Healthy Living – Cardiovascular Health

Salam aleikum wa rahmatullah wa barakato.

Can everyone hear in the back?

Everybody here as well.

So Inshallah, we'll just start settling down and wait couple of minutes people finishing prayer and then we'll we'll start the presentation. Inshallah, we will talk about how to keep our hearts healthy, how to keep our families healthy and safe Inshallah, and we will make this more of an interactive presentation. So I won't be sitting here I would like to kind of walk around and then we'll, we'll, we'll talk and we would like to also leave a little bit of time for the questions and answer for the q&a at the end at the end of the, of the presentation.

So Inshallah, with that, we can get started.

Al hamdu Lillahi Rabbil Alameen wa salatu salam ala Sayyidina Muhammad wa ala early he or Savio, Germain, Loma Linda may have found out and found me via LinkedIn I was in element of a confit Dini or a blind I mean, so there is a lot of cardiovascular awareness and Awareness Month and Awareness Week. And cardiovascular disease is one of the

common things around and it's you will see here why why this is very important. Other than that, I have my own bias because I'm a cardiovascular physician. But cardiovascular disease is one of the leading causes of death in the United States.

What is cardiovascular disease? What would you what does that mean? Anyone has any idea? Yes?

Heart attacks, right.

can hear you?

Any any idea what what cardiovascular disease means? What are the things that make cardiovascular disease? Yes.

Right anything that's pertaining to the heart and vessels that's really good way to start it's it's it's basically conditions affecting the structures and the function of the heart and the vessels. Alright, cardiovascular cardio stands for Heart and Vascular for all the blood vessels that that distribute the blood to the body. One of the diseases that are considered one of the leading things in cardiovascular diseases, hypertension, high blood pressure, also atherosclerosis, which is the scientific word for clogged up arteries with cholesterol plaque. So are it's called hardening of the arteries as well.

Then heart failure, when when the heart becomes weak, and people patients can, can have weak heart muscle or other forms of heart failure. That's also considered cardiovascular disease, heart attacks, like this gentleman here, not having a very good time.

A heart attack is a devastating event.

The other thing is stroke. Stroke happens when a clot transfer from somewhere in the body or formed in the carotid artery into the brain, and it causes brain damage, and sometimes that brain damage is permanent.

So you can see how devastating cardiovascular disease candy. Heart disease is the number one killer in America. If you look at this country, the number one killer is not infectious disease or wars or it is cardiovascular disease. It is heart trouble. And stroke is the number three

leading causes of death. So it surpasses cancers. It surpasses infectious infections, and it surpasses many other common things that you might think would kill people. Cardiovascular disease is by far if you combined heart attacks, heart failure and strokes is by far the number one cause of death in this country. So it's very important that we are aware of it and we understand how to deal with it and more importantly, to know how to prevent it. Right, because Durham will kya Hi, Ronnie pintoresco allege An ounce of prevention is better than a ton of treatment or therapy.

So the lifestyle that we choose and that we live will actually determine and have be our faith first line of defense against heart attacks, heart disease and strokes. And it is our responsibility when it comes to our lifestyle.

This

Here's a map of the United States of America. And that's just to illustrate the cardiovascular death distribution. And we live in the capital, we live in the middle of the highest incidence of heart disease, and death, not just heart disease, death due to heart disease as well. So with that in mind, we know that we are in an area of the country that we need to be even more aware of, of heart cardiovascular disease, and how to prevent it.

Heart disease has many different risk factors, things that will make people more predisposed to developing heart trouble. And there are many, there are actually more than these risk factors. But these are the risk factors that you and I can do something about. These are the risk factors that we can modify, other risk factors that we cannot do much about genetics, right? The things that we inherit, from through our genes from our parents and ancestors? Well, you can't change that. Even if you want to change your family, you still can't change your genes, right? You don't have gene therapy yet. But, but these other factors, we can control, smoking, tobacco use, high blood

cholesterol, high blood pressure, physical activity, obesity, and diabetes. So we're going to go one by one and see what can be done. And why are these things so important in prevention, and treatment of cardiovascular disease, and hence the ABCs. And you will see at the end of the talk, what a and b and c stands for?

Let's start with something that definitely is preventable smoking. Smoking causes plaque, which is the cholesterol buildup to form in the blood vessels.

Also, smoking can cause clots to form, people who smoke have more tendency to have clots than those who don't smoke. So smokers are at a higher risk for heart attacks and is still in a stroke, it decreases the good cholesterol, and it also

makes patients or people at a much higher risk for cardiovascular disease. The other thing is nicotine in cigarettes and tobacco is a stimulant. So it can actually accelerate the heart rate. And it can cause a arrhythmia. And in patients who have heart disease, these this rhythm issues, the change in the heart rhythm can be fatal, can be can kill people. So it is a it's really a very bad situation. Smoking is in the United States is on the average, if you go into the distribution of the ethnicities, for some reason, American Indians, well, I guess they invented the tobacco smoking, right? So they have the highest

level of smokers high prevalence is over 30%. White Black range between 15 to 20%.

