Cardiovascular Risk Explained: Prevention and Management Strategies

This episode is designed to inform listeners about cardiovascular health. It explains what cardiovascular risk is, its significance, and the various risk factors involved, such as smoking, hypertension, and diabetes. The episode details how cardiovascular risk is assessed, including the use of risk calculators for different age groups and the importance of considering risk-enhancing factors. The podcast emphasizes the importance of lifestyle modifications and medical interventions, along with the need for shared decision-making with healthcare providers to reduce risk and promote better heart health.

Takeaways

Cardiovascular disease is the leading cause of global mortality.
ASCVD includes coronary heart disease, strokes, and peripheral artery disease.
Traditional risk factors include smoking, hypertension, diabetes, and obesity.
Family history can enhance cardiovascular risk assessment.
Lifestyle changes are crucial for reducing cardiovascular risk.
Regular exercise and a balanced diet are essential for heart health.
Statins can help lower cholesterol and reduce cardiovascular risk.
Risk calculators can provide a 10-year risk estimation for cardiovascular events.
Consult your doctor for personalized cardiovascular risk assessment.
This podcast is for educational purposes and not a substitute for medical advice.

Keywords

cardiovascular disease, risk assessment, atherosclerosis, health education, lifestyle changes, medical advice, cholesterol, heart health, patient education, wellness

Transcript

Ed Delesky, MD (00:04)
Hi, welcome to your checkup. We are the Patient Education Podcast, where we bring conversations from the doctor's office to your ears. On this podcast, we try to bring medicine closer to its patients. I'm Ed Delesky a family medicine resident in the Philadelphia area.

Nicole Aruffo, RN (00:18)
and I'm Nicole Aruffo, I'm a

Ed Delesky, MD (00:20)
And we are so excited you were able to join us here again today. I really wanted to get a hot button mic or a hot mic when the actual thing happened. But last night. Yeah. But I want to spark you up here. Let me set the scene for our audience that you're walking your beautiful corgi in a tight corner of Philadelphia where like anything can happen around the corner. And, you know, far off, you can see another dog approaching with their owner, of course. And

that owner is like kind of suggesting to you that like, can my dog say hi?

Nicole Aruffo, RN (00:57)
That's the most annoying question. Can they say hi? No.

Ed Delesky, MD (01:01)
It sounds like you

Nicole Aruffo, RN (01:03)
You don't like it either no, I don't off about it yesterday. It's just so annoying cuz like there are the people

Ed Delesky, MD (01:06)
No, I usually don't like it.

Nicole Aruffo, RN (01:13)
that respect it. You know, like you walk past the dog, you both like tighten your leashes, you keep it moving. You're not making eye contact with the other person or the other dog. Like you're deaf and blind. No acknowledgement. It's beautiful. You just keep your walk moving. And then there are the people who like, well, there are like, there are a couple of dogs in the neighborhood that like we're friendly with and Ollie's friendly with.

Ed Delesky, MD (01:39)
Totally. Yeah, I can count.

Nicole Aruffo, RN (01:40)
And

we stop and like talk to them and they like sniff and play and whatever.

Ed Delesky, MD (01:43)
You bet. he has friends. Don't let. All right. He's sitting right.

Nicole Aruffo, RN (01:47)
Like

the other random people who like I don't know them or their dog and

Ali sometimes a little bit of a lunatic on the leash. Yeah. And we don't always know how he's going to react. And we just like, don't feel like getting into that on like a narrow center city, Philadelphia sidewalk. And it's just like so annoying. Well, people are like, and then if the other person's dog, Ali's a corgi and he's like 30 pounds. So almost every dog is bigger than him. Sure. And then if their dog is doing the little like jumping thing.

Ed Delesky, MD (02:08)
yeah.

Nicole Aruffo, RN (02:26)
Like whether, you know, they're probably just excited and whether or not they're aggressive, I don't know that. Right. And I don't really feel like finding out. And then it's so annoying when someone's like, can they say hi?

