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HOUSE CALL WITH DR. SANJAY GUPTA

Battling Heart Disease; Testing Blood for Potential Heart Attacks

Aired February 21, 2009 - 07:30   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: Good morning. Welcome to HOUSE CALL -- the show that helps you live longer and stronger.

You know, in the time it takes for you to watch this program today, 48 people will die from heart disease, on average. Our goal: Not to let you become a statistic.

Then, could a blood test tell you whether you're going to have a heart attack? Well, the head of American Heart Association is here. I'm going to ask him if we should all be tested.

And, diagnosed with prostate cancer in the public eye. My friend, consumer advocate Clark Howard talks with me about his diagnosis and his message for all the men out there.

You know, heart disease does kill more Americans than all forms of cancer combined. So, I've got some questions for you. Do you know your numbers -- your cholesterol, your blood pressure, for example? Well, you should. Do you know which tests can tell you if your heart is healthy or not, and which ones might be a waste of time and money? You might be surprised.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): Carrie Vincent is your typical busy mom. But 18 months ago, without warning, she had a heart attack at age 31, just days after giving birth to her son Griffin.

CARRIE VINCENT, HEART PATIENT: They told me that I had 90 percent blockage to my left side.

GUPTA: The story (ph) is that Carrie suffered from a clotting disorder. A simple blood test warned her of the condition but she never expected heart problems in her 30s.

VINCENT: When I'm 31 and had a heart attack.

GUPTA: Now, she's an advocate for women's heart health. She holds seminars to let women know the signs of heart disease and what tests they can take to prevent it.

VINCENT: Know your numbers and what they mean.

GUPTA: So, what numbers and tests are important? And for whom? According to the American Heart Association, everyone after the age of 20 should have their blood pressure checked along with their good and bad cholesterol levels. And don't forget testing for triglycerides, those are the fats in your blood that can lead to heart problems. If you're at high risk, meaning you're obese, a smoker, have diabetes, or a family history of heart disease, ask your doctor about a test that measures your LDL size, that's your bad cholesterol.

DR. SCOTT JEROME, UNIVERSITY OF MARYLAND MED. CTR.: Some people, if you look at them they have completely normal LDL numbers, but then you break down their LDL size, OK, we find they have small particles.

GUPTA: According to the National Cholesterol Education Program, the smaller the LDL particles, the more likely they will enter the vessel lining, increasing a patient's risk of heart blockages. Another test to consider, C-reactive protein, it's a marker for inflammation that can lead to heart problems.

JEROME: Well, we think it irritates the lining of the blood vessels, and when you irritate the ling of the blood vessels, you allow the cholesterol, the plaque, to get inside the blood vessel.

GUPTA: Cardiologists say this test is a must if you have heart disease in the family. If you don't, you can probably put this one off. And if you're interested in those new heart CT and MRI scans hospitals are touting ...

JEROME: They actually look at the blood vessels and see if you've got hardening of the arteries.

GUPTA: Be careful though. Although some scans can provide good information like coronary calcium scores, the American Heart Association warns, due to radiation levels, people of no risk should definitely think before having these tests. But if you have family history of heart disease, talk to your cardiologist to see if the scans might be right for you.

(END VIDEOTAPE)

GUPTA: You know, and despite multiple national campaigns, heart disease does remain the leading cause of death for minority groups in the United States. Experts say culture barriers could be a large part of the problem. So, some physicians are getting creative to reach those most at risk.

(BEGIN VIDEOTAPE)

ELIZABETH COHEN, CNN SR. MEDICAL CORRESPONDENT: He's known as the "Hip-hop Doc."

(MUSIC)

COHEN: And "Doc" isn't just a nickname.

(MUSIC) COHEN: Dr. Rani Whitfield is a practicing medical doctor who uses hip-hop music to educate young African-Americans about their risk of preventable conditions like heart disease and stroke.

Dr. Whitfield says traditional messages just weren't reaching minority communities and that's why he turned to music.

