Courtney Collen (Host): Hello and welcome. You’re listening to the Health and Wellness Podcast brought to you by Sanford Health. I’m your host, Courtney Collen with Sanford Health News. This series begins new conversations and continues the important ones, all designed to keep you well, physically and mentally. In this episode, we are focusing on heart health, specifically heart and vascular screenings and everything you need to know. Ahmed Abuzaanona, M.D., is a cardiologist at Sanford Health in Fargo and joins us now for this conversation.
Dr. Abuzaanona, welcome. Good to have you.
Dr. Ahmed Abuzaanona: Yeah, thank you for having me.
Host: As we talk about heart and vascular screenings, why are these so important?
Dr. Abuzaanona: Screening, by nature, means that we are getting a patient or an individual who doesn’t really have any symptoms or known disease, and we’re trying to find out if they’re at risk of having a particular heart problem or vascular problem in the upcoming few years. That means if we discover it early in the process, we can do a lot more about it to curb the problem and make sure we don’t progress into a real event, because a heart attack for instance, can be a very dramatic event that can lead to a lot of complications.
Host: Talk about some of the common signs or symptoms that might lead to heart health concerns, heart disease, or may eventually result in a heart attack.
Dr. Abuzaanona: It can be different for different people. We know any discomfort in the chest area or even the upper abdominal area, the upper part of the belly, can be a sign of heart attack. Women can have additional symptoms like maybe nausea, a little bit of vomiting or shortness of breath, rather than the typical heaviness of chest that we were taught as a sign of a heart attack. So, heart attack can have a lot of symptoms. Now, outside of that, heart disease in general can have different symptoms that can be bad lightheadedness, bad palpitations, which means like fluttering sensation and fast heartbeat sensation. It could be shortness of breath, doing things that you are capable of doing weeks before, or swelling in the ankles, or it can be chest pain that maybe not as dramatic, but tends to happen frequently, when an individual is doing things that are their daily activities or exercising. So there are multiple things that the heart disease can present with.
Host: So when we talk about a heart or vascular screening, what’s the difference and how would I know which one I need?
Dr. Abuzaanona: That’s an excellent question. So, the heart screening focuses on the arteries of the heart. Essentially there’s one question we’re trying to answer: What is the likelihood that the person would have a heart attack or a similar event in the next few years? So the way the heart screening answered that question is by checking a few things. That includes an EKG, blood pressure, body weight, and cholesterol levels along with some information about the individual. If the risk is thought to be high enough, we do additional testing that’s called calcium scoring. Now we can expand on this later, but I’ll leave that for the heart part. Now for the vascular part, so vascular, that means blood vessels, and those are the things that run from the heart into the body.
What we’re trying to identify here: do we have high risk of blockages in those arteries? Some of those arteries go to the brain and we call those carotid arteries and those lie in the neck, and if they have problems, they increase the risk of stroke. There is a big artery that goes down our belly called aorta, and that can dilate and cause something called an aneurysm, this is like the Latin word for dilation. So this is something that we want to discover as well. The last thing is the arteries that go to the legs and that can cause issues with the legs, including pain, and sometimes in the most severe form lead to ulcers and amputations and infections. So those arteries also can be studied. Now, if we talk about vascular screening, we’re focusing on the arteries in the neck, the big artery in the belly and the arteries and veins in the legs, and most of the time we just study them with an ultrasound. We can also get some sort of blood pressure measurements in the of legs that help tell us about how healthy those leg arteries are. So they’re a bit different, but as you would imagine, a disease process that affects the heart most likely will also involve those arteries. So, I would say, most people would benefit from screening both things if they’re indicated. So if you have high risk to heart problems, you would benefit from heart screening, and also you would benefit from vascular screening.
Host: Now, if I wanted to move forward with one or both screenings, how does that process work? Where do I start?
