Hello everyone. This is Mc glory with the
Becker health care podcast. Thank you so much
for tuning in. This episode explores the link
between cardiovascular
Health and Alzheimer's disease.
We hear from doctor Michael T, a heart
attack prevention expert, the founder of Apollo cardiology
and a board certified cardiologist.
A decorated veteran, doctor T served as medical
Corp physician in the navy and was appointed
department head of internal medicine.
Following his military career, he continued his path
in cardiovascular
medicine, which led him back to his hometown
of Saint. Louis.
Doctor Trim now serves in the role of
cardiovascular
director for the Institute of muscle centric Medicine,
and as a faculty member for the quantum
biology Collective.
This episode conversation is moderated by Mis misha
Dug, the Ceo, c founder and Director of
Cardio Diagnostics.
At Ai driven
precision cardiovascular
medicine based company
based in Chicago.
Hello, everyone, and welcome to Becker cardiology podcast.
I'm Doug, your host for today. I am
the Ceo and cofounder of Cardio diagnostics, cardiology
a precision cardiovascular
medicine company.
I am excited for today's conversation, which I
think is also very timely
on the heart brain axis, the link between
cardiovascular
health and alzheimer's disease with doctor Michael T.
A heart attack prevention expert, the founder of
Apollo cardiology
and a board certified cardiologist.
Our conversation today will explore the fascinating
and complex
connection between cardiovascular
health. And Alzheimer's disease, which is the most
common form of dementia. Doctor T. Thank you
for being here. Thank you for the opportunity.
Wonderful.
I'd love to start off with,
the data and scientific evidence.
So it's no secret that cardiovascular
disease remains the leading cause of death in
the Us and around the world.
But recently, we've started seeing increasing evidence, linking,
cardiovascular
health, cardiovascular
disease risk factors to alzheimer's disease. So for
instance, that was a study from over 430000
individuals from the Uk Bio bank that was
published.
In the Journal of American Heart Association, and
they found that,
for those who had coronary heart disease before
the age of 45
they had a 13 percent increase risk of
developing Alzheimer's disease compared to those who did
not have coronary heart disease. Could you kick
off
and and help elaborate on the scientific evidence
that is increasingly showing the significant link.
So as you noted, you know, vascular disease
is still the number 1 thing that kills
people. You know, every 40 seconds in the
United States, somebody has a heart attack.
And metabolic syndrome is 1 of the number
1 things that damages the lining of the
arteries that leads to this process.
And so the things that help reduce the
risk of heart attack are very much the
same things I've reduced the risk of cancer
in alzheimer's. So when I work with patients,
you know, I'm definitely trying to reduce our
risk grabbing having a heart attack or stroke,
but many people, once actually understand it, you
know, the game is Health band, not just
longevity, and that health band needs to include
brain function. And many patients are definitely concerned
about the risk of alzheimer's. And sometimes there's
some genetic pre position, You know, if somebody
has an For allele does increase a risk.
My tom, it's not like where it's like
Huntington's where, like, you have 1 gene, you're
absolutely going to get the disease Just put
you into that high risk category.
So vascular disease, micro disease in the brain
is 1 of the contributors to alzheimer's disease,
but also,
talk about it is sort of like, diabetes
type 3. You know, if you're insulin resistant
in your skeletal muscle, there's more risk that
you're be insulin resistant in your brain. And
so that's how I kind of coach with
the patients is that there's a concern change
in hair for mom and dad, and this
it can be your environment that determines if
those genes are turned on or not. But
you have to look at it your healthy
metabolically, so you're not in insulin resistant and
that you have your cardio
metabolic risk factors under control, your lipoprotein controlled.
Your hypertension control. You're much less at risk
in developing alzheimer's then.
I have found this
interconnectedness
between cardiovascular
disease and alzheimer's disease to be absolutely fascinating.
And lately, I would say in my conversations
with health care providers and leaders,
I find that there is a greater sense
urgency when they're thinking about the prevention and
management of cardiovascular
disease.
Because it is a way to help reduce
the risk of alzheimer's.
I'm curious if it's something your patience often
ask you about this connection or is it
generally a topic that
you tend to bring up during
consultations?
