Podcast Transcript

Introduction: Life is about the moments that make your heart tick, and we’re here to keep it ticking strong. I’m Dr. Barry Bertolet, and this is We're All Heart, where we dive into the latest cardiac care with the experts who live it every day.

From breakthrough procedures to the most cutting-edge treatments, we're putting heart health front and center. 

We're All Heart is brought to you by North Mississippi Health Services in partnership with Cardiology Associates of North Mississippi. Let's get to it. 

Morgan Roe: Welcome to a very new and exciting series called We’re All Heart. It's a podcast series. I'm Morgan Burger Roe, and I'm a brand strategist here at North Mississippi Health Services. Here today with me is Dr. Barry Bertolet, cardiologist.  Tell us a little bit about yourself, Dr. Bertolet. 

Dr. Barry Bertolet: Thank you and I appreciate you being here today. I am an interventional cardiologist. I work at Cardiology Associates of North Mississippi. I've been now in Tupelo for 27 years. So many of you may have seen me on some other commercials through the years promoting cardiovascular health. But we wanted to do a podcast representing cardiovascular health and then trying to spread information to the public about disease processes and treatments and procedures that we may have locally here in north Mississippi that they may not know about that would be important for their health. 

Morgan: Wonderful. And so throughout this series, we're going to be talking to some of your colleagues, some other physicians about various types of cardiovascular procedures and instances. Tell us a little bit about that. 

Dr. Bertolet: We are very fortunate in north Mississippi to have a series of experts in a wide variety of medical specialties that are unique for our region or even unique in the state.

And it is interesting, how does a town of 35,000 have this collection of these experts? And a lot of people just don't realize the gem that we have here at north Mississippi and how that has been useful to help patients with high cardiovascular risk survive and have good productive lives. So why Mississippi? Why is Mississippi such a hot spot, if you will, for cardiovascular disease? Well, across the United States, we do see that cardiovascular disease is an important problem and we will see that like one out of five of United States citizens will die of cardiovascular disease. 

But when we look within our own state, we see that number as one out of three. So if you look around you and if there's three people gathered together, one of you is going to have a cardiovascular death. And it is very, very important. And when we look at that, we see that men are a little bit more likely to die than women. And we see that African Americans are going to be a little bit more likely to die than Caucasians. Hispanics are somewhat in the middle there. How do we get that information out and how do we detect this disease? We find that cardiovascular disease is costly. And we're seeing that about $250 billion are spent annually treating cardiovascular disease. And as we'll discuss, there are little things that people can do to have a major impact on their risk of cardiovascular disease and events that may occur.

Morgan: Without spending a dime. 

Dr. Bertolet: Without spending a dime. 

Morgan: Well, we'll talk more about that here in just a moment. Dr. Bertolet, tell us about this graphic that we're looking at here. This is very interesting to see where we live and how dark that color is.

Dr. Bertolet: Right. So this is a graph that the CDC put together looking at the cardiovascular deaths in patients that are above the age of 35.

I did practice for a while at the University of Florida Gainesville, and then I moved to Tupelo. And as you can see, there's not a whole lot of things going on in central Florida, but as we come up to Tupelo, there's a lot of cardiovascular disease.

I think this graphic is also interesting is that when we think about a lot of the places that people think about, I'm going to go there because they're the cardiovascular experts, so I'm going to go to Mayo Clinic, I'm going to go to Harvard, I'm going to go to Scripps.

There's no heart disease there. There's no heart disease death there. And they, in those areas, they may be very smart people and very capable people, but they just don't deal with the, the depth of the disease process that we deal with here in Mississippi. I think it's important for us to also understand where we lie on this map.

Because if you're having chest pain, it's more likely cardiac, it's not just gas. So maybe in at the Mayo Clinic, if you're in Rochester, Minnesota, if your chest is hurting, maybe it is something else going on. In Mississippi, it's a heart attack until proven otherwise. (Continued below)

Morgan: Wow. So tell us more about this map and what we can expect to learn from it. 

Dr. Bertolet: So again, part of this is that we're looking at cardiovascular death and knowing where we are, but when we think a little bit more, we also need to think about the risk of stroke. So it's just not heart disease that people die from, but it's stroke. And oftentimes you hear about the stroke belt and you can see here in the deep purple, this is where people have the most strokes and we clearly are in that stroke belt.

So a lot of the risk factors that we talk about modifying, a lot of the procedures that we will talk about on this podcast series, are designed to help prevent stroke. 

