Beating Time: Dodging the Number One Killer with Dr. Lipi Roy

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Coming up next on StarTalk Special Edition, all about heart health.

What are we doing right?

What are we doing wrong as a nation, as the world?

Turns out cardiovascular disease is the number one killer of human beings in the world today.

What can we do about it?

What are the misconceptions?

How does it all relate to COVID?

And the vaccines given to prevent us from dying and keep us out of the hospital.

How do they all relate?

Coming up next on StarTalk.

Welcome to StarTalk.

Your place in the universe where science and pop culture collide.

StarTalk begins right now.

This is StarTalk Special Edition.

I’ve got with me my two favorite co-hosts in the universe.

Chuck Nice, Chuck, how are you doing, man?

What’s happening, Neil?

All right.

Long time co-host, comedian and actor.

I got Gary O’Reilly, former soccer pro, sports commentator.

And we borrow him for this because his life and heart is in soccer.

But thank you, Gary, for giving of yourself to us.

Oh, my pleasure.

Thank you, Neil.

And where are you going to take us here?

Well, recently, so earlier this year, 2023, we did an explainer about the Demar Hamlin NFL cardiac emergency that he had on field.

And our audience came back with a variety of thoughts and ideas as to what they thought had happened.

And it made us realize because we have a little huddle, as you do.

And you know what, we maybe don’t know as much about the heart, one of the most vital organs in the body, as we think we should.

It is the number one killer in the USA.

And I think really, we needed someone to shed a light on that.

And so we brought back one of our most favorite medical doctors, Dr.

Lipi Roy, MD.

So Neil, would you like to introduce our guest?

Sure, sure.

Lipi Roy, great to see you again.

And we’ve met on several occasions, not only with StarTalk.

So delighted to have you shed some light.

Internal medical physician, public health professional with the Mayor’s Office of Criminal Justice.

Now whose mayor is that?

So Mark Jay, the New York City Mayor’s Office of Criminal Justice, I believe was started during the de Blasio administration.

Got you.

So New York City Mayor’s Office and your host of a YouTube show, Health, Humor and Harmony.

I love the alliteration.

Thank you.

And you’re often sought after commentator and we know why.

MSNBC, NBC News and Forbes, you write for Forbes.

And so welcome back to StarTalk.

I’m so happy to be here.

And this is a topic that matters so deeply to me, to my people.

I’m the daughter of Indian immigrants.

I’m wearing my red.

So we’re told that there’s certain foods out there that are heart healthy.

And they’re heart healthy habits we can undergo, heart healthy lifestyles.

And even so, issues related to our heart is the number one killer of Americans.

So what are we not doing?

What’s missing?

Or maybe we are doing the right things and who was it that said eat well, stay fit and die anyway?

Is this what’s going to happen regardless?

Well, that is the pessimistic approach.

But no, it’s actually, Neil, we have studies, we have data showing that if people adopted these healthier lifestyles or in other words, reduced their risk factors for heart disease, they will live longer, at least they won’t die of heart disease and to Gary’s point earlier, the leading cause of death globally is cardiovascular diseases.

So just a reminder that cardiovascular diseases includes a group of illnesses including coronary artery disease, cerebrovascular diseases, peripheral artery disease, which supplies the arms and the legs, rheumatic heart disease.

But you said cerebral, so your brain.

So why would your heart be implicated by something that happens in your brain?

That doesn’t sound right.

Great question.

Because, because cerebrovascular diseases means that these are blood vessels supplying the brain.

So the blood vessels come under the category of cardiovascular diseases.

Oh, so that’s why the heart is a wide swath of illness.

Exactly.

As you’re describing it.

And remember, I’m not talking about the heart, I’m talking about cardiovascular diseases.

So that includes all these other…

So cardiovascular is your circulatory veins and veins and things.

So to combine, I guess, so a stroke would be cardiovascular, is that right?

It’s exactly right.

So, so a cerebrovascular disease includes most commonly the stroke, strokes.

Oh, got it.

And cerebrovascular disease, sorry, cardiovascular disease also includes congenital heart disease.

And like when you’re, when you’re a baby, and I already mentioned rheumatic heart disease.

So yeah, to the point that we were talking about earlier, it is the leading cause of death around the globe, 17.9 million people died of it in 2019.

And the leading cause specifically 85% are dying from heart attacks and strokes.

So to your question, Neil, so yeah, we know what the risk factors are, or maybe people don’t, but they’re not really adopting all of it.

I really think it’s most people don’t know that the leading causes are the risk factors are it’s smoking, it’s unhealthy diet, it’s lack of physical activity, it’s being overweight or obese.

And it’s also harmful alcohol consumption.

I don’t think well, that’s it.

