Transcript: Dr Paul Oh - Healthy Heart Part 1 | Dec 03, 2003

(music plays)

A slate reads “The advice given in Mini-Med School is of a general nature only. Viewers should consult their own medical professional for medical advice specific to their circumstances.”

Against a blurry background of blue and pink pills, a video reel displays pictures of medical gear such as a needle, a scan of a human body and heart rate monitors.

The title of the show slides in: “Mini-Med School.”

Then, Paul Oh stands on a stage in a university auditorium giving a lecture. He’s in his mid-thirties, with short black hair and clean-shaven. He’s wearing glasses, a blue shirt and a red spotted tie.

Behind him, a computer screen is projected on a tall white wall.

Paul says WE'RE GONNA TALK
ABOUT RISK FACTORS, REVIEWING
WHAT, WHAT THE STANDARD RISK
FACTORS MIGHT BE AND THEN HOW
YOU MIGHT QUALITATIVELY AND
QUANTITATIVELY PUT THOSE THINGS
TOGETHER FOR YOU AS AN
INDIVIDUAL AND FOR THOSE PEOPLE
THAT YOU WILL COUNSEL AFTER YOU
GET YOUR DEGREES FROM HERE --
[Laughter ]

A caption appears on screen. It reads “Paul Oh. University of Toronto. A Blueprint for a Healthy Heart.”

He continues UM, WHAT IS YOUR
RISK AND THEN MORE IMPORTANTLY,
DISCUSS WHAT CAN WE DO ABOUT
THEM TO MAKE THOSE RISKS BETTER?
UM, I KNOW WE'VE GOT AN AUDIENCE
HERE, IF THIS IS TYPICAL OF THE
LAST GROUP, EVERYONE IS SUPER-
HEALTHY HERE, SO THIS WILL BE AN
INTERESTING EXPERIMENT WHEN WE
ACTUALLY GET TO THE RISK
CALCULATIONS.
AND THEN WE'RE GONNA COME TO
WHAT ARE YOU GONNA WALK AWAY
WITH, WHAT ARE YOU GONNA
PRESCRIBE AFTER YOU WALK AWAY
FROM THE, THIS, THIS SESSION
HERE, SO DEVELOPING AN APPROACH
TO MANAGEMENT.

He runs a PowerPoint presentation.

He continues WE'RE GONNA USE A CASE-BASED
FORMAT TO DO SOME OF THIS, SO
LET ME SHARE SOME STORIES WITH
YOU, NO PICTURES, BUT, UH, BUT
AT LEAST STORIES AND THESE KINDS
OF FOLKS MAY LOOK, UH, FAMILIAR
TO YOU PERSONALLY, WHEN YOU LOOK
IN THE MIRROR, OR THEY MAY LOOK,
UH, FAMILIAR WHEN YOU LOOK
AROUND THE DINNER TABLE AT, AT
FAMILY GATHERINGS.
SO LET'S TALK ABOUT A FRIEND OF
MINE, WHO IS 56 YEARS OLD.
HE HAD A HEART ATTACK BEFORE.
HE HAD CLASS 3 ANGINA, WHICH
MEANS THAT IF HE WALKS ACROSS
THE ROOM, HE GETS SOME SQUEEZING
PAIN IN HIS CHEST.
UH, HE IS AWAITING BYPASS
SURGERY WITH EAGERNESS.
HE HAS THE FOLLOWING KIND OF
PROFILE AND AGAIN, THI-THIS IS A
TYPICAL PROFILE FOR SOMEBODY
WITH CORONARY DISEASE, HE HAS
ADULT ONSET OR TYPE II DIABETES
MELLITUS, HE HAS HIGH BLOOD
PRESSURE.
HE TOLD ME HE WAS AN EX-SMOKER.
HE QUIT THAT MORNING.

