The following
program presents principles
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designed to promote
good health and is not
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intended to take the place of
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personalized professional care.
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The opinions and
ideas expressed are those of
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the speaker. Viewers
are encouraged to draw their
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own conclusions about
the information presented.
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Welcome to Wonderfully Made.
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Our topic today
coronary artery disease.
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Hello, my name is
Dr. Christine Salter.
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I am a board
certified family physician
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and I am a medical
director of Vibrant
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Health Family
Medicine St Louis, Missouri.
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Coronary artery disease,
why is this so important?
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It's number one
killer in the United States
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affected over half a
million people annually.
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What are the risks
factors for coronary artery
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disease? First, we want
to establish that there are
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conditions called
coronary equivalence.
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They are not risk
factors, they are if you have
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these you are assumed
to have coronary artery
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disease. What are
those; diabetes mellitus
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and chronic renal
disease. If you have either of
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these you are considered
as somebody who already
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had a heart attack.
But if you do not have
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these what are
those risk factors?
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Physical inactivity
that's a risk factor for heart
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disease, high cholesterol
that is also a risk factor
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for heart disease.
The male gender is a risk
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factor although women are
also dying of heart disease,
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in fact more women
greater than the age of 65 are
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dying from heart disease.
So, we have high cholesterol.
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We have physical inactivity.
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We have the male
gender and then cigarette
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smoking, a big risk
factor for heart disease.
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In fact, recent
study showed that tobacco
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smoking was the number
one risk factor for the
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cause not only for heart
disease, but also of stroke.
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So it is important that
you as an individual assess
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your risk for
coronary artery disease and
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how you are going to do that?
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You need to see your physician
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so that he can or she
can look at these particular
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risk factors. In addition,
risk factors that I did
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not mention initially is
also high blood pressure,
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so we want you to
go to your physician
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and your physician will
take your blood pressure.
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Is it greater than
140/90? We want to know that
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or do you already
have established high blood
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pressure that taken
medicine for this that is a
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risk factor. Your physician
will also draw some blood
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to check your
cholesterol levels.
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Now you need to be fasting
when you do this blood test
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and as a 12-hour
fast, nothing to eat after
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midnight and get the
test done before breakfast.
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Twelve hours of
fasting and will access your
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total cholesterol, your
good cholesterol otherwise
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known as HDL you
remember the H by
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saying happy
cholesterol that's the HDL,
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we will also look at
your bad cholesterol otherwise
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known as LDL cholesterol
or lethal that's the good
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ways to remember
that happy for HDL
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and lethal for LDL.
We will also check your
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triglyceride levels. This
will give an entire profile
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that will contribute
your risk for coronary artery
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disease. So your
physician will check your blood
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pressure, do some blood
tests and will also access a
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fasting blood glucose
to see if you are diabetic.
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Again if you are diabetic,
we will assume that you
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already have
coronary artery disease
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and we will
automatically advance
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you to the high risk category.
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Your physician will
also access your level
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of activity, are you
sedentary or do you have
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an active lifestyle. What
else will your physician do?
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Your physician
will take your weight
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and check your
height. The measurements of
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these two together
with the certain calculation
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will give us a body
mass index and determine
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whether you are overweight
or whether you are obese.
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The ideal body mass
index is between 21 and 23.
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If it's greater than 25
we say you are overweight.
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If it is greater than 30
then we say you are obese.
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Overweight and obesity
both contribute to coronary
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artery disease. So
these are the things that
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your physician will do
for you to access your risk
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and also he will find
out whether you are smoking
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or not. So ideally,
you should not be smoking,
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you should have body
mass index of, let's say 22.
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You should be exercising
at least 30 minutes a day.
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You should not be
diabetic. You should not have
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high blood
pressure. And the gender male
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or female they both
are dying of heart disease,
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so we won't say anything
about either one of those.
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The other risk
factor that your physician
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will find out is do
you have a family history
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of coronary artery
disease or premature death
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from coronary artery
disease. So did your father,
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mother, brother or
sister die of a heart attack
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before age 50? That
would put you at risk for a
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coronary event. What do
I mean by coronary event?
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Let's consider the
blood vessels of the heart.
