Podcast Summary: TED Health

Episode: "A Healthier You: A Cardiologist's Guide to Protecting Your Heart"

Host: Dr. Shoshana Ungerleiter
Guest: Dr. Danielle Belardo (Preventive Cardiologist)
Date: November 14, 2024

Episode Overview

In this episode, Dr. Shoshana Ungerleiter shares her personal journey monitoring her cholesterol and highlights the often overlooked importance of heart health, even for those who already practice "healthy" habits. She is joined by her own preventive cardiologist, Dr. Danielle Belardo, to address common misconceptions about heart disease, explain risk factors, discuss prevention at all ages, and provide practical advice for protecting your heart. The conversation is accessible, evidence-based, and dispels several widely held myths about cardiovascular well-being.

Key Discussion Points & Insights

1. Personal Story: The Value of Staying Curious About Your Health

• Host’s Experience (01:32):
  • Dr. Ungerleider’s LDL ("bad" cholesterol) crept upward despite healthy habits.
  • After diet modifications (high fiber, low saturated fat), her LDL drops significantly.
  • Key lesson: Even with good habits, small tweaks can make a big difference.
  • Quote:
    • "It’s easy to assume that if you’re eating relatively healthy and staying active that you’ve done all you can. But sometimes the smallest tweaks can have the biggest impact." (03:02, Dr. Ungerleider)

2. Heart Disease: Not Just an Old Person’s Problem

• Early Onset and Lifelong Process (05:13):
  • Dr. Belardo explains that heart disease begins developing in childhood.
  • Plaque can be found in arteries of young people—even children—long before symptoms.
  • Quote:
    • "Heart disease is a lifelong process. You know, it is the number one cause of death for men and women." (05:42, Dr. Belardo)

3. When Should You Start Preventing Heart Disease?

• Primordial vs. Primary Prevention (06:39):
  • Prevention ideally starts in childhood with healthy lifestyle choices.
  • However, it's never too late to take action; interventions benefit everyone, regardless of age.
  • Two main strategies:
    • Primary prevention: Preventing the first event (heart attack or stroke)
    • Secondary prevention: Preventing further events after an incident
  • Quote:
    • "It’s never too late, and it’s also never too early to get in with your doctor and start talking about those risk factors." (07:46, Dr. Belardo)

4. How Plaque Develops Inside the Body

• Biology of Plaque Buildup (08:05):
  • LDL cholesterol is the main ingredient; a single-cell "endothelium" protects the artery wall.
  • Factors like smoking, high blood pressure, and diabetes weaken this wall, enabling cholesterol to enter artery linings.
  • Controlling these risk factors is vital even if "only" your LDL is high.
  • Family history and specific female factors (e.g., preeclampsia) are also important.

5. Understanding “Normal” Readings – Are They Good Enough?

• Importance of Individualized Targets (10:37):
  • Population-based "normal" does not equal "optimal" for every individual.
  • Guidelines:
    • Blood pressure: Stage 1 = >130/80; Stage 2 = >140/90
    • LDL cholesterol (primary prevention): Target <100 mg/dL, but "the lower the better".
    • Subclinical atherosclerosis and high calcium scores may demand more aggressive LDL lowering.
  • Quote:
    • "No two patients are going to be identical... evidence-based medicine... has to apply to the patient sitting in front of you." (13:29, Dr. Belardo)

6. Silent Nature of Heart Disease

• Symptoms Often Absent (13:44):
  • 50% find out they have heart disease only when they have their first heart attack.
  • Small plaque can rupture and cause catastrophic events—prevention must predate symptoms.
  • Quote:
    • "Our goal is to put [interventional cardiologists] out of business... because [heart disease] is so preventable." (14:41, Dr. Belardo)

7. Key Questions for Your Doctor

• How to Be Proactive (16:22):
  • Don’t hesitate to ask for referrals to preventive cardiologists.
  • Use resources like the American College of Cardiology’s free, accessible guidelines.
  • Self-monitoring and checklist-based care are encouraged, and primary care doctors are generally supportive.