[ Laughter ]

Paul continues HE QUITS EVERY
MORNING AND NOT-NOT TO BE TOO
NEGATIVE, I CONGRATULATE HIM
EVERY TIME I SEE HIM, DID YOU
QUIT TODAY?
VERY GOOD, IT'S NOT TOO LATE AND
THAT'S ONE OF THE MESSAGES I'LL
TELL YOU LATER ON.
BODY MASS INDEX WAS 40.
NOW SOME OF US KNOW ABOUT BODY
MASS INDEX IN THE AUDIENCE, I
THINK.
THIS IS -- NUMERICALLY THE
FORMULA IS YOUR WEIGHT IN
KILOGRAMS OVER YOUR HEIGHT IN
CENTIMETRES SQUARED, OKAY, SO
WEIGHT OVER HOW TALL YOU ARE.
A GOOD BODY MASS INDEX FALLS
AROUND 25 OR SO.
THIS MAN'S BODY MASS INDEX IS
40, THE CONCLUSION IS, THIS MAN
IS NOT TALL ENOUGH, OKAY?
[Laughter]

He continues THE THERAPY IS WE
WILL STRETCH HIM OUT AND HE'LL
BE JUST FINE.
BLOOD PRESSURE WAS 148 OVER 94,
THOSE OF YOU WHO KNOW ABOUT
BLOOD PRESSURE AND ACTUALLY, AS
I WAS QUIETLY SITTING IN THE
FRONT ROW, I HEARD BEHIND ME
WHISPERS OF, NOW THE BLOOD
PRESSURE, THE TOP NUMBER IS
THIS, THE BOTTOM NUMBER IS THIS?
THE TOP NUMBER IS THE SYSTOLIC,
THE BOTTOM NUMBER IS THE
DIASTOLIC, I UNDERSTAND DURING
THE BREAK, IN THE STONE LOBBY,
NEXT DOOR, THERE'LL BE A BLOOD
PRESSURE CLINIC SET UP, SO YOU
CAN GET YOUR BLOOD PRESSURE'S
NUMBER, UH, NUMBERED OUT, YOU'LL
KNOW WHAT YOUR SYSTOLIC AND
DIASTOLIC AND THE OTHER THING
THAT WE'RE, WE'RE, UH,
WHISPERING ABOUT IS WHICH ONE IS
MORE IMPORTANT, THE ANSWER IS,
THE MODERN ANSWER IS THEY'RE
BOTH IMPORTANT.
BOTH OF THEM ARE EQUALLY
IMPORTANT.
BOTH OF THE, THESE NUMBERS IN
THIS INDIVIDUAL ARE BOTH TOO
HIGH.
TO BOOT, THIS IS HIS CHOLESTEROL
PROFILE AND I WILL SHOW YOU A
SIMPLE WAY OF LOOKING THROUGH A
CHOLESTEROL PROFILE TO DETERMINE
IS IT RIGHT FOR YOU OR YOUR
LOVED ONES.

A slide with a list appears.