Ed Delesky, MD (02:36)
Right, it's, I mean, I get, I get.

Nicole Aruffo, RN (02:38)
But

they're friendly. OK, well, I'm not friendly right now, so keep it moving, sis.

Ed Delesky, MD (02:44)
My line has become like, he gets a little too excited. Because even when he says, when they're like, he gets so excited, he's friendly. And then I used to say, he's excited. When he gets a little excited, people took that as a pass. And they were like, yeah, absolutely, let's go. It's time to play. As in it's time for our dogs to say hi.

Nicole Aruffo, RN (02:48)
You're nicer than me.

Ed Delesky, MD (03:13)
So then I changed my language and I added the word too excited. And that seems to pretty effective. That's also very effective. Well, I think of two times. There was one a couple of years ago where we're walking down the street and there was this big lab and he's sniffing, they're sniffing each other. And then this lunatic intern gets in just like nabs on the guy's face, not the guy, the dog. And I'm like, whoa, didn't know you had an engineer JP as I'm looking at him right now.

Nicole Aruffo, RN (03:19)
I just say no, it's also effective.

Ed Delesky, MD (03:43)
And then the second one is not too long ago. We're walking down Broad Street in the morning and this is my fault. mean, like, I let the leash go a little bit too long and then Ali kind of like.

Nicole Aruffo, RN (03:53)
You were in that, okay, I wasn't there, but in that situation, you were definitely that person where it's like, what you were also talking about, like when we're walking and like, I'm obviously like keeping Ali on my side and we're just trying to walk by and someone is like, just like letting their dog come over. Yeah. What you were doing.

Ed Delesky, MD (04:12)
like every bit of

the body language is like why don't you mind your side of the sidewalk. No I definitely messed up there and then the guy cursed me out and then his I probably deserved it. A little scary and I think I've seen him about three times since then in the neighborhood and I'm you know I a little quiver of fear.

Nicole Aruffo, RN (04:28)
What dog does he have?

Ed Delesky, MD (04:31)
It's a bigger dog.

Nicole Aruffo, RN (04:32)
That narrows it down. Yeah, I think I know who you're talking about.

Ed Delesky, MD (04:42)
yeah, no, it's, no, you're like, where's the hoodie? And like, I don't know.

neither here nor there. despite every bit of body language that you're like shoulders turned away, kind of dodging eye contact, people do go out of their way to say, can they say hi? Most of the time, unless like you're Henry.

Nicole Aruffo, RN (05:07)
Henry Aria, little B.

Ed Delesky, MD (05:12)
Honestly, that's just about it.

Nicole Aruffo, RN (05:14)
I thought there was another one. There is another one. The guy, I forget his name and I feel bad. He has the black glasses. He lives on like that street. It's like parallel to ours. he's always out there with the little black dog that's like always off the leash.

Ed Delesky, MD (05:30)
yeah. He does okay with that dog? okay. he looks so cute right now. He's being very quiet.

Nicole Aruffo, RN (05:35)
right

now for more like I was telling you about that girl that was out front of our house walking or walking her dog and her dog saw Ali she had like a little smaller dog and that dog starts freaking out and she's just like standing here outside and we're finishing our walk so we're standing a little behind so I'm just waiting for this chick and her dog to leave so we could go out and Ali was being the best boy and this girl's dog is going crazy and I'm just standing there like okay girl are you gonna keep walking right

And then she had the nerve after her dogs going crazy to go, can't they say hi?

said no, they can't.

Ed Delesky, MD (06:15)
Can't they say I...

Nicole Aruffo, RN (06:17)
No, can't you keep it moving so I can go into my house? Like move, get out of here.

Ed Delesky, MD (06:21)
I don't know. Reach out to us in the fan mail if you feel differently than us. But I don't see... Look, we named the four dogs who are his friends. And he sees them and he plays with them and it works out. Yeah.

Nicole Aruffo, RN (06:36)
Like we talk to their humans.

I don't really want to talk to anyone else when I'm out on a walk.