I don't have statistics for the Muslim community. So but but you can tell from where we would look around that it is actually a very common problem. We ask Allah subhanaw taala to help all of our brothers and sisters quit and kick this bad habit.

The next thing that is so this is something preventable smoking is the next thing is obesity is gaining too much weight. So what is obesity people generally who are 30 pounds overweight, or at a higher risk for heart disease are more likely to cause heart disease, even if they don't have any other issues. They're not smokers. They're not diabetics, they don't have hypertension, although obesity can predispose people to all of these things. But even if they don't have it, obesity independently, is a risk factor that can cause heart trouble.

And this is the map that I showed you about where the cardiovascular death where deaths from heart disease occur, and United States. And this overlapping one is where obesity is more common in the United States. And you can see the correlation between the two, where obesity is heart disease is and when we have in our area in our communities, and I'm talking about the community at large higher level of obesity, then the risk of heart disease is really significant. Here's the bad news that we are getting as a country don't take that personally. We're getting fatter every year this is the

From RT when you can look, you know, at your screen from 2011 to 2021. This is a 10 year,

statistics that being gathered in 2011, there was only 12 states in the country that have obesity rate between 30 and 35%, which sounds like really a lot. But now, if you go to 22,020 2021, we have 41 states either have 30 to 35, or greater than 35% of obesity. But that's more than 1/3 of the people that live in the state that are obese, I'm not talking about just overweight, obese, that's beyond the 30 pounds that we talked about.

So in the United States, if you combined being overweight, and I'll explain what that means, what is the difference between overweight and obese here in just a minute.

But if you combine that in 1970, the combined rate was about 45%, more than half of the population had normal weight in 1970. Move to 2020 74% of the population is either overweight or obese. So we have three quarters of the people that are living in the United States, either overweight or obese. And that is really the definition of an epidemic. And we are not only getting fatter, but we are fatter than the rest of the whole world. So if you compare the average obesity in America is about 66%, depending on the statistics were twice as much to have obesity than the rest of the world. And that other smaller graph that are there is actually even more scary, our children are twice as much

twice as likely to be obese than the rest of the world. So we are leading where we shouldn't be leading.

If you look at the United States and top 15 countries, and that's combining being overweight or obese, amongst all the industrial or developed countries, we are number one, we have about 70 to 74%. In the world, we only surpassed by two countries, Kuwait and Qatar, where they don't have much physical activity, and it's a culture of access and abundance. And that sometimes is not really very good. So you can see where we're worse than Canada, we're worse than then than many other countries, Spain, UK, Greece, Turkey, etc, etc. We are again leading in obesity.

OB obesity is is considered not only hazardous for the health, but it's really a threat, it's a threat into our national

economy. So it is estimated that in 2030, and these statistics are about two years old before all this inflation happens. So you can actually increase this number, it's estimated that it can cause up to about $600 billion a year by 2030. And you just imagine the amount of money and the amount of wealth that can be lost. Now obesity and being overweight, where the fat in the body matters. So not just the weight, and when we get on the scale, but where that fat is where that extra tissue is. There's two different types that actually make a difference in heart health. One is called the apple, and one is called the pear. The apple is when you look at your waistline, and above it, and

if most of the obesity most of the fat is accumulating in that, that is considered high risk, very high risk for development of heart disease. And the theory behind that is most of that fat is actually called visceral fat, it's fat inside the belly, around the liver, around the stomach and around the heart, while when there is accumulation of the fat not in the waist not in the abdominal cavity, but in the hips and the thighs, then the risk of cardiovascular disease is very low. So things are not equal.

We can tell whether we are on scale or or basically, no pun intended, if we are normal or not by something called body mass index. I was given this talk to PVS and I told them they will be quizzed on this formula, you know, but not really. So there is a formula buried by entering our body weight and our height and he will actually give you the gender different differences well, it will give us something called body mass index. Body Mass Index is just a crude way a general way of measuring whether we fall into normal or

are overweight or obese. But don't worry about memorizing this formula, there is an app for that. So you can download the apps called BMI, and there's actually several of them. And then you can calculate your own BMI.

So what is it good body mass index, anything below 18.5 is considered underweight. And that's a problem not for heart disease, but for many other issues. But normal is between 18 and a half, to up to 24.9. Basically, anything from 25 to 29.9 is considered overweight. Now 30 and above is obesity. And that carries the highest risk. So normal average, the risk is low, overweight, increased risk, and obese is highest risk. So it's important to know our numbers to know where we stand, so we can act accordingly.

Then we go on to the next risk factor, which is high blood pressure. And hypertension is been dubbed as the silent killer. Why is it silent? Because it doesn't hurt things that hurts in medicine and in treatment of diseases actually good. Because when it hurts, it alerts you that something is wrong. But hypertension does not hurt. Many people don't even know they have it. As a matter of fact, 1/3 of the entire population of this country have high blood pressure, just imagine was over 100 million people in this country have hypertension. But the scary part of that is one of every three that have high blood pressure, they're not aware they have it. They don't know they have high blood pressure.