He continues SUFFICE TO SAY, THIS AIN'T GOOD,
EITHER, AND HIS FASTING SUGAR'S
ALSO 14.5.
SO EVERY PERSON THAT I SEE IN MY
RISK FACTOR CLINIC, OR EVERY
PERSON THAT I SEE NOW IN CARDIAC
REHABILITATION, I SAY, FIRST
STEP, KNOW WHAT YOUR NUMBERS
ARE, THAT'S THE FIRST PLACE TO
BE.
AND THEN WE CAN START
INTERPRETING SOME OF THEM.
ALL OF THESE ARE BAD AND WHAT
WAS DISCOURAGING TO ME WAS THIS
FELLOW HAD BEEN THROUGH THE
MEDICAL SYSTEM AND SEEN MANY
PHYSICIANS ALONG THE WAY.
SOMETIMES WE DO PEOPLE A
DISSERVICE BY GIVING PEOPLE
LABELS, YOU'VE GOT DIABETES,
YOU'VE GOT HIGH BLOOD PRESSURE,
YOU'VE GOT ABNORMAL CHOLESTEROL.
YOUR NUMBERS ARE THEREFORE
ABNORMAL, WHAT CAN YOU EXPECT?
OKAY, SO THE ONE TAKEAWAY FROM,
FROM, FROM THIS IS WE SHOULD NOT
SETTLE FOR ABNORMAL, THERE ARE
LOTS OF THINGS THAT WE CAN DO,
BUILDING FROM LIFESTYLE
MODIFICATIONS TO TARGETED DRUG
THERAPIES TO MAKE THESE THINGS
AS NORMAL AS POSSIBLE, TO REDUCE
OUR RISKS AS MUCH AS POSSIBLE,
TO MAKE OURSELVES LIVE AS LONG
AND HEALTHY AS POSSIBLE, OKAY?
SO WE SHOULD NOT SETTLE FOR
ANYTHING LESS THAN PERFECTION.
WE DO IT IN A STEPWISE FASHION,
THOUGH.
SO WHAT ARE THE RISK FACTORS FOR
A CARDIOVASCULAR EVENT, HOW DO
YOU QUANTIFY THAT RISK AND THEN
HOW DO YOU QUANTIFY THE BENEFITS
OF THERAPY, ABOUT RELATIVE RISK
REDUCTIONS AND ABSOLUTE RISK
REDUCTIONS.
OKAY, SO TO STEPS IN DETERMINING
THE RISK AND YOU'RE FOLLOWING
ALONG IN YOUR, IN YOUR HANDOUTS
ABOUT THIS, SO WE'RE GONNA LOOK
AT WHAT THOSE RISK FACTORS ARE,
DO A CALCULATION AND THEN
CALCULATE, UH, COMPARED TO WHAT
AN AVERAGE PERSON IN THE
POPULATION MIGHT LOOK LIGHT.
ALL RIGHT.
SO WHAT ARE THE RISK FACTORS AND
I THINK THESE THINGS ARE
FAMILIAR TO MOST OF US.
AGE, UNFORTUNATELY, IS ONE OF
THOSE FACTORS AND MALES TEND TO
AGE, AT LEAST FROM A HEART
SENSE, YOUNGER THAN, UH, THAN
WOMEN DO, THIS MAY BE PART OF
THE ESTROGEN STORY, ALTHOUGH
THAT'S GETTING MORE AND MORE
MUDDIED WITH, WITH, WITH RECENT
STUDIES ABOUT THIS.
BUT AGE IS CERTAINLY A RISK
FACTOR.

Slides continue to show what he mentions.