Ed Delesky, MD (06:42)
Also, you can't tell in this area what's going on.

Nicole Aruffo, RN (06:44)
That's

also like 90 % of the reason why I wear my AirPods because then I just like even like 99 % of the time I can hear you but I'm gonna act like I didn't.

Ed Delesky, MD (06:54)
Yeah, yeah, totally. Yeah. And then you can like, you know, willfully ignore what's going on around you, not even just in dog walking circumstances, but with all the other stuff going on.

Nicole Aruffo, RN (07:03)
Yeah.

Ed Delesky, MD (07:05)
All right. Well, without further ado, since we have plans to get to tonight, why don't we get started, Nick?

Nicole Aruffo, RN (07:10)
What are we talking about today at?

Ed Delesky, MD (07:12)
so we are going to talk about cardiovascular disease and a cardiovascular risk assessment as well. Since last week, our big episode was on kind of breaking down the lipid panel, good cholesterol, bad cholesterol. We wanted to set the preamble to this episode because it's an extremely important topic. So cardiovascular disease itself is the leading cause of global mortality and a major cause of morbidity. So mortality is people dying.

morbidity is people having injury or illness, preventing them from doing things that they'd like to do. At least is my personal definition. And so in this episode, we will cover what cardiovascular risk is, how important it is, risk factors for cardiovascular disease, the assessment that goes into it and some reduction strategies and ambitious episode. And like, like we say at the end of the episode, all of this is for educational purposes. is not medical advice.

And you really should talk to your own doctor because there are some things in here that are like new and emerging and haven't caught up in guidelines, but some things that have been practiced forever. So let's get started.

Nicole Aruffo, RN (08:24)
Let's get started. Why don't you tell us what cardiovascular risk is?

Ed Delesky, MD (08:28)
So we start with the conversation about what ASCVD means. And that means atherosclerotic cardiovascular disease. And that is caused by something called atherosclerosis. And like we said in last episode, that is the plaque that builds up in the arteries. Arteries deliver blood to your organs and therefore oxygen. And so if there's plaque buildup,

less blood and less oxygen can get to those areas. And so ASCVD risk or ASCVD includes coronary heart disease, meaning plaque in the blood vessels on the outside of the heart that deliver blood to the heart. Cerebrovascular disease, this is like of the elk of strokes and damage to the brain blood vessels. Peripheral artery disease, which is

plaque and atherosclerosis in the arteries of the lower legs that can give pain when walking sometimes and aortic atherosclerosis and the aorta is the biggest blood vessel that leads off of the heart to the rest of the body and you can even have plaque build up there. So all of those diseases encompass ASCVD or atherosclerotic cardiovascular disease. Right on cue.

So then the point is we know this disease and a lot of the times we don't actually. So the thing about these diseases is that unfortunately a lot of times you don't know that they're there until it's too late or something bad has happened. And so the way that we get around that is with an ASCVD risk assessment. And so this is a way of identifying traditional risk factors and other risk enhancers.

for most adults so that you can take a proactive approach to identify and mitigate potential problems that can lead and give you trouble with your heart, your brain, your aorta, blood vessels in your legs.

Nicole Aruffo, RN (10:36)
Shall we talk about the good old fashioned risk factors? Our traditional risk factors are cigarette smoking, hypertension or high blood pressure. If you didn't listen to those episodes, you should go listen to them. Diabetes and then dyslipidemia, which just means your lipid levels are a little off. like from our last episode, the cholesterol episode,

Ed Delesky, MD (10:50)
Juicy.

Nicole Aruffo, RN (11:06)
This would include having a high LDL cholesterol, is the unhealthy cholesterol, or a low HDL, which is the healthy one. and obesity. Yeah. Our favorite thing.

Ed Delesky, MD (11:19)
Yeah, obesity, traditional risk factor. Wow. It is there. I don't. Classic. I'm not sure that that was always there, but it is. Yeah. And then there are other risk enhancing factors. And so some of these may not be included in all of the risk calculators, but we understand that they still increase risk in certain people. And so some examples include a family history of premature ASCVD. This is to say that

Nicole Aruffo, RN (11:27)
Really?