I’m dead.

Yeah, I’m dead.

Well, that’s it.

It was nice knowing you guys.

Chuck’s got three more months and I got three minutes.

Are you kidding me?

I got three minutes.

So, doctor, is it as simple as saying if we cure the cardiovascular disease scenarios, we are now in the situation where we can optimize our lifespan to say 150 without there being too many problems?

No, you die of something else, you know.

I know, but I’m the one the doctors aren’t, so not my fault.

Well, but in this particular case, our astrophysicist expert is right because I hate to be cynical.

I’m almost always optimistic and positive, but in this case, I mean, look, if we, if you’re right, Gary, to your point, if we optimize and suppose we eliminate all risk factors for heart disease, right, and we are not dying of heart disease.

Look, if we are lucky enough to live till the 80s, 90s, somebody, something else is going to get us.

I bet no caveman died of prostate cancer.

Exactly.

They didn’t live long enough.

They only lived until 32.

That’s right.

32 years old.

Yeah, great prostate.

Okay, so this longevity question is not the direct subject of this episode, but it’s way more complex than just solving one disease or another.

But you should keep in mind that you do live better.

So think of all the people who are suffering from all of these different ailments, the cardiovascular diseases and heart disease.

If it isn’t even the big giant widow maker or whatever that kills you, you’re not living well.

You’re suffering all that time.

Yeah.

And can I share a personal story?

So I’m of Indian heritage.

Heart disease is a huge epidemic amongst the Indian community.

My own father was diagnosed.

He had a heart attack in his late 60s.

It’s totally atypical by Western to standard heart patient, right?

Lifetime non-smoker, thin, active, very healthy eater, but he had a strong genetic predisposition.

He had a heart attack in his late 60s and then 20 years later, a common complication is heart failure.

And to your point, Chuck, your quality of life in the last year and a half, two years of my dad’s life, he was really struggling with heart failure, which slowed him down considerably.

This is the same guy that went from India to Europe to Canada, drove to Florida, one of the most active guys I know.

He sadly succumbed to heart failure in March of this year.

Yeah, no, thank you.

But to your point, Chuck, heart diseases, it can really impact one’s quality of life.

But if we don’t die of heart disease, I just don’t think that we’re going to live till 150, Gary, because cancer, Alzheimer’s, other neurologic problems, something else is going to get us.

That’s my suspicion.

Oh, no, I totally understand.

I’m just wondering, just how many different ways does the heart get broken?

Does the cardiovascular system tie itself in knots and just fail to function?

One of the chief ways is being a Jets fan.

That’s the Eagles fan.

Just be the Giants, right, Chuck?

Yeah, well, I’m an Eagles fan.

He doesn’t care.

I don’t care about the Giants.

Don’t leave, though.

I don’t even follow football, but I know that to just one.

Well, Gary, to your point, outside of supporting the wrong sports team, there are other actual causes of ways to attack the heart.

I mean, look, the most common one we think of is coronary artery disease, right?

That’s when the vessels that supply the heart, they get clogged or blocked, right?

Causing a heart attack.

But there’s also structural heart disease.

So that means the blood, the vessel, the heart valves, the heart wall, the heart chambers, they’re all affected in general heart disease.

There’s also arrhythmias, so like a V-tach, V-fib, these can all cause…

So there’s all types of ways to attack or harm the heart.

Wow.

We’ve discussed there what happens internally.

How many external scenarios affect the cardiovascular system?

The heart?

I mean, is it as simple to say not many or just about?

Well, great question.

I mean, the heart is such a fundamental organ.

I mean, I love, love the heart.

It’s so simple and yet, any one thing, one aspect that goes wrong, everything shuts down.

Everything slowly deteriorates.

You can have something acute, like a sudden cardiac arrest, but you could also have something more chronic like the heart failure that I described.

But to your point, Gary, external causes like medications, there are tons of medications or drugs, we talk about alcohol, stimulants like cocaine, these can all adversely impact the heart.

So there’s a lot of other external, we didn’t even talk about tear accidents.

What about marijuana?

Marijuana?

What do you think?

Chuck’s got a lot of marijuana.

Everybody knows cocaine is bad for your heart, but what about marijuana?

I don’t know specifically, Chuck, if cannabis affects the heart.

Cannabis is one of those substances that affects every organ, but I’ll have to get back to on that.

I’m going to take that as you saying it’s absolutely safe.

That is not what I said, but go ahead.

I love that you clarified, but that is not what I said.

Actually, marijuana can make the heart beat faster and can actually increase blood pressure, which can actually harm the heart.

So sorry, Gary.

Sorry, sorry, Chuck.

Sorry.

Maybe Gary, too, at times.

