Scott Webb: Today we're discussing healthy habits that build a healthy
heart, especially for women.
With Dr.
Anthony Bael, he's a board-certified cardiologist practicing
at Franciscanhealth.org,
and he's here to discuss the association between excess weight, inflammation,
heart disease, And so much more.
I.
Scott Webb (Host): This is the Franciscan Health Doc Pod.
I'm Scott Webb,
Scott Webb: Doctor, it's nice to have you back on the podcast Today we're
gonna talk about healthy habits that build a healthy heart, and just about
everything in between, of course.
So I want to start with getting a sense from you, like what's the
association between excess weight, inflammation, and heart disease?
Dr. Anthony Bashall:
Yes.
Well, thank you for having me back.
It's great to be back and that's a great question.
But let's just start a little bit beforehand.
We, we often associate, , fat or adipose tissues as we docs call it inflammation
negatively, but they actually have a good.
Role if you have the right amount of adipose tissue, it's, it performs a
great role, , for energy storage and it helps balance out our metabolism
with lots of signaling molecules it sends throughout the body.
So that's the good.
It actually also helps ameliorate inflammation in the right amount.
And if you think about inflammation, when you cut yourself and bacteria
jump into the cut, it's inflammation that kill the bacteria and prevent
you getting a really nasty infection.
And then it brings the healing properties to the wound to heal the
wound up and it's very self-limiting.
So that's the good, that that's what the sort of adipose and fat tissue is for,
and That is what inflammation is for.
Unfortunately, as we gain weight, the adipose tissue
starts to release low grades of inflammation into the bloodstream.
And if you remember, you know, inflammation is designed to.
To kill bacteria and it actually damages the lining of the blood
vessel in a very slow process.
And then when the lining of the blood vessel gets damaged, even
if cholesterol levels are fairly normal, cholesterol can often jump in
there and start to plug up vessels.
And This is what leads to the bad, and to the ugly.
Which is where you go on from that to lead to your heart attacks, which
is a blocked blood vessel, a stroke, which is a blocked blood vessel in
the brain And the actual inflammation can stiffen up the muscle in the heart
leading to a form of heart failure That is particularly prevalent in people
who carry excess weight, particularly in men and particularly in women.
So that's kind of the role there.
And.
What we really wanna do is these patient's often present us in the ERs,
in the hospitals, or come to our clinics when they're actually symptomatic.
And one of our goals, and, and hopefully the goal for today's talk
is a little bit, is how to catch it early or even before it begins.
Scott Webb: Yeah, and that's, you know, if we all had crystal balls, of
course, but we don't, but it's important then, because we, you know, absent
of the crystal balls to see into the future is, as you say, understanding
the association between excess weight, inflammation, heart disease, knowing
our risks, spotting the warning signs, even if they're kind of subtle.
So then what doctor can women do to prevent heart disease?
Dr. Anthony Bashall:
So I think getting assessed early, don't wait for symptoms.
And let me, I will touch on symptoms here in a little bit because men,
men and women do share symptoms.
And both can be a little unusual, not the classic, oh, my chest
really hurts, although that's still, fairly common as a symptom.
But we'll talk about it's how do we get to it beforehand,
before we have the symptoms.
And the heart can also be very sneaky.
You can actually be developing symptoms.
And blame a lot of other things.
Things like fatigue, things like shortness of breath.
You say, oh, well I'm getting a little older or I've gained some
weight, and sometimes this can be actually early building heart disease.
But one thing I would really encourage people to do, particularly in that.
30, 40, 50 age group coming through is, is you've gotta get
an assessment of your future risk.
And so while we don't have a crystal ball, we can actually
make fairly good predictions of where you lie on the spectrum.
And obviously there's always, normal and there is mild and there is high-risk.
And if you are normal, that's not like you're out in the woods.
That's like saying, well, your younger normal, a normal
evaluation, we wanna keep it that
Scott Webb: Right.
Yeah.
Dr. Anthony Bashall:
And then if you have mild, there are ways of treating it.
So certain things, one of the first things most people need to do I is
kind of go to their primary care physician, their primary care provider,
and get in a proper assessment.
And I think some of the traditional ones still run very, very true.
And time tested.
One is blood pressure.
A good, blood pressure will go a long way.
To preventing future cardiac events and stroke events.
A, a good cholesterol, well-controlled, if you're a smoker, advice and support
on smoking cessation strategies goes a long way for prevention.