DR. RANI WHITFIELD, "THE HIP HOP DOC": You can't get away from hip-hop. Those messages do get to the young people and they deliver them to their parents. So, (INAUDIBLE), heart disease, stroke, the same stuff my doctor tells me in the office.

COHEN: According to the CDC, African-Americans have the highest rate of high blood pressure of all racial groups, putting them at risk for heart disease, stroke, and congestive heart failure. But these risks aren't limited to black Americans.

DR. CORNELIUS FLOWERS, CARDIOLOGIST: Asian Americans are likely to get hypertension and cholesterol problems when they come to other countries. Many (ph) American may have more diabetes but the Mexican American that comes across the border, one out of two have diabetes.

COHEN: Experts believe there are many reasons why so many minorities suffer from heart disease, high blood pressure and diabetes. Part of it may be genetics but cardiologist Cornelius Flowers says another reason is that physicians don't always communicate very well with their minority patients.

FLOWERS: You may have the best treatment in the world. You may have the best medication. You may have the best advice to your patients. But your patient is not getting the message, if they're not understanding what you're talking about, if they're not getting it through their head, then it's no good.

COHEN: That's why the "Hip-hop Doc" is taking matters into his own hands.

WHITFIELD: Whether we have to go to the barber shops, to the schools, you know, using hip-hop music, using country music, whatever it takes to address that particular community, we have to find ways to get the messages to them.

COHEN: Educating patients the best way he knows how.

(MUSIC)

COHEN: Elizabeth Cohen, CNN, Atlanta.

(END VIDEOTAPE)

GUPTA: All right, Elizabeth, thanks.

Here's a question we're asking on HOUSE CALL today: Should you be giving genetic testing to screen for heart disease? Our guest is answering your questions. And, Clark Howard's surprising announcement this week that he has prostate cancer. So, how does a leading consumer advocate find his own doctor? We'll ask him.

Stay with HOUSE CALL.

(COMMERCIAL BREAK)

GUPTA: We're back with HOUSE CALL. Let's take a look at this week's medical headlines.

A new CDC report on U.S. health statistics, paints a portrait of an increasingly less healthy class of young adults. Now, obesity rates have tripled among young adults in the past three decades. Get this: 1/4 of 18 to 29-year-olds are considered obese. A third of 18- 29-year-olds are also cigarette smokers -- that surprised me. Nearly 2/3 of young adults have no regular physical activity and 1/3 of people age 20 to 24 are uninsured.

Also this week, a report by the Infectious Diseases Society of America is raising concerns about new super bug infections in hospitals. Grand negative bacteria can become resistant to antibiotics and as a result, can become very difficult to treat. As things stand now, the exact number of these resistant grand negative bacteria infections and deaths are hard to pin down because they are not routinely reported to the CDC.

We've got HOUSE CALL back in 60 seconds.

(COMMERCIAL BREAK)

GUPTA: Those are some signs, of course, you don't want to ignore. Now, there's some good news to report. According to the American Heart Association, in the last decade, death rates for stroke and heart disease have dropped by about 30 percent. Researches say while our health habits have not improved, they believe science has.

And here to discuss what medical advances might work for you is the president of the American Heart Association, Dr. Timothy Gardner. He's also a cardiac surgeon.

Welcome back to HOUSE CALL, sir.

DR. TIMOTHY GARDNER, AMERICAN HEART ASSOCIATION: Thank you. Glad to be back with you.

GUPTA: Yes. Our viewers really enjoyed the last time you were here -- lots of good information. There are some interesting things going on. And one of the questions I want to ask you before we get to some of our e-mails is about this idea of genetic testing ...

GARDNER: Sure.

GUPTA: ... to try and figure out the right medications and the right doses of medications in particular, medication such as statins for cholesterol, medications like blood thinners. What do you think about that? Should we be going to a more individualized medicine approach?

GARDNER: Well, I think we're definitely going to get to an era of personalized medicine when we're going to be able to take advantage of the tremendous explosion in genetic analysis, that human genome project, which allows us all to be characterized gene by gene.