He continues YOU HAVE TO PICK YOUR PARENTS
PROPERLY TO PROTECT YOUR HEART.
AND FAMILY HISTORY CERTAINLY IS
IMPORTANT IN, IN, IN ADDING
RISKS IN A SOMETIMES INTANGIBLE
OR HARD TO MEASURE FASHION.
SMOKING EVEN A CIGARETTE TODAY,
UH, PER DAY OR GETTING EXPOSED
TO SECOND-HAND SMOKE IS CLEARLY
A RISK FACTOR.
BLOOD PRESSURE, UH, I-IS THERE,
AS WE TALKED ABOUT, 140 OVER 90
AND HAVING DIABETES.
THE EFFECT OF BLOOD PRESSURE
OVER A LONG PERIOD OF TIME IS
THICKENING OF THE HEART MUSCLE.
IN PARTICULAR, THE LEFT-SIDED
PUMPING CHAMBER, THE LEFT
VENTRICLE.
SO LEFT VENTRICULAR HYPERTROPHY
OF THICKENING OF THE LEFT SIDE
OF THE HEART IS A CONSEQUENCE OF
HYPERTENSION, UH, HIGH BLOOD
PRESSURE AND THAT IS ALSO AN
ADDED RISK, UH, OVER AND ABOVE
BLOOD PRESSURE NUMBER IN AND OF
ITSELF.
AND ABNORMAL CHOLESTEROL NUMBERS
ARE ALSO GOING TO PLAY INTO
THIS, OKAY?
THAT ISN'T VERY EXCITING, IS IT,
TO GIVE YOU JUST A LIST OF
THINGS.
UM, IT'S GONNA COME TOGETHER,
THOUGH, HANG IN THERE, ALL
RIGHT, WITH RESPECT TO THE
CHOLESTEROL NUMBERS, IT'S NOT
JUST ABOUT WHICH NUMBER IT IS,
BUT ALSO WHAT TYPES OF
CHOLESTEROL THAT YOU HAVE.
AND I KNOW SOME OF YOU HAVE
GOTTEN YOUR PROFILES DONE, UH,
THERE ARE RECOMMENDATIONS FOR
SCREENING, FOR MOST OF THE
HEALTHY FOLKS IN THE AUDIENCE,
THERE REALLY ISN'T A, A NEED TO
GO RUSH OUT AND GET A
CHOLESTEROL PROFILE, BUT IN THE,
UH, PERIODIC HEALTH
EXAMINATIONS, CHOLESTEROLS WILL
BE DONE AT SOME POINT AND, AND
HERE ARE THE THINGS TO CONSIDER.
WHAT IS YOUR TOTAL CHOLESTEROL
IS JUST ONE OVERALL MARKER.
MORE IMPORTANTLY IS WHAT IS
INSIDE THAT TOTAL CHOLESTEROL?
TO DERIVE THAT, THAT, THAT TOTAL
NUMBER, THERE ARE COMPONENTS OF
HIGH DENSITY LIPOPROTEIN
CHOLESTEROL, HIGH, “H” FOR
HEALTHY, THIS IS THE GOOD STUFF
AND YOU WANT MORE OF THE GOOD
STUFF IF AT ALL POSSIBLE.
WE'LL TALK ABOUT HOW YOU GET
THERE.
THERE ARE TRIGLYCERIDES IN THE
BLOODSTREAM, KIND OF FATS THAT
ARE DERIVED FROM DIET, THEY
INTERACT WITH SOME OF THESE
OTHER PARTICLES AND THEN THE BAD
GUY IS THE LOW DENSITY
LIPOPROTEIN CHOLESTEROL, “L,”
LOW, LOUSY, YOU WANT THIS ONE AS
LOW AS POSSIBLE, TO, TO MAINTAIN
A HEALTHY LIFE, OKAY?
SO THOSE ARE GONNA BE THE