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The blood vessels feed
the heart during the stage
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of diastole when the
heart is relaxing after
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it pumped the blood out
into the major circulation,
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it relaxes and during
that time the coronary
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vessels are fed. The
coronary vessels bring oxygen,
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glucose and nutrients
to the heart muscle enable
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it to continue to pump.
These vessels are fairly
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thin and if you look to
the lining it's very smooth.
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If you can imagine
going down a slide,
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if you go down a slide
and you just slide so freely
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and smoothly that's
the way it should be in the
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coronary vessels, but
imagine if there is dirt
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and debris on that
slide and as you come down
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the slide you
are going to hitch.
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You are gonna stop,
you're not gonna able to go
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through so smoothly
that's the problem with
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coronary artery
disease. The nice smooth vessel
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now becomes irregular and rough.
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We call that
endothelial dysfunction.
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The endothelium
is a thin lining.
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The inner lining of the
blood vessel that allows
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the blood to flow by
smoothly and unimpeded,
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so if you have high
cholesterol and were still
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if you have LDL cholesterol
that's elevated and if it's
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of the type we
called the small dense type
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that's small dense type
likes to go and lying in
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those coronary vessels.
As it lines those vessels
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it damages that nice,
thin, delicate endothelium.
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What is the body
response to that?
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Well, whenever there is an
area of damage in the body,
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the body sends
platelets, little cells,
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little blood cells that
will go and patch up the area.
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We see this when
you cut yourself.
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When you cut yourself
you bleed for little bit
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and you notice
that the bleeding stops
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and that is because
the platelets are coming
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and they are aggregating,
they are clumping together
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to prevent any further bleeding.
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Well, that's what
happens on the inside of the
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coronary vessels. The LDL
or that lethal cholesterol
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causes damage to that
nice thin endothelial lining,
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it becomes oxidized and
then in so doing damages
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the lining and the platelets
come rushing to the area
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to try and wall it off
and prevent any further
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damage. But let's say
that area was called the LAD,
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the left anterior descending
artery that supplies a
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large area of the heart
and we have that kind of
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damage going on or those
platelets will go to that
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area and form a clot
trying to wall off the area,
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but in so doing it
blocks off the entire vessel
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and there is no more
blood flow going to that area
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of the heart muscle,
we call that ischemia.
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If it's completely blocked
off we say that the person
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has a heart attack. There
is death of the myocardium
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or the heart muscle and
the person may die on the spot.
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It is unfortunate
that for some people their
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first symptom of coronary
artery disease is sudden
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death. Other people
have different symptoms
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and we would like to
talk about those symptoms now.
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Symptoms such as chest pain,
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chest pain when you are
running up the flight of
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stairs. Chest pain
when you are coughing,
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chest pain when you are eating,
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what's so common to
nominate of those three
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activities. The heart
is having to work harder,
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it's having to work
harder and if there is an area
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of clot buildup or plaque,
the blood is not gonna be
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able to get through
as well and so it's gonna
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be manifested as
some chest discomfort.
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Sometimes it may be
manifested as discomfort
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in the jaw or it may be
manifested pain in the arm.
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Most people think of the
left arm as the area of pain,
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but I've seen
patients where they presents
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with pain in the right
shoulder or the right arm.
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The point is chest pain
or discomfort, jaw pain,
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arm pain is
occurring with exertion that is
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considered ischemia
until proven otherwise,
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so sudden death, chest
pain can be manifestation
00:12:27.91\00:12:35.82
of coronary artery disease.
So, the signs and symptoms
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we say can be asymptomatic
or they can be symptomatic.
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We want to try and
find people when they are in
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the asymptomatic
stage of coronary artery
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disease or better still
determine what their risk
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factors are before they
even develop heart disease.
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But how we to do
that, we need you to go
00:13:03.39\00:13:06.91
and see your
physician, so your physician can
00:13:06.94\00:13:09.81
access your risk. It
is important to find out
00:13:09.84\00:13:13.57
about your family history
and other lifestyle factors
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and disease factors to
know where you are in risk
00:13:17.94\00:13:22.53
stratification. Once we
know what your risk is then
00:13:22.56\00:13:26.72
we can be
aggressive in your management.
