Pink Prescriptions - February 2021

Living a Heart-y Life



February 2021 Issue - Pink Prescriptions
Living a Heart-y Life

Everyone wants life to be fun, full and heart-y, which is easy when you’re healthy. But it’s hard to follow your heart when it’s sick. Heart disease is still the No.1 killer for both men and women in the US. However, with a little TLC, many risks associated with heart disease, heart attacks and strokes can be drastically reduced. The heart is our lifeline, without it we cease to be. It’s not difficult to take care of, so why not begin marching to your heart’s beat, and take the easy steps to be heart healthy? A healthy heart gives a heart-y life!


PinkRx1020 Giganteby James F. Gigante, MD

If I don’t smoke and my cholesterol is within normal limits, what impact does my family history of heart attacks
have on my risk?

You left out one important factor in your question. Do you get at least 30 minutes of exercise a day? A new study shows that inactivity is a huge risk factor for heart disease, especially for women. A “normal” cholesterol is simply not enough information to answer this question. We determine a person’s 10-year risk for a stroke or a heart attack using the algorithm in the link below. If this risk is over 7.5%, then that person is at risk for either condition and warrants treatment with a “statin” type of cholesterol medication.

The algorithm includes “Good Cholesterol,” known as HDL, and automatically calculates the bad cholesterol, known as LDL. The LDL is not shown on the calculator but is calculated in the background. Notice that blood pressure, diabetes and smoking are all included because they are huge risk factors.
Interestingly, the American Heart Association does not include family history, but most doctors take this into account. This computer-driven model has its limits and sometimes recommends a statin in situations where doctors previously would not have.

In these cases, I really like using a research technology called Coronary Calcium Score (CCS). The cost is only about $100, and the radiation exposure is fairly low. This is a CT scan picture of the arteries that feed the heart. If there is calcium, there is plaque and this would justify treatment. Sometimes the algorithm calls for medication. If the CCS is 0, then the patient and I can watch that recommendation with more confidence for a while. Computers can’t substitute the doctor-patient relationship. We make the decision as partners.

James F. Gigante, MD is a Board Certified doctor of Internal Medicine and a fellow with the American College of Physicians. He has been practicing medicine for 25 years, the last 17 here in the Lowcountry. 843-681-2222; 35 Bill Fries Drive, Bldg H, HHI.

PinkRx0220 Balchandaniby Ravina Balchandani, MD, FACC

What is the No. 1 way to prevent heart disease?

During my 20+ years of practicing cardiology, I have learned the No. 1 method to prevent heart disease and take control of your health is to absolutely “know yourself “ and your risk factors. Knowing yourself, inside and out, will lead to accountability of those particular factors specific to you and your genetics, sparking a healthy practice of prevention for a lifetime, which is most certainly better than cure. When it comes to knowing yourself, it is important to have a advanced, detailed lab work done, which will look at your genetics, advanced lipid profile and any deficiencies. Knowing your lab numbers will help your doctor and you take care of and prioritize any current or developing issues. This also helps fine-tune the types of foods to absolutely avoid, as well as the types to incorporate into your daily diet. In addition, it can help determine how much and what kind of exercise is good for your body and condition, and more importantly, what specific medications should be taken.

Prevention can be primary or secondary for a heart condition, which means either the heart disease has already happened and you are trying to prevent a secondary episode, or you are trying to avoid developing a heart condition, primarily since you have significant family history, or a tendency for it. Advanced lab work is key to prevention, and that is what we look at in most patients on their first visit.

Tell us the good, that bad and ugly on good cholesterol,

bad cholesterol, triglycerides and blood pressure?
I can talk for hours on this topic. I would say there is a lot of good in good cholesterol (HDL).The higher the number the better. There is very little bad in regards to HDL, and the ugly part is it is the hardest type of cholesterol to maintain high numbers. They increase in slow increments, and there are not many medications that increase HDL.

The good about bad cholesterol (LDL) is there are several medicines and various diets that can help lower bad cholesterol quickly. Exercise also has a good impact on LDL. More importantly, most medicines are directed towards the bad cholesterol. Recently there have been many advances, and the injectable medicines also efficiently act on lowering bad cholesterol. We just should have a willingness to do it. The bad and ugly of bad cholesterol: It remains the most important cause of heart attack, stroke and cardiovascular diseases. The medications can definitely cause side effects, but need to be taken prudently. Unfortunately, bad cholesterol is so easily available—it’s in almost everything we like to eat.