Maybe Gary, too.

You never know.

Can I just go back to alcohol?

I mean, people associate alcohol with the liver, but actually alcohol can cause cardiomyopathy, it can elevate your heart blood pressure, it can really attack the heart in many ways.

And it’s a big issue now because with COVID, alcohol consumption has gone up in women and alcohol-related mortality has gone up in women, so look, as a woman and an addiction doctor, as an internal medicine and primary care doctor, this really matters to me.

But that was one of the big surprises during COVID that liquor store sales went up precipitously that entire time.

Yeah.

Because that’s when they started delivering.

So it seems like you can track the health of a country by the runs on the liquor stores.

I mean, I don’t mean to laugh, but just without even testing the people, you can get a first cut at the health by how many cigarettes are sold, how much alcohol is purchased just at the point of sale.

Right?

Well, it’s also a hard…

I’m actually glad that liquor stores were open from a harm reduction lens, because if you cut off a person’s alcohol supply, somebody who drinks regularly, you’re going to put them into acute withdrawal, and that’s a medical emergency.

That means the hospitals are going to see more of these patients coming in.

So from a harm reduction standpoint, I’m glad that liquor stores were actually open.

But you’re right…

You are my kind of doctor.

But to Neil’s point, he’s right that we did see a rise in alcohol consumption, cigarettes, all that stuff, which is a sign of increased stress and stressors, which of course we saw with the pandemic.

Right.

Now, what about the…

I think the amateur person, the uninformed person, uses these terms interchangeably.

But if you could detail for us, you may have done this the last time, but I can’t hear this too often.

What’s the difference between a heart attack, cardiac arrest and heart failure?

Those are different things, right?

Yeah.

And I’m so glad you’re right, Neil.

I remember in med school and resident training, repetition is the key, right?

You always repeat the same thing and people confuse these concepts all the time.

So let’s start with cardiac arrest.

Very simply, it’s the heart and it stops.

Heart just stops.

There’s many different reasons, but the leading cause is a heart attack.

And a heart attack or myocardial infarction, the blood vessel…

I’ll go with heart attack on that one.

Yeah.

It’s MI, but a heart attack.

So, but the leading cause of a heart attack is when the cornea arteries or the vessels that supply the heart get blocked.

There’s a plaque.

So that’s a heart attack.

Heart attack means the heart stops because the blood vessel supplying it get blocked.

And then what was the third?

The heart failure.

Wait, wait.

Just to be clear.

The vessels are getting blocked, constraining blood flow.

Correct.

If you’re undergoing that, a person can walk around and say, I think I’m having a heart attack.

Correct.

Whereas if they actually had a cardiac arrest, they’re on the floor.

Yeah.

And that almost all causes usually, cardiac arrest is usually a sudden thing, right?

So you’re dropping, you’re unconscious.

That doesn’t mean you die, but that’s what that means.

Heart stops immediately.

Heart attack to your point, Neil, you’re right.

People almost always have symptoms indicating because it’s a slower process.

It could be fast, but it could also be slower.

So that means that part of the heart muscle is no longer getting nutrients, specifically oxygen.

So it starts to die and my part of infarction means death of that heart muscle.

And that third distinction, Neil, you got heart failure.

Yeah.

So that means that that’s just, again, a general term where the heart just isn’t pumping strong enough.

Again, a lot of causes, the primary cause for heart failure being coronary artery disease or heart disease.

And what about the, what they call AFib?

You just described that to me.

So again, another category for what attacks the heart or a form of heart disease is really what we call arrhythmias.

And one of the most common arrhythmia or a heart rhythm abnormality is atrial fibrillation or AFib.

So there’s different chambers of the heart, the atrium.

That atrium, it starts to kind of not have a regular rhythm, but it kind of what we call fibrillation.

Yeah.

Well, there’s AFlutter and then there’s AFibrillation.

That’s actually two different things.

Flutter is a formal term?

Atrial flutter, absolutely.

Well, all right.

So if you say, my heart was a flutter, that means you’re about to die.

Oh, look at that.

Isn’t it funny how we-

You’re a cheerful soul today, Neil.

You really are in a cheerful mood, aren’t you?

We romanticize the heart in so many ways, don’t we?

A broken heart.

A heart is a flutter.

But yeah, I’ll be the medical geek here and say that a flutter.

Can I tell you that atrial flutter, a flutter, your heart rate.

So what’s the normal heart rate?

Do you guys know?

Well, mine is 65.

Which is in normal range.

So normal range is from 60 to 100.

But can I tell you, patients with a flutter, their heart rate can go up to the 200s.

It is a absolute medical emergency.

They need to get…

I thought that was tachycardia.

So tachycardia, Chuck, great point.