CHOLESTEROL COMPONENTS THAT WE
LOOK AT AND FOR THE
MATHEMATICIANS IN THE AUDIENCE,
THERE IS THE FORMULA FOR YOU IF
YOU WANNA GO CALCULATE ANY LDL
CHOLESTEROLS JUST FOR FUN WHEN
YOU LEAVE HERE.
OKAY, OTHER THINGS THAT WE CAN
THINK ABOUT, BEING OVERWEIGHT IS
TIED INTIMATELY WITH HAVING
THINGS LIKE DIABETES OR ABNORMAL
CHOLESTEROL PROFILES, BEING
SEDENTARY, I DON'T THINK ANYONE
WILL BE AFTER THIS, THIS
SESSION, RIGHT?
IF YOU WALK ZERO MILES PER DAY,
YOU ARE A SLUG, I GUESS, NO ONE
WILL BE A SLUG ANYMORE, YOU WILL
GET OUT AND WALK THAT MILE PER
DAY IN SOME FASHION, YOU WILL
ALL FOLLOW REASONABLE DIETS FROM
HERE ON IN, UM, THERE ARE
INTERESTING THINGS AND THOSE OF
YOU WHO SEARCH THE INTERNET
ABOUT HEART DISEASE WILL HAVE
HEARD ABOUT SOME METABOLIC TYPES
OF DISORDERS WHERE WE JUST DON'T
SEEM TO PROCESS THINGS THE WAY
THAT WE SHOULD AND WE MAY BUILD
UP INTERMEDIATE PRODUCTS LIKE
HOMOCYSTEINE IN OUR BLOOD.
MORE ABOUT THAT LATER IF ANYONE
IS REAL INTERESTED, UH, SIM --
ON A SIMILAR LINE, THERE MAY BE,
UH, SOME DEFICIENCIES OF
VITAMINS IN OUR BLOODSTREAM THAT
DON'T ALLOW US TO BREAK DOWN
PRODUCTS, TOXINS PROPERLY.
OKAY.
AND THEN THE, THE, THE ROLE OF
STRESS AND ANXIETY AND
DEPRESSION AND POOR SLEEP HAS
ALSO ADDED RISK FACTORS FOR
HEART DISEASE OR MAKING OUR
HEART DISEASE WORSE.
OKAY, SO LOTS AND LOTS OF
THINGS.
THE WAY YOU CAN QUANTIFY SOME OF
THIS STUFF, WOW, SOME BRILLIANT
DOCS A-AND EPIDEMIOLOGISTS WENT
AND DID THIS THING.
RECOGNISING THAT WE HAVE THESE
RISK FACTORS, LET'S ACTUALLY PUT
THEM TOGETHER IN SOME KIND OF
FORMULA.
SO LET'S FIGURE OUT HOW OLD WE
ARE, WHAT ARE OUR CHOLESTEROL
NUMBERS, WHAT IS OUR BLOOD
PRESSURE NUMBER, DO WE SMOKE OR
NOT, DO WE HAVE DIABETES OR NOT
AND PUT THAT TOGETHER
NUMERICALLY TO ARRIVE AT SOME
KIND OF SCORE.
OKAY?
SO IF YOU WILL FOLLOW ALONG NOW
IN YOUR SLIDES AND KIND OF DO A
RAPID SCORE FOR US, OKAY?
THIS IS ALSO A COGNITIVE TEST,
THOSE OF YOU WHO FAIL TO ADD UP
FIVE NUMBERS PROPERLY WILL BE
DOING A REMEDIAL SESSION LATER
ON, WE'LL START AROUND 11:00,
OKAY?
OKAY, SO, THE, THE POINT HERE
FROM AGE, AS WE SAID, THE OLDER
YOU ARE, THE GREATER NUMBER OF
POINTS THAT YOU'RE GOING TO GET
IN TERMS OF RISK.