And then some of the newer testing emerging, we're gonna see and,
and you perhaps have to advocate for yourself with your primary
care doc or or provider and say.
You know, I'd like to for you to measure the inflammation in my bloodstream Very
recently, even just in the last few months of 2025, the a CC has recommended
testing, high sensitivity, CRP.
And if it's elevated, even if you have a normal cholesterol, they suggest you
get your cholesterol treated because that high level of inflammation is what
leads to some damage of the blood vessel wall and can lead to a future event.
And That is particularly true of a woman's body.
In addition, , an emerging marker of risk.
And we're not sure whether tore treated directly, but certainly indirectly is
the emergence of the lipoprotein a, a, a genetically derived, cholesterol that.
is a marker of risk and it is being studied very closely now
to whether we need to treat it directly or not, but once again, it
adds that crystal ball prediction.
If your number's high, then ways of treating it, ways of treating
the things we can control.
Perhaps there's a final one, and people find this a little confusing
to understand is you need to ask them to check the protein in your urine.
It's called a urine album in creatinine ratio, and if you have a little protein
in your urine, it's a sign of inflammation and some damage to the kidney.
It.
And if you have that damage in the kidney, you have that damage
in the heart and it pretends an increased risk of some heart disease.
So putting this just so real simply together.
And the nice thing about all this, it's single visit, it's some blood
work, it's a urine test, it's a visit to your doc, perhaps check
some blood pressure numbers at home.
I know people don't have much time, so a single visit to assess your risk and get
this done early and perhaps a couple of other things just to throw into the mix.
I know a lot of people have very limited time and some testing can get
quite expensive, is to get a heart scan that's also known as a calcium score.
What exactly is
Scott Webb: Yeah.
What is that?
Dr. Anthony Bashall:
Yeah, the heart scan is, is a quick CT scan.
It's usually charged less than 50 bucks.
And what happens when the inflammation damages the lining of the blood
vessel And the body puts bits of cholesterol in there, it then tops
it off with calcification And the heart scan can see that calcification.
So if you have an abnormal scan, it means you do have some coronary artery disease
and while it can't see the cholesterol.
It can see the calcification as a marker of blockage, and it allows us to risk
assess the patient And the person, and it allows us to take us down a pathway
of treatment and let's say to if you have a zero score, This is really good news.
Now you might have a little bit of the cholesterol that we can't see.
The idea is then to keep it that way with good blood pressure control,
and, you know, smoking cessation exercise and things like this.
But if you have a higher score, sometimes it leads us to trigger
some testing and say, oh, well, is this causing some problems?
Is this causing some symptoms that we haven't fully recognized?
, I had a case recently where a lady had a very low cholesterol, But when we tested
her, she had a moderately high score, And we put her on cholesterol medicine
and she said, well, my number's good.
I said, I understand
Scott Webb: Mm-hmm.
Dr. Anthony Bashall:
you have a little bit of blockage, the main ingredient in blockage.
Cholesterol.
So by using cholesterol med, we'll prevent its progression.
So just by doing this test and someone who is asymptomatic continues
to be asymptomatic, we've reduced her risk of a future heart attack
and stroke event substantially.
And this was just out of a simple test.
And if the score's a bit high, then it does lead to additional
testing and evaluation.
But it does lead to a, a situation where we can prevent future harm from heart
attack, and potentially people needing stance and bypasses or having strokes
Scott Webb: The, the bad stuff, as you said before, right?
Dr. Anthony Bashall:
Yeah, exactly.
And that's the whole goal here is let's get on this early And then let's treat
early to prevent the bad stuff and I think one thing That is emerging as a test that
people perhaps can talk with their doctor and their primary provider, and that's
emergence of their liver evaluation.
And if you are found to have fatty deposition in your liver, it's
a marker of risk that you may be having similar harm to the heart.
So this, again, is a good early warning indicator And that we can
use some lab work to decide whether a fibro scan of the liver, appropriate.
Scott Webb: Right.
Brings me to this question, doc, you know, just this understanding the association,
you talked earlier about excess weight, inflammation, heart disease.
How does that then inform or help women to know their risks and really pay
closer attention to their symptoms?
'cause as you're saying.
A lot of these symptoms we chalk up as being something else.
Oh, well I'm older.
Oh, I'm, I haven't been sleeping well.
You know, we find ways to sort of explain these things away,
whereas an expert like yourself might know exactly what's going on.
Dr. Anthony Bashall:
I'm gonna take the second part with symptoms first.
