Columbus Monthly Special Section: Three Steps to a Healthy Heart

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Three Steps to a Healthy Heart Avoid these mistakes to make sure your ticker keeps on ticking.

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By Nicholas Youngblood

APRIL 2021 Columbus Monthly

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Heart disease is the leading cause of death in the United States, but many people still don’t understand what causes it and how to prevent it.

“Traditionally, people don’t pay attention to anything until it causes problems,” says Dr. Kanny Grewal, an OhioHealth cardiologist who has been practicing at Riverside Methodist Hospital for 23 years. Although the trusty heart is often neglected in this way, a proactive focus on heart health is perhaps the biggest favor you can do for your future self.

While most of Grewal’s patients come to him when they are over 50, with existing heart complications, he has seen in recent years an uptick in younger patients who are looking to get a head start on maintaining their heart health. “Those are really enjoyable patients to work with, because they come in pretty educated and pretty motivated. They just need some guidance on how to reduce the risk going forward,” Grewal says.

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If you want to join the movement of healthy heart maintenance, Grewal and Dr. Thura Harfi, a cardiologist at the Ohio State University Wexner Medical Center, have some guidance on the biggest hearthealth mistakes people make and how to combat them.

Mistake #1: Poor Physical Health Obesity and a sedentary lifestyle are two of the biggest controllable risk factors for heart disease, Harfi says. Although the issues are deeply intertwined, he stresses that it is important not to conflate them.

Patients who are told to exercise often immediately think of weight loss, but any physical activity—regardless of its effect on weight—has massive benefits. “A lot of people underappreciate how important it is to stay active,” he says.

Grewal says weight loss is a great reason on its own, but regular physical activity also reduces blood pressure, low-

ers cholesterol and helps manage stress.

He recommends getting about 2.5 hours of dedicated exercise each week, but understands this is a tall order for many.

Luckily, research shows that even a minimal fitness regimen is a vast improvement over no activity at all. Grewal posits that a completely sedentary person who decides to walk just 10 to 15 minutes each day will see a greater improvement in heart health than a physically fit person who decides to train for a marathon.

When it comes to living a sedentary lifestyle, Harfi says excessive sitting can negatively impact heart health, even for someone who gets regular exercise. Half an hour of running each day won’t negate eight hours of sitting at a desk, so he recommends standing while working or taking regular breaks to walk around.

On the other hand, Harfi says obesity introduces its own problems, regardless of activity level. Associated conditions like

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diabetes and sleep apnea all increase the risk of heart disease.

“As a heart doctor, we are facing an epidemic, if not even a pandemic, of obesity and obesity-related problems,” says Harfi. “And we really do not understand it very well. This is the new disease of the 21st century.”

How you get your calories is as important as how you burn them off, according to both doctors. It’s hard to make specific recommendations on any individual food, Harfi says, but there are general rules for finding good foods.

Both doctors warn that excessive saturated fats present the biggest threat to heart health. Grewal cites red meat and dairy as the most prominent offenders. The saturated fats they contain lead to plaque buildup in the arteries—a direct cause of heart disease.

Instead, Grewal suggests replacing these foods with healthier sources of fat, such as nuts, olive oil, fish and chicken. Harfi takes this a step further, saying consumption of any meat—not just red meat—should be limited to just two or three times each week. At the very least, he says, fruits and vegetables should make up half of each meal.

Another common concern for the cardiologists is processed foods, which tend to be excessively high in fats and carbohydrates. “I tell my patients, if the meal cannot be recognized by your grandmother, it’s probably not really healthy,” Harfi says.

Even so, this doesn’t mean you can never indulge in junk food. Harfi says moderation is key, as well as recognizing that metabolism slows with age, so diet should be adjusted accordingly.

Mistake #2: Ignoring Mental Health Even as the stigmatization of mental health treatment lessens, Harfi says it is common for people to consider their mental health as a separate entity from their physical health.

In reality, he says, anxiety, depression and excessive stress increase the risk of heart attack and stroke, in addition to a host of other health problems.

Unfortunately, it’s much harder to quantify than other risk factors. “I can ask the patient, ‘Do you have diabetes, yes or no?

All right, do you have a family member who died from a heart attack, yes or no?’” Harfi says. “And then if I ask a patient, ‘Do you have stress?’ They say yes. … But everybody has stress.”

Poor mental health typically exacerbates existing health concerns, but Grewal says

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APRIL 2021 Columbus Monthly

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it can create new problems, too. Acute stress from powerful emotions can cause what doctors call “broken heart syndrome,” when an otherwise healthy individual has a spontaneous heart attack. Grewal emphasizes that this is an extremely rare condition, though it has been diagnosed more frequently in recent years.

Short of shedding earthly attachments and achieving enlightenment, there are ways to mitigate the effects of stress on your health. Grewal recommends exercise, yoga, meditation and breathing exercises as heart-healthy ways to unwind. He adds that poor sleep habits are an ever-increasing problem that can lead to high blood pressure and weight gain, in addition to adding stress, so it is also essential to get plenty of high-quality sleep.

Mistake #3: Waiting Until Problems Arise Although heart disease primarily affects older men, Harfi says cardiovascular health is everyone’s concern. “The disease, even

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though it manifests later in life, really starts very early, during young adulthood,” he says.

Grewal says that about two-thirds of his patients are men, but heart disease can affect anybody at any age. He insists that the healthy habits you build earlier in life are essential to preventing heart disease, no matter who you are. Both doctors say you should schedule semi-regular screenings for cholesterol and blood pressure beginning as early as your 20s.

Even at an early age, Harfi says it’s possible to do permanent damage to your heart. He has four tips for 20-somethings who want to lay the foundation for lifelong heart health: avoiding tobacco by all means, keeping BMI under 25, exercising at least 30 minutes each day and maintaining a healthy diet.

Regardless of your age, Grewal says knowing your individual risk factors is also important, especially if you have a family history of heart disease. Advanced heartscanning technology developed in the last decade allows doctors to detect the early

stages of heart disease, such as atherosclerosis, before symptoms arise. Atherosclerosis is the buildup of plaque, fat and cholesterol in coronary arteries, and it can lead to a heart attack. Harfi says the initial stages of atherosclerosis are detectable as early as your teen years, and a scan is a good idea for anybody with an immediate family member who suffers from heart disease.

Even after symptoms arise, Grewal says people often wait too long to address them.

“One of the mistakes people routinely make is they have chest discomfort, but they assume it’s something less serious, like maybe a heartburn or an upset stomach,” Grewal says. “So they tend to basically ignore symptoms, and they’re just kind of hoping that it’s something more benign.”

Common symptoms of the onset of heart disease are chest pressure or pain, breathlessness, dizziness, heart palpitations, nausea, vomiting and pain in the left shoulder or arm. Grewal says anybody who sees any of these symptoms emerge and persist should seek medical attention immediately.

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