A slide under the title “Step 1: Age” appears on screen. It shows a table with three columns. The first one reads “Years,” the second one reads “Men” and the third one reads “Women.”

He continues THE OTHER, THE OTHER THING THAT
WE NOTICE FROM HERE IS THAT
YOUNG WOMEN, THE YOUNG WOMEN IN
THE AUDIENCE, IT'S REALLY HARD
TO KNOCK YOU OFF FROM HEART
DISEASE, SO, THE MEN IN THE
AUDIENCE THERE WITH THE YOUNG
WOMEN, HEART DISEASE IS THE WAY
THAT YOU'RE GOING TO BE ABLE TO
SCORE SOME POINTS ON THE --
WHAT'S THAT?
WELL, 74 -- LOT OF THESE -- THE
QUESTION WAS, WHY DOES THE CHART
ONLY GO TO 74, A LOT OF THIS
INFORMATION WAS DERIVED FROM A
COHORT STUDY CALLED THE
FRAMINGHAM STUDY, UH, A CAPTIVE
TOWN IN, IN NEW ENGLAND, UH,
WHERE THEY LOOKED AT THE
RELATIONSHIP BETWEEN LOTS OF
BASELINE VARIABLES AND WHAT
HAPPENED TO THEM OVER THE NEXT
20 YEARS, THEY ENROLLED A YOUNG
COHORT AND THEY FOLLOWED THEM
THIS FAR.
THEY'RE JUST NOT THAT OLD YET,
OKAY?
UM, BUT YOU CAN SEE THAT IT KIND
OF FLATTENS OUT OVER THE AGE OF
60, OKAY?
SO AGE, EVERYONE'S GOT THEIR
AGE?
OKAY, GOOD, YOU DIDN'T NEED ANY
HELP WITH THAT ONE, THANKS.
OKAY, NEXT POINT IS TOTAL
CHOLESTEROL, IF YOU, IF YOU
HAPPEN TO KNOW YOUR TOTAL
CHOLESTEROL, THAT IS GREAT AND
YOU WILL SCORE YOURSELF UNDER
THE APPROPRIATE GENDER CATEGORY.
IF YOU DON'T KNOW WHAT YOUR
CHOLESTEROL, TOTAL CHOLESTEROL
IS, LET'S SAY IT'S 5.2, BEING A
KIND OF AVERAGE NUMBER FOR A
POPULATION.
SO IF YOU DON'T KNOW WHAT YOUR
TOTAL CHOLESTEROL IS, LET'S MAKE
IT 5.2.
AND SCORE YOURSELF A SINGLE
POINT.
NEXT THING IS THE HDL
CHOLESTEROL, AGAIN, “H” FOR
HEALTHY, HIGH, YOU WANT THIS ONE
TO BE AS HIGH AS YOU CAN BE, SO
YOU'LL NOTICE IF YOUR HDL
CHOLESTEROL IS UP ABOVE ONE AND
A HALF, YOU ACTUALLY SCORE
NEGATIVE POINTS, YOU'RE
PROTECTED, ALL RIGHT?
SO ONCE AGAIN, IF YOU KNOW WHAT
YOUR HDL CHOLESTEROL IS,
TERRIFIC.
IF YOU DON'T, ENTER IT IN IN
THIS CATEGORY, ASSUME YOUR HDL
CHOLESTEROL IS 1.0, WHICH IS
AROUND AN AVERAGE FOR A
POPULATION.
OKAY?
WITH ME THERE?
LET'S KEEP GOING, BLOOD
PRESSURE.
AS WE SAID, BOTH SYSTOLIC AND
DIASTOLIC BLOOD PRESSURE ARE
IMPORTANT IN DIFFERENT WAYS.
FOR MEN AND WOMEN, DO YOU KNOW
WHAT YOUR BLOOD PRESSURE IS AND
OF THOSE, WHI-WHICH IS YOUR
HIGHER ONE AND BASED UPON THAT,
GIVE YOURSELF A SCORE, SO FOR
INSTANCE, IF YOU KNOW THAT YOUR
DIASTOLIC BLOOD PRESSURE IS 90
AND YOU'RE A MAN, YOU'LL SCORE
YOURSELF TWO POINTS.
IF YOU DON'T KNOW, LET'S ASSUME
THAT YOUR, YOUR DIASTOLIC
PRESSURE IS AROUND 80, WHICH IS
A NORM, THAT'S GOOD AND, AND
REASONABLY HEALTHY, OKAY?
IF YOU'RE ON MEDICATIONS, YOU
STILL GET TO SCORE WHATEVER YOUR
NUMBER IS.
OKAY.
WITH ME STILL, YOU HAVEN'T LEFT
THE ROOM YET, THANKS, THIS IS
REAL EXCITING, OKAY, NEXT POINT
IS ON DIABETES.
THOSE OF YOU WHO KNOW YOU HAVE
DIABETES, UM, IN THIS SCORING
SYSTEM, IT'S JUST CATEGORICAL,
YES OR NO FOR DIABETES.
I'M GONNA SHOW YOU A SLIDE LATER
ON THAT I THINK WILL SAY THAT'S
NOT NECESSARILY THE WAY IT IS,
THAT THERE ARE DIFFERENT
GRADATIONS OF DIABETES AND MOST
IMPORTANTLY, IF YOU GET GOOD
CONTROL OF YOUR BLOOD SUGARS,
YOU CAN DO BETTER, BUT IF YOU
HAVE DIABETES IN THIS MODEL,
GIVE YOURSELF A COUPLE OF
POINTS, IF YOU DON'T KNOW, LET'S
SAY, NO, YOU DON'T HAVE
DIABETES.
OKAY, EVERYONE'S DONE THAT SO
FAR?
FINALLY SMOKING SCORE A YES AND
A NO.
TWO POINTS IF YOU ARE A SMOKER.
OKAY, HERE IS THE MATHEMATICAL
COGNITIVE TEST FOR YOU.
CAN YOU TAKE EACH OF THOSE
ELEMENTS AND THEN ADD UP ALL
YOUR NUMBERS TOGETHER.
ALL RIGHT?
SO WE'RE GONNA TAKE THOSE SIX
NUMBERS AND ADD THEM TOGETHER.