00:13:26.75\00:13:30.95
And so what can we do
to lower your risk for
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heart disease,
coronary artery disease.
00:13:40.56\00:13:44.72
Well, it's the same
story just the different song.
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Recent guidelines
showed that the majority of
00:13:51.30\00:13:56.07
heart disease is
due to tobacco smoking,
00:13:56.10\00:14:00.88
physical
inactivity, and poor diet.
00:14:00.91\00:14:04.66
It's the same story
just the different song.
00:14:06.01\00:14:09.33
Lack of physical
activity, tobacco smoking,
00:14:09.36\00:14:13.53
and poor diet.
Tobacco smoking, if you are a
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smoker and you
quit smoking right now,
00:14:19.48\00:14:23.74
you would decrease
your risk of coronary event
00:14:23.77\00:14:27.86
by at least 50 percent
why? Let's think again about
00:14:27.89\00:14:34.53
that endothelial
lining. That endothelial lining
00:14:34.56\00:14:39.88
when it has the
cholesterol plaque buildup can
00:14:39.91\00:14:45.81
become unstable. Tobacco
smoke contributes to that
00:14:45.84\00:14:53.84
and makes it unstable,
it makes it inflammatory,
00:14:53.87\00:14:57.43
sticky. You've seen,
you cut yourself sometimes
00:14:57.46\00:15:02.33
and you've seen the
blood oozing and then you get
00:15:02.36\00:15:05.73
a crust and is it's all
kind of gooey and sticky
00:15:05.76\00:15:08.54
that's what happens
with endothelial lining.
00:15:08.57\00:15:12.75
The tobacco
smoke makes it sticky.
00:15:12.78\00:15:15.52
The high
cholesterol makes it sticky.
00:15:15.55\00:15:18.36
The diabetic state
with all that sugar floating
00:15:18.39\00:15:22.71
the blood
stream makes it sticky.
00:15:22.74\00:15:25.72
So if you quit smoking
right now and never smoke
00:15:25.75\00:15:30.61
another cigarette
again you will significantly
00:15:30.64\00:15:34.07
decrease your risk
for a coronary event.
00:15:34.10\00:15:37.47
What else can you do? Get
up and move become active.
00:15:39.59\00:15:46.24
The Institute of
Medicine recommends at least
00:15:47.99\00:15:51.71
30 minutes of
moderate intensity exercise,
00:15:51.74\00:15:54.71
optimally up to 60 minutes
on most days of the week.
00:15:54.74\00:16:00.90
And so quit
smoking, start moving.
00:16:02.30\00:16:06.79
Now if you been a couch
potato for the last 10 years
00:16:06.82\00:16:11.48
we do not want you to
jump up and run out there
00:16:11.51\00:16:14.10
and start exercising for
60 minutes. Now if you are
00:16:14.13\00:16:18.88
greater than age 40
it's important that you do go
00:16:20.16\00:16:23.26
to see your physician
as I said earlier assess
00:16:23.29\00:16:25.97
your risk, determine
if you have any symptoms
00:16:26.00\00:16:30.36
of coronary artery
disease, the chest pain,
00:16:30.39\00:16:33.02
the jaw pain, your physician
may then order something
00:16:33.05\00:16:37.20
like a stress
echocardiogram to determine
00:16:37.23\00:16:40.60
if they really put
your heart under stress,
00:16:40.63\00:16:43.05
does it show any
evidence of ischemia.
00:16:43.08\00:16:46.92
But we always want you
to stock low and go slow,
00:16:49.51\00:16:54.02
but do something
everyday, stock low and go slow,
00:16:54.05\00:16:58.93
but do something everyday.
Plan when you will exercise.
00:16:58.96\00:17:02.28
If you to say to
yourself oh I think I should
00:17:02.31\00:17:05.25
exercise 30 to 60
minutes a day and then just
00:17:05.28\00:17:08.69
trying to work it in
somewhere it's probably
00:17:08.72\00:17:11.36
not going to happen.
We want you to look at
00:17:11.39\00:17:14.73
your schedule in the
same way that you plan
00:17:14.76\00:17:17.35
when you are going to
eat and when you go to bed,
00:17:17.38\00:17:20.10
when you're gonna go
to store and do shopping
00:17:20.13\00:17:22.33
we also want you to
plan when you will exercise.