So 30 million plus have high blood pressure in this country. And they don't know they have it. So why why is that important? Because when someone has hypertension, it changes the entire dynamic of the cardiovascular system. First of all, arteries that are exposed to high blood pressure become enlarged and thickened. The muscular layer within an artery and otter is an amazing structure. But Allah subhanaw taala, it has layers of different things. And some of it is what called the smooth muscle that becomes enlarged, and endothelial of that vessel becomes dysfunctional. So that vessel not only become an issue in kidney disease, and we have some nephrologists here that can also speak

about that, but also, not only in blood supply, but it's also much more vulnerable to be clogged up with cholesterol and other things that may cause lead directly to heart attacks and a stroke. So it is a killer without a doubt.

This slide shows that that as we increase in age, the likelihood of having high blood pressure increases. So this is actually statistics that were performed in the United States by the national home health organization. And it shows if you're over the age of 75, chances over 70% that you have high blood pressure.

But but even if you look at the what we call middle age between 45 I guess 45 is young these days, middle aged like me, I guess, then it's almost 50%. Half of people my age have high blood pressure. But the problem with that is, if they don't check it, they don't know it. And again, I hate to keep bothering you have these maps that you can see the purple is the highest level of hypertension. And again, we're smack down in the middle of where hypertension is worst in this country.

So invest in one of these, if you don't have one of these pressure cuffs at home, get one, it's really a good investment.

Make it a read gift for your family, or Ramadan gift for your family just to keep everybody healthy. Because if we don't check it, we don't know it. And if we if it doesn't hurt, we will not be aware of it. So it is really important to do that. The other thing is what is considered normal. And you will hear different things than when we check our blood pressure. The machine or the physician or whoever is checking it will give us two numbers, one on top and one on the bottom. Or the one on the top is called the systolic blood pressure. And that's the blood the pressure in the arteries when the heart is actively pumping the blood out. Then you have the diastolic blood pressure or relaxed

heart blood pressure when the heart is relaxed. That's the lowest part of the blood pressure in the arteries and then the vessel. Now normal should be less than 120 on top and add on the bottom.

So someone said Well, for me 140

is good that that actually is absolute nonsense. There is no good blood pressure for this person and a bad blood pressure for that person. There are only few exceptions when someone is having a stroke, they need the blood supply, then the neurologist will recommend that we allow higher blood pressure to occur. But in general, when we're looking at the diagnosis of hypertension, normal is 120, over at between 120 and one and then one 140 is considered pre hypertension. So if someone is checking their blood pressure is 131 35. It's not normal, but they're not yet diagnosed with hypertension. And then same thing on the bottom, if anything between 80 and 89. Now once someone hits that 140,

over 90 and above, then the diagnosis of hypertension is established. And stage one hypertension. If it is over 160 on top and over 100 on the bottom, that's a high risk blood pressure that stage to over 180 You go to the emergency room,

you need to seek immediate medical attention, because that's considered hypertensive urgency, or an emergency and the blood pressure needs to be lowered more rapidly. Any questions about about the hypertension and the blood pressure? Before we move on to the next one? Yes. And to speak up least Lou?

So the question is, is it genetic? Or is it environmental? Well, it is it is it there is a definitely a genetic component. And there's also what we call an environmental component, meaning overweight people can have high blood pressure, diabetics is they will have high blood pressure, kidney disease can lead to high blood pressure. But here we're talking about things that and our ability to modify and to work with. So even if it is genetic, and there is a genetic component, but there are things we can do. And the first step is to diagnose it is to know that someone has blood pressure. And that's what this talk is emphasizing. Not how you treated, there's about 100

medications out there, depending what your physician will will be will be recommending for you what would be fitting you the best. But in general, these are risk factors that we can do something about.

Sorry, I can't hear you.

So generally, the question is the systolic and diastolic as a proportional when the systolic goes up does the diastolic go up, and vice versa, for the most part is true. But there's also something called systolic hypertension, where the diastolic is normal, and the systolic is really high, these numbers still apply, so that that person is still hypertensive. And the same thing with the diastolic hypertension, then then also the same thing apply. So over 90 on the bottom or over 140 On the top is definitely hypertension.

So the number the numbers may change, depending you know, if you're yelling at your child, or going through stress, or relaxing, they're you know, making the speed, the blood pressure will fluctuate. Blood pressure is not the same every time you check it. So don't panic if you just went through an argument and you check it and it's 160 wait an hour, sit in a chair, back supported and relaxed, and then recheck it again. So what we're talking about here is persistent, high blood pressure, not if you get excited and the blood pressure go up. And then and then it relaxes. Now there's something called Central I don't want to make this too complex. There's something called situational

hypertension, where people have really significant high blood pressure when they have stress and sometimes the stress is very minimal. If that is recurring, then that also requires some treatment.