Is anything above a heart rate above 100.

So tachycardia, you can have like a lower range, but you can have really, really fast.

But just to be clear, just to be a little more complete here, so the Greek word tachyous means speed or it’s swift.

And this we get tachometer from it and tachyons, hypothetical particles that exist traveling faster than light.

And now the medical folks, you’re all into the Greek and Latin words there.

So I presume it’s the same root for the word.

I died faster than light.

I beat you deaf faster than light this week.

You can’t kill me.

I’ll kill myself.

I won.

I outran death.

So give me that word again.

Tachycardia.

Tachycardia.

Tachycardia.

Got it.

Yeah.

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So Lipi, are there top five misunderstood things about the heart that run around the public?

I mean, I can say the top five things people misunderstand about space.

First, they think that you can hear explosions in space because every movie…

I can go down, I got my list.

So what’s your list of things that people think is true, but are not?

Yeah, I’ll put this under, say the top five, I mean, there’s so many I can share, but the top five human heart facts and or myths.

First of all, let me start off with that.

I’ll say that most heart attacks, I don’t think people know this, most heart attacks happen on a Monday morning.

So why is that?

It turns out that Mondays cause more stress than other days for most people and stress hormones are the highest in the morning.

And both of these combined increase blood pressure, increase heart rate and stress hormones.

They break off a piece of plaque, leads to blocking of the vessel and a heart attack.

Another-

Wait, Chuck, I need you to sing here.

Rainy days and Mondays always keep me.

Yeah, I just call out.

There is another pop song by an Irish band called the Boomtown Rats called I Don’t Like Mondays.

Yeah, Bob Geldof, right, Gary?

Thank you, Lipi.

Good knowledge.

Thank you.

I know what you’re saying.

Mic drop.

Thank you.

Another one of my favorite, like top five kind of human heart facts are missed.

Men and women have different heart attack symptoms.

People think, oh, women have that crushing chest pain.

That’s actually not true.

Women present somewhat differently, often more kind of benign, subtle things that get missed.

Some nausea, some difficulty breathing, sweats.

So I think that’s important for women to recognize that, but especially doctors, when they present in the emergency department, don’t just brush it off as heartburn or they have anxiety.

Do the proper testing, get a proper history.

And by the way, so we already talked about a broken heart.

Well, a broken heart can feel like a heart attack because they have the sudden intense feelings of sadness or grief, which can mimic a heart attack with symptoms with chest pain and a shortness of breath.

And why is that?

Because those stress hormones and the treatment for that, for a broken heart is just getting rest.

Another one of my favorite myths.

Well, I’m reminded, wait, wait, so Aristotle would famously, infamously declare that the source of our feelings are in our heart.

So he was partially right there in this case.

Yeah, partially, but it’s in the brain, but yes.

He’s right, but he’s not right.

It’s a part of your heart that’s in your brain.

Chuck said it right.

Oh, man.

Yeah.

Well, you’re going to like this myth.

Sneezing does not stop your heart or it doesn’t make your heart skip a beat.

The heart may temporarily change rhythm, but the heart only stops during a cardiac arrest.

And lastly, I want to share that laughing is good for the heart.

Blood vessels relax when you laugh, and that at least 20% more blood going through your body so your heart doesn’t have to work as hard.

So someone in the middle of a heart attack, we try to bring Chuck Loran and tell him jokes.

Well, no, that has surely killed him.

No.

Another really kind of cool heart fact, did you know that there’s 60,000 miles of blood vessels in your heart?

And if one of those blood vessels is damaged, your heart has to work even harder.

And just for reference, Neil is going to love this.

The circumference of the earth is about, say, almost 25,000 miles, but you’d have to take three trips around the earth to have equal the length of blood vessels.

I thought that was kind of cool.

Okay.

So I once tweeted that if you take all the veins, capillaries and arteries out of a person’s body and string them end to end, that the person would die.

That was my constant issue.

That’s just what we are.

So, Gary, you’re still thinking about COVID here.

What’s up?

If we think back, Dr., to that period that’s just recent, lots of different things entered into our mind space as to what could be happening, what was happening, what this could do and what that could do.

I mean, the causes and effects of things was very actively thought about.

Yes.

And there was very little, you know what?

These are the facts.

So was it an external thing?

Was it an internal thing?

Was COVID going to give us a heart attack?

Was the vaccine going to do some damage that we couldn’t tell because no one had been there yet?

What are the actual facts going forward as we know now that were real and not fantasy of some conspiracy?

So we’re trying to unpack the COVID virus, our physiological reaction to the COVID virus and the vaccine and our reaction to the vaccines, right?

Yeah.

Yeah.

So really great question, Gary.