And, and This is probably one of the most important aspects of cardiology, for both
men and women, but particularly women.
So, for example, a patient I was carrying for early in the week
came in to talk to me and said.
I just get exertional fatigue.
That's so intense.
I just feel so tired.
And it's just like last time when they stented me and it went away prior to
the first stent going, and she had attributed that to her being older.
Another patient I had, had some chest pressure but no pain, so
didn't think it was a problem.
And particularly women often have a cluster of symptoms.
They're often a little short of breath, maybe feel nauseated with exertion,
dizzy and lightheaded, and often just struggle with exertion, which.
When we carry excess weight or we're older, we're tired,
we're busy, we have jobs.
We care for kids and our parents.
It's easy to distribute it out.
And then sometimes you have to advocate to yourself 'cause you kind of go to
your primary care provider and they're like, well, you know, have some diet
and exercise and see how you feel.
And that's where these simple tests can come in of, of just assessing risk.
And perhaps one additional test that I will often do in patient's
is just a simple exercise treadmill, just to see how.
They can exert And what their capacity is.
And we can sometimes walk people for six minutes.
We sometimes walk 'em on the treadmill.
And if a person comes back and goes, doc, I really struggled to do that.
I was really short of breath.
I spent incredible fatigue.
My chest got tight, I felt nauseous.
These are red flags that maybe we need to sort of progress testing
and investigate a little more.
And if you get a heart scan and compare that score with simple test, we can
really reveal, your risk of current and future events very readily.
Scott Webb: Just give you a chance here, doctor.
, Final thoughts, takeaways.
When we think about these healthy habits And we think about all the things that
can lead to heart disease, you know, the bad, what's your best advice?
Dr. Anthony Bashall:
So best advice, uh, going to the falling, be proactive with yourself and advocate
for yourself with your primary care.
And we're seeing a lot of the emergence of cardiometabolic physicians and providers
that really address, a comprehensive approach to everything we've discussed
today to try and reduce your risk of future cardiac events or recurrent events.
So really getting seen and getting an evaluation.
And it's okay to say to your dog, Hey, can we check my inflammation?
Can we check urine own protein?
Can I get a heart scan?
These are things and here's my blood pressure at home.
These are all things go a long way.
The second component, is.
Also as people struggle, I, I, I think we shared before I str I've struggled
with my weight, my whole adult life.
We now have numerous ways to approach it.
So yes, avoiding excess consumption and particularly processed food and eating out
processed food is really harmful for us.
And that's a podcast in itself.
Will perhaps do another time.
But just to put it simply, if you eat a hundred calories of processed
food and a hundred calories of non-processed food, you will gain more
weight and have more inflammation.
And so trying to avoid That is just that our brains love it.
And This is where diet and exercise can help considerably.
But sometimes switching over to the obesity meds.
'cause the obesity meds really are anti-inflammatory meds.
They are metabolic meds.
They promote metabolic health.
And oh by the way, it's a secondary benefit that you lose weight.
You get metabolic benefit from those meds long before you lose
weight, which is why people often say, Hey, my joints aren't as sore.
Hey, my diabetes is better.
Hey, I actually feel better.
And then, hey, Presto, in the next six to 12 months, they've lost maybe
as much as 20% of their body weight.
So that's something to sort of approach.
And in the, historically, the prices were so, , challenging.
They've really come down And the new meds on the way are highly helpful.
So, for the cardiometabolic person, , to promote health, . Diet,
exercise, and those medication can go a long way to really reversing
a, a person to metabolic health.
And the final one is just as it is, be aware of symptoms just to
give you a good old-fashioned list.
Chest pressure, chest pain.
Sweating, nausea, exertional challenges, feeling intense fatigue, sometimes
pain between the shoulder blades.
These are all symptoms and they often cluster, but if you're struggling
with exertion and you have some risk factors, please get an evaluation.
So
Scott Webb: Yeah, it's all good stuff and I just love having experts on
picking their brains, you know, for 15, 20 minutes or so, something like that.
You gave us some ideas of some other podcasts we can do, but
for today, thanks so much.
Dr. Anthony Bashall:
You are welcome.
My pleasure as always.
Scott Webb: And to learn more, visit franciscanhealth.org
dot org slash HeartCare.
Host: And if you found this podcast helpful, please share it on your
social channels, and be sure to check out the full podcast library
for additional topics of interest.
This is the Franciscan Health Doc Pod.
I'm Scott Webb.
Stay well, and we'll talk again next time.