Yes.

So the blood pressure has something we call it and you aware of it, diurnal rhythm, so and that varies from one person to another. So some of us have higher blood pressure at night, and some have higher blood pressure when they first wake up in the morning. So it's really good if you are doing a surveillance on your blood pressure is to check it in the morning. Occasionally check it in the middle of the day and check it towards the end of the day. And then just see if you can stay

publish your rhythm. And if you always wake up with a blood pressure of 150 over 100, but in the evening is 120, then that means there's, there's definitely a reason to treat that morning blood pressure.

Does that answer the question?

So diabetes? Yes, I'm sorry.

Is the diastar No, no, there's no one more important than the other. And actually, there was a famous trials actually took a took took place right here in Memphis called systolic hypertension in the elderly. And it shows that even isolated systolic hypertension is detrimental. And it's associated with increased cardiovascular death, this even if the diastolic was fine, so they're both equally important.

All right, diabetes, I'm just looking at embarrass, speak about that in the presence of some endocrinologist here in the in the audience, but I'll give it a shot. But I'll speak about it from cardiovascular standpoint, how does diabetes affect heart disease? Diabetes by itself, just the diagnosis of being diabetic, increases the risk of heart disease between two to eight falls 200 to 800%, more

of risk of heart disease in diabetics. And most diabetics, as probably Dr. Qureshi can tell you, they don't die, because just just only because the blood pressure gets too high, or too low 75% of patients with diabetes die with heart disease, or cardiovascular disease, like a stroke, or heart failure. So diabetes is a very important risk factor. And onboarding, you have the slide. But if you put the cardiovascular death map, and then the diabetes map, you will see that the overlapping is, and these are all the CDC maps, and this is CDC data that tells you where diabetes is, death occurs, we're not talking about just heart disease, we're talking about death that occurs due to the heart

disease. So it is a very serious matter. Diabetes is not to be ignored. And diabetes is not to be overlooked. And diabetes needs to be diagnosed. How do we diagnose and that's the other thing. Diabetes is getting worse in this country. So this is the map in 2004 2012 and 2019. And you see it's getting darker bluer. That means the prevalence that diabetes is on the rise. And this graph below that shows percentage of diabetes and diabetics, you can see that this is starts, it's hard to read, but it's from 1968 to 2014. Without giving up my age, that's through my lifetime. So you can see that it's a steady increase. But somewhere in the late 80s, mid 90s. It took a sharp increase

up. Why?

What are the theories? We I mean, we did of course, we don't know exactly. But what why why do we think that that just happened in the mid between the mid 90s. And now it's taken the sky? Yes.

But Donald has been founded Allahu Allah. But that's a good, that's a very good yes.

Was that.

And that's realize food. It's the food industry. But what's wrong with the food industry is what? There's a lot of research on that. But the idea is that a specific product made its way to the American market. And it became very, very widely used. And it's invented by the Japanese, and it was exported to this country, and we took away with it. And everybody considered it a retaliation for Hiroshima that they're getting back out as they want to kill more people than we did in Hiroshima. With high fructose corn syrup. The worst type of sugar that you can put in your body. It metabolizes on the same pathway as alcohol and it can cause fatty liver that lead to liver cirrhosis to liver

failure. And then it is a very important in the in the epidemic of the diabetes. Now if you look at a can of Coke of the classic Coke, right? How many spoons of sugar of high fructose Do you think you'll find in there?

That 1212 spoons and one can in one serving. So and then if you look at your cereal that you buy in the store, you'll see that it's one of the main ingredients. If you look at most of the in

industrialized food that you will see that because it's so cheap to produce. And we are one of the leading corn producers in the world. So we have a lot of it. And then it is used till today in a very, very common way. So that's just a digression. But but you can just see how diabetes continues to worsen This chart just to show you. And if you look at that last graph, that the risk of cardiovascular disease and stroke is at least three to four folds in the diabetics, which is the orange bar. So you can see diabetics do worse with hypertension, do worse with obesity, and do much worse with cardiovascular problems.

Yeah, so the question is about a solid heart attack, maybe we'll come to it a little bit later. So.

So diabetes, how do you how do you check for diabetes? For the most part, if you have access to something like like this machine, the glucometer? Then you can, then then it's recommended that you periodically check the sugar in the morning. And

if it is more than 110? Is that still valid Dr Qureshi than it is considered an abnormal Dr Qureshi gave a really extensive good talk about diabetes and diagnosis of diabetes. But for the most part, it's not like the blood pressure cuff. A lot of us don't have access to it. But it's so important to keep up with your regular physical examinations with your primary care physicians, because they can check that and make sure you're okay. And the other thing they will check is something that Qureshi spoke about during his talk, it's called a one C level that looks at the blood sugar reading over three months. And if the level is more than 6.4, then someone is definitely a diabetic. If it is

less than 5.7. They're not an in between they're pre diabetic, and they should try to do something. And we learned from Dr. Qureshi talk that you can actually move from being pre diabetic back to normal, but it's so hard to go from diabetic to normal, is that still accurate?

