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Heart Health & Heart Disease Prevention

February 26, 2015 12:00 PM with Dr. Jason Robin

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Heart disease is the leading cause of death in the U.S. for both men and women. During American Heart Month, Jason Robin, MD, Cardiologist at NorthShore, will answer your questions on heart health and heart disease prevention, from lifestyle changes like diet and exercise, to when one should begin discussing blood pressure, cholesterol and a family history of heart disease with a doctor. Submit questions early.

Brenna (Moderator) - 11:46 AM:
Thank you for joining us today. Our chat is schedule to begin at 12 p.m. You can submit questions now or at any point during the chat.

Dr. Jason Robin (NorthShore) - 12:01 PM:
Hello everyone! Excited for today's on line chat. A little bit about me.... I grew up in Flossmoor, Illinois and earned a BS in Biology from the University of Illinois and Medical Degree from Rush Medical College in Chicago (2002). I served my internship, residency and a cardiology fellowship at the Northwestern University Feinberg School of Medicine, where I was Chief Medical Resident in 2005. I completed my fellowship in 2009 and have been with North Shore since. My interests are preventive cardiology, valve disease, sudden death in athletes, coronary disease, atrial fibrillation and heart failure. Please feel free to ask questions outside of these interests! Let's go!

  Sergio (Des plaines iL) - 12:02 PM:
when diet and Exercise are not enough,whats the best way to keep a Healthy Heart.
Dr. Jason Robin (NorthShore)
Great question! Diet and exercise are part of the equation but often we need to use medications to keep our heart healthy. One of the most used medications which has consistently shown benefit is "the statin." Lipitor, Crestor, Zocor etc

  jo (niles,IL) - 12:07 PM:
Aside from angioplasty, is there any other non-invasive treatment for atherosclerosis of the artery of the heart?
Dr. Jason Robin (NorthShore)
Another great question, Jo! Outside of an acute myocardial infarction or when there is multi vessel coronary disease seen on an angiogram, revascularization (stents or bypass surgery) have not been shown to improve survival. In most patients, standard medical therapy is the key-statins, anti platelet meds like aspirin, ace inhibitors etc. If one is having angina-chest pain due to insufficient coronary flow, we can alleviate the symptoms with medications such as nitrates, calcium ch blockers, beta blocker and Ranolazine. Often, people will not need angioplasty because these meds are effective. Read up on COURAGE trial

  Traci (Pawnee, IL) - 12:07 PM:
I had a Stent inserted in 2007, with my last follow up in late 2011, as my Doctor retired. I see my family doctor regularly, do I need to see another cardiologist?
Dr. Jason Robin (NorthShore)
Hi Traci. My practice is typically to obtain a stress test every 2-3 years after someone has an event (for example a stent). You are probably getting great care with your PCP but never a bad idea to make sure i's dotted and t's crossed as the guidelines continue to chnage based on new and exciting data!

  Deb (New Palestine, In.) - 12:10 PM:
Would you advise a 67 year old woman, with no history of heart disease, whose small, dense LDL particles number around 2260 to take a statin drug. I was tested 2013 but have made some dietary changes and hope my next test will be better.
Dr. Jason Robin (NorthShore)
Okay Deb! I am going to share with you the secret formula! Go to: Open up the risk calculator and enter your age, gender, total cholesterol, HDL cholesterol, systolic blood pressure, whether you are on meds for blood pressure, whether you smoke or have diabetes. IF your risk of having a cardiovascular event between now and age 77 is >7.5%, YES, you should be on a statin. If <7.5%, assuming you don't have diabetes or any real clinical events, you may not need one.

