The Doctor Is In
February 13th, 2012 - By Lari Robling
A conversation with Dr. Paul J. Mather, Professor of Medicine at Jefferson Medical College and Director of Advanced Heart Failure and Cardiac Transplant Program at Jefferson Heart Institute, on cardio-vascular disease.
What is under the umbrella of heart disease?
It is actually a total body disease. It might be better to say it is a cardiovascular problem. Since our vessels go through every part of our body it can impact on it. In general in America, cardiovascular disease basically means hyper-tension, coronary artery disease, and elevated cholesterols. Those are the main things. Below that in a subcategory will be metabolic syndromes such as diabetes and connected to that are neurovascular diseases such as strokes.
What is a stroke? How does it relate to heart attack?
Without getting into too minutia details they are both vascular diseases of different organs. Heart attacks are when blockages occur in vessels in the heart and those vessels carry oxygen to the heart and because the blockage occurs the heart muscle cells don’t get enough oxygen and that's what we call an infarction and heart attack.
There are two major types of strokes -there are multiple, but two major types—one is embolic which is clot formation and plaques that form in brain just like in the heart and that deprives the brain of oxygen. So usually someone will have a vessel with narrowing because of cholesterol plaque or something and they form a clot on top of it. There are embolic strokes that come from clots elsewhere in the heart and then there are hemorrhagic strokes where people have this slower flow or blockage of flow that bleeds into the brain tissue.
Is it different for men and women?
It is interesting if you look at it physiologically they are not that different—but there is both a cultural and physiological difference—and what I mean by that is that women tend to be smaller than men so their vessels are smaller. So when they start having diseases it is further along than with men and that is linked to our cultural problem of women being care givers instead of care takers, so what the medical establishment needs to do is to listen to women more and learn how to interpret their symptoms earlier.
As far as heart attacks are concerned, men classically describe pain as an elephant sitting on my chest. Women may have the same type of symptoms but they may also have certain manifestations such as shortness of breath when they are walking that they don't classically relate to chest pains. They may have dizziness, light headedness, fatigue, heart palpitations—some people may have gas when they eat and so there are different ways of women manifesting, and men too. But, unfortunately, we tend to ignore women more because they are the ones taking care of other people.
And what about ethnic differences?
There are certain groups that have a predisposition to hypertension, but I am going to be honest with you it is hard to say if its genetic pre-disposition, diet, exercise, cultural or access to healthcare. It's multi-factorial.
So basically I want everybody to listen to their bodies at all times and if they don't understand it, I want them to talk to their doctors about it. Self-awareness is the key you know your body best and are your best advocate. If you don't understand something get a professional to help you understand it.
Can we reverse heart-disease?
OK. That's a difficult concept because that suggests getting back to a pre-disease state. We can retard the progression of the disease, we can prevent the disease but once people get it, we like to retard the progression and control it. That would be our key. There are cases where with good cholesterol control and exercise we can see what we call have plaque regression, we can measure that can see it get better so I want to emphasize that as an important point—plaque regression and improvement of blood pressure. But all of that falls under the rubric of control and taking care of yourself well and that can prevent worsening affects of disease process.
What about the relationship of diabetes to heart disease?
Diabetes is one of the most disabling diseases known to man. It is a disease that eats you from the inside out so it can affect your vasculature and make it stiffer and less responsive. So where your blood goes you can have disease, so kidneys get affected, the heart gets affected, brains get affected. Diabetics are at higher risk for heart disease, kidney dysfunction and strokes from the vasculature relationship to insulin and poor glucose control.
If we know all this why don't we take it seriously?
We like to live like there is nothing wrong and we just keep moving forward, that is us as people. We always want to be optimistic and I'm not saying be pessimistic but take care of your vessels so you can live the life you want. It's a philosophical thing!
So, what advice are you giving patients?
For people with disease or people we see for checkups? The best type of disease you can have is the one that is preventable. Prevention is the best therapy but some people can't run away from their genetics so then controlling it early on and approaching it multi-disciplinarily—meaning if you have heart disease not only work with your cardiologist but also with your diet, exercise, family and support group. Change the way you handle stress—remove yourself from stress. These are things we can all do whether we have the disease or are at risk for the disease.
What would be first steps?
I would get a sense of what and how you are eating. I think we are making more of an emphasis on looking at a global perspective of the patient it is not just heart disease, it is a patient with heart disease. Hey, you got here because of who you are so let’s change things that put you at risk.
How did you become interested in the treatment of cardiovascular diseases?
Well when I went into medicine I found cardiovascular disease to be the most fascinating because it seemed to be the nexus for the whole body. I'm sure every sub specialist tells you their organ is the most important, but you know the heart carries the soul in a lot of philosophical ways. That's why I was very interested in it—it has electrical conduction, it has pump mechanics and it has life. So it was always a very fascinating thing for me.
What are some new advances in the field?
We are always talking about stem cells and what we can do to reverse damage .The joke with stem cell is it is always five years away, but I think we are making slow progress. As far as heart failure and transplant we have new artificial heart developed and so that's always an interesting thing especially for people with disease that can't be reversed. We’d like to help them live longer with a good quality of life.
We always think of heart disease as a problem in older individuals, but it knows no age.
Unfortunately if you go all the way back to the Viet Nam war what we saw when sadly many young men were dying—we saw from autopsies that many young people in their early twenties in superb condition had already started forming plaques in their arteries from our diets heavy lipid diet. There's an epidemic of childhood obesity and we are putting are next generation at risk. I think you start modifying risk factors as soon as you can, and for us we watch what our children eat.
What, then, do you do personally for a healthier lifestyle in your family?
Hopefully self awareness will work for me. You can't run away from family genes, so you have to do what you can to minimize their effects. I don't cook, I'm an eater, but my wife is an excellent cook—she's also a physician—so we try to eat a Mediterranean diet with beans higher fibers and less red meat because there's a lot of data that suggests red meat has inflammatory properties on the vasculature of the body. Even though we are not vegetarian, four out seven dishes is non-red meat just out of preference and style. We eat a lot of fish. We all exercise. You make it a part of your life.