And part of the reason why we have such a high cardiovascular problem is our risk factors. And we've seen in this graphic here, this is looking at diabetes.

Morgan: When you say risk factors, what does that mean? 

Dr. Bertolet: So these are medical conditions that a person might have that would increase their risk of developing blockage and blood vessels. So traditionally we think about those being family history - really can't change - that your age - you really can't change that, that if you're a male or female - really you can't change that. But there are modifiable risk factors and those are the important ones to think about.

Are you diabetic? Do you have high blood pressure, do you have high cholesterol? Are you overweight? Do you have a sedentary lifestyle? And those are things that you can modify. And as we'll discuss by changing those things is that you can decrease your risk of having some bad event happen to you. 

Morgan: Why are our rates for heart attack and strokes so high compared to other parts of the US? Is it the risk factors? 

Dr. Bertolet: I believe it is the risk factors. And then again, this map is just one great example - we have a lot more diabetics in our area. And because of that, then that risk of cardiovascular disease goes up, the risk of stroke goes up and heart attack goes up. 

Morgan: Okay. Interesting. So what can we do to decrease the risk factors?

Dr. Bertolet: Well, there are a lot of things that we can do to decrease risk factors. And with regard to diabetes, most of the diabetes that we run into in Mississippi is Type 2 diabetes, meaning that people developed this as an adult. This was not something that they were born with.

And so a lot of this gets back to obtaining an ideal body weight and then exercise on a regular basis. We have seen with the advent of some weight loss surgeries, as well as some of the newer weight loss medications, when people have dramatic changes in their weight is that they're, if they were a diabetic, they are no more. 

And so you can actually make that go away. So that's something that you can abolish with just weight control and exercise.

Morgan: And it's free essentially. I mean, maybe not the medications or the surgery, but you can eat right, you can exercise and those things do not cost money. 

Dr. Bertolet: Do not cost a thing. And that's widely available and there's good data to show that that works. So there's a study that looked at a Mediterranean style diet that's a diet that we promote a good bit at the hospital. And with that diet that's eating primarily chicken and turkey as your protein sources, fish, not so much pork, not so much beef. More complex carbs. So leaving the simple carbs out of the equation, not so much in the way of sugar.

And when you do that, you can get sustained weight loss that translates into a reduction of diabetes, reduction of cardiovascular death, a reduction in dementia. And so that gets to be important when we think about just something simple like changing your diet.

Morgan: Absolutely. Tell us about this next map that you have here. 

Dr. Bertolet: So again, this is looking at one of the risk factors and that's obesity.

And unfortunately, we can see that Mississippi is the fattest or close to the fattest state in the nation. And then when we are thinking about obesity, a lot of times we look at body mass index. And we see that this body mass index of 20 to 25 is ideal. When you're 25 to 30, that's considered to be overweight, but above 30 is considered to be obese.

That's how you get on this map. And so we can see that nearly 50% of the people that live in Mississippi are obese, meaning that their BMI is above 30 and so much greater than that ideal range. And so with that, obesity comes, the other medical problems comes, the diabetes comes, the joint pain comes the gastric acid reflux disease comes sleep apnea syndrome comes, hypertension, comes, high cholesterol levels. 

And so there are a lot of negative consequences that come from obesity. One of the things that is somewhat striking is that how used to obesity we are. If someone is a normal weight - I know that my grandmother used to tell me that I was too skinny is that, you know, I think I'm an ideal body weight, but she said I was too skinny. I needed to put, you know, some weight on. In the south, particularly in Mississippi, if you're a normal weight, people will almost point you out and say you’re not a normal weight. But in other parts of the nation, we that are overweight from Mississippi stand out because we are overweight. 

Morgan: Sure. Sure. And you can see in this area - around in the south in general, we have that higher body mass index. And not so much in some of these other states, Colorado, very active state. Does that play a role into it? 

Dr. Bertolet: It plays a big role into it. In Colorado you're going to have more athletic, outdoors-minded people to begin with there because they're there to enjoy the mountains. So I do think that that environment has attracted that. But I think that in Mississippi, we've moved away from our agricultural roots. And so when we were farming, maybe eating that high fat diet was important to help sustain us as we worked on the farm all through the day to get us to the evening meal. But now we've moved away from that agricultural society. We have sedentary jobs, we have more indoor jobs, but we still eat like we're going to go work on the farm for the day. 