Ed Delesky, MD (11:48)
If someone is young and has these things, that's what I mean by premature, because a lot of the times like you like someone comes in and they're 40 years old and they're like, oh, yes, my 95 year old grandfather had a heart attack when he was 94. Thankfully, they own all. But at some point, yeah, like living in America, having this diet or just anything like there will be some of this disease in there. So that's the early.

Nicole Aruffo, RN (12:03)
yet don't they all?

Ed Delesky, MD (12:17)
premature ASCVD being a risk. Exactly.

Nicole Aruffo, RN (12:19)
Like Bob Harper. Both

of his parents died young of heart attacks and then he had a heart attack.

Ed Delesky, MD (12:25)
Right. But this guy is a fitness fanatic and we're watching a rerun of The Biggest Loser because of the traders. But right, this guy, like the pinnacle of health.

Nicole Aruffo, RN (12:30)
There's only so much you can do.

which if you guys don't know who Bob Harper is, he's our king. And from the biggest loser.

Ed Delesky, MD (12:42)
But he's also on the Traders and we won't say anything more or less if you're going to go watch that show. But that's why it was sparked up us rewatching it. risk enhancing factors for adults with diabetes, the duration of having diabetes or having protein in your urine, having chronic kidney disease or the retinopathy neuropathy. These things also increase your risk of cardiovascular disease and of course, diet.

and the level of physical activity are also important factors in cardiovascular risk.

Nicole Aruffo, RN (13:14)
Okay,

let's talk about how we are assessing this cardiovascular risk and maybe some things that people can think about.

Ed Delesky, MD (13:23)
Definitely.

I think people start to have conversations really whenever they'd like to because this is such a profound, prevalent issue. think when you, here on the outline we have that people can start with, of course, like a general medical history, physical exam at the right time determined by you and your doctor, the lipid profile like we talked about last week. And for ages like 20 to 29, I think,

Essentially, it's going to be a vibes based assessment. It's a qualitative assessment of your cardiovascular risk. Are you out here? Are you suffering from obesity? Are you smoking cigarettes? Do you have diabetes? There's not a calculator out there for people who are 20 to 29 that's being actively used. That's reasonable and has a lot of evidence and guidelines behind it. That's going to say like your lifetime cardiovascular risk is this. Some things start to pick up around 30.

And that's an even like expanded conversation from there. But it is essentially just like how healthy are you? What areas can you improve? Do you stop smoking? Do you get a better hold on your weight? Is your blood pressure out of control? Those are things that you look at and say, maybe your risk is low, medium, high in your lifetime, essentially is how that goes from 20 to 29. So from ages 30 to 79, there are risk calculators out there.

The purpose of this episode is not to debate which risk calculator is good or is not good because that is something that always is a conversation that has a lot of evidence driven behind it. There are a couple high points that I'll mention here that are important. Is that like people can put in with your doctor the risk factors that are important or your age, blood pressure, all those things that we talked about go into this calculator to give you a number. And that number is usually a 10 year risk estimation.

of a cardiovascular or ASCVD event, heart attack, stroke, peripheral artery disease. And so there are calculators, like there are ones that give 30 year risk. I will say in my training, in commonplace practice, I don't see the 30 year risk calculator being used that often. And so take that with a grain of salt. Some of the calculators, there are newer ones like a

the 2023 American Heart Association prevent equations. Those use a ton of different factors. Everyone's really excited about them. It includes A1C, different lipids and cholesterols. And it doesn't include race. Other calculators include race. And so recently there's been this theme to not use race-based medicine, which is great. And some of the older calculators do use those. Some of them omit them.