But it's a little early. We're just beginning to get the information sorted out. There are some hints, for example, that certain people respond differently to different drugs. That's important new information. But in terms of genetic testing for heart disease, we think that's a little early.

GUPTA: There's a "one size fits all" approach that, I think, a lot of doctors take. They prescribe a certain dosage of medication for a lot of patients. But if a patient feels that the medication is not working for them, if the statins aren't working or aspirins do not thin their blood enough, what do they do? What should they do?

GARDNER: Well, with their doctor, they can sort that out. And we are getting hints. We've learned, for example, that warfarin, the most commonly used anticoagulant, has different affects or different levels of affects with different patients. And we might be able to use genomics to sort that out.

GUPTA: Let's get to some email questions here. We have one from Linda in California who writes this, "My 53-year-old sister-in-law just had a heart attack. She has a family history of high cholesterol. Does changing her diet and exercise really matter when it comes to genetics?"

I don't think she's trying to sound hopeless here, but how much of this is preordained?

GARDNER: Well, a family history is a risk factor. There's no question about it. But a family -- even a bad family history is not a death sentence. It's a warning sign, a wake-up sign. And for someone that has a family history, they need to be much more vigilant about how they take care of themselves and avoid those known risk factors that contribute to premature heart disease.

GUPTA: If you have -- if you've had a lot of first degree relatives who've had heart disease, exercise, good eating, is it enough, do you think -- or as a cardiac surgeon, are you thinking in the back of your mind, look, this person, they're really going to have trouble, we've got to start acting early?

GARDNER: Well, they need to know their numbers, as you said in the beginning of the show. That's very important. People -- especially people with a family history need to have their cholesterol check, they need to make sure their blood pressure remains in a normal range. They have to be physically active.

The other number they need to know is their weight and waist size. And those are -- all those things give you a heads up when you're in a high-risk subgroup.

GUPTA: Right. Let's get to another question. I thought this was an important question.

It came from Joe in New Jersey. Dr. Gardner, the question is this. "Is there any solid proof that statins actually reduce heart attacks and save lives? I know they reduce cholesterol but how about the bottom line -- deaths?" Dr. Gardner?

GARDNER: Yes, the data on statins being effective in reducing cardiac events, heart attacks and other serious cardiovascular events is clear and compelling. Statins work. And that doesn't mean everybody needs to take a statin.

And the first line if you have an elevated cholesterol is diet and exercise. But if you're one of those people whose cholesterol will not come down with lifestyle modifications, you should take a statin with your doctor's direction and you can be assured that you are getting some protection against cardiac events such as a heart attack.

GUPTA: Dr. Gardner, this is a month that we all talk about heart disease and hearts in general. So, I really appreciate having you back on HOUSE CALL. Thanks so much.

GARDNER: My pleasure.

GUPTA: All right, sir.

Now, women, if you're having your cup of coffee this morning, you need to listen to this. According to a new study, women who drank two to three cups of coffee a day lowered their stroke risk by 19 percent as compared to women who drank less than a cup a month. A pretty good news there. The study looked at the ingredients in coffee other than caffeine and found they may be responsible for the reduced risk.

We should also point out two things. First of all, this was a group of nonsmokers. And second of all, too much caffeine still has its own risk. Too much can caused jitteriness, rapid heartbeat, and also, boost your blood pressure. Bottom line -- two to three cups a day, generally considered safe.

A new look at what's making America fat and a finger being pointed at home cooks. One study looked at portion size and calorie counts, and their respective cookbook "The Joy of Cooking." I own one myself.

Researchers looked at 18 recipes that were in the first printing in 1936 and are still in the book today. Now, in 1936, the serving had an average of 196 calories. Today, there's 273.

Some of the rise, of course, is blamed on a change of ingredients. But a change in portion size is also major factor in fattening up the bottom line, if you will.

