← The Neuro Experience
The Neuro Experience
Why Most Women Are Taking Heart Medications Wrong - And Dying From It | Dr. Jayne Morgan
01:10:13
Loading summary
Transcript235 lines
- [00:00]
Dr. Jane Morgan
We've been killing women. In helping women, we've been killing them. We know now for every 10 millimeters of mercury that your blood pressure is increased, your risk of heart disease goes up by 20%. Beta blockers actually harm women, and if you give them to women after the first heart attack, they're more likely to have a second heart attack. Dr. Jane Morgan is a board certified cardiologist and vice president of medical affairs at hello Heart. She's exposing the deadly gender bias in medicine that's been hiding in plain sight for decades. Women aren't included in clinical trials. We have an entire industry that has developed based on data on men to the detriment of women.
- [00:41]
Louise Nicola
Blood pressure is one of the risk factors for cognitive Decline. Even at 130, you can start to kill off the tiny little capillaries in the brain.
- [00:50]
Dr. Jane Morgan
We need to understand that heart disease is the number one killer. Get your blood pressure down to 120 over 80 or less and be serious about it.
- [00:58]
Louise Nicola
What does a woman have to do to prevent her risk of getting cardiovascular disease? I'm Louise Nicola and this is the neuro experience. Dr. Jay Morgan, welcome to the podcast.
- [01:10]
Dr. Jane Morgan
Thank you. I love being here.
- [01:12]
Louise Nicola
Well, so I, let's, let's first start. You're a cardiologist, so what does that mean?
- [01:16]
Dr. Jane Morgan
Yeah, what does a cardiologist mean? So a cardiologist is, is a physician that specializes in the organ that's in your chest, which is the heart. And the heart is really interesting because it's the only striated organ. So it's the only, the only organ that is an actual muscle. It has striated muscles, meaning the fibers slide in and out the same as your arms, the same as your legs. The rest of our organs are smooth muscle, but the heart is actually striated muscles. That's why when we talk about exercise, we talk about things that impact our bodies, but what we're doing with our bodies is also going to impact our heart because the heart is also striated muscle. So I work on that heart. That muscle that's in your chest, inside, that you're not thinking about.
- [02:04]
Sponsor/Ad Voice
Yeah.
- [02:05]
Louise Nicola
And so the reason why I wanted you to come on the podcast, we've just spent a weekend together here in la and I absolutely fell in love with your talk. And it was, you know, we don't often think of the heart and the brain as sex differences. Right. I mean, so when do. I don't know when you trained. But when you first trained and when you went to medical school, did you learn that there was Sex differences between these organs?
- [02:28]
Dr. Jane Morgan
No, absolutely not. Everything was gender neutral. And what I didn't know then is that gender neutral means men biased. So there really was no gender neutral. So we were learning everything based on information that was coming from data from men, and then we were applying it to women. Not only women. We were applying it really to all populations. I did not know that. And most physicians don't. We don't think about where the information is coming from. Our job is to know the information, manage the information, apply the information. We don't necessarily know where it's coming. How did it get started? Who thought up the trial? What drug company was doing it? You know, how was this vetted? Never, never really think about that. We don't necessarily come into the equation until the FDA has approved the device or drug. Now it's on our radar. If it doesn't get approved, we're not thinking about it because we're on the other side of medicine, the practical application. So it's not something that we really think about. And it was only later, when I started doing more and more research, started getting more and more involved in clinical trials, that I started to say, huh, there's something wrong here that I've never thought about. When you pull back the curtain, there's a whole process that's happening before the doctors get these medications. Yeah, we don't think about that. That's not our job. We don't see that as our job. Our job. There's so much to learn.
- [03:58]
Louise Nicola
Yeah.
- [03:58]
Dr. Jane Morgan
As a doctor, our job is to know the medications, assume that the FDA has vetted them and know the side effects, know the indications, know who to give them to. That's it. Not how they arrived at those decisions.
- [04:12]
Louise Nicola
What's a. What's a classic example of this?
- [04:16]
Dr. Jane Morgan
So the most recent example probably is beta blockers, which is sort of the biggest glaring example that has me just so angry, because I know there are others like that. And so when we talk about beta blockers, beta blockers are not one drug. It's a class of drugs. This is a big class of drugs. So there are many of them in there. They usually end with something called oils, like metoprolol, propranolol. These are beta blockers. Old drugs. They've been around for a few decades. They've been studied and studied. We feel so good about these. They've got to be safe. They've been studied for so long. But who are they studied on? And so how do we give them?
- [04:59]
Louise Nicola
Well, first of all, what are they? What are they.
- [05:01]
Dr. Jane Morgan
So beta blockers are a class of medications that we give to patients. And when we talk about what are these medications we give them, the indication is for people who have had heart attacks. And we give beta blockers, which also can lower your blood pressure to prevent a second heart attack. So it helps you. Helps the heart relax and prevent a second heart attack. So many people who suffered heart attacks will be prescribed beta blockers to help protect their heart and keep them strong and keep them from going into a second event. When I was in Madrid in August at the European Society of Cardiology Conference, 30,000 cardiologists showed up, really the biggest conferences, really in the world for cardiologists. And I went to listen to this new data that was coming out on beta blockers. And women, really, just to hear the data, didn't know what I was getting ready to hear, just blew me away. But not surprising. The summation of the lecture is that when they decided to actually take a look at beta blockers and really do studies and look at women, and not just 70 kilogram men, it turns out that beta blockers actually harm women. And if you give them to women after the first heart attack, they're more likely to have a second heart attack, they're more likely to have an incidence of heart failure, they're more likely to be hospitalized, and they're more likely to die.
- [06:36]
Louise Nicola
So you only found this out in August of 2020?
- [06:38]
Dr. Jane Morgan
Just in August. And just to make this even scarier, it takes a long time for all of this information to go out. Just because I was just at a big academic conference, this didn't show up in everyone's practice. It takes a while for that information to be propagated and for physicians to learn. Many physicians are not at big academic practices. They get their CMEs online, they do other things. And so we've, we've gotten better at how that information gets moved forward. But sometimes it takes up to five to 10 years for the information to completely infiltrate a specialty stands within the academics. Now, for me, this was a big headline. I've certainly been shouting it from the rooftops. I think others have as well. I think social media helps to get that information out. But the fact of the matter is we've been killing women in helping women. We've been killing them. And surely there are other medications and devices where we've done the same thing. Because women aren't included in clinical trials. That's not something that doctors think about. We don't think about where the medicine comes from. It's Sort of like at the grocery store, you're there shopping, you don't think about, was this sourced ethically in India? Did I, you know, where is it coming from? You're just picking up, oh, is this an orange that I want to have? Is this an apple that I want to have? You. We aren't trained to think about what is the process of getting the food to the market for us to choose. That's how medicines are. We are the supermarket doctors are the supermarket. We have the medicines once they arrive. Yeah, from the fda. Now we pick and we know how to manage them and what their interactions are, but we've got to start looking behind that.
- [08:33]
Louise Nicola
And you're also told how to prescribe dosages.
- [08:37]
Dr. Jane Morgan
That's right, yeah. That's our job.
- [08:38]
Louise Nicola
That's your job.
- [08:39]
Dr. Jane Morgan
That's our job to know. Not to make the medicines, to manage them and prescribe them and to make certain we know everything about them. But it means that we've missed a whole big section of how did the medicines even get here? We don't think about that.
- [08:56]
Louise Nicola
Because you have put trust in the fda.
- [09:01]
Dr. Jane Morgan
Right? Right. In the FDA and in the clinical trial process, it's just that whole process is almost invisible. We just see the drugs once they're available. Our job is to know how the drugs work, to know how they're prescribed, to know the indications, to know the side effects, to know who to give them to based on the data that they are giving us. We never asked, well, how did get this data? Right.