Morgan: The good stuff. Right? 

Dr. Bertolet: Yeah. All the good stuff. And so I think that's what gets us in trouble. 

Morgan: So what can we do to decrease that obesity prevalence in our area?

Dr. Bertolet: I think a close attention to your numbers, know what you weigh, go ahead and get an idea of what your body mass index might be, and then develop a strategy to get that under a better control. Little changes make a big difference. 

You may weigh 400 pounds and you may never get down to an ideal body weight, but we have found medically that if you lose just 10% is that, that could make a big difference in your medical outcomes. And so if you're 400, then you lose 10% of that. So that means you're losing 40 pounds, you're 360, you're by no means normal weight with that. But the thing is you've reduced your cardiovascular event rate by 50% from what it would've been at 400. 

Morgan: So let's say you are that person, what, what do you do? Some people may not know, where do I start? How, how can I get past this? I know that there are people that maybe feel like I don't, I don't know what to do. I'm a lost hope, I'm too far gone. How can they get started? 

Dr. Bertolet: A good place to get started would be with your local doctor or your nurse practitioner. I think getting a baseline idea about where you are. Get some numbers. Those are then also numbers that you can go back to compare to, to see am I making progress or not? A lot of times going in and seeing that doctor may allow you to find out things about you you did not know, maybe there are reasons why you're overweight. Maybe your thyroid is not performing as it should. There may be medical issues that may be interfering with your ability to achieve the goals that you would want to. So I think understanding some of those goals and then where you are medically to begin with is important.

And then setting out a strategy and understanding is that there is truly no quick fix. Unfortunately, I think that we live in an instant society, we want it now. You know, if I buy something, I want it delivered on my doorstep in 24 hours and it just doesn't work that way with weight loss. And then any weight loss that you do get that quickly is not good weight loss, you will gain it back plus more. Everybody that's listening today probably has gone on a weight reduction diet and they've done something where they've lost five or 10 pounds quickly and then as soon as they got off that diet, they gained the 10 or 15 back and so they almost went backwards in time. And then that can be discouraging.

So I think setting out realistic goals. Starvation diets don't really work. It's really more moderation of the meal. The all you can eat mentality really needs to sort of go away. Think about portion size, the dinner plates should be about this big. The dinner plates that we see are about this big. And so going back to even a normal sized dinner plate is a great way to get started. So mentally you sort of know, hey, if I can't get it on that smaller dinner plate – a proper-sized dinner plate, then I shouldn't be eating more than that. 

Morgan: Well and eating to fuel your body, rather than just eating to always enjoy. Or overconsume. Or overindulge, which I know we can do in the South sometimes. Dr. Bertolet, tell us more about high blood pressure. 

Dr. Bertolet: Yeah, high blood pressure is a big problem that we have, particularly in the South. Interestingly, there is a new procedure which we will discuss in a future podcast that is a medical treatment or a surgical treatment for hypertension. 

Interestingly I was with a physician that was from Philadelphia. And so if you can think about Philadelphia, or a surgical treatment for hypertension. But interestingly I was uh, with a physician that was from Philadelphia. And so if you can think about Philadelphia, Pennsylvania, surrounding area. And they were looking at the number of patients that were in his catchment area that had resistant hypertension. That means that they have high blood pressure, poorly controlled on at least three medicines. And that number was 155,000. In his catchment area, which is a lot.

Then they did the same analysis for Tupelo, smaller population. More rural, more spread out. Our catchment area is 155,000. So it speaks to high blood pressure being such a problem here. Is that in a town of 35,000 people – in its surrounding areas 155,000 patients have blood pressure that's poorly controlled and a lot of this is just not knowing the numbers.

I went to a black church recently and did blood pressure checks. And I was amazed at how many people had high blood pressure, but when I told them their number, they said, oh, that's good. They did not know what a normal blood pressure should be.

Morgan: So tell us, what is a normal blood pressure? 

Dr. Bertolet: Yeah, a normal blood pressure is about 120/80. And then if the top number gets it to be above 130, then that's borderline hypertension. And if it's 140 or above, then that's hypertension.

Morgan: Is there anything we can do at home or in our everyday lives to lower it If we do have high blood pressure?