Up next: CNN's Clark Howard diagnosed with prostate cancer. Learn what he says he did about it. He's one of the nation's leading consumer advocates. And learn why this might save his life. His story -- after the break. (COMMERCIAL BREAK)

GUPTA: You know, one in six men will get prostate cancer some point in their lifetime. It can be is a scary, sometimes confusing diagnosis. And one of our own just received that diagnosis. HLN's consumer advocate and radio talk show host, Clark Howard. He joins us now.

Thanks for joining us.

CLARK HOWARD, HLN CONSUMER ADVOCATE: Thanks for having me.

GUPTA: A lot of people have heard this news.

HOWARD: Yes.

GUPTA: First of all, how are you doing? How is everything going?

HOWARD: Symptom-less, feel great, doing my workout every day. And this is one of those things that I never would have even known if it weren't for a routine PSA. I didn't even know what a PSA was when I had one, by the way.

GUPTA: So, your doctor was recommending you get this PSA, prostate specific antigen checked every year or something? What happened?

HOWARD: Well, no. I was in for a physical and the doctor did the blood work stuff. And one of the things that he did without me even knowing was this PSA and he called up later and he said, "You have a bad PSA." And I said, "Well, what is that? Is that catching?" Because I didn't know what that was.

And he said, "Well, it's related to prostate cancer." I said, "Cancer, what are you talking about?" He said, "Well, you have a number. It doesn't mean necessarily that you have cancer but we should check it out."

And so, he referred me to a urologist. And I went in there, had a PSA from the urologist and my number was yet a little higher than it had been with my primary care doctor. And then I had my first of four biopsies that I've had over the last two years. And the first one showed an area of suspicion. And then as I went through the biopsies, finally, the fourth one did show just recently that I had a tiny amount of cancer in one of the samples.

GUPTA: Yes. Everyone knows you as a consumer advocate. You're always giving great tip, I should add. I listen to you all the time.

HOWARD: Well, thank you.

GUPTA: About how to go about living your life and buying things and all that sort of stuff. When it comes to you yourself, finding a doctor, taking care of your own health now, at issue.

HOWARD: Right.

GUPTA: How do you do that? What did do you?

HOWARD: Well, first thing is cheap guide. Although I've been all these cracks that I'm going to go look for the cheapest way to get this taken care of, that's not what I'm doing. I have been methodically going through information that on the Web, as you know, you have crazy stuff. You have facts, and then you have research and all the rest. And I've been drilling down reading, reading, reading.

And at first, it's completely overwhelming, and all the claims, because everybody claims that this treatment or that treatment or the other, you just change your diet, the cancer's going to go away and all that.

GUPTA: Right.

HOWARD: And so, as I've gone through that process and talked to people in the field, I've tried to narrow -- what is the right thing for me to do. And that's what people should do, because there's an initial emotional reaction. You know, cancer's such a loaded word.

GUPTA: Sure.

HOWARD: And, the reality with cancer is that, although you go back two generations ago, cancer equals death. Today, in most cases, cancer equals disease management -- a whole different ball game. And so, you have to manage it. You can't rely on medicine or doctors or facilities to manage it. You have to manage it.

GUPTA: Have you decided what you're -- I mean, I'm sure there's lots of different pieces of advice you're getting.

HOWARD: Right.

GUPTA: Have you decided what you're going to do?

HOWARD: Not yet. And I'm getting closer to what I'm going to do. But because I have the luxury of through routine screening, finding cancer so early, it's not like -- if I don't make a decision tomorrow, I'm going deep six.

GUPTA: Right.

HOWARD: I have the ability to continue, to research and inquire and then with -- not ignoring it -- but with deliberate speed make a good decision.

GUPTA: Well, we've all been thinking about you. We got your news. And we all thought about you and we wish you the best of luck.

HOWARD: Well, thank you very much.

GUPTA: Thanks so much for being on HOUSE CALL.

HOWARD: Thanks. GUPTA: Appreciate it, Clark Howard.

Now, a couple's facing infertility can sometimes be devastated us. So, how do you find the right doctor to treat that special little miracle? We have that answer -- next.

Stay with HOUSE CALL.