So let me try to unpack this.

So let’s go back to early 2020, if not even late 2019, when we’re starting to learn about this SARS-CoV-2, this novel coronavirus.

What makes it novel?

Where does that word come from?

It means, honestly, Neil, the medical scientific community had never seen this particular virus before.

We’ve seen the first SARS coronavirus that caused SARS, but we’ve never seen this version.

That’s what novel means.

It’s new on the scene.

Exactly.

That’s exactly what that means.

Remember, we didn’t even call it COVID in the beginning.

We called it the coronavirus.

We learned slowly but surely, this is not your typical respiratory virus.

It was attacking all these different organ systems compared to, say, the common cold virus or influenza virus.

These viruses strictly cause respiratory symptoms.

And to your point, Gary, we soon discovered that SARS-CoV-2, it attacked the brain.

It causes neurologic symptoms, it causes GI symptoms, and it causes cardiovascular or heart symptoms.

People were getting myocarditis, cardiomyopathies, all these heart problems, clots, and we’re still trying to understand why.

But studies now are suggesting and indicating that SARS-CoV-2 and COVID-19, it’s not even so much an infection as it really is like an immunologic problem.

And to your point, Gary, unfortunately, back when Damar Hamlin, the NFL player, underwent a cardiac arrest, he’s thankfully alive.

But when I posted a video about his cardiac arrest and he was making the different explanations why it happened, so many people responded and thought incorrectly that the COVID vaccine on booster caused his cardiac arrest.

And let me just say, the studies are very clear that COVID-19 or the SARS-CoV-2 virus has been shown to cause cardiac problems, but not the vaccines.

Just as a reminder that vaccines, they are medications that are designed for all people.

And so they undergo perhaps the most rigorous testing more than any other medication.

Are there some side effects?

Yes, they’re usually minor, but cardiac arrest is really not one of them.

Wait, wait, you mentioned something.

I have to emphasize it because I haven’t heard it put so succinctly that if I’m developing a big pharma or any kind of pharma and I’m developing a medicine for a particular ailment, then I’m going to test it on people that have that ailment and maybe a few others just for control.

But I don’t have to test it on everyone because it’s only targeting an ailment that I’m trying to see if I can cure.

A vaccine, obviously, if we’re reaching for herd immunity, that goes into everyone, essentially everyone.

And so you would expect vaccine trials to involve manifold more people in the testing of it than any other kind of drug.

Is that a fair exposition of what you just said?

Yeah.

And I’m glad you emphasize it again.

In fact, I’m going to re-emphasize your emphasis of what I stated.

And I’m doing this, Neil, because as you all know, the anti-vaccine movement and vaccine skepticism has really skyrocketed.

It was already on the rise before COVID.

It has just skyrocketed, and this is a major public health problem because we’re seeing rises, epidemics a little in pockets of communities of measles, of polio.

And to your point, Neil, vaccines, think about it, childhood vaccines, vaccines that we all got as babies to prevent diphtheria, prevent not to treat, prevent getting tetanus, polio, diphtheria.

These were designed to make sure they were safe for babies so that we can then all grow up to be healthy adults.

And I think I’m all going to have had a smallpox vaccination.

And I’m Canadian, so I got smallpox in Canada, sorry, the vaccine, not the disease.

Wow, I’m now going to Canada now.

So doctor, uptailing on what you just said, do vaccines actually prevent because you just said some prevent, or do they actually lessen symptoms and keep you out of the hospital?

Yeah, that’s a great, great way of actually structuring this issue of vaccines and to address the confusion that the public has.

So historically, all these childhood vaccines, they were mostly designed to prevent you from getting the disease, diphtheria, tetanus, pertussis, polio.

The COVID vaccines, however, that were developed in the last couple of years, there’s confusion because it doesn’t necessarily prevent you from getting the disease.

The COVID vaccines were designed to do three things, and they do them very well.

One is to reduce the severity of the disease, reduce hospitalizations, and reduce deaths.

Unfortunately, it wasn’t a message necessarily that way in the beginning by the CDC.

Well, not at all.

We think we thought of it as another vaccine where then you’ll never get it again.

That’s why a lot of the pushback from the public was, well, I got the vaccine, I still got COVID.

It wasn’t designed to prevent you from getting COVID.

It was designed to really prevent you from getting severely sick and dying, getting hospitalized and dying.

So that’s the same as influenza too.

I mean, this is the deal with influenza that many people say, well, I don’t need it because it’s, and let me tell you, you get the flu once for real.

I got it once in my life for real and I’ve never not gotten vaccinated again.

Can I tell you, Chuck, I just interviewed rapper Ice T because he’s promoting the flu vaccine.