So diabetes is a very bad risk factor, it needs to be diagnosed. And again, I'm not talking about how you treat it, that will be up to you and your physician. And the cases are so much so different. But it's important to know to know that you have it last summer hallelujah, and he or anyone has it so it can be treated.

The next risk factor is again silent, you don't feel it, you don't see it. You don't you cannot touch it. And you can only measure it in the blood and that's the cholesterol level. Now, cholesterol is not a bad word. Cholesterol is not a curse word. Colette, we need cholesterol, we need cholesterol to to have our the membranes of our cells intact. We need cholesterol to produce the important hormonal factors in our body. So cholesterol is needed. And it's also needed for bile acids that help us digest. But there are different types of cholesterol. And what we're talking about here is a specific type carried by a lipid protein called low density lipoprotein.

Which is LDL. LDL is a bad player, people who have high LDL have high risk of heart disease. And you can rarely see someone that has chronic elevation long term elevation in the LDL, that have good vessels or good heart. So LDL, if you're not going to remember anything or any of these numbers in this in this presentation, remember the LDL and what the LDL should be. And then plus we're going to talk about what why is this important because those small particles of cholesterol called APB that is carried by the LDL, they float in the bloodstream. And then when they find a vulnerable vessel, either due to blood pressure, or diabetes, or genetic predisposition, they find a way to deposit

themselves inside the wall, the wall of the vessel, and that accumulation of the LDL particles or the APB bartered particles can lead to something called plaque formation. And that's what we talked about Atheros, we called atherosclerosis in the beginning of this talk, that's hardening of the artery that's clogged up arteries, so to speak, clogged up arteries can lead to heart attacks. So first, you get a normal artery that has no cholesterol in it, and then you start having deposits, and then the plaque can progress. And if you see that volcano right there on at the end of this cartoon, that that's a vulnerable plaque that's a plaque that started cracking and exposing the

inside the inside components of

bad cholesterol, and that can lead to clots and clots in an artery that

is already tightened is a massive heart attack is a heart attack that can occlude the artery completely.

So that's what we're trying to avoid is the heart attack and heart attacks is to go back to the brothers question it can be, it can definitely be

clear will like like what you saw in that in that picture someone is having crushing chest pain. Sometimes the pain may radiate to the jaw to the arm, they get nauseated, they feel really sick, and really bad. But sometimes the symptoms are not very typical. Sometimes it's just being more tired than normal. Sometimes it's having indigestion type of discomfort. And women have a much different presentation than men. They don't have that crushing elephant sitting on the chest, they have milder and different symptoms. So it's very important that if someone is having a problem, that sudden issue to be checked, it's better to go to the ER and suffer through the waiting and the checkup than

to miss a heart attack.

There are things that we can check to see if we actually have plaque in our hearts. And this is a test that I want you all to be aware of. It's called coronary calcium score. When plaque occurs when plaque happens in the heart, calcium comes and deposits itself on top of the plaque. And on the bottom of the plaque, it kind of trying to trap that that that cholesterol inside, and that what causes the hardening, right, calcium is rock, calcium is hard. So the hardening of the arteries happens because of the calcium. Most plaques that have been there for a while will accumulate some calcium. So there is a test that is very simple. It's a low exposure to X ray, it's done through a

CT scan, it takes literally five minutes under the scanner. And he will give us a number of how much plaque how much cholesterol buildup how much calcium is in the heart. If it is less than 10 is minimal, between 10 and 100 is mild 100 to 400 is considered moderate. But if the score is over 400, then someone really needs to make sure that they do the test to check with their physician, and to probably consult a cardiologist at that point. So at this test, most of the time, they probably need a doctor order, but you can get it done. Also in many imaging centers, because unfortunately, it's not covered by insurance. But the only good part about that it's only about 100 $225 per test for

the entire scan, and the information is valuable. So if someone has risk factors, I highly recommend they invest in that, that test as well.

This is just a quick

look at how you treat an acute heart attack. And that's what I do for a living is you go in there, you do a heart catheterization, you're looking at the arteries. And if there is a plaque, you can you can try to take care of it, he cannot remove it, but you can do is you push it out of the way and allow the bloodstream to occur using a balloon and a stent.

This is actually a patient that we had, that if you look it's hard if you're not used to looking at these, the dark, the darker the fatter the color, the more blood flow. And you can see right here, there is a 90% blockage. This patient was having an acute heart attack. And this is what it looks like after the stent was deployed, the blood flow is restored. So there are things we can do when heart attacks occurs. That's why do not ignore the symptoms. If someone is in the emergency room and are in the cath lab, within 90 minutes, the damage to the heart is minimal. Once it's over that 90 minutes, then the damage can be permanent and irreversible. So again, quick diagnosis is very

important.

