Easy Tips for Heart Health

Courtney: Welcome to Health Matters, your weekly dose of the latest in health and wellness from NewYork-Presbyterian. I’m Courtney Allison.

February is Heart Month, and this week I’m joined by Dr. Emmanuel Moustakakis, a cardiologist with NewYork-Presbyterian and Weill Cornell Medicine. He shares some easy tips that we can all follow for better heart health.  

It might seem intimidating, but there are actually simple, everyday things you can do to improve your heart health—and it’s never too early to start—from knowing your numbers, like blood pressure and cholesterol; to getting more fiber in; and finding an exercise you actually enjoy, Dr. Moustakakis tells us how we can protect our hearts and breaks down heart healthy tips that can last.

Courtney: Hi, Dr. Moustakakis. Thank you so much for being here today.

Dr. Emmanuel Moustakakis: Thank you for having me, Courtney.

Courtney: February is Heart Month. What is heart disease? And what types of heart issues are included in that term?

Dr. Emmanuel Moustakakis: So heart disease, well, it is the number one killer in the Western world. We’ve known that for many years. It really encompasses a whole spectrum of disease processes. Coronary artery disease, which would be blockages in the arteries of the heart that supply blood to the heart muscle.

Heart failure is the idea that heart muscle is really weak and doesn’t pump strong enough to get blood to the body.

And then there’s a couple of others. There’s rhythm disorders and, you know, things of that nature.

Courtney: What’s the first thing someone can do if they’re looking to take better care of their heart health?

Dr. Emmanuel Moustakakis: Go to the doctor.

You’d be amazed how many people I meet in their 50s and 60s and 70s who are having their heart attack and they’ve never been to a doctor in their adult life. And I’m not talking about a cardiologist. I mean, just go to a regular primary care doctor even once a year for annual physical, routine blood work. Usually they’ll do an EKG. And these types of basic screenings can really help both detect and prevent heart disease.

Courtney: When should someone start paying attention to their heart health?

Dr. Emmanuel Moustakakis: Yeah. Early. I would say even as parents, we want to know our kids’ numbers. The reason it’s important as teenagers and getting into young adulthood is because there is plenty of evidence that coronary artery plaque begins in young adulthood, even in late teens and early twenties. You’ll see evidence of disease in coronary arteries if you look for it.

And so that by the time people in their 30s, 40s, 50s, 60s, when heart attacks happen or coronary artery disease manifests clinically, that disease process has been going on for the entirety of their adult life.

You know, people who have high blood pressure, it’s doing damage. It’s having an effect on overall health over decades, not over weeks and months. And so people typically with higher blood pressure do not even feel anything, for the most part, until many years down the line when they have organ damage. And it’s not just heart disease, but it increases the risk of stroke and kidney disease. So I advise people to know numbers early and to get started with heart healthy habits that really, that really last into the rest of your adult life.

Courtney: There’s things we can do in our lifestyle to help with those, right?

Dr. Emmanuel Moustakakis: Absolutely. There’s a couple of things you can do.

When we talk about overall heart health, whether it’s cholesterol and so forth, there’s the phenomenon of insulin resistance. An important concept to understand because it really has to do with one, how we eat, the types of foods that we eat, and also how we exercise.

When we talk about insulin resistance, we’re talking about spikes in insulin levels related to eating, for example, a lot of processed carbohydrates, a lot of pastas, a lot of simple sugars, cookies, ice creams, a lot of junky foods, those things cause big spikes in insulin levels. And so it kind of throws your glucose metabolism, your sugar metabolism all over the place.

And that’s why a lot of times when we eat these types of meals, you know, a heavy carb meal we’ll feel that crash a couple of hours later where we’re hungry again. It’s because of these surges in insulin and we know that surges in insulin and insulin resistance in general lead to an overall inflammatory condition and that definitely increases risk of heart disease.

Courtney: Wow. And ultraprocessed foods has been so in the news lately, so it’s interesting hearing you talk about this. I saw a tip recently about, “shop the perimeter of the grocery store,” you know, kind of like aim for those fruits and vegetables, which I thought was a good tip.

Dr. Emmanuel Moustakakis: I agree. That’s how I try to shop. You know, more things that go in your refrigerator and less things that don’t. I am a proponent of a high fiber diet, and there’s a lot of places you can find fiber, but chief among them are green leafy vegetables and whole grains.

More salads, spinach, broccoli, asparagus, so those types of vegetables. Most fruits have a good amount of fiber in them, especially berries, apples. I’m a proponent of fruit. I know a lot of times we get a little bit concerned about sugar in cookies or ice cream. That’s different. I will always tell people that fruit is good. Okay. Fruit’s good, cookies and ice cream, not always so good.

If you look at a label, they always include a line called added sugar. When you see a lot of grams of added sugar, that’s not a good thing when it comes to cardiovascular health. So that’s important because if you look at added sugar in your favorite ice cream brand, that number is going to be understandably high. But where you like to focus on added sugar is places where people maybe would be surprised.

I didn’t know that this protein bar that, you know, is marketed as something that is health conscious, but really has a lot of added sugar in it. That’s not going to help you, sort of, maintain cardiovascular health as a benefit.

So there are any number of high fiber cereals and high fiber nutrition bars, for example, that are out there and quick nutritional snacks that are out there that are good. But pay attention to the added sugar component.

