13+ Things Cardiologists Won’t Tell You

The surprising things your heart doctor really thinks about your weight, your red wine habit, and more.

By Lauren Gelman
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    Overweight? I may not discuss it.

    When people are massively overweight, it’s an obvious issue. When they’re only moderately overweight, it’s more difficult [to bring it up], because we accept people being a little overweight. It’s harder to tell someone like that they have weight to lose.
    —Stuart Connolly, MD, director, division of cardiology at McMaster University in Hamilton, Ontario

    Sugar is the real villain in heart disease, not fat

    When you eat refined sugar, you create an insulin response that is toxic to blood vessel linings. Most attention seems to be on cholesterol; I don’t know that doctors are checking insulin and A1C levels [measures of diabetes risk, which is closely linked to heart health].
    —Stephen Sinatra, MD, cardiologist and author of numerous books about heart health, including The Great Cholesterol Myth

    Most supplements do nothing for your heart health

    Doctors who strongly recommend certain supplements are often the ones selling them in their office. For primary prevention, if you’re not eating fish two to three times a week, then fish oil is probably a good idea. I also recommend vitamin D because 80 percent of U.S. adults are deficient. Those are the only two I take.
    —Sarah Samaan, MD, cardiologist at The Legacy Heart Center in Plano, Texas and author of Best Practices for a Healthy Heart

    If you or your spouse isn’t sleeping well, I want to know

    Sleep apnea is a major cause of cardiac events such as heart attack, cardiac arrest, and stroke.  If you suspect you have sleep apnea (snoring and feeling exhausted when you wake up are big clues), you should tell your doctor about it. And if your spouse is always nagging you for snoring, that’s an important sign too.
    —Stephen Sinatra, MD, cardiologist and author of numerous books about heart health, including The Great Cholesterol Myth

    Had a dramatic pregnancy? Tell me

    Preeclampsia is a hidden risk factor for early heart disease. It tells me that there’s an underlying problem with the blood vessels. Young women should recognize it’s important for their doctor to know if they develop it. And most doctors won’t ask a 50-year-old woman about her pregnancy health from 25 years ago.  The same goes for rheumatoid arthritis and lupus. Heart attacks are the number one cause of death in these patients, and they need aggressive management of risk factors.
    —Malissa J. Wood, MD, American Heart Association’s Go Red for Women spokesperson and co-director of the Women’s Heart Program at Massachusetts General Hospital

    Red wine isn’t a cure-all

    My patients tell me, “I started drinking red wine” and I say “what for?” They think its good for the heart, but you have to be careful not to overdo it and raise your risk of other health issues. Same goes for dark chocolate. People think that you can eat as much as you want. It is good for you—it lowers blood pressure and has antioxidants—but most people are not eating just that one ounce a day.
    —Stephen Sinatra, MD, cardiologist and author of numerous books about heart health, including The Great Cholesterol Myth

    What makes me mad? Smoking

    If someone’s a smoker, they gotta stop. I feel sick when I talk to people who still smoke. It’s never too late to stop. Even quitting in your seventies improves survival. If patients want to do one thing for their health, it would be to stop smoking.
    —Stuart Connolly, MD, director, division of cardiology at McMaster University in Hamilton, Ontario

    It’s easier for me to prescribe you a drug than to address lifestyle factors

    Emotional toxicity is a major cause of heart disease. Depression, heartbreak, and uncontrolled anger are major risk factors. A good cardiologist can see that a patient is suffering from these issues. Many doctors believe in drugs but less in healing the whole person.
    —Stephen Sinatra, MD, cardiologist and author of numerous books about heart health, including The Great Cholesterol Myth

    I can help you save money on meds

    There’s been a huge rollout of generics over the last few years, and this is key for anyone who wants to lower their drug costs. To name a few: Lipitor, Zocor, and Pravachol for cholesterol, and Diovan, and Cozaar for blood pressure. Ask me about them.
    —Sarah Samaan, MD, cardiologist at The Legacy Heart Center in Plano, Texas and author of Best Practices for a Healthy Heart

    I should examine your teeth

    If you have lots of inflammation in your mouth, it’s a sign your whole body is experiencing an inflammatory response. Patients with gum disease have much more heart disease. I always check my patients’ mouths.
    —Stephen Sinatra, MD, cardiologist and author of numerous books about heart health, including The Great Cholesterol Myth


    Your family history isn’t as bad as you think

    People will come in and say "my grandma died of a heart attack when she was 80, so heart disease runs in my family." That’s not true—everyone has to die of something. We define family history as a cardiac event before age 60 in women and before 50 in men. It’s much narrower than people realize.
    —Sarah Samaan, MD, cardiologist at The Legacy Heart Center in Plano, Texas and author of Best Practices for a Healthy Heart


    You probably don’t need that stress test

    People used to start getting them at age 50 and then get them yearly. But a stress test will only pick up blockages of 70 percent or greater. A normal test doesn’t mean you don’t have blockages. There’s no medical reason to have a stress test unless you have symptoms, like chest pain or shortness of breath, or an abnormal EKG. It’s become a patient security blanket, and many insurance companies no longer cover them [for preventive reasons].
    —Sarah Samaan, MD, cardiologist at The Legacy Heart Center in Plano, Texas and author of Best Practices for a Healthy Heart

    And that stent may not be necessary either

    If a blockage is not causing symptoms or a reduction in blood flow, then it doesn’t need to be stented. In the absence of a severe blockage, treating with medication is just as good. And once you do a stent, then you need to do another, and the problem can proliferate.
    —Malissa J. Wood, MD, American Heart Association’s Go Red for Women spokesperson and co-director of the Women’s Heart Program at Massachusetts General Hospital

    It makes me happy when you come in with questions—and a family member

    The best time to get my attention is the first few minutes of the appointment, before I start the physical exam. That’s when you need to bring up the things that are bothering you. I also like when you have a family member or friend to help. You may be hearing hard news and walk away with mixed messages.
    —Malissa J. Wood, MD, American Heart Association’s Go Red for Women spokesperson and co-director of the Women’s Heart Program at Massachusetts General Hospital

    I care more about your blood pressure at home than in the office

    I see a lot of white-coat hypertension [where blood pressure is elevated in the office but normal at home]. If patients are surprised by their blood pressure number, I’ll retest it or ask them record it at home for a week and bring in their readings. This way if it is high, they're more motivated to work to lower it.
    —Sarah Samaan, MD, cardiologist at The Legacy Heart Center in Plano, Texas and author of Best Practices for a Healthy Heart

    Please tell me the truth: Do you have erectile dysfunction?

    Erectile dysfunction is also marker of blood vessel disease. The small blood vessels are a barometer of what goes on in the large blood vessels. My own father found out that he had a blockage in his neck when he went in for a prescription for [ED].
    —Malissa J. Wood, MD, American Heart Association’s Go Red for Women spokesperson and co-director of the Women’s Heart Program at Massachusetts General Hospital

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