How do we reduce the cholesterol level that leads to all of these problems? Again, the normal cholesterol levels total is less than 200. So if someone checks their total cholesterol and it's, you know, 190, they may feel good about it, but that's really not adequate. Or if it was to 30 they may feel like they're having a problem with cholesterol but that's also not adequate. The reason being is the total cholesterol looks at the good and the bad combined. So if someone has too much good, like most females do, their LDL, HDL can be 70 or 80. And I have patients that have 120 of HDL, then their total cholesterol is 250. But it's all

A lot of it is just good cholesterol, and bad cholesterol is a smaller portion. So it's the ratio between the good and the bad. But if you are to remember one number, remember, again, the lousy cholesterol, the L D, L, you want it to be less than 100. If you have any risk factors for heart disease, if someone has established heart disease, the American Heart Association change their criteria used to be less than 70. Now they're recommending less than 55 on the LDL to prevent further heart attack and further plaque buildup.

How do we reduce cholesterol now I said, we are talking about all of the things that we can do something about to take care of, we can take the initiative, of course, medications is important. And for someone who has a really high cholesterol over 130 with risk factors, they need to consult with their physicians, make sure their annual cholesterol is checked. And that's the recommendation of the heart, American Heart Association. But also we can reduce the cholesterol with weight reduction, we can reduce the cholesterol with exercise, and we can reduce the cholesterol with the quality of the food that we eat. So things that we called omega three fatty acids that are available

in fish, and in some nuts and vegetables, like avocado and other things. They can lower the cholesterol, olive oil is a very

good source of nutrition that can lower the cholesterol.

There is if the saturated fat is bad player that can increase the cholesterol. So we want to make sure that the saturated fats, the unhealthy fat is less than 7% of the calories that we take. And unfortunately, again, the food industry, they don't care about that they care about what's cheap, and how they can market it and what tastes good. So you will see you need to be a label reader. When if you bring things that are processed and you're not cooking it yourself.

The other thing that can lower the cholesterol is something called plant sterols. Now the word sterile is included in cholesterol, right? Because they have the same molecular structure, the same biochemistry, but plant sterols are beneficial. And they can actually reduce the cholesterol as well as soluble fiber example of that is what you see there on the slide. plate of hummus is very, very high in sterols, and it can really help in lowering cholesterol levels. You put olive oil on it, and you eat it with some whole grain bread and you're ready to face your cardiologist any day of the week. Right? Because this is really a healthy play. Just don't eat too much of it. Right, because

calories still count. The other thing is, what kind of cereal is that? Kids adults Cheerios, why Cheerios, because it's high and sterols. And it's high in fiber, it's a whole grain. And most the plain Cheerios have very low sugar, and it has carbohydrate, but doesn't have added sugar. While if you look at other cereals in the market, like whatever Trix mix who I don't know what they call them, that they have, they have high fructose corn syrup, in the in the cereal itself. Salmon, fish in general, is a very good source of omega three fatty acids, a handful of nuts every day handful of almonds or, or pistachios or or you know, other knots can definitely be a very good source, and then

healthy vegetables and healthy fruit.

So we need to know our numbers. And this is you know, a slide that you can take a picture off or keep it in mind. But these are the good numbers and the bad numbers of everything we talked about. The LDL is good if it's less than 100 over 160 is really bad. The good cholesterol if it's over 50 is great. If it's less than 40. It's not good. The triglycerides we didn't talk much about but in general, it's a secondary risk factor. So I'll skip over that quickly. But the blood pressure needs to be 120 over 80. If it's over 140 over 90, that's bad. A blood sugar needs to be less than 100 or 110. We said probably less than 100 is the more accurate number. It's over that it's not good. And

the body mass index needs to be 25 or less.

So these are the numbers that we need to remember.

Yes.

So yeah, the question that Adam is asking is What did

difference between low density and high density. The low density particles are compact, they're small, and they carry a passerby, which is bad cholesterol, bad player that can invade the arteries, the HDL, the high density, or fluffy and big, and they actually remove cholesterol from the from the artery. So they're totally, totally different.

Yeah.

So stress can definitely exacerbate heart disease by doing many things. Stress produces hormones in our body, like cord cortisol and cortisone. And that increases blood pressure, it increases blood sugar, and it can accelerate the heart as well. So a chronic exposure to that recurrent stress that will pump the adrenaline up and cortisol up, and he can actually damage the arteries and make him more vulnerable.

So is that what you're asking? So definitely, stress is a factor.

And that's why when you look at what the things that does a good heart healthy lifestyle, actually, that very bottom is reduce your stress level. Right, that's so that is an important risk factor that that needs to be modified. So if you want a healthy heart, stop smoking, be physically active for at least 30 minutes a day. Eat a healthy heart healthy diet, maintain healthy weight, keep an eye on your weight, keep an eye on the blood pressure, keep an eye on the blood sugar, and trying to reduce your stress. Take a vacation.