Dr. Abuzaanona: There are two ways to go about this. Through the primary care physician or provider they always do a good job evaluating cardiac and vascular risk. When it’s believed at a certain point that the risk is high enough, we tend to discuss the options. That can be just treating directly, giving some medications like cholesterol medication that could help lower that risk, or if we’re not 100% sure we can do additional testing. The other way to do it is through the community and this is what Sanford is doing… trying to keep this open to the community through our screening program. What happens in the screening program is you are met with a technologist from the screening center.
They evaluate the risk based on multiple things, include the age, the gender assigned at birth, the blood pressure. They check an EKG, they also check a cholesterol level, and they put all of this information together and identify the risk in the next 10 years. If the risk is considered to be high and for us here at Sanford, we define as more than 6%, then they would recommend the calcium score test. So there’s multiple different ways to do it. If you are in the community and you want to directly get that evaluated, it can be through the screening center or you can just do it through the primary care physician, the primary care provider.
Host: Now, what can I expect during that screening appointment? Walk me through the process.
Dr. Abuzaanona: Part of that screening is identifying the risk. So after the blood pressure, the cholesterol, the EKG, and the brief conversation to ask about family history, etc., the next big thing that is done – if a patient is eligible – is called calcium scoring. And we’ll talk a little bit about this. Calcium score is essentially a CAT scan and it’s considered a low dose CAT scan. We do it without injecting dye, without even needing IV access. So we don’t use an IV line for this, and it’s a quick process where the patient would go into the CAT scanner. It typically takes seconds to take the picture itself. The whole process might take few minutes. What we do is we look at calcium depositions. So how much calcium there is on those arteries that supply the heart and what that tells us, if someone has some calcium on their arteries, that tells us they have higher risk for coronary problems or, like a heart attack or heart attack-like conditions in the future, and that allows us to start treating them to prevent them from happening.
Now, if someone does not have any calcium, we call that a calcium score of zero. The risk is extremely low and this actually adds up to be less than 1% in the next 10 years. So it would be quite reassuring if someone is concerned about a high-risk, maybe due to family history or due to higher cholesterol or anything else, having a negative or a zero calcium score is very, very reassuring. And even having a positive test where we uncover some early process will allow us to treat effectively and prevent future heart attacks.
Host: Do you recommend these screenings every year? So what about those of us who are not at high risk, assuming a low risk score like zero can be associated with good health?
Dr. Abuzaanona: Yeah, I really like the way you describe it: it’s good health. Even though it’s initially designed to comment on the heart and the risk for heart attacks, it turns out if someone has a low, or like a zero score, which is normal, they actually have lower risk for a lot of other things. So lower risk for cancer, lower risk for chronic kidney disease, lower risk for a lung obstructive disease and even lower risk for hip fractures. There is a comment that we sometimes use is: someone who has, even if they’re in their sixties or their seventies or eighties, if they have a calcium score of zero, we call them healthy agers in general. So, you are aging in a very healthy way, and it’s not just a testament to how healthy your heart and your vascular system is, it is just a reflection of how healthy the entire body is.
How often do you need to repeat this? If it was zero, I would say, not earlier than five years. If it was, it can be three to five years. We don’t really know for sure, but the earliest that we do it three years after maybe it could be delayed up to five years and I would think that’s appropriate. If it was positive, so we found an abnormality, we really don’t need to repeat that anymore, because once we identify someone who is at higher risk, we would just treat [them] and we will essentially do a lot of things to prevent heart attacks. The things we do: we focus on the lifestyle, so diet, exercise, weight loss, we manage the blood pressure. So we try make sure the blood pressure is well-controlled. And we manage the cholesterol and we start typically the patients on cholesterol-lowering medications and make sure the cholesterol is at a good level, a satisfactory level.
Host: When it’s time to look at the results of the screening, where does that information go? Who reviews it? What comes next?
Dr. Abuzaanona: In our screening program the patients will be counseled about their results, and if they’re positive, which means there is some coronary calcium, they get referred to the primary physician and we end up seeing most of those patients. So most of those patients, particularly if the calcium score is high, I would say above a hundred, we end up in cardiology seeing most of those patients. And the goal at that point is to see if additional testing is required, if there is any concern about blockage and those arteries that we need to fix. Otherwise, we just make sure that we’ve corrected all the risk factors and we’re maintaining a good blood pressure, maintaining good cholesterol and treating appropriately.