What I'm trying to get across here is that it's a complicated thing that you should talk with your doctor about, but simply know that there are calculators out there. And if you're at your visit with your doctor, ask them what your ASCVD risk is, and they'll give you a number. And they'll say, is that low risk? Is that intermediate risk? Or is that high risk? And then go from there and see what the conversation looks like. And then for people who are like 80 and older,

This one gentleman I take care of comes to mind where he is over 80 and he looks phenomenal and he is so active and we're more aggressive with his cardiovascular health. So now that we know that there are risk calculators and you should talk with your own doctor about which calculator should be used. Nick, why don't you take us through a little bit about how we can actually be proactive? What steps can we take in our life to reduce cardiovascular risk?

Nicole Aruffo, RN (17:11)
Well, the lifestyle modifications are pretty easy. Regular physical exercise, a healthy diet, and then smoking cessation, which... Huge. It's huge. Yeah.

Ed Delesky, MD (17:26)
That is like the such a huge risk factor for this. And we have an episode on the fundamentals of a balanced diet that you can refer back to. And the headline for the exercise is 30 minutes, five times a week of moderate intensity cardiovascular exercise. And two days of strength training is the bare minimum. More is better, but not to the point of injury. And that's the headline of that episode. But we also have a whole episode on the benefits of exercise.

So there are also medical interventions that can reduce your cardiovascular risk. We will have a whole episode on statins coming in the near future, but a medication like statins to lower cholesterol, specifically the LDL can be very helpful and medications that improve and optimize someone's hypertension and diabetes. And sometimes in certain situations, aspirin therapy can be used. You really should talk with your doctor because if you're over 60, it's a whole different conversation, but

That one specifically is for you and your doctor. So now we talked about reducing cardiovascular risk and the lifestyle modifications. We've talked about medical interventions, but there's also some management that goes into this. And so if someone is low risk, mainly you just have to maintain the healthy lifestyle that you have and then check in again in four to six years about. But you should be seeing your doctor more consistently than four to six years for sure. If someone's borderline risk

Then talk about your doctor about those lifestyle changes and risk enhancers. And maybe think about a 30 year calculator. For intermediate risk, this is more of a conversation. I have a lot of patients where it can go either way. Someone may want to start a statin. Someone may want something called a coronary artery calcium score, which is a low dose CT scan that takes an image of your heart and

is able to look at the arteries outside your heart and give an impression of is there a little or a lot of coronary artery disease based on the calcification. And so that could help make a decision for people who are really on the fence in this intermediate risk. And then there's the high risk category where we got a lot of work to do. You're probably starting a medicine or probably monitoring really closely and most importantly, engaging in these lifestyle changes.

We've come to the end of our episode about atherosclerotic cardiovascular disease. This is not the end of our run addressing these topics. I think you can expect that we'll talk about statin medications coming up soon enough because for some reason that's a hot button.

Nicole Aruffo, RN (20:09)
There's another one. God, don't you get me started.

Ed Delesky, MD (20:12)
So I don't understand but for some reason it is and my hope is that we will come on here and we will dispel whatever disinformation is out there about those medications. But in the meantime, hopefully today you were able to learn something about atherosclerotic cardiovascular disease for yourself, a loved one or a neighbor. Join us next time on the next week's episode of your checkup. Check out our website, share with a loved one or a neighbor.

Check out our Instagram, TikTok, send us some fan mail. We read them, we talk about them at home, and maybe we'll talk about it on next week's episode. But most importantly, stay healthy, my friends. Until next time, I'm Ed Daleski. I'm Nicole Rufo. Thank you and goodbye. Bye.

This information may provide a brief overview of diagnosis, treatment, and medications. It's not exhaustive and is a tool to help you understand potential options about your health. It doesn't cover all details about conditions, treatments, or medications for a specific person. This is not medical advice or an attempt to substitute medical advice. You should contact a healthcare provider for personalized guidance based on your unique circumstances. We explicitly disclaim any liability relating to the information given or its use.

This content doesn't endorse any treatments or medications for a specific patient. Always talk to your healthcare provider for a complete information tailored to you. In short, I'm not your doctor. I am. And make sure you go get your own checkup with your own personal doctor.

Nicole Aruffo, RN (21:35)
your nerves.