It tends to be more
my... Bringing it up when I'm going through
an advanced, you know, lipoprotein analysis with them.
You know, I will also have it in
their intake account. They have a family history
of Alzheimer's or other
neuro cognitive disorders, I will then link it
into the, like, you. They're coming to me
because they got quote, high cholesterol, and we're
like, well, yeah have high cholesterol, but it's
because you have an 4 allele affecting all
receptor, but I know you have the same
history of alzheimer's. We're gonna fix both problems
and try to lower the risk for both
issues.
You know, I couldn't agree more about sort
of the complex nature taking into various aspects
into account when when
educating and talking to to patients.
Speaking of
prevention specifically,
what are some ways
you are encouraging your patients to stay heart
healthy and prevent alzheimer's disease. And if we're
thinking of your patients, who maybe already have
some form of cardiovascular
disease like coronary heart disease, what steps are
you specifically
recommending, they take take to better prevent alzheimer's.
So I talk with patients about how disease
actually develops.
It's, it's much more complicated than having quote
high cholesterol.
So it really starts as un called endothelial
dysfunction. It's when the inner inter lining of
your arteries,
aren't able to release sufficient levels of nitric
oxide to dilate the arteries. That'll show up
as high blood pressure assure stiff arteries on
pulse wave analysis testing,
and this can happen in 20 years before
you develop significant plaque in the arteries.
So while atherosclerosis is common,
and it typically presents in mid to late
life, it's actually starting in your teens and
twenties.
So healthy lifestyle interventions in your teens and
twenties really reduces the risk that you go
to having basket disease. But while we have
great treatments for vascular
disease, we don't have that many great options
for patients once to develop alzheimer's. So it's
all about prevention. And most of it it's
going to be life lifestyle induced. You know,
it's how you move the body.
Exercise probably the number 1 drug to reduce
the risk of alzheimer's. You know, nutrition. Now,
probably a meta mediterranean templates is probably a
good starting point for most people.
Stress management.
If you don't manage your stress wall, you're
gonna age faster,
and then the big health in the room
for many people, is their sleep quality. It's
those 4 pillars, nutrition, exercise, stressed, but sleep
is the biggest 1. If they don't sleep
well, we're gonna age much faster because when
you sleep, the mitochondria are gonna be repairing
themselves. You know, I tell patients think about
mitochondria engines,
If you don't tune up your engines, it
doesn't matter how much healthy gas you're putting
in it throughout the day, you have to
get the engines right. And there's definitely studies
that if you short sleeping yourself, you know,
giving 4 or 5 hours an Night of
sleep, your risk of dementia it goes up
relatively significantly.
I'm curious based on that conversation with your
patience, how how receptive are they and and
how much
do you think
they're accepting or their their willingness if you
will to to incorporate those life's style changes,
And I'm assuming it's probably also more gradual.
Right?
It is all gradual. You know, and I
think I might be a little bit of
a
a biased population that, like, many of my
newer patients, they're coming in
already seeing me talk on different podcast about
these topics. And like, okay, I'm interested in
this type of, you know, testing to look
at my vascular age now or, you know,
I went to look at my genetic risk.
I wanna look at my advanced lipoprotein through
a different lens than just stands for quote,
high cholesterol. So I think Patients already coming
in with these ideas, but they may or
don't understand which lever that they're really kind
of deficient on until we really start diving
into, you know, kind of the discussion.
I I think you'd make a very good
point about the levers, and and I think
when we're talking about levers. Start it's very
hard to to get away from talking about
the different tasks or technologies, or different ways
to to get the necessary data and insights.
About the specific patients, so we can know
what levers to pull.
So along those lines, you know, we've seen
advancements in medical technology, we've seen that respect
to cardiovascular
disease. We've seen that with respect to Alzheimer's
disease,
although probably more so on the cardiovascular
side than the Alzheimer's side with I'm curious
what's your take on,
the role of new technologies
and biomarkers
in being able to better understand... Stand and
address the interconnectedness
between cardiovascular
disease and alzheimer's.
You know, that's a great point. I mean,
I'm trying to stay at tip the spear
in finding the best technologies to how my
patients reduce the risk of having heart attacks
and strokes.