Dr. Bertolet: There's actually lots of stuff you can do to help lower your blood pressure. So one of the big things - I'd say this is all communities, but definitely the American community - is salt, is that we have found that African Americans are definitely salt sensitive. We see that a lot of hypertensive patients are also salt sensitive. And so just backing off the amount of salt, maybe not adding it after you've cooked your food or maybe not cook the food in such salty food. We have to be really, really careful because salt can sneak up on you. A lot of the foods that you buy if you go to the restaurant are heavily salted. You turn on any food network and the judge is telling the person, well, you know what? I would have added more salt. And so it is a problem to get away from the salt there, but salt is a big issue.

We're seeing that if someone were to consume magnesium. So magnesium is a mineral that you can buy over the counter. And I would just the caveat there is if you have kidney disease, don't take magnesium, because it could build up, but anybody else could take magnesium and it could help lower blood pressure.

And then weight loss, exercise, these are key things in helping reduce blood pressure. 

Morgan: Okay. Are there non-medical ways to control our risk factors? I know we talked a little bit about that. Can you go more into that? 

Dr. Bertolet: There are many non-medical ways and one of the big things that we've not really approached just yet is cigarette smoking.

And that's one of the major risk factors that we see that has become quite expensive for people to do. If they were able to leave cigarettes alone can make a major impact.

So we see that there's a couple of different layers of that. So when you smoke even just one cigarette - we've done this in the cath lab where I'll have a person on the cath lab table, I'll take pictures of their heart arteries, I'll have them smoke a cigarette in the cath lab and retake pictures of their heart arteries and immediately their blood vessels have narrowed, they've spasmed. So that's not only happening in their heart, but it's happening in their brain. It's happening in their kidney, that's happening in their leg. 

Morgan: Was the patient surprised to see that? 

Dr. Bertolet: They were very surprised. But it was the power of showing how even one cigarette can cause a lot of damage. A lot of people will talk about, well I used to be a pack a day smoker and now I'm down to three cigarettes a day. Yes. That's great. But still that three cigarettes a day is still causing that immediate damage of spasm. 

Morgan: Well, and more recently I feel like some people have opted to vape or smoke marijuana instead of smoking cigarettes. Is that really a better option? 

Dr. Bertolet: I will say this, for the people that chose vaping, there was a moment in time where we thought that vaping could be an alternative to cigarette smoking. It may be a tool that we could use to get people off of smoking cigarettes. 

Unfortunately, we have found that to not be true. We found that when people vape, a lot of the toxins that are in there are almost more immediately absorbed in the body. There's actually a new disease process where you can get a very sudden lung problem called popcorn lung. And then that may actually not go away.

And so a 24-year-old girl who wants to be cool and smoking the vape and blowing a lot of smoke, she could do damage to her lungs that could impact her at 25 that may be with her for the rest of her life. And so unfortunately we're finding some issues with vapes.

And then marijuana has been one of the question marks that's been out there. But now there's some studies that show that smoking marijuana - and so it may be for just for us to inhale anything may be bad for our body.

But we have found that daily marijuana users have a 40% increased risk of having a stroke and a 25% increased risk of having a heart attack, as compared to non-marijuana users. And so it is a risk factor. 

So when we talk about cigarette smoking, I think that we have to throw in vaping. And then smoking marijuana is an equal risk factor across the board.

Morgan: So let's walk through these non-medical ways to control risk factors. I know we've touched on them, but can you just list them out for us so that we understand? 

Dr. Bertolet: Right. So we've talked about losing weight. We've talked about lowering cholesterol, briefly. When we think about the cholesterol level, it's important is that there are different levels of normal depending on who you are. The more risk factors that you have, the lower the number. And so there's actually three or four different normal goals that we get to. 

So if you're a healthy person, we'd like to see your bad cholesterol, your LDL under 100. If you have some risk factors, we'd like to see your LDL under 70. If you've now had a stroke, if you've had a heart attack, we'd like to see your LDL now down to 55. And if you've had multiple of those events, it's even down to 45 now. So that number's getting lower and lower and lower. And part of that, we have found that cholesterol is part of that plaque buildup process. And so by lowering the cholesterol, we can prevent plaque buildup and in some cases actually make it go away.

It's called plaque regression. So we've done a couple of studies now on the heart where we can see blockage actually disappear in time after we get the cholesterol level low enough. 

Morgan: So you talked about the blockage. Can you explain some to us a little bit more about this calcium score and and what we're supposed to be looking for? 

Dr. Bertolet: Yeah. A good way to screen to find out if you have blockage in your heart blood vessels is this test called a calcium score. This is a low dose X-ray test that we can do of the heart and it will look for plaque buildup in your heart arteries. There is a computer algorithm that then gives you a number and then we can plot that number based on your age and your gender and then give you some idea of risk.