Host: For our listeners now who might be ready to get their screening, how can they make an appointment?
Dr. Abuzaanona: The heart and vascular screening is essentially a service. So if you’ll go into our website at Sanford, look up the location – because we have multiple locations – look up the location closest to you, and there is a number. You just call and schedule an appointment. You don’t necessarily need to see a physician prior to that, because it’s a well-structured process. So only the things that are considered necessary will be done, and in terms of seeing a doctor, you can see the doctor beforehand to discuss if you need to do that or not if you want a tailored answer depending on your risk profile. But if there is any concern, any issues with the results of the test, you will be referred to see a physician afterwards.
Host: So as a cardiologist, Dr. Abuzaanona, I imagine you’ve seen a variety of patients with varying heart health. If we want to take better control of our heart health, you mentioned lifestyle changes a little bit ago. What are some simple recommendations that you have to get us started?
Dr. Abuzaanona: Yeah, I would say introduce some changes because we all can. If we look in into our diet, there is always something that we can do to improve the quality of our diet. And we can always move a little bit more. So that’s different for different people. What we would recommend in general, like general outlines or general guidelines: in terms of diet, try to introduce more vegetables, fruits and grains. Try to replace some of the unhealthy fat with healthier fat. We don’t say stay away from fat. We don’t say that anymore. We try to replace with healthier fats. Healthier fats are found in fatty fish and extra virgin olive oil and in nuts – unsalted nuts, obviously. The unhealthy fat, as you all know, is probably in the red meat and you know the lard, the butter, etc. And stay away from highly processed food. The more processed the food is, if you look at a package that has 20 ingredients, that’s probably no matter what food product that is, it’s probably not the good choice for you.
In terms of exercise, we recommend about 30 minutes of intermediate intensity. So something that gets your heart rate up, but it doesn’t get it up really high. So you can still talk while you do this. You won’t feel very tired. Walking can be a very good exercise for most people and do that for 30 minutes, about 3-to-5 times a week, and that should be good enough.
The biggest advice I try to give is introduce small changes because small changes are usually the ones you can sustain and over time you’ll find yourself, if you introduce enough small changes over a course of a year, that it becomes easy. If you start trying to adapt a lot of things at the same time, it becomes overwhelming and difficult.
Even for, like on a personal level, like if I want to introduce more than two, three changes in diet or exercise regimen, I usually see it that doesn’t really last that long. So just keep it simple. Give yourself a lot of time. So maybe a year or two, and just say, ‘I want to do this by the end of the year’ and make small increment, small changes, and towards the end of the year you’ll find yourself there. You’ll have a better diet, you’ll have a better exercise regimen. And the other thing is if you have any health conditions, health problems, make sure you address them and stick to the medications. So if you have high blood pressure, make sure that’s well addressed and blood pressure is controlled. If you have sleep apnea, make sure that you stick to the CPAP machine and follow the recommendations of your physician, and just make sure you keep up with appointments. This is how you take good care of your heart and overall good care of yourself.
Host: I love that. Thanks. So much of our overall health aligns with having a healthy heart as well. So, this is such great information, doctor, is there anything else that you want our listeners to know today?
Dr. Abuzaanona: I would say that here at Sanford, we have a strong preventive cardiology program. We’re trying to catch heart disease early. And we take pride in the fact that we prevent procedures rather than just do procedures. And in the future, there is a lot of focus on helping people stay away from the hospital and take control of their health. So, we’re going to expand the preventive cardiology program in the future, and that’s my goal and it’s actually my passion. So hopefully in the upcoming few years we will just continue to provide an excellent service for our patients here.
Host: Wonderful. Heart disease prevention is key all year long. Dr. Abuzaanona, thank you so much for your expertise and all that you do for Sanford Health.
Dr. Abuzaanona: Yeah. Thank you for having me. Appreciate it.
Host: For Sanford Health News. I’m Courtney Collen.