And I know, you know, your company is
very much at the forefront of using Ai
technologies to help with this. I mean, that's
sometimes a challenge of medicine that there's just
this overwhelming, you know, data dump that we're
trying to, you know, find they need dom
haystack
Ai is just helping us trying to kind
of c that data And I'd be like,
oh, we need to focus here.
In my own practice, you know, we've been
using Ai,
with the clearly analysis for the past 3
years to look at patients, total plaque volumes
in their coronary arteries.
You know, the more plaque you have in
your arteries the more cardiovascular are likely to
have. So it's been a game changer because
patients are gonna test normal on traditional testing,
even including Ct coronary calcium scans, the My
own scan included it. My calcium score is
0.
My Ct read by a human radio is
completely normal, but send images to the clearly
analysis and I have some small amount of
salt plaque in the arteries. And I'm aggressively
managing that rest. So I think Ai is
gonna be a real kind of game changer
at helping people focus in on what it
really is going on with their vascular systems.
And I really really like, you can get
the vascular system right, you're really gonna lower
the risk
or these neuro cognitive disorders because you're able
to get an oxygen nutrients into the brain
tissue and get the waste products out.
I'm curious to learn
when you talk to your peers when you
talk to your colleagues,
we're also...
Providing care for
maybe more elderly patients just because, again, we
see largely alzheimer's being present in those 65
or older into their seventies.
What kinds of,
areas are they focusing on,
does it also tend to be heavy on
the technology side? Of things? Are they using
more traditional biomarkers
coupled to more newer
advanced technologies.
I'm curious what you're hearing from your peers?
So I don't know too much what technology
they're looking at for just looking for Alzheimer's
risk, but, you know, hypertension is going to
be 1 of the biggest. Things. And that's
where you do have to be a little
bit careful as patients are over age 65
is that you don't become overly aggressive at
Lowering the blood pressure and introducing falls because
if you break your hip, know, the mortality
is nearly 50 percent at a year. So,
you know, looking at hypertension is something that
every primary care doctor can do very well.
And generally, you do want to keep people
near 01:20 80 as long as are not
dizzy or light headed with those 7 activities.
But goes back to the sleep. Now, as
you age, people tend not to sleep as
well. And so just really I see is
there, you, sleep disordered breathing, Do they have
apnea? It did treat it, you know, do
they rest legs because they bow and iron,
treat their iron deficiency. So just trying to
help people get their sleep probably dialed in
as best they can because
It really starts with, you know, healthy mitochondria,
and it's light water magnet. So the light
circadian rhythms, it's your sunlight exposure,
You know, they... You, the way that mitochondria
repair is when you sleep. So, yeah, while
alzheimer's isn't that completely, a mitochondria disorder, there's
a large component to it because without energy,
cells don't work well. So you have to
tune up the mitochondria.
If I'm a patient listening
to this
conversation and I'm interested... Stood in bro,
the the conversation around Alzheimer's disease and maybe
my risk for it and how that relates
to my risk for cardiovascular
disease.
What are some questions do you think they
could ask there are... Primary care provider, they're
cardiologist,
or just a provider, the family medicine provider,
who they're seeing. What are some questions you
would recommend they ask
So start first with just a good family
history. Now does... Do your grandparents or great
grandparents that anybody have any levels of dementia.
They may not have been called alzheimer's.
Nope. Then,
genetically, the most common 1 is this gonna
be Ap ear as an echo. If you
have an Ap 4 Allele,
Now, you increase your risk. If you have
2 copies at Ap before Allele, it's, nearly
11 to 12 increase risk of developing alzheimer's.
Again, it's not deter. If you have an
Ap 4 allele. I don't want people to
be too concerned that that means you automatically
gonna get alzheimer's. It's just a risk factor
for it. But the people would tend to
go on to having
alzheimer's are likely to be in some resistant.
So you don't wanna wait until human hemoglobin
A1c is 5.7
you're called pre diabetic. That's been smoking for
count many years before that process happened.
So you should ask for a fasting insulin
level.
Your insulin bubbles generally should be less than
8. If you're having high insulin bubbles, then
it means there's insulin resistance generally at the
skeletal muscle level. And know, if you can
get into a resistance training routine, getting adequate
factor protein to maintain your muscle mass, you
can potentially reverse that instant resistance before wears
on. You to start damaging your cardiovascular system
or damaging
the brain
neurons.