And so we have found that the calcium score is a great simple, easy tool to find heart disease early. We can find heart disease on that test earlier than we could find with a stress test, a heart catheterization, an echo a nuclear medicine scan.
This is our early warning detector. And if we see plaque buildup there, that is really a signal that you gotta get serious. You have to start modifying those risks. If you're lazy with your diet, it's time to get more active. If your cholesterol level was roughly about 100, your LDL, now it's time to get it down to 70.
If your blood pressure was borderline, now it's time to get it under control.

Because that's a marker that you do have disease. And then that, that disease will build up in time if you don't modify it. 

Morgan: Well, and of course any of your providers and physicians at Cardiology Associates can help our patients with that. And I think a lot of people don't realize how quick this test is. It's in and out. You're in, they do it very quickly and you're out and you have your results almost immediately.

Dr. Bertolet: Exactly. And we promote the three tests in 30 minutes, but it's less than 30 minutes that you're there. And in those three tests we're doing a EKG on people. We're looking for atrial fibrillation. We'll talk about that in the upcoming podcast. 

We are checking your cholesterol level, so we're trying to give you that number that is so important that you need. And then we're doing this calcium score. We're giving you that number and then we're also giving you an idea of your risk. 

Interestingly enough though, we had set this up as an early screening to detect people early in the, in their state, but we have found many, many people later in their disease state. And it's amazing how many people don't have that warning device to let them know that, hey, I got a heart problem. They're not having the chest pain.

Or maybe they've just got a high pain threshold, and they just don't know they're in trouble. And this test has been the tool that we've used to, to find that, to detect it and then to be able to do something about it. 

Mogan: And, and you said earlier how many have, how many of these scores have you done roughly? 

Dr. Bertolet: We've done, we've been doing this calcium scoring test for about 15 years now, and we've done over 30,000 calcium scores. 

Morgan: That's incredible. 

Dr. Bertolet: It really is. And we've seen this wide variety of someone, if you just looked at 'em, you know that they're gonna have heart disease and they got a calcium score of zero. 

And then you see the other person that's a picture of health and their calcium scores a thousand and they're really high risk.

Morgan: So I think the biggest takeaway for our patients and our listeners is know your numbers. Right? 

Dr. Bertolet: Absolutely. Know what your blood sugar is, know what your cholesterol level is, know what your blood pressure is, know what your calcium score is 'cause it can be a big role in your future outcome.

And those are the numbers that we use in a risk calculator. So we can plug those numbers in and we can calculate what is your five year, your 10 year, your 20 year risk of having a heart attack or stroke. And then we have found that little things matter.

So there was a nice study, and I think this speaks to one of your questions earlier about how cheap or low cost this can be.

There were four things that were found that helped people and they could reduce cardiovascular events by 80%. 

Morgan: Ultimately anyone should be able to meet with their primary care provider or their cardiologist and make sure that they know their numbers so that they can get on the right path if they're not on it, so we can live long healthy lives. 

So last question I have for you. You know, with North Mississippi Health Services, we really stand true to who we are and continuously trying to improve the health of the people in our region.

And we've recently adopted this new term true north, and our patients are our true north. And I know that you ultimately are just trying to make sure that your patients are healthy for the continuation of their life. What does True North mean to you? 

Dr. Bertolet: Well, if we go back to that first graphic, why did I move back to Mississippi? Why did I move here from Florida? And part of that is that this is where the disease is. Truly cardiovascular disease in Mississippi is an epidemic. This would be like if there was the plague and then there was ground zero? We're ground zero.

And I think it's important that we recognize that. And so for me, that's been important to make an impact on the state where I was born.

I was born in Jackson, Mississippi at St. Dominic's Hospital. And so to come back to Tupelo, to come back to Mississippi, and then to bring in high technology, to bring in research medications and research devices that are important. Some of these newer medicines and devices and procedures are very expensive. But if I can bring them in here and I can bring them in here free for a patient, then I think that I've served the patients of my home state. And then I think that we can take that red stain off of Mississippi and so we're no longer the leader in cardiovascular death, and then maybe we can make an impact.

And so that would be my true north. 

Morgan: Well, thank you Dr. Bertolet, for a great episode. I look forward to hearing more from you and your colleagues as this series continues. You can of course find more information in our show notes and we'll see you next week.