So again, if you look at physical activity, and I promise you this is the last couple of maps that I'm going to show. Again, the death rates, you can see in the dark red. And the dark blue is the level of inactivity, people who exercise less than others in this country. And that's why you see in our area exercise, and I hope that doesn't apply to our community. Exercise is not very fashionable. But in California and the Northeast and in some of the mountain areas. Exercise reduces the level of heart disease, and that's well documented.

So do this walk, exercise, be active.

And don't do this.

So the ABCs and I'll conclude with that a Four Avoid smoking be is become more active and see, you do choice of good nutrition and good food. So inshallah we'll open the floor for some questions. It's took a little bit too too long, but I thought it was really an important thing that we all should be aware of. Any questions? Any anything that Yes.

Heart disease is like the number one killer newest within diseases or like the main cause, like is it more than traffic accidents MORE THAN correct? It's more than traffic accidents more than alcohol. It's more than suicide. It's more than anything else. So it's the number one killer bar none, not just amongst diseases.

Yeah, yes.

So

want to use the mic?

Yes. And having a defibrillator in a public place is also important. Because you have minutes to react if someone is having a heart arrest. Go ahead, Shawn. Yeah. So now when it comes to Zach,

learning how to do CPR and use a defibrillator is very important. So shameless plug, we have an EMR t here, emergency medical response team.

We're having training and you can also get

on to we're having training next Saturday from one to five here, if you want to sign up, they're gonna send out the link in over the weekend. So sign up, we have two defibrillators here in this building, one over there, in the entrance to the Nissim Hall, and one over here in this entrance down here. They're checked regularly that they're working, but it's very important that you know how to do this. So next Saturday, sign up for the emergency class, learn how to save a life in somebody's heart. Definitely highly recommended that you do that. Anyone else has a comment or question? Yes.

I recently moved to the States. Yes. And I was seeing a doctor and back home. He

gave me medicine which called for Vega for sugar, blood sugar. And since then, my blood pressure is lower than 120. That's one one point. The other point was the difference between stroke and heart attack symptoms. So how Stroke affects the brain. Yeah, heart attack.

x is in the heart. stroke symptoms can be anywhere from sudden paralysis, not moving an arm, not able to talk, the Face drooping, you know the face become paralyzed on one side. Stroke is mostly nerves, neurological symptoms, while heart attacks can be related to the heart chest pain. Have you talked about the symptoms, right? chest pain, shortness of breath, and things like that. So there are two different things. Because the same process, the same underlying problem, but one affects the vessels in the brain, and one affects the vessels or not. One more question, doctor, excuse me? How can we distinguish between the

pain in the chest and the pain in the chest through the colon? So that's sometimes you know, the question is, how can you tell if I'm having a lot of times he can't, a lot of times the pain may radiate. And you may think, and you know, that's one thing and some people may think it's another. So it's important if someone is having an acute pain that's not usual is not had it before. Just go get checked. You know, go go to the closest hospital get an EKG gets a couple of there's enzymes that can be checked called troponin that are very, very highly sensitive to diagnose heart attacks very early. Now someone had a heart attack, just want to question

what are the chances of dying of a heart attack? Someone less? I'm Hala? May Allah forbid? Yes.

No, it's not 5050 is actually less than that.

Close? Does anyone in let's talk about what is what are the odds of dying with the Russian roulette? Does anybody know what the Russian Roulette is? Right? You put a bullet in a revolver, and you take your chances? What are the chances of dying with the Russian Roulette,

one out of six. That's 15%. That's exactly the odds of an acute heart attack. So if someone is allowing themselves to have a heart attack, there might as well be playing Russian roulette.

It's the same statistics, just with my last question was about this. How can we see you know, more than younger people who had heart attack, die more than the oldest 50 and more. So number one, that's not completely true. But you probably see that a lot of times younger patients like in their 40s and 50s, when they have their first heart attack, and if it is in a major artery, they immediately collapse, and they don't have much of a chance. And it all depends of where the heart attack occurs, there is certain arteries that are much more vulnerable to to death than others. If a heart attack occurs in his side branch, or a small artery or down the stream, then most people can

actually survive that. But there is something called the Widowmaker, or the left main or the left anterior descending. These are major arteries, that if a heart attack occurs in those arteries, the chances of dying are much greater.

Any other questions? Yes, yes.

Okay, so low blood pressure is not a risk factor for heart disease, it's bad. It allows if the blood pressure is chronically low and low be below acceptable limits. And it leads to the what we call lack of perfusion, the blood flow is not going to the kidneys well not go into the liver, well, then that's that's not a good situation. Not that this doesn't increase heart disease, but it can still cause organ damage. But high blood pressure is the only thing that can cause a problem with

low blood pressure. So the could be many things, infections can lower the blood pressure taken too much medications, dehydration, and many other things can cause low blood pressure.

Yes.

Yes.