00:17:22.36\00:17:25.50
It takes about 30 days
to build a habit and so it
00:17:26.44\00:17:30.66
will be better if you
spend those exercising for 5
00:17:30.69\00:17:35.22
minutes everyday at the
same time build that habit
00:17:35.25\00:17:41.72
and then thereafter
you may add more minutes
00:17:41.75\00:17:44.87
until you reach your
goal of 30 to 60 minutes.
00:17:44.90\00:17:48.76
So right away, you
can decrease your risk
00:17:50.29\00:17:55.11
for coronary event
by quitting smoking,
00:17:55.14\00:17:57.76
by planning to exercise,
and then improving your
00:17:58.91\00:18:04.61
dietary habits. What all
those dietary habits that
00:18:04.64\00:18:08.84
can be so detrimental
to the coronary vessels.
00:18:08.87\00:18:12.19
Let's talk about
trans fatty acids and
00:18:14.42\00:18:18.03
I'm sure you've heard of those.
00:18:18.06\00:18:19.62
Trans fatty acids,
when you read your labels
00:18:19.65\00:18:23.49
and we hope you
all reading your labels
00:18:23.52\00:18:25.45
when you go to the
store. You don't want to eat
00:18:25.48\00:18:27.64
food blindly unless
you know it's an apple,
00:18:27.67\00:18:30.31
you see this is an
orange, that's pretty safe,
00:18:30.34\00:18:33.36
otherwise, read your
labels so you know what you are
00:18:35.09\00:18:38.01
ingesting into your body.
Trans fatty acids otherwise
00:18:38.04\00:18:43.76
known as
partially hydrogenated oils.
00:18:43.79\00:18:46.93
When you read your
labels, it will say partially
00:18:46.96\00:18:49.58
hydrogenated soybean, corn oil
00:18:49.61\00:18:52.10
or whatever oil that has
been partially hydrogenated.
00:18:52.13\00:18:54.99
It changes the structure
and those trans fatty acids
00:18:55.02\00:18:58.97
when they are
ingested and they get into
00:18:59.00\00:19:02.66
the cell membranes all
over our body including
00:19:02.69\00:19:06.34
the coronary artery
cell membranes they cause
00:19:06.37\00:19:11.50
a distortion that is
more likely to attract those
00:19:11.53\00:19:15.07
clots, those platelets
causing more damage to that
00:19:15.10\00:19:19.81
endothelial lining.
Read your labels, avoid trans
00:19:19.84\00:19:24.01
fatty acids like the
plaque. Where do you find them?
00:19:24.04\00:19:28.06
Cakes, pastries, baked
goods those things that
00:19:29.09\00:19:32.70
can sit in the shelf for
50 years without going bad.
00:19:32.73\00:19:36.70
Those have the partial
hydrogenated fats in them
00:19:36.73\00:19:39.65
and those you want to
avoid. What else in your diet?
00:19:39.68\00:19:43.73
Well, of course,
fruits, vegetables and whole
00:19:43.76\00:19:47.10
grains give
nutrients that cause health
00:19:47.13\00:19:52.22
and regeneration to
the endothelial lining
00:19:52.25\00:19:56.73
and to the coronary vessels.
We want you to eat fruit,
00:19:56.76\00:20:01.25
vegetables, whole grains.
Ideally to be a vegetarian
00:20:01.28\00:20:07.99
you would have less
heart disease than you would
00:20:08.02\00:20:12.17
if you a meat eater.
What is in meat that is so
00:20:12.20\00:20:16.32
damaging to the
vessels not trans fatty acids,
00:20:16.35\00:20:21.33
trans fatty acids we find
them in vegetable products
00:20:21.36\00:20:25.42
and they are
damaging. And meat we find the
00:20:25.45\00:20:29.95
saturated fats that you
find in the stake in the
00:20:29.98\00:20:35.63
marveled meat in the
skin. You know, of chicken,
00:20:35.66\00:20:40.04
these saturated fats
are damaging to the blood
00:20:41.99\00:20:46.72
vessels. The
Institute of Medicine as said,
00:20:46.75\00:20:51.79
there is no safe upper
level of normal for trans
00:20:51.82\00:20:58.45
fatty acids
basically avoid those.