- [09:25]
Louise Nicola
Okay, well, we've got so much to talk about in such little time. I really want to talk first and foremost about obviously cardiovascular disease, number one killer. But there is a difference between. I really need to get down to the bottom of the difference between male hearts and female hearts. And I heard you say on stage that female hearts are smaller. Okay. And they've got estrogen receptors on the vessels, on the blood vessels, but I don't know anything more than that. So let's talk about, like, the anatomy of the heart.
- [09:57]
Dr. Jane Morgan
Let's talk about the anatomy of the heart.
- [09:58]
Sponsor/Ad Voice
I love it.
- [09:59]
Dr. Jane Morgan
So the anatomy, I was going to say it's the same. It's not the same. I would say the anatomy is similar, but female hearts in general are smaller. Not only is the structure of the heart smaller, the vessels are smaller. Like the aorta arteries are smaller, they're smaller. So that's one of the reasons why our symptoms of a heart attack are often not the same as a man's symptoms, because we have smaller Vessels. So here's how I will start with symptoms. When we talk about symptoms, men can have this crushing chest pain and chest pressure. Why? Because they can have sudden blockages. They can have sudden blockages because they tend to have large plaques that we can see in the arteries, and it just obstructs the blood flow, which means it blocks the oxygen. And they have these symptoms of chest pain. A woman actually develops plaques differently. Sometimes we develop plaques, small ones, that just stud the arteries. It's not one big thing that gives you that sudden. That sudden. Those sudden symptoms is many plaque, small ones that sort of stud the arteries. And so the blood can still get through. It's just kind of meandering.
- [11:12]
Sponsor/Ad Voice
Right.
- [11:13]
Dr. Jane Morgan
But it can get through. Sort of like a little bit more of an obstacle course, but it can get through. And unless you're really pushing yourself or it starts to be more severe, you don't get the chest. The crushing chest pain. You get the symptoms of oxygen deprivation, of slow movement. So you start to feel tired. You don't get a sudden blockage, so you get the chest pain. So you're feeling kind of run down. You're getting weird symptoms like in your abdomen and nausea and that type of thing. That's because of the small vessels. And women can also have microvascular disease, meaning we have lots of small vessels, and the disease can be in those small vessels. And that's not picked up on our cardiac cast because they look at the big arteries that, you know, because that's where the men are focused. So there's so much there, and we're starting to just peel that back. And so women telling you they don't feel well, it's true, they're not feeling well. They may have arterial plaques that are not picked up with our conventional therapy. They might have microvascular disease. More likely to have microvascular disease in these tiny, tiny, tiny vessels and then have symptoms that are very, very different. That's why primary care physicians, in a recent survey, most of them said they weren't comfortable treating women with heart disease. And then cardiologists, there was a large number of them, at least 40% said they weren't even comfortable. And that's literally what we do. But we're not. We're not trained on that. We're trained on what we call the main thing. And the main thing is always the symptoms of men.
- [12:49]
Louise Nicola
Yes.
- [12:49]
Dr. Jane Morgan
But, you know, as, you know, women are the majority of the population, so we're actually the main thing.
- [12:55]
Louise Nicola
We are the main thing. And why do you think it's so hard to study?
- [12:59]
Dr. Jane Morgan
Well, so it goes back to the 60s, if I say the 1960s, which still relatively young in the, you know, the history of humanity. But women in a trial were given a drug called thalidomide. T H A L I D O M I D Thalidomide. And thalidomide later caused birth defects in these women's children. They had arm and limb defects after that.
- [13:29]
Louise Nicola
What were they? What, why? What was the indication of giving this?
- [13:32]
Dr. Jane Morgan
Well, I don't remember the indication for thalidomide at the time. Yeah, but they were given this medication, their children had limb defects. And after that, all of research included for women was shut down, just shut down to protect women for our own good. And that's a great example of kind of a knee jerk reaction. Something went wrong, something terribly went wrong. These children were, were impacted without limbs. But it doesn't mean that everything had to be dialed back. So after that, no more women were in trials. So we go another 30 years. Only men are in trials. They do the Women's Health Initiative. It's not, this is not a trial of including women in trials. This is a trial of women and they want to look at some things. And then that, that trial ended up with negative results and it just ended up overstating results on cancer showing that hormones increase the risk of breast cancer, which was not true, and increased the risk of heart disease, which was not true. And they had the wrong population for the wrong indication and the wrong age group and on and on and on and on. But that just made big headlines. And after that, then hormones were removed from the market and got a black box warning. So women just were kind of toast after that. We're just done. Not in clinical trials, right?
- [14:50]
Louise Nicola
Yeah.
- [14:52]
Dr. Jane Morgan
And so what has happened is we have an entire industry that has developed based on data on men to the detriment of women. I think this trial and beta blockers in, in August, that's mind blowing. Is just the tip of the iceberg.
- [15:12]
Sponsor/Ad Voice
One thing I talk a lot about with athletes and executives is that longevity.
- [15:17]
Louise Nicola
Isn'T just about what you add.
- [15:19]
Sponsor/Ad Voice
It's about what your and clear. Oxidative stress, inflammation, environmental toxins, those things quietly tax the brain over time. That's why I use ROW nutrition. Specifically I use their liposomal glutathione. If you haven't heard, glutathione is your body's master antioxidant. It's what your cells use to neutralize free radicals. And this is what supports detox Pathways and really it helps to protect your mitochondrial health. And this one specifically directly impacts cognition, energy and how you age. The liposomal product that I use from RO actually gets absorbed. So you feel like it's working instead of just taking a glutathione supplement. This is one of the few supplements I take that supports resilience at the cellular level. If you want to try this, you can get 20% off with code neuro@rownutrition.com neuro, that is code neuro for 20% off@rownutrition.com.
- [16:23]
Louise Nicola
So why does it cause maybe another heart related event or increased risk of a heart related event for women and not men?
- [16:32]
Dr. Jane Morgan
Yeah, and I think that's what they are surprised about. That's what they need to find out.
- [16:36]
Louise Nicola
Okay, so we don't know why yet.
- [16:37]
Dr. Jane Morgan
Well, I think we are understanding that women have microvascular disease that's not being detected and not being addressed, that there are parts of their cardiac anatomy that are somewhat different that we need to think about, that they develop heart disease a little bit differently. So these all classes of drugs then don't act the same on all women. And then when we talk about hormonal fluctuations and variations and not just menopause, premenopause as well, none of those things are ever taken into consideration. Never.
- [17:09]
Louise Nicola
I, interestingly, I had my first mammogram. Okay. A bit younger. I don't know what the general age is to have it, but so I had mine and it came back clear. But when I was getting it assessed by Corinne, she's an ob gyn and one of my friends, she's like, oh good, and you've got no, no heart disease. Or she said something about the calcification. I said, well, how do you know that? From my mammogram. She goes, oh yes, but people aren't. Doctors aren't telling us about that.
- [17:39]
Dr. Jane Morgan
And that's Right.
- [17:39]
Louise Nicola
And can you tell me a bit more about that?
- [17:41]
Dr. Jane Morgan
Yeah. So we don't read calcifications on mammograms because it's not relevant to the breast.
- [17:50]
Louise Nicola
But that's interesting. So you're talking about the arteries around the breast, right? Yeah.
