A Gastroenterologist’s Approach to Cardiology

After my residency in Internal Medicine, I knew I wanted to pursue a fellowship in either gastroenterology or cardiology. I loved how both fields provided the mix of clinic and procedures. While I eventually elected GI as my specialty, I never lost my passion for cardiology — a passion that was largely inspired by my mom. My mother, Carol, survived an acute heart attack in her 60s in her right coronary artery. My mom was a health conscious woman who worked out, avoided alcohol/smoking, and ate a diet comprised of fish, chicken, and vegetables. I was always curious about how a woman who took such great care of her health could experience such a severe heart attack, especially at a relatively young age. I wrote it off as a fluke, freak event. That was until I had a carotid ultrasound that indicated my vascular age was 20+ years older than my age with an almost 80% narrowing in my right coronary artery (the same artery blocked in my mom). I was shocked. Like my mom, I value my health and avoid saturated fat (with the exception of an occasional slice of cheesy pizza), don’t drink alcohol, and strength train/run. I felt like history was repeating itself. I was scared and thus, began my journey into heart health.

Below are the steps that I took for my cardiac health:

1st Step

Check your LDL, HDL, Apolipoprotein B (Apo B), and Lipoprotein (a)

• LDL = transports cholesterol to organs and tissues - BAD

• HDL = transports cholesterol from organs and tissues to liver - GOOD

• Apo B = primary protein that carries LDL and lipoprotein (a)

• Lipoprotein (a) = low-density lipoprotein (carrier of bad cholesterol) that is “sticky” and can be attached to the LDL.

My labs came back with high LDL (>150), high lipoprotein (a) (>100), and low HDL. After my labs came back, I started taking a statin along with high dose Omega - 3 (which helps thin blood to prevent blockages), berberine (shown to decrease bad cholesterol), and baby aspirin (can help prevent a heart attack). I also made an appointment with a cardiologist. Although my appointment was a couple months away, I wanted to take the steps immediately that I could. I paid for a CT Calcium score through Penrose Hospital. The CT Calcium score is also known as a “coronary calcium scan” which is a CT scan that measures the plaque in your heart’s arteries. I refer many of my patients to Penrose for this scan which is only $99. I paid for an echocardiogram and repeat carotid ultrasound. I also had an exercise stress test per my primary care physician’s recommendation and referral.

2nd Step

Get all imaging possible done prior to cardiology appointment

• Carotid Ultrasound

• Echocardiogram

• CT Calcium Score

• Exercise Stress Test

With all my imaging results and labs, I was ready for my cardiology appointment. With my cardiologist, we reviewed my labs, family history, and imaging. I elected for a cardiac catheterization with my cardiologist. This procedure is relatively low risk. The cardiologist inserts a small catheter up a vessel (commonly in arm or groin) and looks in the heart vessels for any major blockages. If indicated, they can place stents (which helps keep narrowed arteries open) or take tissue samples. My cardiac catheterization results weren’t concerning, and I have continued with my heart-healthy diet, supplements, medications, and cardio. I’m really relieved that I was able to comprehensively address my cardiac care, and now, I am passionate about addressing it with my patients, too.

3. Consult with Cardiologist

Based on my family history, elevated labs, and imaging results, I elected to meet with a cardiologist for further intervention.

When speaking with my cardiologist, I realized much of my cardiac health wasn’t an indication of being “unhealthy” but rather, genetics. Lipoprotein (a) is actually a hereditary trait, meaning if you have high lipoprotein (a), your children have a 50% chance of inheriting it. My young adult children all have been tested and all have high lipoprotein (a) which is why I discuss the importance of preventative cardiac care with them frequently. Regarding cholesterol and LDL, some families can also have familial hypercholesterolemia (or genetically linked high cholesterol) which is also the case for my family. All of my children have had high cholesterol since they were young, and we are in the process of discussing possible statin intervention. According to Dr. Peter Attia in his book, Outlive: The Science of Art & Longevity, peripheral arterial disease can start in young ages and can be prevented through statin use.

While lifestyle modifications are important in cardiac health, it’s also important to note the genetic component of lipids. I’m going to continue my supplements, medications, and healthy lifestyle while also working with my cardiologist to make sure I’m keeping my heart happy AND healthy. I am committed to addressing cardiology in all my patients as well which is why I do a comprehensive cardiac lab panel for new patients and offer cash-pay, preventative vascular screenings monthly.