He wants to tell his story and so the flu vaccine, to your point, Chuck, will mean you’ll never get the flu?

No, but it significantly reduces your risk of getting the flu.

And as somebody who rotated through the Duke ICU, I remember seeing a 35-year-old man, otherwise completely healthy guy.

He was on what’s called an ECMO machine, which is like a more advanced ventilator.

And I asked the fellow, my ICU fellow, hey, what’s his deal?

And he said, oh, he has the flu.

This is a guy that nearly died from influenza.

People forget that.

Still 35,000 people a year, people.

Yes.

Still just influenza.

Vaccines work, people get the vaccine.

And don’t write, please.

If you don’t want to do it, that’s you.

That’s you.

Well, it’s science.

This is a science show.

What we’re saying is vetted information.

It is empirical.

It has been proved.

And so when we say it, we’re not telling you to do anything.

We’re giving you the information.

That’s all we’re doing.

So don’t write.

I don’t want to hear about it.

Does Chuck need an offer?

You guys are getting all political.

Look at you and Star Talk getting all political.

It’s not political.

It’s science.

You’re political.

You’re political.

Okay, it’s the facts.

Thank you.

I’m glad you vented.

Yes.

And moving into thickening of ventricle walls, doctor.

This is, if I’m wrong, correct me, please.

Isn’t this one of the side effects of getting something like COVID?

Now, if that’s the case, can you rehab out of that?

Unlike if you got sort of hypotropic cardiomyopathy, which it thickens and it stays there.

Yeah.

Does this, with COVID and it thickens, it can be rehabbed out or is it going to stay there?

I’m glad we’re talking about heart inflammation and not anger management.

Put that in the review mirror.

We’re out.

Yeah, Gary.

Thanks for clarifying.

So, heart inflammation, cardiomyopathy, can it be reversed through treatment?

The answer is actually yes.

First of all, heart inflammation is rare.

It occurs post-injury or after an infection.

Mild cases don’t even need treatment.

Treatment depends on the type of inflammation and the underlying cause.

The most common types are endocarditis, myocarditis, pericarditis, and the treatment would be antibiotics, steroids, antifungals, sometimes blood thinners.

But yeah, most…

Wow, antifungals.

Yeah, because the fungus can cause cardiomyopathies and heart inflammation.

So yeah, that’s the good news.

Now, see, I have something called left ventricular hypertrophy.

So that’s a thickening of the wall.

But my cardiologist said that…

I mean, he gave me some medication to soften my heartbeat, but he was like…

I said, so how do we unthicken the wall?

And he said, it’s a different kind of muscle.

It doesn’t work that way.

So what you’re describing, Chuck, is LVH.

We use that term very commonly, or left ventricular hypertrophy.

So that’s different from say like HCM or hypertrophic cardiomyopathy.

So that’s a different…

Often, there’s a genetic causes for that.

But what you’re describing, Chuck, is actually very common.

And that’s because one of the most common causes for LVH is actually hypertension or high blood pressure.

That’s what I have.

Yep, yep.

That’s exactly what did it.

Yep, exactly.

And valve disease, particularly the aortic valve and mitral valve disease.

When you get any kind of blockage or impairment of that valve, that left ventricle has to pump even harder, which is why that heart muscle gets bigger and bigger.

The good news is that these are treatable.

So this is the reversible type of LVH, right?

So treat the high blood pressure, treat the valve, reverse the valve disease.

You can actually treat and manage the LVH and reverse it.

I’m not gonna die after all.

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Of all the people who die of heart disease, what percentage of them does it come from a congenital condition that they just were sort of cheating time their entire life?

So for example, I’m old enough to remember the 1970s, where jogging and running became a craze, basically for the first time.

There were books on it.

There was a guy named Jim Fix, who was a big running enthusiast.

He was interviewed everywhere, and he wrote a book, a best-selling book, and he dropped dead of a heart attack.

And only then did we learn, sorry, he dropped dead of a heart attack in his 40s or 50s, that his father had heart disease, died very young, and maybe he cheated time at many years beyond his due date for even having died young.

So I’m just asking, what percentage of that is it?

And I didn’t realize that congenital heart disease is as common as it sounds like it is.

So look, the vast majority of people who die of heart disease really die of heart attacks and strokes from preventable causes.

So let’s be really clear about that, okay?

The vast majority, especially today, it’s lifestyle modification which can prevent that or significantly reduce your risk.

What you’re talking about, Neil, with the congenital heart disease, it’s actually pretty rare.

Are there, could there be more cases of that if we did our testing for it?

Sure, but the good news is that if you’re not getting diagnosed with it until much later in life, that’s actually the good kind of congenital heart disease to get.