- [17:54]
Dr. Jane Morgan
So, you know, so when we look doing mammograms, they're looking for lesions and cancer and masses and then those other things are just kind of like artifacts. This has nothing to do with the main thing. We are trying to prevent breast cancer. This is what we're looking for. All that other stuff is noise, background noise, artifacts. But the fact of the Matter is those calcifications, while maybe not as relevant to the breast, are an indicator of what might be happening in the heart. And so sometimes, if you have calcifications in the breast, have calcifications in your heart as well, because these are still all of the arteries. So we really are trying to push radiologists to not dismiss these calcifications because they are irrelevant to the objective of the mammogram, but to call them out and put them in the official reading such that we can say, aha, her mammogram is free of cancer, but she has calcifications. Let's refer her on to a cardiologist for further workup. So you see how we need to all hold hands and hand the patient off, as opposed to having on blinders. Like, that part's not me. That part's not me. This is what I'm supposed to do. Yeah. So calcifications aren't even read on mammograms. I mean, they're just, they're considered artifacts. Incidental, you know, they're always things. Not always, but radiologists are trained to read things that come in to detract you from the main thing. Like, I'm making this up, really simplifying. Someone had a button on their jacket and, you know, a corner of the button shows up on the extra. You know, you need to make certain you can not see that or ignore that and not consider that part of the diagnosis. So little things that may come up, shadows and something. Usually we have the patient disrobed for that reason. So we don't have jewelry and buttons and weird things show up on the X ray that make it hard to read. But yeah, micro calcifications are considered artifacts because they. On the mammogram, we were looking for lesions and things that make us suspicious of breast cancer. Yeah. But the calcifications are indication of heart, not heart disease, but perhaps an increased heart risk. Yeah.
- [20:14]
Louise Nicola
And you can start an intervention to prevent that.
- [20:16]
Dr. Jane Morgan
That's right.
- [20:17]
Louise Nicola
Yeah. And I heard a statistic which was wild, that a, at the onset of menopause, a woman's risk of having a heart related event triples.
- [20:27]
Dr. Jane Morgan
Yeah. Doubles or triples. It certainly does.
- [20:29]
Louise Nicola
And does that have to do with estrogen?
- [20:32]
Dr. Jane Morgan
It does. Okay. Yeah, it does. And you talked about that earlier when we, when we came in. Because estrogen receptors are not just in our reproductive organs. They're not just in our breast and our uterus and our vagina. We have them in our heart. We have them in our brain, right. And we have them in our arteries. So as your estrogen declines, it's not that you lose receptors, but you lose binding. You don't have as much estrogen binding to those receptors. So estrogen is a direct cardio protective agent to the heart, directly protects the heart, but it's also an anti inflammatory agent for the body. And it's inflammation that also drives atherosclerosis. And then estrogen receptors are on all those arteries, all those important arteries both inside the heart and in the body. And without estrogen binding to those receptors, we have less compliance, meaning that the vessels are less able to expand and contract. That's how we control blood pressure, because they're able to relax, kind of like a rubber band, and then become stiff again and relax and stand and respond to exercise and stress and those kinds of things. So when you lose estrogen, we lose that ability to expand and your arteries become increasingly more rigid. They're staying more in sort of that upright pole position. And that's why you see your blood pressure going up, because the arteries now have lost their ability without the estrogen to relax and increase and manage that blood pressure.
- [22:03]
Louise Nicola
That is so interesting because I wanted to ask you about blood pressure, because have you seen the Sprint trial on blood? Of course, you know, and blood pressure is one of the risk factors for cognitive decline, because what it can do, even at a certain, I think in the Sprint trial it stated 130 systolic, which we know the gold standard is 120 over 80. Even at 130, you can start to kill off the tiny little capillaries in the brain which are delivering blood and oxygen to these neurons. So that's incredibly important to know. And blood pressure, I mean, how many people are hypertensive? How many people are on ACE inhibitors?
- [22:41]
Dr. Jane Morgan
You want to know how many? 62% of people have blood pressure or high cholesterol and are not being treated or not being treated to goal. That's in the U.S. it's a huge.
- [22:50]
Louise Nicola
Number, not women, both men and women.
- [22:52]
Dr. Jane Morgan
Men and women people. And we do a very poor job of sort of socializing that. Hypertension will be a primary driver of heart disease and brain disease. And so by treating blood pressure, you can protect your heart and your brain and bringing it down. And 130, you know, it used to be when talk about systolic of 1/3, it used to be we would tolerate a blood pressure of 130, you know, not bad. But the fact of the matter is, we know now for every 10 millimeters of mercury that your blood pressure's increased. Your risk of heart disease goes up by 20%.
- [23:33]
Louise Nicola
So your heart. So at 130, you're 20% increased risk.
- [23:39]
Dr. Jane Morgan
That's right.
- [23:39]
Louise Nicola
Oh, my gosh.
- [23:39]
Dr. Jane Morgan
That's right. That's right. And imagine if you're at 140 now, you have 40% increased risk of heart disease. And your increased risk of heart disease means increased risk of dementia. So now we know in our hypertensive guidelines from the American heart association that came out in August, we want our blood pressure. They didn't even say 120 over 80. They said less than 120 over 80, less than, less than. So we need you at like 119.999, you know, because, you know, I think they made a point to say that because Doctors would say 122, 123, good enough. But they want to emphasize how important blood pressure is.
- [24:20]
Sponsor/Ad Voice
One of the most fascinating things that I have come across over the last 12 months is the use of exogenous ketones. Your brain uses ketones more effectively than what it does glucose. Now, the glucose is the primary fuel source of the brain, but it doesn't use it as well as what it uses with ketones. Now, it's so hard to get into a ketogenic state. So I take exogenous ketones. I use ketone iq. And this is because it delivers the most efficient fuel to my brain. And this is the best thing I can do when I'm traveling long hours and when I'm working so many hours during the day, I use it for recording days, travel days, whenever I want my brain to stay sharp for long periods of time. If you've been wanting to try exogenous ketones, you don't know which one tri ketone IQ, just go to ketone.com neuro to get 30% off your subscription. And if you do sign up using this code, you'll get a free gift with your second shipment. That is ketone.com neuro for 30% off.
- [25:27]
Louise Nicola
I got a blood pressure cuff for my parents, okay? And what I do is they've got a book at home and they've got the dates on one axis and the blood pressure there. And I get them to do dots, okay, where my father is, because he had. He had a stroke in 2019. And we track him due to afib, okay, untreated afib. And so we track it over time and we can see. And I said to my parents, you know, give me a call if you see A little line going upwards, you know, over time. And sometimes they can read it wrong. I saw that, I went to Australia and I said, how are you measuring my, you know, he's got his legs crossed. He's like, his doing this. And I was like, let's just, let's go back to basics. And so it can be a really great way because it's, it's effective if you've got blood pressure monitor at home. It's inexpensive and it just takes five minutes.
- [26:13]
Dr. Jane Morgan
It is. And you know, you're speaking my language. You know, I, I am the vice president of medical affairs for hello Hearts, a digital heart health AI company where we are looking to really bend the arc on cardiovascular disease. And, you know, we have a slate of services that we offer, but at its core is a home blood pressure monitor, Bluetooth enabled, and it connects to your phone and it drives that information. So instead of your father having to write down all of those points, as soon as you take your blood pressure, it just goes directly into the app.
- [26:51]
Louise Nicola
Oh, wow.
- [26:51]
Dr. Jane Morgan
And it just draws the graph for you. So you can just see, see the graph.
- [26:54]
Louise Nicola
Oh, gosh, we need to get one of those.
- [26:56]
Dr. Jane Morgan
Yeah. Amazing. And you can send it to whoever you want. So then they can send it to you in Australia or wherever you are. They just hit the button and send it to you.
- [27:04]
Louise Nicola
Yeah.
