Joey (Host): It's the leading cause of death in the United States, so we're discussing preventing heart disease. Our guest is Dr. William Dixon. He's a cardiologist specializing in interventional cardiology. This is The Pulse at Tallahassee Memorial Healthcare. Thanks so much for joining us. I'm Joey Wahler. Hi there, Dr. Dixon. Welcome.

William C. Dixon, MD: Thank you. Good afternoon.

Joey (Host): Good afternoon. Thank you for the time. We appreciate it. First, what is your take on heart disease being very common? Really for years now? Right?

William C. Dixon, MD: Yeah, the leading cause of death, certainly in the us and more broadly, cardiovascular disease, which includes heart attack, stroke. Peripheral vascular disease? absolutely the most common cause of death,

Joey (Host): And so what are the most common causes of heart disease these days?

William C. Dixon, MD: by far smoking. I think fortunately, the rate of smoking is much lower than it used to be, 30 years ago when it was, more in vogue. But, people still smoke. so that's a big thing. Diabetes, Obesity because obesity frequently causes sleep apnea, which causes high blood pressure, which increases the risk of stroke and heart attack.

But if there's one thing that's the primary driver, I think is smoking.

Joey (Host): And how about family history? If heart disease runs in your family, how much likely or is it that you'll follow suit perhaps?

William C. Dixon, MD: So nothing's a hundred percent, but if you've had a lot of family members who have heart disease early in life, what we consider early is a man before age 45 or a woman before age 55. So if your grandfather died at 85 from a heart attack, that doesn't put you at any greater risk.

But if. Your father died at 45, then that certainly increases the risk. And we wanna be aggressive at managing any risk factors.

Joey (Host): Yeah, absolutely. So speaking of which, doctor, how important is knowing your family? History and should you be screened earlier for heart disease than usual if you're considered higher risk.

William C. Dixon, MD: I think so. and there's some tests that we can do now. We used to do stress tests on everybody when they're in their forties. And if you test everybody, you get a lot of false positives. So we found that probably wasn't the best strategy, but in somebody with risk factors or, a very strong family history of premature coronary disease, one test I like to do is a coronary calcium score.

It's a CT scan of the heart. There's no dye, and it looks for even very early stages. So that may push me to put a 30-year-old on a cholesterol medicine, for example, as opposed to waiting till they're 50.

Joey (Host): And so what are the warning signs of heart disease, especially early onset heart disease?

William C. Dixon, MD: there frequently aren't warning signs, so it's little bit unfair, but a lot of the people that come in having heart attacks in their fifties, that may be the first warning they ever had, that anything was going on. but anything that affects your exercise tolerance. If you have trouble going upstairs that six months ago, you could do it with no problem.

If you're getting really winded, obviously any chest discomfort. with activity primarily, there's a lot of things that cause chest discomfort. Unfortunately, most of the time it's not the heart, but any predictable exertional symptoms like shortness of breath or chest discomfort, that's something to get evaluated.

Joey (Host): Alright, And so when we talk about effective lifestyle changes to reduce risk, how about diet? Generally speaking, what are the best things to eat more of And the best things to stay away from?

William C. Dixon, MD: So I keep it simple for my patient's. Most people know what's bad for you, so cheeseburgers and. Baked potatoes and, And the good stuff. don't eat that as often. You know the things that are better for you, like vegetables and, chicken and fish. I'm not, an extremist about it and I don't tell patient's never eat eggs, never eat steak.

But simply the things that you know are good for you, like fruits and nuts and vegetables and lean meats, eat that most of the time. It's fine to have stuff that's not quite as healthy. The other times,

Joey (Host): In layman's terms, why are some of those things that taste so good but aren't as good for our health? What do they do to the heart?

William C. Dixon, MD: well, fat and sugar tastes good. So, your body has to process that. And some of us process it very efficiently. So we all have people we know who are thin as a rail and eat whatever they want and they never have any problems and their body just processes it more efficiently.

so especially if you have a family history. That suggests that your genetics, that you don't necessarily process some of this stuff as well. And the fat tends to build up And that fat can build up in blood vessels.

Joey (Host): Gotcha. So. Getting back to lifestyle. How about the role that physical activity And it's intensity and frequency play in maintaining that optimal heart health?

William C. Dixon, MD: So that's a great question. People think you have to join a gym, to get appropriate exercise. Really 30 minutes of exercise that gets your heart rate up, four to five times a week. Walking is perfectly fine. You don't have to start training for marathons. The other thing to keep him in mind is there are tremendous benefits of exercise above and beyond losing weight.

So as you get older, it is harder and harder to lose weight. With exercise, it's actually easier with diet. But I tell patient's, don't be discouraged if you don't lose any weight exercising because you're getting a lot of benefits at lowers blood pressure. It helps you sleep. and there are some, data about, ways to walk.

So do you need to walk fast? You need to walk slow. Interesting study, the Japanese do where they'll walk very briskly for three minutes. Slow down for three minutes and they'll alternate those. But you don't have to become a runner. you don't have to join a gym. if all you can do is walk, that's probably good enough.

If you have joint problems, swimming is an excellent exercise. not everybody has a pool, but. getting out, bearing weight and getting your heart rate up a few times a week is absolutely beneficial.