8. Lifestyle—What Really Matters?

• Fad Diets & Real Advice (19:02):
  • Widespread confusion exists around diet; the evidence is clear:
    • High-fiber plant foods, vegetables, fruits, whole grains, legumes, lean protein, and fatty fish are beneficial.
    • Both food and medication may be needed depending on individual biology.
  • Newer medications (e.g., GLP-1 receptor agonists) help those who struggle with weight/metabolism—it's not about willpower.
  • Quote:
    • "A lot of it has to do with the way these hormones work in our brain. And now we have new medications... that can help. It has nothing to do with willpower." (20:46, Dr. Belardo)

9. Risk Calculators and Better Screening Tools

• Limits and New Frontiers (21:35):
  • 10-year risk calculators are a helpful starting point but miss many individual factors (family history, pregnancy history, autoimmune disease).
  • Calcium score imaging and genetic testing add nuance but aren't right for everyone.

10. What Everyone Should Know

• Simple, Powerful Takeaway (23:34):
  • Heart disease is highly preventable; know your numbers and take action early—and revisit regularly.
  • Screen for cholesterol, blood sugar (A1c), and blood pressure in your 20s and keep monitoring as you age.
  • Get referred to a preventive cardiologist if you notice unhealthy trends.
  • Quote:
    • "We can treat and mitigate all of those different risk factors with a variety of tools in the toolbox, as you so brilliantly mentioned." (24:10, Dr. Belardo)

11. How to Find a Preventive Cardiologist

• Navigating the System (24:30):
  • Search for "non-invasive" or "general" cardiologists, as "preventive" is not always a formal specialty.
  • These doctors typically focus on prevention, risk reduction, and lipid management.

Notable Quotes & Memorable Moments

• On the importance of early action:

  • "It is the number one cause of death for men and women. And so changing that mindset that, you know, it’s only something that affects older people will really change the trajectory of prevention in general." (05:42, Dr. Belardo)

• On dietary confusion:

  • "The biggest misconception is... diet doesn’t matter at all... That’s not correct. And then... diet can fix everything and you just need to be on X, Y or Z diet and that's all you need. That’s also not correct. The truth is somewhere in between." (19:18, Dr. Belardo)

• On prevention’s power:

  • "Our goal is to put [interventional cardiologists] out of business... because it’s so preventable." (14:41, Dr. Belardo)

Timestamps for Important Segments

• [01:32] – Host’s personal health story and cholesterol findings
• [05:13] – Why heart disease starts early, not just in the elderly
• [06:39] – Primordial prevention and action at any age
• [08:05] – How plaques build up and why risk factors matter
• [10:37] – Population normal vs. personal optimal
• [13:44] – The silent danger: why lack of symptoms can be deceptive
• [16:22] – What questions to ask your doctor about your heart health
• [19:02] – Real-life advice on diet, lifestyle, and medications
• [21:35] – Tools for calculating and predicting personal risk
• [23:34] – Essential advice for everyone and the importance of monitoring
• [24:30] – Tips for finding the right heart doctor

Final Takeaways

• Heart disease develops over a lifetime; prevention should start early but it's never too late.
• Knowing your cholesterol, blood sugar, and blood pressure (and family history) is essential.
• Dietary tweaks matter—even for the already "healthy."
• Individual risk profiles vary; use guidelines and calculators as starting points.
• Don’t hesitate to ask questions or seek specialist care—a collaborative, informed approach saves lives.
• Prevention requires both lifestyle and, if needed, medical interventions—a message of hope and empowerment.

For Further Information:

• Visit the American College of Cardiology Guidelines for free, patient-friendly resources and infographics.
• Consider looking for non-invasive or general cardiologists with a focus on prevention if you’d like more specialized support.
• Connect with Dr. Shoshana Ungerleider on Instagram @shoshanamd for more content.