- [27:05]
Dr. Jane Morgan
And a text message. You can see how your father is just kind of whatever he's doing. The other thing about blood pressure monitors that doctors are starting to realize is that when patients come into the office and get your blood pressure checked independent of white coat syndrome, just a patient even who does not have white coat syndrome. And white coat syndrome means that when you come into the doctor's office, you're really anxious and nervous and so your blood pressure is up because you're worried about your doctor's visit. So that's white coat syndrome. So I'm saying even patients who don't have white coat syndrome, we are realizing it's kind of like checking your hormones in perimenopause. If you come in and get your hormones checked the same as getting your blood pressure checked, it's just that snapshot in time.
- [27:44]
Louise Nicola
Exactly.
- [27:45]
Dr. Jane Morgan
It doesn't really tell us what's happening to you out in the real world. It just tells us where you were at 11:00am on a Wednesday day. And so we now realize that home blood pressure monitoring is really the information and the data that we can get on patients where they live, work and play and then have that information transmitted either into our electronic medical records, which is what we do at hello Heart. So everybody can just, you know, everybody who's managing that patient can see those trends or you can keep the, the, the information private. And like your dad, just. I don't want my doctor to see it. I just want my daughter to see it because she's going to help me. So whoever it is. And it gives you, you know, back to hello Heart encouragement and coaching and, you know, confetti if you are doing well. And also teaches you how certain types of things are actually impacting you. So. Hello, Louisa's dad. Yes, hello, Louise's dad. We see that you've been walking a little bit more in the last week. Well, look at what happens. We'll overlay the graphs, look at what happens as you've been walking more, look at what's happening to your blood pressure. And then we'll overlay the graphs on your.
- [29:00]
Louise Nicola
Oh, that is.
- [29:00]
Dr. Jane Morgan
And show you how. And now he's like, oh, my walking. Had my blood pressure go down. Or Louisa's dad, I see that you started taking your medications, your ACE inhibitors or whatever you're taking. And look at what's happened as you've taken your ACE inhibitors each day. Look at how your blood will overlay the graphs and show how your medication adherence is helping you. Now people are starting to connect how their behavior actually impacts their health. I didn't know walking, but they can improve my blood pressure. But they show you objective information and it's so helpful.
- [29:35]
Louise Nicola
Dopamine release, motivation.
- [29:36]
Dr. Jane Morgan
Because that's right. And now people are like, oh, oh, I can impact this. Look at what's happened. I'm gonna walk for another 10 minutes tomorrow. I can't wait to see what my app is saying.
- [29:47]
Louise Nicola
Yeah, what is the, what's the mechanism there of exercise and blood pressure? Because we hear that one of the best ways to maintain a healthy blood pressure is by getting fitter and exercising and possibly walking. But what is that? Is it just the sheer force of blood flow?
- [30:02]
Dr. Jane Morgan
Yeah. So it's not just the blood flow. It's the, the ability of the arteries to adapt and continue to move in that movement as you're, as you're making blood and oxygen go through those arteries, the ability for them to adapt and stay healthy. So what we don't want is for atherosclerosis and plaque. Those are like fatty deposits to build up on there. So the more that you can exercise, the healthier you are. And something to think about when we think about that is remember the heart is is a muscle just like the rest of your body. So you're actually making your muscles stronger. That means your heart is getting stronger.
- [30:45]
Louise Nicola
Yeah.
- [30:46]
Dr. Jane Morgan
And so that's how you're managing and keeping that blood pressure down.
- [30:50]
Louise Nicola
And so when the heart is stronger, it's better able to overcome an infarct or you know, something that may occur.
- [30:58]
Dr. Jane Morgan
Yeah, it's, it's not necessarily better able to overcome, but yes, there's more reserve.
- [31:04]
Louise Nicola
Yes.
- [31:05]
Dr. Jane Morgan
But it's practicing prevention, Prevention, preventing something from happening.
- [31:10]
Louise Nicola
There's a like one of my favorite studies and it combines exercise and cardiology, was by a sports cardiologist. His name is Dr. Ben Levine. Have you seen this study? So what he did was he took a group of 50 year olds and he did everything on echoes. He did everything to look at this structure of the heart. And he put them on this protocol of putting them through like zone four to five exercise. Okay. Which is high. You're working at around 90 of your maximum heart rate for two years. And he tracked them and monitored them. And then at the end of the trial, at the end of two years, and this was four days a week.
- [31:48]
Sponsor/Ad Voice
Right.
- [31:48]
Louise Nicola
He took all the same scans that he did and he found that he reversed the age related events by up to 20 years. So these 50 year olds had 30 year old hearts. And when he looked into the mechanism, what he saw was that he helped the, with left ventricular hypertrophy. Because as you age your left ventricle gets thicker, I believe like the, the, the muscle around it. And as a result it doesn't get as much blood, blood flow that goes in there. And he was able to minimize that. So over that period, just from exercise alone, he was able to improve left ventricular hypertrophy. Therefore there was more blood that's being able to get pumped in there, go out to the body. And it also resulted in a lower resting heart rate. It was a beautiful randomized control trial study.
- [32:42]
Dr. Jane Morgan
Yeah, sounds like a great study. And that, and that tracks right along with pathophysiology of how the heart works and how the left ventricle. So the left side of the heart is where you're getting most of the force of the contraction of the, of the oxygenated blood going out to the rest of the body. So yeah, it sounds like a great study. I'll have to read that one.
- [33:03]
Sponsor/Ad Voice
The new year always comes with big intentions. Better focus, better habits, better energy. But consistency is where most people fall off. This is why I like IQ bar their bars, hydration mixes and mushroom coffees. Are built around brain and body fuel because they're low sugar clean ingredients and nutrients that actually support cognition like magnesium and lion's mane. So I keep IQ Bars in my bag for long days. I actually use IQ Mix. I do this after my workouts. So if you guys are struggling and you're working a lot and you're outside of the house and you want to something that delivers clean, natural energy with nutrition in the form of a bar and that is supporting your brain throughout the day, not just in one moment, you need to try IQ Bar. Right now, IQ Bar is offering 20% off all of their products plus shipping. And guess what? All you have to do is text neuro to 64000. Again, text neuro n e u r o to 64000.
- [34:17]
Louise Nicola
Really want to talk about statins?
- [34:18]
Dr. Jane Morgan
Okay.
- [34:19]
Louise Nicola
Okay. So for a reason. Because there was a landmark study that came out that actually showed, and this is correlation to the brain showing that statins increase your risk of dementia. Right. And this is when we got this whole. I didn't know about it, but I didn't know that people were, were scared of statins. And I didn't know that it was political. Statins for some reason are political. I'm not sure why. And so we had so many people refuse statins even though they were indicated to be on a statin because of either LDL or apob. And here we are increasing their risk of dementia because they have been scared out of it because of a flawed study. It's now been retracted, and we're now seeing that statins can actually decrease your risk of dementia by up to 20% and another trial showing up to 30%. There's various types of statins, PCSK9 inhibitors. You know, we've got so many different types of statins. I, I believe if you have, you know, a high, you know, a high cholesterol panel and you need statins, it's not bad for you.
- [35:23]
Dr. Jane Morgan
No.
- [35:23]
Louise Nicola
Are you. So what's the controversy around statins?
- [35:26]
Dr. Jane Morgan
What is the controversy? So this is so multilayered. So you hit on a number of really good points in that studies came out and women got scared.
- [35:37]
Louise Nicola
Always happens, right?