Most of them are the babies that are getting it, and we now have in utero cases where you can, because remember, the cardiac development ends by week eight of gestation.

And we now have great fetal technology imaging, so we can detect in utero if a person, if at fetus, is going to have a congenital heart defect, most congenital heart defects.

So, that’s, it’s rare, many are treatable in utero, and once a baby is born.

So neonatal cardiology, there’s amazing cardiac surgery advancements in that regard.

When you said about, you know, these genetic mutations that predispose you to cardiac events, and you say, screen them, are you always looking for the same flags or do these things change and are tricky?

So there are several genes that are involved in various ways.

Some can increase your risk for arrhythmias.

Some can increase your risk for coronary artery disease.

Like I’d say in my dad’s case, without doing any testing, I almost promise you he had a strong family history and genetic history.

So there’s a lot of genes that are involved.

I think we’re finding more and more gene therapy is an exciting area, to be honest.

The field of cardiology has not really utilized gene therapy as much as the other fields like cardiology, but there are exciting advancements in that area.

Just to clarify, when you say gene therapy, I guess I don’t really know what that is.

Are you going in and nip tucking the gene sequence or are you learning about the gene defects and then you give support?

Yeah.

Great question.

Let me clarify that.

So gene therapy, again, there’s different ways.

Let’s use the example.

Cleveland Clinic infused the first gene therapy for hypertrophic cardiomyopathy and it’s based on this myosin binding protein C3 gene mutation, which is actually the most common genetic cause of HCM.

So, what they’re doing actually is kind of going in and replacing or repairing that gene.

Again, it depends on what the genetic mutation is.

Sometimes you just have to just rectify the mutation.

Other times there’s no protein at all, so you just have to replace the gene.

So it depends on the mutation.

So that’s all gene therapy that you describe.

Correct.

Interesting.

And if you make that change, will their offspring no longer be susceptible?

Do they pass the gene on to the gene or the edited gene?

Couple of ways to answer that.

So it depends on at what stage, if they’ve already had kids, then obviously they’re going to pass on that same defective gene, right?

If it was done before, early on, then at that point, if the gene is repaired, they’ll just pass on the healthy gene.

Oh man, well, we need to make gene therapy the order of the day for everything.

Everything.

Everything.

It’s damn expensive, Chuck, that we need a lot more research in it.

Again, the field of oncology is really on top of this and other areas.

Cardiology is surprisingly not as much, but that said, there’s so much research behind cardiology because it’s the leading cause of death.

So I think there’s going to be exciting stuff coming out.

So now, I’ve seen where there are doctors that say certain medications, they use the genes to, your genetic makeup to tailor certain medications to your disease.

Is that part of gene therapy or is that just a treatment option?

Yeah.

You guys are familiar with like, what is it?

Ancestry and what’s that?

The one, two, three, something 23andMe?

23andMe, yeah.

Let me just say that the true medical opinion where that’s concerned, first of all, really don’t go by those tests.

Those tests, I mean, don’t use that to make medical decision making.

Doctors, cyber specialists, we don’t really utilize that.

If you are, it depends on the patient, Chuck.

It depends on their history and what the actual clinical indication is.

We’ll do appropriate genetic testing, like say for colon cancer.

Chadwick Boseman died in his 40s, which is really young to die of colon cancer.

But if you have a strong family history, then yeah, or BRCA, if you have a strong family history of ovarian breast cancers, then yes, that will prompt us to test you for these genes.

So Angelina Jolie had the BRCA gene, is that correct?

That’s exactly right.

Which prompted her to exactly proactively get the prophylactically get the double mastectomy because she knew based on genetic testing that she was at very high risk.

Remember, her mother died of, she was either ovarian or breast cancer.

But I got to tell you, Chuck, genetic testing is very expensive, A and B.

It’s mostly still unavailable.

So that’s why we don’t, it’s not like for high blood pressure, get screened for high blood pressure.

That’s a very simple and cheap screening technique.

We just don’t have that really for most conditions.

But doctor, we’re dealing with the number one killer.

I mean if this number one killer were an individual, a person of interest, they’d be a manhunt manhunt and then son, right?

So are we talking about financing?

Are we talking about research dollars here?

Because we understand the need for it to go into oncology is most definitely there.

But surely if it’s number one, and it’s been number one for some time now, surely this has to be dollars well spent.

Yeah.

So let me tell you, I’m really glad you brought that up.

And this is where I might get a little angry and frustrated with the system.

Not with you though.

I’m going to need anger management right now.

Chuck is the anger management.

We’re going to do a whole show just on anger management, man.

Geez.

No, but my frustration lies in, to your point, Gary, yes, it still remains the leading cause of death in this country and globally.

But here’s the thing.

We know how to fix it.

