New York City-based cardiologist Robert Ostfeld, M.D., is the founder and director of the Cardiac Wellness Program at Montefiore Medical Center. A Yale- and Harvard-trained physician, Ostfeld strongly recommends that his patients make healthy lifestyle changes, including adopting a plant-based diet. He confesses that when he gives this recommendation, “sometimes patients look at me like I have five heads,” but that doesn’t stop him from promoting healthy lifestyle practices.
Many Americans are relying heavily on statins
Q: Based on two new studies from Harvard researchers, cardiologists may have carte blanche to increase the number of statin prescriptions they’re writing from 40 million to upwards of 60 million. It seems many Americans readily accept statins, and perhaps even assume they can eat whatever they want because “the cholesterol pill will take care of it.” Do you consider that a dangerous attitude?
A: Yes, I do think it’s dangerous to think that a cholesterol medication will reverse the impact of a poor diet. Of course, in the appropriate settings, various interventions and medications—including statins—should be pursued. On average, cholesterol-lowering medications may lower the risk of cardiac event by perhaps 20 to 40 percent, depending upon the population. If someone is fairly unhealthy, there may be more benefit from the medication than in someone who is healthier. Statin medications do have side effects, but, on the whole, they are quite safe. But I think lifestyle changes are the first line of defense, and the cornerstone of that defense is healthy eating—it will not only protect you from high cholesterol, but also multiple health concerns.
Just 20 minutes a day can change your health
Q: What about exercise for heart patients or people hoping to minimize their risk of heart disease?
A: Exercise is an important contributor to overall health. The degree and intensity of exercise we recommend varies depending on the health of the patient. Before starting on a new exercise regimen, it is a good idea to discuss that regimen with your physician. In general, we recommend at least 20 minutes of brisk walking each day.
For my patients recovering from heart problems, I typically do not advise monitoring heart rate. Rather, I ask patients to monitor how they feel. If it feels like they are pushing themselves too hard, then of course slow down and recover. If you feel new or worsening chest pain, chest pressure, shortness of breath, or other untoward symptoms, call 9-1-1. Despite that caveat, exercise is your friend for many reasons. We just need to be sure it is embarked upon in a safe manner.
You can’t escape your DNA . . .
or can you?
Q: What would you say to someone who worries that heart disease is determined by their DNA—that if they’re genetically predisposed to have a heart attack or stroke, then they’re stuck waiting for it to happen?
A: To paraphrase a line from David Katz, M.D., “DNA is not your destiny. Dinner is.” You can’t change your DNA. But there is data that shows that through a healthier lifestyle you can make your healthy genes speak more loudly, and your unhealthy genes speak more softly. You can influence which genes speak, or express, and that’s pretty impressive. Interestingly, there are animal studies showing that when we’ve positively turned on healthy genes through the lifestyle “on and off” switch, that healthful activation may be passed on to our kids and grandkids. What an incredible responsibility.
Putting your heart to the test
Q: Screening: Are there any new diagnostics that we should be getting?
A: Having a regular doctor’s visit is an incredibly important thing to do. In addition to having your blood pressure taken and cholesterol monitored, there are some other screening tests that may be appropriate. For example, a high sensitivity C-Reactive Protein (CRP) test looking for markers of inflammation. Or, perhaps a coronary calcium score, which is a very quick computed tomography (CT) scan to check for calcium (related to plaque) on the walls of the arteries in the heart (atherosclerosis). If a blood clot forms, this can cause a heart attack or stroke. I don’t believe these tests should be used for everyone, but in the right setting they can be quite helpful, and also might prove to be motivational for helping the patient change their lifestyle.
Developing a healthy diet
Q: You’ve been quoted as saying, “Outside of emergency surgery, I’ve never seen anything come close to the breadth of benefits that a whole food, plant-based diet provides.” That’s a pretty powerful statement.
A: The appropriate lifestyle changes can profoundly improve your health. I would strongly encourage people to eat a whole foods, plant-based diet that not only protects blood vessels from developing blockages, but benefits us in many, many ways.