- [35:38]
Dr. Jane Morgan
Always happens. Number two is that women are not offered statins by their physicians to the same degree that physicians offer men statins. Women simply aren't on them. They said they were never offered them. If you ask women, for whatever reason, similar histories, the woman is not offered a statin and a man is. Now, why is that again, that I don't have the answer to that because I certainly would not do that. But there's inherent bias in the system, even that heart disease is not the woman's number one risk, that, you know, she doesn't necessarily maybe really need it. She can tolerate a higher estrogen. Women have more fat on their bodies anyway. You know, just whatever, whatever nonsense is happening and there's not the recognition that heart disease is the number one killer of women. And statins are very important. Women should not refuse them. If you are offered a statin, I think you should not only take it, but if you're not offering it, you should ask why no one's talking to you about cholesterol lowering medications. Because statins in particular have been the only drug that have been shown to cause a regression of atherosclerosis. And we've got microvascular disease. We've got all these tiny little beads in there that get undiagnosed, but yet we still aren't feeling well. Wouldn't you like to have some regression of that? And so we need to understand what our risk factors factors are. We need to understand that heart disease is the number one killer and that statins are not the enemy. They're not sort of the. The boogeyman under the bed. They are being offered to men. They should be offered to women. Now, women, when we look at the side effects, more often have myositis, which is muscle soreness. Muscle soreness.
- [37:33]
Louise Nicola
That's a very small percentage, just very.
- [37:35]
Dr. Jane Morgan
Small percentage, but more often occur in women. And you know, just like any medication, if you have a side effect and it's intolerable, stop taking it. That's it. Don't not take it because you've heard there's a side effect. Yeah. So if you get myositis, and actually that's not really the more serious one. The more serious one is liver function test. Lft. If, if it impacts your left, you will have to have your liver function measured, blood work every three months in the beginning just to make certain that it's not being impacted. If it's impacting your liver, that is really probably the more serious indication to come off of the medications. Again, a rare finding that happens in men and women, but women just have been fed a negative line and then it's made worse by. By physicians also not offering statins. And we just continue to see women fall off the cliff with heart disease and people are scratching their heads. That's weird. How is she getting heart disease? Well, let's see. Was she on a blood pressure medication? Nope. And her blood pressure was at 135. Was she taking a cholesterol? Lori? Nope. She was not taking cholesterol medication. Anybody talked about hormone replacement therapy? Oh, no. Did anyone bother to read the micro calcifications on her marigram? Nope, that wasn't relevant. I mean, what are you talking about?
- [39:03]
Louise Nicola
Literally, right? It's. It's scary, it's sad. But what I think is happening on social media, we have this uprise.
- [39:14]
Sponsor/Ad Voice
There is.
- [39:14]
Louise Nicola
There's such debate, and I can't imagine what it must feel like to be you. Okay. Like a cardiologist, you know, you're seeing a lot of people. Biohackers, hate that word. Who are saying, oh, My LDL is 300. I'm fine. Cholesterol is not bad for you, and it doesn't cause heart disease. I've seen that.
- [39:33]
Dr. Jane Morgan
So not seen that.
- [39:34]
Sponsor/Ad Voice
Oh, yeah.
- [39:34]
Dr. Jane Morgan
I guess they're pushing that away from my.
- [39:36]
Louise Nicola
Yeah.
- [39:37]
Dr. Jane Morgan
Like, lose my mind.
- [39:38]
Louise Nicola
Yeah. And there's this. There's a heart surgeon that's gone, you know, viral saying that having an LDL of 300 is not bad. And like, of course, like, of course, course people are confused. Of. I would be confused. You know, people without any medical knowledge, going on the Internet, seeing a cardiac surgeon saying, LDL does not high, LDL does not cause heart disease. And then do not take statins because they will actually kill you. I can't understand how somebody would not be confused in this world. So when it comes to a cholesterol panel, LDL and apob, if they're high, I think the American Heart association says anything over 100.
- [40:19]
Sponsor/Ad Voice
Yes.
- [40:20]
Louise Nicola
Is considered high. And APOB is the same over 100. That is an indication that, hey, we need to monitor you.
- [40:27]
Dr. Jane Morgan
Right, Right. Right.
- [40:28]
Louise Nicola
So why. So why are we having this confusion?
- [40:30]
Dr. Jane Morgan
So I don't know who these people are, but I would just say this. The American Heart association issues guidelines.
- [40:37]
Sponsor/Ad Voice
Yes.
- [40:38]
Dr. Jane Morgan
And they're pretty clear.
- [40:39]
Sponsor/Ad Voice
Yeah.
- [40:40]
Dr. Jane Morgan
So I would just say this cardiac surgeon is well outside the guidelines issued by the American Heart Associ Association.
- [40:46]
Louise Nicola
Yeah.
- [40:48]
Dr. Jane Morgan
So, you know, there. That's just.
- [40:50]
Louise Nicola
It's a.
- [40:50]
Dr. Jane Morgan
It's a. I thought you were going to say when you said that that we can tolerate an LDL of 300 if your HDL is really high, which is still also not true.
- [41:00]
Louise Nicola
But two to one ratio, right?
- [41:03]
Dr. Jane Morgan
Yeah, but I, I don't. That's 300ish time is.
- [41:07]
Louise Nicola
Yeah. And these, you know, because it ends up forming plaque. Is that correct? And you can't manage this other than diet, because I know that exercise can't really, you know, at some point you.
- [41:18]
Dr. Jane Morgan
Can'T manage it other than open heart surgery or cardiac catheterizations and stents. And yeah.
- [41:26]
Sponsor/Ad Voice
Five years ago, I never thought twice about what I put on my skin. I never did. But now, as I'm becoming more conscious about skin health and aging, I protect my skin at all costs. And this is why I use Jones Road Beauty. Because their products are simple, gentle and focused on supporting the skin barrier instead of stripping it. I use their moisturizer and face wash daily because they keep my skin calm and resilient. And by the way, for those of you who follow me on Instagram, I get so many questions about what is your skincare routine. I never thought about doing one because that's not my forte. But let me tell you, the real Louisa Nicola cares about her skin so freaking much. I take so much pride in doing care on my skincare routine that I will probably do a real talking about this because I am obsessed with this product. Jones Road Beauty has completely transformed the way that I view skin health. I use it every single morning and every single night. Because healthy aging isn't about doing more. It's about supporting the systems that protect you. If you want to check out Jones Road Beauty, go to JonesRoadBeauty.com use code NEURO. You'll get a gift with your purchase. You will get money off. I just want you to go to this and read more about them. You will not be sorry. Jones road beauty.com use code neuro.
- [42:49]
Louise Nicola
Let's talk about heart prevention. I would say heart related event prevention or cardiovascular disease prevention for women specifically, as they're going through, you know, they hit 45 and things are starting to change. Maybe they're not as fit as they were. And so what does a woman have to do to prevent her risk of getting cardiovascular disease?
- [43:12]
Dr. Jane Morgan
So a couple of things. I like to have a panel of lab tests that you should test for. And this is not all inclusive. These are just a few things, you know, where it's not super sophisticated. Some basic things that I think every woman woman should check, should check your vitamin D levels because vitamin D deficiency increases your risk of heart disease. So simple to supplement with vitamin D that you can buy over the counter.
- [43:43]
Louise Nicola
Wait, wait, why is that? Why vitamin D?
- [43:45]
Dr. Jane Morgan
Because vitamin D is used by the heart as fuel. And so vitamin D deficiency increases your risk of heart disease.
- [43:53]
Louise Nicola
Your heart uses vitamin D as a fuel source. I did not know that.
- [43:58]
Dr. Jane Morgan
So vitamin D deficiency. Yeah. Increases your risk of heart disease.
- [44:02]
Louise Nicola
30 nanograms per deciliter or less is considered deficient?