00:20:58.48\00:21:01.60
For saturated fats depending
on your risk assessment,
00:21:01.63\00:21:06.51
if you are at high
risk it may be that you have
00:21:06.54\00:21:09.26
to completely avoid them.
If you are at low risk then
00:21:09.29\00:21:13.48
occasional use, you
know maybe permitted without
00:21:13.51\00:21:16.81
detriment. Ideally
again we want you to be
00:21:16.84\00:21:22.15
or want you to have a
plant based diet, fruits,
00:21:22.18\00:21:28.29
vegetables, whole grains.
So the things that we eat,
00:21:28.32\00:21:34.21
toxins that are
ingested such as caffeinated
00:21:35.85\00:21:41.40
products can
also affect the heart
00:21:41.43\00:21:45.09
and the nutrients. If
your diet consists of chips,
00:21:45.12\00:21:49.98
soda, crispy cream donuts
or that is a vegetarian diet
00:21:50.01\00:21:58.15
and I have to say
it's also plant based,
00:21:58.18\00:22:01.22
but it's not gonna give
you healthy coronary arteries.
00:22:01.25\00:22:05.60
So, we do have to
look at the big picture.
00:22:05.63\00:22:07.97
We have to avoid things
that are bad and include
00:22:08.00\00:22:11.69
things that are
good, fruits, vegetables,
00:22:11.72\00:22:15.39
whole grains. Lean meats
if you are going to eat meat
00:22:15.42\00:22:19.81
depending on
your risk assessment.
00:22:19.84\00:22:22.16
So coronary artery
disease is a marker not only
00:22:24.97\00:22:31.46
for conditions in the
heart, but in other areas
00:22:31.49\00:22:34.35
of the body. You may
suffer from cramping in
00:22:34.38\00:22:38.95
your legs when you
walk that tells you that
00:22:38.98\00:22:42.98
the same process that
maybe going on the heart
00:22:43.01\00:22:45.59
is going on in the
legs. Erectile dysfunction in
00:22:45.62\00:22:51.20
males can also be a marker
for coronary artery disease
00:22:51.23\00:22:56.00
and so if you suffer
from this condition do not
00:22:56.03\00:22:59.20
simply get a medicine
to mask the condition.
00:22:59.23\00:23:02.85
You need to have thorough
cause your vastly workup
00:23:02.88\00:23:06.60
or else you will first
manifestation of coronary
00:23:06.63\00:23:10.41
artery disease maybe
sudden death and that
00:23:10.44\00:23:13.80
would be very unfortunate.
So, we want to implement
00:23:13.83\00:23:18.80
if possible primary
prevention and secondary
00:23:20.17\00:23:24.98
prevention.
Secondary prevention means that
00:23:25.01\00:23:29.22
we want to try and
find the disease when it is
00:23:29.25\00:23:32.70
asymptomatic, we want
to get that coronary artery
00:23:32.73\00:23:35.27
disease before
there is an event.
00:23:35.30\00:23:38.14
Primary prevention
means we want to prevent
00:23:40.40\00:23:44.87
coronary artery disease
occurring in the first place.
00:23:44.90\00:23:48.05
So you can see that
the coronary equivalence
00:23:49.32\00:23:52.62
diabetes and chronic renal
disease already tells us that
00:23:52.65\00:24:00.44
most likely coronary
artery disease is present,
00:24:00.47\00:24:04.06
and so in individuals
like that we have to be very
00:24:04.09\00:24:08.31
aggressive with diet,
with exercise, tobacco smoking.
00:24:08.34\00:24:14.72
We will even look
for markers in the blood
00:24:14.75\00:24:19.71
stream that you can
check with them by getting
00:24:19.74\00:24:23.22
blood drawn looking
for something called cardio
00:24:23.25\00:24:26.26
CRP or C-reactive
protein. That tells us about the
00:24:26.29\00:24:30.87
inflammatory state
of the blood stream.
00:24:30.90\00:24:34.36
So it's not enough just
to know the levels of your
00:24:35.49\00:24:37.93
cholesterol,
although they are important.
00:24:37.96\00:24:40.47
We need to also
know how is your blood
00:24:40.50\00:24:44.52
stream behaving.