Courtney: So what sorts of lifestyle choices make the biggest difference for heart health? You know, we’re talking about this a little bit, diet, exercise, sleep.

Dr. Emmanuel Moustakakis: Sleep is important. Whether it’s a job that we have, or whether it’s parenting and little kids. Some of us, you know, are pulled in all directions on any number of responsibilities, of course, but it just seems like for most of us, we run out of hours in the day.

But people who get eight hours of sleep or more have significantly reduced risk of heart disease compared with people who get six and a half or less.

Courtney: Wow.

Dr. Emmanuel Moustakakis: And that hit me hard because I frequently get six and a half or less. So that sleep is critical.

Aside from that, I think everybody knows that smoking is not good for you. I think people generally understand that there is significant health impact. That doesn’t mean that people can quit. It’s not always the easiest thing, but you just have to.

Courtney: So let’s spend some more time talking about exercise. What role does exercise have in heart health?

Dr. Emmanuel Moustakakis: Cholesterol is impacted far and away the most by regular exercise. So that comes up sometimes. You know, patients will say, well, I don’t really have to exercise that much because I just take my cholesterol medication and my numbers are good. But the reality is that typical cholesterol medications don’t really impact good cholesterol very much compared to regular aerobic activity. You can increase good cholesterol 30, 40, 50 percent or more with regular aerobic activity.

Courtney: Wow.

Dr. Emmanuel Moustakakis: And there’s certain types of exercise that are very helpful in maintaining a healthy blood pressure. And typically I’ll recommend things like resistance training or walking or any type of aerobic activity, swimming and so forth. And that gets into, sort of, individualizing for each patient.

But if a patient comes to me, a lot of times I’ll just ask them, what do you like to do? Even brisk walking, the American Heart Association has recommendations about that. They’ll typically say 30 minutes up to 5 days a week of brisk walking is helpful.

Courtney: OK!

Dr. Emmanuel Moustakakis: So you’ll hear 150 minutes of moderate activity is good for overall heart health, and that includes blood pressure management.

Resistance training and cardiovascular training is far and away the most important. I think people can generally understand that aerobic things are good for you, whether it’s running, whether it’s bicycling, whether it’s swimming. I’m a runner for example. I have a few patients who just love to play pickup basketball a few days a week. I have a few patients who are singles tennis players. They do that a few days a week.

But resistance training is important and I think it’s helpful for people to hear because it’s not just weightlifting or weight training, but any type of resistance, whether it’s stability balls, resistance bands, agility training of various forms, that kind of synergistic movements where we’re talking about lunges and squats and burpees. That type of resistance weight training can be very helpful.

Anything that works your core, really. Your core is not just your abs. I think a lot of people have a misconception that cores are abs. It’s not, it’s also the spine muscles, it’s the hip flexors. Everything that wraps around your core too, not just the abs. Any kind of core training is really good for you because it improves the insulin resistance that we were talking about and the overall inflammatory condition.

So yoga, Pilates, you know, the simplest core move is a plank. So just getting into a pushup position and holding it for as long as you can. Anything where you’re holding certain positions for a period of time can improve your strength, can increase cardiovascular fitness.

I personally enjoy yoga just because I like incorporating breathing into it. Yoga is great and I think it’s a great low impact way for people who have joint issues, for example. You know, to get back into fitness in general and exercise in general. So people with chronic arthritis or recent injuries, that’s a good way to stay active.

Courtney: That’s so great to hear. I love yoga and I never really thought of it in terms of heart health benefits, so that’s really good to hear. I think it’s great too that you tailor it to the patient, like you find out what they’re interested in, what they’re more likely to stick to

Dr. Emmanuel Moustakakis: Yeah, you have to. I have, actually, a few patients who love swimming, but a lot of patients, they don’t have access to a pool. So, if you don’t have access to a pool, how are you going to tell someone to go swimming?

Courtney: I would love to ask, because I know you mentioned, like, your own journey and running and yoga. Would you be open to sharing just a little bit about some of those things that you did? And I, we did see some medals in your background.

Dr. Emmanuel Moustakakis: So I’ve been on New York Presbyterian faculty for, this is my 16th year now, and in my line of work, I started seeing a lot of young men with heart attacks and heart disease. And so that sort of prompted me to get into exercise and really learning about nutrition, things that we’ve talked about, fiber, added sugar. I ended up losing almost 60 pounds over the course of probably about a year, year and a half.

And then, you know, a few years after that, I had a friend who was running the Long Island Half Marathon and asked me if I wanted to go on a little three mile run with him, and I said, sure, why not? So I ran that, and then he asked me if I wanted to run the Long Island half marathon. This was in 2014. So I ran it and then that was a euphoric feeling. ‘Cause I never thought I’d get into running like that. Certainly not that distance.

And then about six months later, somebody asked me to run the Hartford half marathon in Connecticut. So I ran that and that is right around the time that the New York City Marathon is being run, and I thought, man, it’d be really cool to run that. The long and short of it is that I’ve run now 24 full length marathons in the last 10 years.

Courtney: That’s really, really incredible. Thank you so much for joining us, Dr. Moustakakis. It was so wonderful to speak with you.

Dr. Emmanuel Moustakakis: It was my pleasure. Thank you for having me.

Courtney: Our many thanks to Dr. Emmanuel Moustakakis. I’m Courtney Allison.

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