(COMMERCIAL BREAK)

GUPTA: We're back with HOUSE CALL. You know, many have questions about the lady some call the "octo-mom." But there are just as many questions about her fertility doctor. How could they implant six embryos? Something experts say never should be done. They just want to know, could this happen to me?

So, of course, we got Elizabeth Cohen joining us for some tips on how to avoid what some are calling a "fertility fiasco."

COHEN: Right. Because the point when you're infertile is to find a doctor who'll help you get pregnant, not who will help you have puppies.

(LAUGHTER)

COHEN: So, that's why some call it a fiasco. The eight kids is risky, it's risky for the mom and it's risky for the babies. So, in this week's "Empowered Patient," we have some tips to find a fertility doctor who will help you get pregnant without having too many babies.

Our first tip is to go to the CDC Web site. A lot of people don't realize that on the CDC Web site, they have all sorts of great statistics about success rates for every fertility clinic in the country, and a lot of people don't realize that. So, that is the first thing, is you've got to go to the CDC Web site.

GUPTA: I mean, there's a wide variety of doctors out there. How do you find someone who's the good one or who's the right one?

COHEN: Well, one of the things you do is go to the CDC. The other thing that can you do is you can ask around. And so, of course, you can ask your friends.

But maybe you don't have friends that have had fertility issues. In that case, there are several places on the Internet that have great discussion boards -- moms who trade tales of who helped them and who didn't help them. For example, Resolves.org has a lot of good discussion boards. And there's another site called FertileThoughts.org. And both of those places have some really good discussion boards.

GUPTA: All right, Elizabeth, thank you so much ...

COHEN: Thanks.

GUPTA: ... for keeping on top of that. Be sure to read the rest of Elizabeth's tips as well on fertility by visiting her Web site: CNN.com/empoweredpatient.

Here's a question. You wonder what that thing is that hangs in the back of your throat. Well, young yet inquiring mind of ours wanted to know. Get the answer after the break.

(COMMERCIAL BREAK)

GUPTA: And it's time for our segment "Ask the Doctor." Let's get right to it.

Here's a question from some parents in Atlanta, Mark and Gina write this: "My four-year-old so, Dodge, has a question. What is a uvula and why do I have one in my mouth?"

Well, hey, Dodge, first of all, it's a very smart question for a four-year-old. Thanks for bringing our demographic age down. The uvula is a little piece of flesh that hangs down at the back of your throat. That's my medical explanation.

Maybe you've noticed that when you're brushing your teeth, it actually looks like the letter "U" or maybe like a grape. Now, the uvula has a couple of important roles. It helps for sounds and speech. It also helps food from going down the wrong way and it's also been blamed for snoring.

Here's something for you, Dodge. Remember this word, uvulo- palato-pharyngeal-plasty. That's when they reshape the uvula so you don't snore as much. Dodge, take my advice. Take a peek in the mirror. Have another look at your uvula now that you've got some answers, and always stay curious.

Another question, Nicole from Florida asking this, "I have a six- month-old daughter. Recent reports suggest children under two years old should not watch television. It delays their speech development and it may contribute to ADD. Is this true?"

Well, the American Academy of Pediatrics does recommend no television before the age of two. As a parent of young children, I can tell you it's hard to do the full disclosure. Research does show kids under 30 months don't gain any benefit from watching television and there have been many studies showing attention problems as early as age three.

Now, this can also have a negative impact on the child's ability to focus later on in life. Other studies have linked tube time to problems with vocabulary development as well. But until we have more definitive answers, parents should err on the side of caution and stick of what we know is good for infant and childhood brain development such as reading to them.

If you're concerned about media exposure, the key is not to make it a regular habit. We hope everyone there is listening to that.

And that's, unfortunately, all the time we have for today. If you miss any part of today's show, go ahead and check out my podcast, CNN.com/podcasting.

Remember, this is the place for the answers to all of your medical questions. I'm Dr. Sanjay Gupta. Thanks for watching.

More news on CNN starts right now.

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