damage to the heart, damage to the kidneys.

Faith: Sleep was added this year as the eighth measure for cardiovascular health.

Dr. Majure: Yeah.

Faith: Can you tell me why sleep is so important for our heart?

Dr. Majure: With good sleep, your blood pressure tends to decrease. Your heart rate decreases. There are all sorts of physiologic processes that are improved with sleep.

One of the things that is also wrapped up into all of this, with obesity in particular, is the development of obstructive sleep apnea. There’s too much tissue in the neck and when they sleep, the airways collapse. Their body has to work really hard over and over again to open the airway. And then finally they break it open, and that’s when you hear that kind of gasping snore that happens.

When that happens, hormones, epinephrine and the like are surged. The blood pressure spikes and that imposes a huge burden on the heart.

And effectively treated, it is like a miracle because all of a sudden they get sleep, they’re sleeping, they’re no longer tired during the daytime.

Faith: What is one thing that you wish people knew about the heart?

Dr. Majure: I’d like people to not need to be aware of their heart as much. I’d like people to be aware of health and live the healthiest life they could.

I realized a couple of years ago that young people have this idea sometimes that you can live hard and then you’re just gonna die. But what they don’t realize is that usually what happens is that people collect conditions that really impact the latter part of their life, where they struggle to live well. And so you might have 10, maybe 15 years of poor life until you die.

And so this “life’s simple eight,” achieving these things allow you to live your best life for the longest period as compared to your worst life for the longest period.

So, I’d like people to not be aware of their heart, because once you’re starting to be aware of it, it probably means you’re starting to talk to somebody like me.

Faith: Dr. Majure, you are so compassionate and you have this real holistic view of people and their bodies and I also appreciate your kind of global view of the way we need cultural and societal support to live our best lives.

It has been a real pleasure talking to you. Thank you, Dr. Majure.

Dr. Majure: Well, thank you Faith. I really appreciate it.

Our thanks to Dr. David Majure.

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