  Chana (Chicago, IL) - 12:14 PM:
What's the best way through diet to lower boarderline Cholesterol levels? Is there a way to increase HDL levels? Does having a periodic racing heart increase your Heart Disease Risk?
Dr. Jason Robin (NorthShore)
The best way to lower cholesterol through diet: Change Fat (Opt for mono- and polyunsaturated fats, instead. Your body needs to take some fat in, but these sources are considered healthier and will not impact triglycerides. They include olive oil, canola oil, rice brain, walnut oil, and flaxseed oil) Increase Fiber (Fiber helps regulate the way that food is absorbed and passed through your body, and high-fiber foods can significantly lower both your triglycerides and LDL cholesterol) Cut red meat, eat more fish (2 servings/week) Cut excessive alcohol Cut refined carbohydrates. White rice and baked goods made with white flour or semolina can cause elevated triglycerides in some individuals HDL is tough to increase but cutting carbs, lowering blood sugars, exercise all help My heart is racing right now!

  J. Aguirre (Chicago, IL) - 12:18 PM:
If there is a family history of heart/cardiac issues, besides lifestyle changes, what other diagnostic testing is good for someone to have? Ex. 2D echo for a baseline, blood work up specific to heart disease, stress test? For someone 40+. Thank you.
Dr. Jason Robin (NorthShore)
It's important to know what type of family history you are referring to...a hereditary cardiomyopathy, sudden cardiac death, drowning from Long QT syndrome, atherosclerosis etc I assume you are referring to the latter which is the most common concern and is the most prevalent issues. Assumng you are not having symptoms, at the very least I would order a fasting cholesterol profile to gauge your 10 year and lifetime risk for a cardiac event or stroke. If your risk is borderline based on blood pressure and cholesterol, I may also order a blood test called a CRP or get a coronary calcium score to help further risk stratify. A stress test may be reasonable but in someone who exercises regulalarly without symptoms, probably NOT going to add much.

  G (Skokie, IL) - 12:25 PM:
I was diagnosed with a different heart rhythm via EKG. Then followed up with an echocardiagram. My doctor found out I have a high pressure in my right atrial chamber. Then I was referred to neurology for sleep studies (i.e. at home and in the sleep center). Why wouldn't I have been referred to see a cardiologist? What are some things I could do to lessen my chances of an adverse event due to my high right atrial pressure?
Dr. Jason Robin (NorthShore)
I suspect you have sleep apnea which is very common and typically duu to carrying to much weight. If you lose the weight with diet/exercise, the sleep apnea will improve, the right sided pressure will come down, and the arrhythmias will lessen or perhaps resolve.

  Lori (northbrook, il) - 12:28 PM:
My dad's first heart attack was in his 40's and he died at age 64 even though he was active & taking medications. At what age should my siblings and I see a Cardiologist as routine to prevent any issues?
Dr. Jason Robin (NorthShore)
Lori, If your Dad's first MI was in his 40s, I would have a very low threshold to start statin therapy (Lipitor) once you are in your 30s. Of course we would need a baseline lipid profile first. A stress test to serve as a baseline is reasonable although if you are asympotmatic and exercise regularly, it will probably be normal since stress tests are onyl abnormal when there are severe (70% or higher blockages). Occasionally we will order a CT of the heart to look for subclinical disease. But, at the end of the day, all roads lead back to statin therapy, in addition to making sure blood sugars and blood pressure is well controlled

  B - 12:33 PM:
Are there any side effects to worry about with statins? Are there people who shouldn't be on them?
Dr. Jason Robin (NorthShore)
As with any intervention, we must always look at risks vs benefits. As a whole, statins are VERY safe and have proven time and time again to reduce risk. Some people will devleop muscle aches with statins. This is almost always benign but we check muscle enzymes to make sure there is no breakdown of the muscle-that is a VERY rare event and when it does occur, we will temporarily stop the medication Liver enzymes can also increase in some people so we check this after we start the medication or if we increase the dose. The likelihood of causing serious liver damage with a statin is very close to 0%. We even put people who have cirrhosis on statins! If your risk is high (previous cardiac event, known diabetes, LDL >190 or 10 year risk >7.5%, almost certainly you should be on a statin).