- [44:07]
Dr. Jane Morgan
I would, I would say yes, but I've seen numbers, including my own down in the teens. So you definitely want your vitamin D levels to be high. And here's something I'll just say as an aside about vitamin D levels. Generally you can supplement sufficiently with about 2000 international units, maybe per day, 2000, maybe 1000 to 2000. But the darker your skin, the more supplement you may need because melanin blocks UV light absorption. So it's one of the reasons why people with darker skins don't age as quickly because the melanin blocks UV light absorption. But in blocking UV light absorption, you need that sunlight to convert vitamin D in your body. So because there's more melanin in the skin and you have UV light blocking, you're more likely have vitamin D deficiency.
- [45:04]
Louise Nicola
Oh, that's so interesting.
- [45:05]
Dr. Jane Morgan
So your patients with darker skins, you should be more prone to check their vitamin D and they probably will need more, maybe even double, maybe up to 4,4000 international units per day to replace that.
- [45:19]
Louise Nicola
So, and do you get your patients to also for absorption of that to have K2, vitamin K2?
- [45:25]
Dr. Jane Morgan
Yeah. And sometimes magnesium as well for absorption if there's an absorption problem. You know, sometimes I, you know, and I know I differ from, from people with this. I try not to prescribe just so many supplements that it's just, you know, overwhelming. So I'll have you take vitamin D. If it looks as if you're getting poor absorption, then we can start adding some things. Or if for whatever reason you're saying, you know, I don't sleep well or something, I'll say, okay, let's go ahead and add some magnesium. But I don't necessarily just start adding things. I think people are taking a lot of stuff. Oh yeah, a lot of things. And, and I'm not against supplements at all. In fact, I'm pro supplements. But I also have to weigh the likelihood that the patient can manage all of these things. So sometimes the more medications you prescribe, the less likely they are to get the regimen right because it's just too much to remember. So I try to keep the main thing, the main thing and keep it simple. So can you just take this vitamin D? Let's just start there.
- [46:34]
Louise Nicola
And it's interesting because was a great massive study that came out last year to show a 50% reduction in all cause dementia if you've got optimized vitamin D levels. So I'm very bullish on that. So thank you for teaching me that.
- [46:47]
Dr. Jane Morgan
And so you see, what you do for the heart helps the brain.
- [46:50]
Sponsor/Ad Voice
Yes.
- [46:50]
Dr. Jane Morgan
That the two go hand in hand.
- [46:52]
Louise Nicola
They're a relationship. Okay, so what else can we do?
- [46:55]
Dr. Jane Morgan
And so.
- [46:55]
Louise Nicola
Oh, what, what are the other biomarkers?
- [46:57]
Dr. Jane Morgan
Yeah. So I would. I would probably check your ferritin and iron levels. Women are likely to be more likely to be anemic, especially during perimenopause. I would also check the lp, but.
- [47:09]
Louise Nicola
If that's high, what can you do about it?
- [47:11]
Dr. Jane Morgan
Yeah. So LP is lipoprotein A, and it is a type of cholesterol that has a genetic component and can increase your risk of early heart disease. And it generally runs in families. We generally, as a specialty in cardiology, have not been checking it. And unlike menopause, that we really just don't know anything about, we actually know a lot about lp. We just don't check it. And here's a little secret about medicine. We don't like to check things if we don't have a treatment for it.
- [47:44]
Sponsor/Ad Voice
Yeah.
- [47:45]
Dr. Jane Morgan
So we just don't check it. Not only do we not check it, we didn't tell you about it. I mean, why raise all of this fuss about something when we can't do anything nobody can do anything about? Yeah, but we do study it. We are required to know it, but we never apply that knowledge because what are we going to do with it? But now we know that what we should have been doing is checking for LP little A, by the way, LP little A, it is thought, is a once in a lifetime test and that it doesn't change throughout your whole life. So that's another story. Of course they did that on men.
- [48:18]
Louise Nicola
What? Because people have been telling me that you only have to check LP once in your life.
- [48:23]
Dr. Jane Morgan
That's right. That's right. So that's the standard. I'm going to deviate from the standard. That's the standard.
- [48:30]
Louise Nicola
Please do.
- [48:31]
Dr. Jane Morgan
And the reason that is is because those are the studies that they did on men. I'm going to postulate we haven't seen these studies yet, that a woman should probably have her LP checked before menopause and then again after menopause. I would postulate that there probably is a change in women and that we haven't studied women. This once in a lifetime rule probably doesn't apply to us and it's probably not really good advice. So that's Dr. Jane Morgan saying that to you. There's no scientific evidence on that. This is just me working in women's health Going, hmm, once again, not sure that that applies to women. Yeah. So anyway, your lp, what we can do about it now is we know that we need to do aggressive risk modifying behavior. So back to that home blood pressure monitor, which is what I do at hello, heart. Get a blood pressure monitor, aggressively lower your blood pressure, get your blood pressure down to 120 over 80 or less. And be serious about it. You have to be serious if you're smoking, quit yesterday. If you've got high cholesterol, stop diddling around with your, with. Whether you're going to take statins or not, you're going to take them, you've got this elevated lp, little A. If you're not moving. And you know, I don't like to necessarily use the word exercise. If you're exercising, great. But if you're not moving, getting 30 minutes of movement in every day, you've got to get going. Like, this is really serious. And look in your family history to see if you have relatives who have died young or who've died from unknown causes or. Remember when my cousin Bill, you know, died in his sleep? He was 38, it was so sad. Or my dad, you know, suddenly had a heart attack on the baseball field at 42. Or my, you know, think about things in your family that you really didn't think much about. You thought were just kind of like lightning striking once and it was a random thing. Or especially, especially. This is. In my culture, in the black culture, we have relatives who die in their sleep. We never think anything about, like, oh, my God, you know, Sarah died in her sleep last night. Or, you know, what does that even mean?
- [50:51]
Sponsor/Ad Voice
Like, why?
- [50:52]
Dr. Jane Morgan
What does that even mean? In my culture, we say that all. We always have relatives. What did they die? We don't. They died in their sleep. What?
- [51:00]
Louise Nicola
Of what? You know, it's the same as.
- [51:03]
Dr. Jane Morgan
But, you know, it's a cult. I didn't even. I had to go to medical school before I started questioning. Wait a second.
- [51:09]
Louise Nicola
I know, right?
- [51:10]
Dr. Jane Morgan
Yes. What does die in your sleep mean?
- [51:13]
Louise Nicola
It's the same as when on, you know, people say, oh, my grandfather died of dementia.
- [51:17]
Sponsor/Ad Voice
I said, well, you can't really.
- [51:19]
Louise Nicola
So first of all, was it Alzheimer's disease? But you can't die of Alzheimer's disease. Was it asphyxiation? Was it like, did they run into a wall? What was the cause of death? Because it's never Alzheimer's disease. It's something else. And people don't have that knowledge.
- [51:34]
Dr. Jane Morgan
Right. So if you're in your culture, you know, we're all in some subculture and you, and you're listening to me, you're saying, no, I've never heard of anybody having a heart attack early in my family. No. Nobody has strokes. I've never heard of that. Think about other things.
- [51:49]
Louise Nicola
Yeah.
- [51:51]
Dr. Jane Morgan
That people may say. Yeah. And have an aha moment.
- [51:55]
Louise Nicola
Yeah. Be smart.
- [51:58]
Dr. Jane Morgan
Yeah.
- [51:58]
Louise Nicola
And be inquisitive.
- [52:00]
Dr. Jane Morgan
Right. And even for me, I mean, you know, I was in college, went to medical school, it took medical school. I was learning. I started to think, wait a second. Yes. Because when you grow up in a culture, it just is the culture you don't question is the language that's spoken. And this is how things are. And you know, nobody really. It's kind of like doctors using medications. You don't really dig deeper into how the medications got there. So you know, if people have sudden death in, in, you know, you know, somebody had a stroke early or had sudden death or dropped dead on the tennis court and oh, you know, those are the kinds of things that you need to think about. And don't just accept them as folklore in your family and say, wait a second, do we have elevated lp? Let me get it checked.