Joey (Host): And if you're able to, always better to walk with a little bit brisk or pace at least than normal, right? It shouldn't be like you're going for a walk in the park. It should be more.

William C. Dixon, MD: That's right. So strolling down the sidewalk while you watch videos on your phone is not the same thing as a brisk walk, and especially if there's some hills or you get a little more. Exertion going up and down hills. But yeah, a, brisk walk, something that's gonna get your heart rate up.

You probably don't get your heart rate up walking through the mall 'cause you're not walking that fast. But something that gets your heart rate up and gets things moving.

Joey (Host): so walking with a purpose, like you're headed somewhere,

William C. Dixon, MD: Absolutely. With intent. Yes. With.

Joey (Host): Yeah. But I guess your message, it seems, doc, overall, when it comes to being active is whatever you do better to do something than nothing. Yes.

William C. Dixon, MD: Start somewhere and you can get deconditioned really fast. Even elite athletes, if they take a week or two off, they lose. So if you're not doing anything, your joints get stiff and then it becomes harder to do things and. people can be very short of breath. It's not because they have a heart problem, it's just 'cause they're in such bad shape.

'cause they never do anything. So start somewhere again. even if it's walking in the mailbox and back briskly as opposed to just strolling. Start somewhere. I see so many people in my neighborhood walking they'll pass me. I'm a little embarrassed sometimes. they're serious walkers.

Joey (Host): They're probably walking past saying, I just passed the heart doctor over there.

William C. Dixon, MD: exactly right.

Joey (Host): It's funny. So let's talk about stress. We've all heard the term you're gonna gimme a heart attack. Can that really happen? Or at least perhaps not quite that dramatically. Can too much stress eventually lead to that?

William C. Dixon, MD: So I tell patient's there's no test for stress. What stress does is it typically increases your heart rate and blood pressure. So, sleep deprivation increases your heart rate and blood pressure. if you have stress in your life, which we all do, you have to have some way to, you need apoB off valve, and that's where exercise comes in.

So exercise. is apoB off valve for stress? Probably not Alcohol, probably not the best option 'cause that doesn't affect your heart rate and blood pressure like exercise does. so that's probably the best thing to counter stress is exercise. We all have stress, we can't eliminate it. but that's typically the way it affects us.

It, raises heart rate and blood pressure.

Joey (Host): And so. What then is happening to your body beneficially, that reduces stress by being more active.

William C. Dixon, MD: You actually, can lower your blood pressure. So if you, check your blood pressure before you exercise for 30 minutes and check it when you're done, it's gonna be lower. So your body has a, a more restful state. After exercise, your blood vessels dilate. you're working your heart. So, Those are the kind of benefits that we see from a physiology standpoint.

Joey (Host): All right. A couple of other things for you. You touched on sleep. I want to ask you more about that for a moment. We hear, quote unquote, about the ideal amount of sleep, but it's different for every person. Right? So what guideline do you share with patient's?

William C. Dixon, MD: So what I'll ask them is, do you feel rested when you wake up in the morning? if you feel great after five hours of sleep, then that's probably all you need. some people may need eight. like you said, everybody's different. So the question I like to ask, do you feel rested when you get up?

Are you falling asleep constantly during the day? either of those could be related to sleep apnea, which is a very, very common problem. That also raises blood pressure. It increases the chance of having abnormal heart rhythms. so the amount of sleep is individualized. The question is, is it restful sleep?

Joey (Host): So it's really more about how you feel than how many hours you put in, right?

William C. Dixon, MD: Correct. How do you feel when you get up? That's right.

Joey (Host): In summary Doc, what's your main overall message for those joining us about maintaining good heart health from this day forward as a result of this conversation? Perhaps if people just try to do one thing, keep one point in mind, what would it be?

William C. Dixon, MD: think exercise by far. And again, you don't have to be an exercise nut. you don't have to start training for marathons, but getting up and moving, it does a lot more for your bones and skeleton. In addition to your heart, it's easy to do. You don't need any equipment.

walking is all you need. Find a friend to help keep you motivated and have a chat while you're walking. Briskly, maybe get a little winded 'cause you're walking fast, but exercise and obviously if you smoke, stop smoking. I tell patient's if you stop smoking, that will do more for you than any medicine ever invented.

And it doesn't, it takes a couple of years. To get back to kind of baseline cardiovascular risk after you quit smoking. So, it can take a little while, and I tell people I've never smoked. I know it's not easy. I can't just tell you to put it down. but if, they can ever stop and I congratulate them.

I tell that's a big deal. If you can quit smoking, congratulations. That's not easy to do.

Joey (Host): Yeah, and as he said. Several different benefits if you're able to tackle it. Right.

William C. Dixon, MD: Absolutely.

Joey (Host): Well folks, we trust you are now more familiar with preventing heart disease. Dr. Dixon, great advice for all of us. Keep up all your fine work and thanks so much again.

William C. Dixon, MD: Thanks a lot. I enjoyed the discussion.

Joey (Host): Same here. And to learn more about Tallahassee Memorial Healthcare Services, we ask that you visit tmh.org/services/heart and a d vascular. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler, and thanks so much again for being part of the Pulse at Tallahassee Memorial Healthcare.