So that begs the question is, is regarding the silent heart attack? Why does it happen more often in diabetics, and that's true. The diabetics have something called neuropathy that sent the nerves after prolonged exposure to diabetes become numb. And you can see diabetic patients sometimes they can stepped on a nail and not feel it in their feet because of neuropathy. Well, it is known that that also can happen in the same way to the nerves that that supply the heart, so pain is not a major

symptom. When when a diabetic is having heart attack, they can still have pain, but but but a lot of them don't. They just feel nauseated. Sometime they throw up they feel like you know that they're having a lot of shortness of breath and many other many other things.

And that's why in diabetics sometimes hard to diagnose those and that's why the death rate in diabetics is much higher

yes sir

so heart attack can be somebody who's really stable just telling you I'm having chest pressure you just take him to the hospital don't don't pump on their chest. But if someone collapses, right, someone, we're just talking to you and they just drop there was a football soccer player that had that you know recently and that's that's a heart attack due to sudden rhythm problem he can happen with a clogged up otter is sometimes can happen in, in healthy adults for electrical issues. The most important thing is to start CPR and what Shawn said, if there is an access to defibrillator, just go ahead and put it on that person. And that's really what saved that soccer players life is

they had a defibrillator right there and they were able to revive

the pain

while waiting for the EMS or reaching to the hospital.

I'm sorry, you did an aspirin. Yeah, so if someone is having chest pain, you already called 911 to come and get them if you have an aspirin in the house, go ahead and give it to him. If it was not a heart attack, it was a false alarm is not going to hurt him. But you might increase their chances of survival if you do so.

Just don't give them medications that are not prescribed.

I'm gonna say my, my neighbor had this and you know, don't don't do that. Okay? Don't Don't borrow medications for anybody. Yes.

Many years ago, my dad was a pharmacist.

There was a, you know, he worked in a restaurant. And he would, he would come I remember him, he would come to my dad, because we used to go buy bread from him. And he was complaining of heartburn. It turned out to be a massive heart attack. So you know, again, that if someone's having persistent heartburn, they definitely should be seen, right? It could definitely be just a little bit of acid reflux. But like I said, heart, you know, not what we say here is like a doctor's joke. Not every heart read the same book, right? Not every heart will follow the classic textbook description of the elephant sitting on the chest, or the radiation to the left arm. Sometimes they just feel

indigestion. And I tell my patients of your have a lot of risk factors, that if you're having indeed, you're not sure what it is, we'll go get it checked out, we'll have to wait in the ER for five hours. Well, it's better to be there five hours and survive, then to just ignore it and go to bed and not wake up. Right. So it is always important if someone especially those who have risk factors. So for example, if someone is diabetic and hypertensive and they had family history of heart disease and they start having recurrent indigestion, then that could be a sign. The other thing that could be a telltale is what makes it worse. If it happens only after they eat a pizza,

then could VGI right, but they still need to be checked. But if it happens, every time they walk, they exert themselves they carry something related to activity, then that could be a very clear sign of possible heart disease. Does that answer your question?

Yes.

For your exercise that you mentioned.

So now like

I just remembered one more thing. So the exercise that you mentioned, there are a lot of programs here that they do it on my C

shape physique guys agos here, he's got the soccer in the volleyball. There's basketball, and shameless plug. We also have an MIT cycling group too, if you'd like to bike and all any mean, you know, different strokes for different folks. If you can play soccer, more power to you if you're as old as I am, and you're worried about your knees walk. brisk walking is one of the highly recommended most effective things in in prevention of heart disease and in improving the physical activity. Just brisk walking for about 30 minutes a day. If you cannot do it everyday, do an hour every two or three days. Yes. Yes.

Well I consider

so the first question is how nonsteroidals affect torque.

Oh, anxiety. Okay. And the second question

how can you manage stress, okay. So, anxiety is a type of stress and like I, you know, was when I was answering a prophetic question, that that stress can can be a bad player anxiety can do the very same thing as is it really a form of acute and sometimes it's chronic stress. So if someone has

As recurrent anxiety and recurrent stress, there really needs to be consulting with their physician to see if they need to take something to reduce that. Or if they have recommend like exercise

routine that can actually relieve the stress and it can help with the anxiety.

The other part of the question is how do you treat that? How do you deal with stress? Actually, one of the websites that I do recommend that you all go to if you have time, and it's very, very easy to navigate, is the American Heart Association, ah, a.org, American Heart Association website. And he goes over all the things that I spoke about, and also how to manage stress. But in a nutshell, I'm not just diverting the question, it says, you know, the kind of recommendation is what relieves my stress may be different from relieves your stress and the type of stress that I have is different than the type of stress that you have. So the recommendation is to be consulting with with

physicians, and if someone needs psychotherapy or other you know, things they should be referred to. So it all depends some people relieve stress with meditation and relaxation, some relief stress by playing soccer, some relief stress by punching a bag, right. So these are so many different things to stress relief. And it's again, it's different from from from one person to the other.

So Giselle Kamala here, if there are no more questions, you've been more than great attentive audience may Allah Subhana Allah keep you healthy, keep your families healthy. And may Allah subhanaw taala allow us to be good tools to spread better health practices in our community and in our city in sha Allah does that come along?