We know how to prevent it.

We don’t need more research, Gary, in this particular area.

We know it’s just not happening.

And why?

I’ll focus on the United States because in this country, we don’t invest in prevention.

We don’t invest in what we already know.

We don’t help the communities that are marginalized, that are at most risk.

We are targeting those people, those communities.

We aren’t telling them, hey, if you just do X, Y, and Z, and this is how we’re going to help you do it, you’re going to live a longer and healthier life.

That’s where the focus needs to be.

Okay, so there needs to be a preventive care profit structure.

I disagree.

Go ahead, Neil.

Read on.

I think in the future, you should be able to, I should be able to take a pill or something so that I don’t have to change my habits and I still don’t get heart disease.

That’s the typical Western approach, right?

In this country, we want to pill for everything, right?

I want to eat all the cholesterol I want.

I want to sit on a couch.

I want to be overweight and still not die.

That’s the solution.

I made a bacon and lard sandwich the other day.

Then I went back and made another one.

And then a donut and ice cream for dessert, right?

Right, right.

On the couch.

Yeah.

Yeah, so there’s this idea of, just give me a pill, doc.

I don’t want to lose weight.

I don’t want to eat healthy.

Yeah, that’s a very Western mentality, right?

Yeah, and I’m from the West.

There’s something wrong with the West.

And guess what, Neil?

This is why we’re dying.

This is why heart disease is killing us.

Look, I just came back from Denmark and Poland at the end of the summer.

I was doing some speaking, some vacation.

And let me tell you, they have, especially in Denmark and in the Nordic nations, they have really healthy outcomes and they live healthier lives.

They are active, they live healthy, they also, not coincidentally, have universal healthcare.

So yeah.

All that’s good, but they also don’t have the most delicious food.

So come on, let’s just be honest.

You’re not going to find that same outcome in Italy, okay?

You can go to Poland and Denmark, but yeah.

Well, but…

I’m pretty sure they have Italian restaurants in Copenhagen, really pretty sure.

I actually dined at Noma, one of the best restaurants in the world, but…

That’s in Denmark.

Yeah, Chuck doesn’t know about that.

The number one ranked restaurant in the world right now is in Denmark.

Oh, they bought that ranking and yes, I do.

They bought that ranking and you know it.

Yeah, that’s the reason I went to Denmark because I got invited.

I was a pandemic hero, so I was invited by Noma.

I was very honored.

But can I tell you, Chuck, you’re right.

Greece, Italy, they are known for their cuisine, but they are also known for having a very active lifestyle and eating healthier ingredients.

There are pizza and pasta made with much more healthier ingredients.

So look, in the…

It’s not processed and you’re right, but now wait a bit.

You just sparked this in me.

One of the chief proponents of long life is community and friendship.

And what you find in those two communities that you just mentioned is tight relationships where people have lifelong companions and friends.

What’s that do to the heart?

Is that part of it?

Absolutely.

I’m so glad you mentioned that.

A common essay and motto in my field of, the opposite of addiction isn’t sobriety, it’s connection.

And what have we seen in the last six months or so?

US Surgeon General’s report, loneliness is the new epidemic.

Drug overdose has skyrocketed.

This is all connected because social connections have been disrupted.

These connections, human beings, the most introverted human being still needs, craves, some type of connection and human interaction.

All of this, believe it or not, is still heart healthy because indirectly, it’ll reduce your stress hormones, it’ll normalize your blood pressure, your heart rate, which remember are all risk factors for heart disease.

And let’s not omit the fact that if you have now a close friend, they’ll say, Dude, you’re not eating healthy.

Yeah.

These forks are operating back on you.

Or a friend that’s saying, Hey, Chuck, man, you’re getting a little too angry for me.

Right, so you need a friend to say that, right?

Yeah, yeah.

So Lipi, where can we find you?

Yeah, great.

People can reach me on like Twitter at LipiRoy, Instagram and TikTok.

Lipi, L-I-P-I, Roy.

Correct.

And then Instagram and TikTok at LipiRoyMD.

And I launched my new speaking company, SitaMed, that’s S-I-T-A-M-E-D, llc.com.

So reach out anytime.

So you getting out there then?

I’m trying.

And of course, my YouTube health show, Health, Humor and Harmony.

Yes, yes, we heard that.

And so we like the humor part, especially.

Trust me, I know.

Delight to have you back on Star Talk.

Thanks for your time and your expertise.

Thank you, Neil.

A pleasure being here.

All right, Chuck and Gary, always good to have you guys.

Always a pleasure.

Thank you, Neil.

Pleasure.

Thank you, doctor.

Thank you.

Neil deGrasse Tyson here.

Your personal astrophysicist as always.

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