- [52:50]
Sponsor/Ad Voice
Hydration is one of the best things you can do for your brain, your skin health and your overall long longevity. As we age, hydration becomes one of the biggest drivers of cognitive performance. I am so protective of what I put in my body. And I used to pack my body with electrolytes that were full of sugar. Now I use cure hydration. It's a plant based electrolyte mix with no added sugar. Built on oral rehydration science. Hydration isn't just about thirst. It's about protecting your memory, your mood, your focus. Over time, your brain cells look literally need electrolytes to function. So it doesn't mean that you need to take electrolytes only if you are out there sweating. You need to take electrolytes every day and they need to be clean and they need to be accessible. Cure Hydration comes in these little sachets that make it really, really easy to travel with. If you want to check these out, go to cure hydration.com neuro to get 20% off. P.S. cure hydration is FSA HSA eligible.
- [53:51]
Louise Nicola
My father, when he had the, when he had the stroke in 2019 and it was due to afib and I was like, okay, well we now I've got two older brothers. I'm like, we all need to now like figure out like, you know, I don't know if you can figure out if we've got AFIB or not, but, you know, it's on my radar. Oh, you can? Okay, so you. Yeah, you can go and do a test for that.
- [54:11]
Dr. Jane Morgan
Sure, sure. Okay, let's. Let's get to the next one. And now we're talking about afib. The next thing I want you to get. I want you to get an ekg.
- [54:17]
Louise Nicola
Okay.
- [54:18]
Dr. Jane Morgan
EKG will show afib. Yeah. Especially if it's chronic. Now, if you're going in and out of it, EKG may not catch it. And. And the type of AFIB called paroxysmal afib, where you're going in and out, is more likely to cause a stroke. But sometimes if you're having symptoms, then those symptoms can drive things like event monitors and those types of things. But I want women to get an EKG because men get them and women get mammograms and pap smears. We don't get EKGs because women's health is reduced to just reproduction. We are only reproductive vessels. And anything beyond that is of no use to anyone for whatever reason. But heart disease is the number one killer of women. And if you go to assess a woman in an emergency room who's having vague symptoms that they will be. That will be called atypical, which just annoys me to no end because that drives. Not only does it drive action, it mostly drives inaction. It's a wink and a nod in the health care system of another hysterical woman. Another panic attack or not an emergency. Move slowly triage to lower level of care and concern. That's really what happens. And so you go and see a woman, let's say a man and a woman come into the emergency room at time. The same. Same time, both with. With having a heart attack, but the man is having.
- [55:38]
Louise Nicola
Yeah.
- [55:38]
Dr. Jane Morgan
Chest pain and shortness of excuses. That's what we've studied.
- [55:41]
Louise Nicola
Yeah.
- [55:41]
Dr. Jane Morgan
And the woman's having more vague fatigue symptoms. The man also, you can pull up his electronic medical records as an EKG this year, had one last year, had one three years ago. So you literally can track when the changes started to occur. You can look at the EKG he's having right now compared. And you know what. What's happening that he's having a heart attack. You know, where the area in his heart, everything. Women. The same woman who comes in, who's now being triaged to lower levels of care and concern. We pull up her electronic medical records. Looking for an EKG is like mammogram. Yeah, mammogram, Pap Smear, Pap smear. Mammogram. Mammogram. Like can't. Not an EKG to be found. Not even a recommendation. Nothing.
- [56:21]
Louise Nicola
No, it's never recommended.
- [56:23]
Dr. Jane Morgan
Yeah. So now not only is she at a disadvantage in that we're dismantled, missing her symptoms, she's at a disadvantage because we don't even have the same objective medical information that the man has. And it doesn't mean you get an EKG because you're sick and not feeling well. It means get an EKG when you're healthy so that we have a time point in your chart when your EKG was normal and how long ago that was.
- [56:50]
Louise Nicola
That would be the same for a CAT scan.
- [56:52]
Sponsor/Ad Voice
Right? What do you do?
- [56:54]
Louise Nicola
Like, do you think that women should be getting like a. Figuring out what their CAC score is as well?
- [56:58]
Dr. Jane Morgan
Oh, I see. I thought you said CAT scan. Oh, no, the calcium score. So that's something that I would recommend next level. But yes, the calcium score I think would be recommended. Again, you need to be asymptomatic. Calcium scores are not recommended for women who are having any symptoms. You have to. You should go on to more advanced diseases, more advanced diagnoses and testing, more advanced workup. A calcium score is a CAT scan, but it doesn't drive a workup or further testing. It is a marker that we use to assess your 10 year risk profile. So you need to be asymptomatic. If you have symptoms, you can skip the calcium score. We're going on to actually doing a workup. A calcium score is not a part of your workup if you're having cardiac symptoms. So yes, you can have a calcium score.
- [57:56]
Louise Nicola
And you want a score of zero.
- [57:57]
Dr. Jane Morgan
Yeah. You want a score of zero. So one test you kind of want to totally bomb.
- [58:01]
Louise Nicola
Yeah.
- [58:01]
Dr. Jane Morgan
And fail. So the other thing that I would say is get a thyroid panel because thyroid is a great mimicker of heart disease, especially in women, especially with palpitations. So get a thyroid level. I would probably just start there and probably would exclude the calcium score in my first level of test. Just keeping it simple. I would get vitamin D, iron level, your ferritin, an EKG and lp and maybe your thyroid. Maybe I'll throw the thyroid. Maybe there's five. So just those four blood tests and an ekg. Let's just start. Let's just keep it simple. It's kind of like prescribing vitamin D. I wouldn't throw K. And let's just keep it simple. Take a breath. Yeah. Okay. And then let's See what those come back. And then you can go to kind.
- [58:50]
Louise Nicola
Of track and monitor.
- [58:52]
Dr. Jane Morgan
Yes. Next level testing, if you'd like.
- [58:54]
Louise Nicola
Yeah, it's. It's a. You don't have to go too aggressive.
- [58:56]
Dr. Jane Morgan
Right.
- [58:57]
Louise Nicola
Have you heard of the new kid on the block when it comes to statins? Bempedoic acid? Is that the. Is that the new kid? I've heard that this is the new kid on the block. Because I don't actually know the mechanism. This is just fresh in my mind. But I believe that it's bypasses some pathway when it comes to the liver. And it doesn't cause muscle. Yes. It doesn't cause the. The muscle weakness. So it's now given to people who can't tolerate statins at the very low percentage. So bempedoic acid, I don't know what it is, but that's apparently the new.
- [59:27]
Dr. Jane Morgan
I love that. And I hope that they have included women in those trials and that.
- [59:33]
Louise Nicola
That I didn't get to the bottom of.
- [59:35]
Dr. Jane Morgan
Right. So I hope that that's. That they're there and we can have information and feel confident in how we're prescribing this medication to women.
- [59:44]
Louise Nicola
You mentioned your AI the, you know, AI in health care. I got given a. One of this. This new stethoscope, and it actually picks up. It's an AI stethoscope. Yeah. And it picks up on afib. I don't know if you've seen it. Eco ako. I don't know what your thoughts are, but as a cardiologist, you are. Out of all the specialties, you use the stethoscope the most.
- [60:04]
Sponsor/Ad Voice
Right.
- [60:04]
Louise Nicola
What do you think of something like this?