Triglycerides are the sugars of cholesterol. There is a lot of bad and nothing good about triglycerides. We need to keep an eye on this number and remain informed, so the numbers don’t creep up, which then can cause pancreatitis.

Blood pressure: The best part of blood pressure is there are several correctable causes we can ultimately control. The bad part is it is variable throughout the day, and keeping an account of the real deal of blood pressure becomes difficult. Unfortunately, there is an UGLY aspect of blood pressure. When it remains asymptomatic, end organ damage, like renal failure, stroke, vision and congestive heart failure, can ensue.

The gist of it all is to be careful. Speak to your doctor in depth and remain accountable for all the risk factors for heart diseases!

Dr. Ravina Balchandani graduated from Gandhi Medical School and completed her medical residency, cardiology residency and interventional cardiology residency at Maimonides Medical Center in New York City. Dr. Balchandani finds great enjoyment in the challenges of interventional practice, however, her primarily philosophy is that prevention is more important than the cure. She is a huge advocate for women and heart disease. Dr. Balchandani has two offices, one on Hilton Head Island and another one in Bluffton. To contact her office, call 843-816-3733.

PinkRx1020 KerriDodsenby Kerri Dodson, MCHC, CNT

Fatty foods have a bad reputation for causing heart disease, but what is the role of sugar and carbs in
high cholesterol and heart disease?

Complex carbohydrates are not bad for your heart. Think whole grains, sweet potatoes and oatmeal. Whole grains are actually beneficial in removing cholesterol from your body due to the high fiber content.  However, simple, highly processed carbohydrates will raise your triglycerides, also known as blood fats.  Triglycerides are an important marker of metabolic health, and high levels are associated with coronary artery disease and non-alcoholic fatty liver disease. Processed carbohydrates (breads, pastries, cookies, cake, sweetened beverages) are converted into sugar after consumed and increase triglycerides, blood sugar and contribute to insulin resistance, which are major contributors to type II diabetes and heart disease.

What is an example of a heart-healthy diet?

The Mediterranean Diet, Mind Diet and Dash Diet are all great heart-healthy diets. They are similar in that they all promote whole foods. The foundations for these diets are vegetables, fruits, herbs, nuts, beans and whole grains. The meals are built around plant based foods with low to moderate intake of dairy, poultry, eggs and seafood.  They also focus on polyunsaturated fats, such as olive oil, and reduce saturated fat intake from red meat. These diets also reduce salt intake to help lower blood pressure. So enjoy your fruits and veggies!!

Kerri Dodson is a Certified Nutrition Therapist and Master Certified Health and Wellness Coach for NuBodia, LLC. She specializes in Nutritional Counseling and nutritional protocols to help clients overcome chronic diseases such as high cholesterol, high A1c, Type II Diabetes and autoimmune diseases. Call today: 843-816-3733.


PinkRx0221 SmallheiserWhat are some major risk factors for
coronary artery disease (CAD)?

By Stuart Smalheiser, MD

Family history:
  A strong family history of coronary artery disease—stents, bypass surgeries and heart attacks, especially at a young age (earlier than age 65), is a major warning sign that you are at high risk.

High cholesterol levels:
People with higher total cholesterol levels have nearly twice the risk of CAD as those with optimal levels.

High blood pressure:
Nearly one-third of American adults have high blood pressure (also called hypertension), a major risk factor for both heart attacks and strokes.

People with diabetes are significantly more likely to develop CAD than those who don’t.

Extra weight can lead to increased high cholesterol levels, high blood pressure, and diabetes, all major risk factors for CAD.

While most people know smoking increases your risk of lung cancer, few realize that it also greatly increases the risk of CAD.

Physical inactivity:
Regular physical activity helps reduce the risk of CAD. In addition, it can help control blood cholesterol, diabetes and obesity – all major risk factors.

While you can’t change your family history of heart disease, you can lower your risk of developing cardiovascular problems by managing the factors you can control.

Dr. Stuart Smalheiser is a board-certified cardiologist with Beaufort Memorial Heart Specialists. A graduate of the University of Miami School of Medicine, he developed Beaufort Memorial’s heart attack program and is the medical director of cardiac rehab at its LifeFit Wellness Services.

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