Is it inflammatory?
00:24:44.55\00:24:47.86
Is it likely to stick?
And large study have done
00:24:47.89\00:24:53.70
actually in women
show that exercise,
00:24:53.73\00:24:57.77
regular exercise
decrease the C-reactive protein
00:24:57.80\00:25:02.96
to safe levels and so
in my patients as part of
00:25:02.99\00:25:08.59
myocardial risk profile,
not only like a family history
00:25:08.62\00:25:13.77
and a personal social
history about smoking, etc.,
00:25:13.80\00:25:17.60
we will check a
fasting lipid profile and the
00:25:17.63\00:25:21.20
blood glucose but also
we will check their cardio
00:25:21.23\00:25:24.30
CRP as well as the
cardiac homocysteine,
00:25:24.33\00:25:28.28
which is also a marker
not only for coronary disease
00:25:28.31\00:25:31.56
but also for
cerebral vascular disease,
00:25:31.59\00:25:34.74
so we want to look
at a variety of markers
00:25:34.77\00:25:39.39
to assess the risk, once
the risk is assessed that
00:25:39.42\00:25:44.37
will determine just
how aggressive we will be.
00:25:44.40\00:25:48.23
If you are found to be
in the high risk categories,
00:25:48.26\00:25:52.61
aspirin is recommended
to be taken just the baby
00:25:54.56\00:25:57.95
aspirin more is not
better, taken 2 and 3 regular
00:25:57.98\00:26:04.97
aspirins simply increase
your risk for hemorrhagic
00:26:05.00\00:26:08.12
stroke and
gastrointestinal bleeding.
00:26:08.15\00:26:11.30
A simple baby aspirin if
you are at high risk would
00:26:12.37\00:26:16.82
be very useful for
you. If you are at low risk,
00:26:16.85\00:26:20.05
there is no help at
all. Again medicines only
00:26:20.08\00:26:26.03
complement the
lifestyle factors.
00:26:26.06\00:26:28.92
Is the lifestyle
factors that are the foundation
00:26:28.95\00:26:33.29
for the management of
prevention and treatment
00:26:33.32\00:26:37.80
of coronary artery
disease. The recent women health
00:26:37.83\00:26:41.68
initiative study
addressed hormone replacement
00:26:41.71\00:26:44.90
therapy. It was
thought that this was important
00:26:44.93\00:26:47.98
for women to prevent
them having heart disease
00:26:48.01\00:26:50.81
and that is found to be a false
00:26:50.84\00:26:53.38
and in fact
hormone replacement therapy
00:26:53.41\00:26:56.33
may in fact increase
the risk for coronary artery
00:26:56.36\00:27:00.19
disease, so if you are
taking hormone replacement
00:27:00.22\00:27:02.58
therapy to decrease
your risk of coronary artery
00:27:02.61\00:27:04.95
disease that is not
the reason to do that
00:27:04.98\00:27:08.87
and we will suggest that
you go back to your physician
00:27:08.90\00:27:12.56
and have a
discussion about the reasons for
00:27:12.59\00:27:15.62
using hormone
replacement therapy.
00:27:15.65\00:27:18.30
And so what are the
steps for prevention
00:27:19.87\00:27:23.84
and treatment of
coronary artery disease,
00:27:23.87\00:27:26.08
you need to see your
physician so that your risk
00:27:26.11\00:27:29.72
can be assessed using
the global Framingham scale.
00:27:29.75\00:27:33.67
Once your assessment
of your risk has been
00:27:35.76\00:27:39.91
done then we can
implement lifestyle guidelines
00:27:39.94\00:27:44.61
to prevent an event
occurring such as sudden
00:27:44.64\00:27:50.72
death or heart attack.
And so we are truly fearfully
00:27:50.75\00:27:56.79
wonderfully made. The
Lord has made our coronary
00:27:56.82\00:27:59.66
vessels so fine that
there are simple things that
00:27:59.69\00:28:02.77
we can do to keep them
clear. I wish you have all
00:28:02.80\00:28:07.37
the things that you
will prosper and be in
00:28:07.40\00:28:08.81
health even as
your soul prosperous.
00:28:08.84\00:28:12.63