- [60:05]
Dr. Jane Morgan
Oh, so. Oh, my gosh, I am such a proponent of A.I. i love it. Now, I would just say the old stethoscopes, you're pretty bad if you can't hear atrial fibrillation. Like if you need AI to hear atrial fibrillation because you don't even need to hear it. You can just. You can really put your fingers on someone's pulse. They have a great idea of whether or not they're in. They are in AFIB or not, or if they have any kind of irregular heartbeat. But I think AI is definitely. So I can't say enough things about AI because my hope and where I'm putting all my eggs in this basket, I rarely, rarely put all my eggs in the basket, is that because there's been such a dearth of information and research done properly and appropriately on women, because women have been excluded from trials. And because the gold standard in medicine is evidence based based medicine. So that means randomized clinical trials. And we do phase one with our healthy patients in phase two, which is going to be dose finding phase three where we look at our indication and we have 30 and 40,000 people around the world and, and then we're going to follow them for three years and 10 or 15 years later we're going to give you that information. You know, we're not waiting another generation. And so it is my thought that it will be women's health that will say hell no to the evidence based trial. Thank you, men, you've done quite enough. We're going to move on now to AI and we're going to generate our own trials and get answers maybe every five days or so, because we should be able to model our trials, model our risks, figure it out, aggregate information from all over the world and, and get very informed information because women's health needs it. And so I think, and I am a proponent that women's health will be the drivers of AI in health care because we need it and we are going to insist on it and we are going to refuse to wait another generation for all the randomized clinical trials. And it may even be longer than that because funding for women has almost been cut to nothing in the last year. So I guess they want us to wait another two generations. And I think we're all like collectively going to say, hell no.
- [62:26]
Louise Nicola
So you think that I can actually help?
- [62:30]
Dr. Jane Morgan
Irrespective of rct, I am confident that we will be able to leverage AI to drive outcomes and indications and prescription profile practices and that those naysayers will be left behind because women's health will be the drivers. Women's health will be on the forefront of adopting all of the new technology and all of the new AI because we are the most desperate for answers, for health, for longevity, and to live fulfilled and equal lives. Men don't need it. They can wait another 10 or 15 years. So I imagine they're all going to sit there in their, you know, corners and, and naysay and poo poo. But that's okay. They don't need it. We need it. And so I think AI adoption is going to be rapid in health care because women are going to drive it. We've got to have this.
- [63:36]
Louise Nicola
Well, we were discussing, you and I, on the weekend, the Cleely exam, and I think that that's. I don't know what your thoughts are on it, and I'd love for you to tell us a bit more about what it actually does. But I'm seeing a lot of people now adopt this in their practice.
- [63:50]
Dr. Jane Morgan
Yeah. You know, again, we're sort of like next level. So we talked about. Clearly, it is, it is. It's. So when we talk about. Clearly, we're talking about the calcium score. And let's say you have a calcium score that's zero. The clearance clearly goes in and does more of a deeper dive to see if there are tiny plaques that are insignificant, so wouldn't come to the attention of the calcium score, but are actually there, but small and insignificant. So clearly gives you sort of a deeper dive, a more granulated view of this calcium score of zero. I mean, I like it. I, you know, kind of like everything. I. I am concerned sometimes with too much information is too much information, and what are you. What are you going to sort of do with it? But is it a good tool? It's a good tool.
- [64:50]
Louise Nicola
It's. It's kind of like, you know, I. I do like the full body MRI scans, but also, I don't.
- [64:57]
Dr. Jane Morgan
Right.
- [64:58]
Louise Nicola
I'm like, that's great. Yes, I know. Is that just because it can create more fear for no reason with the artifacts involved?
- [65:04]
Dr. Jane Morgan
The older you get, the more likely you are to have, you know. Yeah. Incidental findings. Incidental findings drive huge workups and so much stress. Now, incidental finding can save your life as well. So that's, you know, it's. Yeah, so you're right. It's kind of like the yin and the yang, you know, if you get a total body scan and everything's normal, you feel great. If you get a total body scan and you've caught something so early that would have killed you later, it's great. But if you get a total body scan and you end up with kind of random stuff that nobody knows what it is, and now for the next 10 years, you're chasing all these different things, and, you know, then your life is upside down. So.
- [65:45]
Louise Nicola
Yeah, it's.
- [65:46]
Dr. Jane Morgan
I don't encourage it nor discourage it. It's, you know, it's like.
- [65:48]
Louise Nicola
It is what it is. Yeah. It's really about how much money you have.
- [65:51]
Dr. Jane Morgan
Yeah.
- [65:52]
Louise Nicola
Okay. Because they cost a lot, I think. You know, one thing that is really interesting to me is, like, when you look at Alzheimer's disease and we know that women are disproportionately affected, and we can look at the estrogen receptors on the brain, and I always get asked, well, well, you know, what about men? And it, you know, it's like, well, they go through andropause, but they have a lot of testosterone throughout the brain that actually aromatizes into estrogen, which is in one part protecting them. There's a number of different reasons why they're more protected as well. And I wanted to know, is there a role that testosterone plays in the heart for women?
- [66:29]
Dr. Jane Morgan
Yeah, you know, we are increasingly looking.
- [66:32]
Louise Nicola
At that because it is neuroprotective.
- [66:35]
Dr. Jane Morgan
Yeah. And so I'm going to say yes, I think there is a role for testosterone for the heart and the brain for function. So sort of more to come on that. But I think absolutely, yes. I think there's so much to learn. We are in some ways in an unfortunate time, but also an exciting time because we really had the ability to be the change makers and to kind of push this envelope and to adapt, to be early adopters of new technology, to not step away from the digital march and to say we must embrace this because this is how we're going to dig ourselves out of this hole and how we're going to dig ourselves out of it and not let another century go by while we're doing it. This we will be able to accelerate and not only impact the health of our daughters, we'll be able to impact our own health. We're going to move this fast.
- [67:40]
Louise Nicola
Is that your mission?
- [67:41]
Dr. Jane Morgan
That is. It's just what I do. It's why I work for my digital heart health company. I put my money where my mouth is. I love my job. You know, it's. It's exhausting to do all of this. And then this is Sunday, by the way, in Los Angeles. On Monday I have to be at my job in Atlanta. So, you know, it's exhausting to.
- [68:01]
Louise Nicola
Work.
- [68:01]
Dr. Jane Morgan
Full time at a company. The vice president of medical affairs at hello Heart and. And work in my mission there in women's health, in digital health, in artificial intelligence, in bending the arc on heart disease, in the importance of blood pressure monitoring, the importance of digital coaching and digital tracking and people understanding their metrics. How does walking actually affect my heart and affect my brain? I never knew that. We show you those things. That's like so incredibly important. But then here I am on the weekends trying to get the information out.
- [68:38]
Louise Nicola
Yes.
- [68:38]
Dr. Jane Morgan
To the rest of the world as well.
- [68:40]
Louise Nicola
So graciously.
- [68:42]
Dr. Jane Morgan
Yes. So this is my mission both inside and outside of my job. And so I hope if, you know, one person has learned something today, please move forward and, and support us and support women. That's for the men out there as well, because I'm sure you have women in your life, and we want everybody to be healthy.
- [69:01]
Louise Nicola
Oh, my gosh. Dr. Morgan, I have learned so much from you over this weekend. You're my new favorite person. Thank you so much for being part of the New Experience podcast.
- [69:08]
Dr. Jane Morgan
Thank you. And you can follow me on Instagram @doctorjanemorgan. Dr. J A Y N E M O R G A N I'm also on LinkedIn, Jane MorganMD, and I'm on many other platforms. You can find me at Dr. Jane Morgan.
- [69:23]
Louise Nicola
We're gonna link all of that as well below. And the company that you spoke about.
- [69:27]
Dr. Jane Morgan
I am the vice president of medical affairs for hello Heart.
- [69:31]
Louise Nicola
I can't wait to get my hands on that.
- [69:32]
Dr. Jane Morgan
Thank. You.