  Audre - 12:39 PM:
Can children have high cholesterol? My daughter is 12 and overweight and I'm worried about the long term effects on her heart health but I don't know how to address this without making her feel self-concious.
Dr. Jason Robin (NorthShore)
Yes, kids can have high cholesterol. Sometimes pediatricans only chdeck the total which is not very useful since the total may be high because the good HDL is also very high. It is great that you are thinking about this now. Plaque starts to develop very early on in life-teens and 20s. Unless her cholesterol is dangerously high (seen with familial hyperlipidemia-very rare) I would not expose her to a statin yet and work on lifestyle modifications. Talk to your pediatrician on lifestyle changes. Sometimes a dietician can be useful. I send my patients to Lisa Bookstein in Highland Park-she is great!

Dr. Jason Robin (NorthShore) - 12:43 PM:

  Nikki - 12:44 PM:
I've been reading about the harm sitting too long can do to your heart. Is this something you really should be concerned about? How often should you be getting up if you do have a 9 hour a day desk job?
Dr. Jason Robin (NorthShore)
The main issue with sitting to long is you are not burnding calories! it is more of a long term issue as being sedintary all the time will lead to weigth gain, insulin resistance and diabetes. Make sure you exercise before or after work. If you are worried about blood clots in the legs, as long as you stand up and walk around for a few minutes every hour, you should be fine! But do MOVE MORE!

Brenna (Moderator) - 12:45 PM:
There are 15 minutes left in the chat. Please submit your final questions.

  Jamie (Deerfield, IL) - 12:47 PM:
If you had someone in your family die young from a heart attack at what age should that person's children start seeing a Cardiologist?
Dr. Jason Robin (NorthShore)
Excellent question, Jamie! When I hear stories of father's having heart attacks in their 20s-40s, I like to start seeing the kids once they are post-adolescent. These are the kids who I may start statin therapy on at a young age and consider studies such as a 64 slice CT of the heart to look for early subclinical coronary disease. Also very important to make sure that the cause of death was indeed a myocardial infarction/heart attack. If it was due to a hereditary heart muscle or primary electrical problem, that takes us down a different path! Hope that helps:)

  Shonna - 12:52 PM:
What is a silent heart attack? Does it really mean there are no signs?
Dr. Jason Robin (NorthShore)
You got it Shonna! It is not uncommon for us to perform an EKG, echocardiogram, stress test or angiogram to find out a coronary artery closed off and the patient does not recall it. Often seen in older patients who are less sedintary or in people who ignore symptoms. Hope this helps!

  Martha p (chicago, illinois) - 12:54 PM:
I have had chest pains & palpatations all my life, 10 years ago I was dx with mvp. I have not had an exam since. At my yearly physical, my new pcp doesn't seem to think I need a cardiologist. I am now 40. Should I not worry if my pcp is not concerned?
Dr. Jason Robin (NorthShore)
Those with MVP will often have unusual chest symptoms which are almost always benign. A small segment of those with MVP will develop a leaky valve-called mitral regurgitation. If it has been a long time since your last echocardiogram, I would obtain another one. It's just an ultrasound (worst part is the cold gel). If there is any significant mitral regurg, we may want to follow it with annual or every 2-3 years echocardiograms. Most likely, nothing to worry about! remember, 5-10% of the general population has MVP-very common!

Brenna (Moderator) - 1:00 PM:
That will be the final question of our chat today. Thank you to everyone who joined us for our popular chat on heart health and heart disease prevention.

Brenna (Moderator) - 1:02 PM:
For more information on the NorthShore Cardiovascular Institute, click here.

Dr. Jason Robin (NorthShore) - 1:03 PM:
Time flies when you are having fun! A lot of great questions. For those interested in screening young athletes for heart disease, please see my recent segment on Fox: Thanks for joining! Best wishes, Dr J

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