So, you know, all those metabolic markers for
glucose know, so a1c glucose insulin. Mh.
Blood pressure.
Again, ideally, 01:20 over 80, you know,
you be careful if somebody has a history
of Sync to be or passing out, it
maybe have a little bit, you know, kind
of higher goals for those people.
And then looking at their lipoprotein. You know,
if you're gonna simplify it, look at
lipoprotein b ap b for short,
Generally, Ap b should be less than 70,
really decrease the risk of as disease when
your Ap april b is less than 70.
You make a very good point about not
waiting. Right? That's that's really what the the
premise they're on prevention is. It's it's don't
wait.
So thinking about that, you know, we talked
about the patient side,
and to flip it around,
I'm curious what
recommendations do you have have for,
your peers and other healthcare care providers,
who would like to take a more holistic
look at both cardiovascular disease and Alzheimer's disease
have what
recommendations would you help have for them so
they could better help their patients, manage both
conditions.
So back to the kind of 4 pillars,
you know,
it's not all about pills and procedures. It's
really hammering in on these lifestyle interventions.
So
nutrition. I mostly talked about it in terms
of, you know, timing of meals is important.
You know, the the meal timing is can
tell your mitochondria is it daytime or nighttime.
So most people ideally should eat during daylight
hours.
You should get adequate dietary protein,
generally, at least 1 gram. So of protein
for pound of body weight would be ideal.
So that you have the skeletal muscle mass
to help maintain your metabolism,
eating high levels of omega 3 fatty acid
foods, You know, think of Dha is like
the cell phone charge for your brain, the
higher levels of Dha,
better that neurons can communicate amongst themselves.
So again, mostly kind of a mediterranean type
of template for most people probably is a
good starting point. The then
exercise,
combination of resistance training and, you know, cardio
respiratory
fitness, training. So
lift weights or body weight exercises at least
2 times a week.
And then ideally, at least a hundred and
50 minutes, of moderate aerobic activity. So
biking running treadmill growing, whatever of activity can
routinely do. And generally, in they zone 2
have a pattern, probably at least 80 percent
of the time, So that's a kind of
a lower and slower type of activity so
that your maximum fat burning capacity.
So that's the nutrition exercise kind of
levers.
The stress management 1, you know, I'm wearing
an uber ring. You know, there's other devices
that can measure your heart rate durability, which
is just the instantaneous amount of stress your
body is sensing.
So
people are under this fight flight response all
the time. You have to teach them meditation
or yoga, deep breathing exercise. Or mindfulness or
whatever they can do to dial back their
autonomic nervous system. The patient's stress is not
bad for you, which just this how well
do you respond to it and get back
down to a baseline where your levels are
back to normal.
And the fourth lever is asleep, you know,
as you've maybe in person, young always wearing
these kind of bow hacker blue bak glasses,
just so that my circadian rhythms are always
gonna be in trained appropriately.
Know, your light really does control, you know,
your metabolism,
your hormones, your neurotransmitters. So I tried to
recreate, you natural wavelengths of life as much
as possible.
So spending time as I either, or I'm
in front of technology where I can't necessarily
control the light,
protecting my eyes with a pair of boot
blocking glasses so that the non receptors don't
get ping with this high intensity boot light
all day long. Because I wanna ensure that
I can sleep as well as possible,
So I shoot to get at least you
know, 7 and half, 8 hours of sleep
every single night. And so figuring out 1
of those 4 levers, So and trying to
pull on them all at the same time
as best you can.
That's amazing. Well,
I I truly wish we had more time.
Time you, to keep going. But doctor T,
and thank you so much for your time
today. Thank you for sharing you valuable insights
with this today.
This has been a truly informative
conversations. And, in fact, I have a few
more things to to add and change to
my lifestyle.
To to keep the prevention aspect going. So
thank you so much for being here. You're
very welcome. Thank you.
Thank you so much, Doctor. Toy and For
your... Time and insights today. We also wanna
thank our podcast sponsor for this episode, Cardio
diagnostics.
You can tune into more podcast podcasts from
Becker Healthcare care by visiting our podcast page
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dot com.
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