He hums the theme song from “Jeopardy.”

A slide shows a summary table.

He continues OKAY.
NOW THE WAY THIS SYSTEM GOES IS
DEPENDING ON THE NUMBER OF
POINTS YOU'VE SCORED IN THOSE
YELLOWS, THEY DENOTE A HIGHER
RISK FOR YOU, OKAY?

He uses a laser pointer to point at the slide and continues SO ON THIS TABLE THAT YOU'VE GOT
HERE, FIGURE OUT HOW MANY POINTS
YOU'VE GOT, HOW MANY POINTS HAVE
YOU SCORED AND THEN LOOK ACROSS
THE TABLE TO FIGURE OUT WHAT
YOUR 10-YEAR RISK OF HAVING A
CORONARY EVENT IS.
ALL RIGHT, IS THAT CLEAR?
EVERYBODY BEEN ABLE TO DO THAT
SO FAR?
OKAY.
AND THEN HERE'S THE LAST THING
WE'RE GONNA DO, IS YOU FIGURE
OUT WHAT YOUR PERCENT RISK OVER
10 YEARS IS AND LET'S COMPARE IT
TO AN AGE MATCH NORM, OKAY?
SO FOR THE 50-YEAR-OLD IN THE
AUDIENCE WHO IS A MALE, THE
CHANCE OVER THE NEXT 10 YEARS,
UNFORTUNATELY, UH, FOR THE
AVERAGE PERSON, IS ABOUT 14 percent
CHANCE OR 1.5 percent PER YEAR, THAT
SOMETHING BAD IS GONNA HAPPEN
WITH YOU WITH RESPECT TO YOUR
HEART.
OKAY.
NOW HERE IS THE, HERE IS THE
QUIET POLL OF THE AUDIENCE.
WHO IS ABOVE RISK FOR YOUR AGE
MATCH NORM, ANYBODY?
WHO IS ABOVE RISK AND THIS IS
VERY PREDICTABLE THAT THERE
IS -- WHO IS BELOW RISK FOR THE
POPULATION AND THIS IS TYPICAL
FOR OUR LAST AUDIENCE, AS WELL.
THE PEOPLE THAT COME OUT FOR
THESE KINDS OF SESSIONS ARE VERY
UNUSUAL ANIMALS.
UH, THEY ARE THE HEALTH-
CONSCIOUS SEEKING TYPES OF
PERSONS, WHICH IS GREAT.
BUT THE OTHER THING THAT WE
MIGHT SAY, IF WE JUST GO BACK
ONE SLIDE, IS YOU WONDER IS
THERE ANYTHING ELSE THAT'S
MODIFIABLE?
WAS YOUR SCORE ZERO, FOR
INSTANCE, PROBABLY NOT, 'CAUSE
EVERYBODY IS OVER, OVER THE AGE
OF 30, FOR INSTANCE, MAYBE NOT,
UH, IN THE AUDIENCE, UH, AT
LEAST WILLING TO ADMIT THAT
THEY'RE OVER THE AGE OF 30, UM,
SO, SO -- BUT THERE MAY BE
THINGS THAT WE CAN DO AND THIS
IS A QUANTIVE WAY --
QUANTITATIVE WAY OF FEEDING BACK
TO FOLKS.
OKAY.
THE OTHER WAY, THE OTHER THING
WE DO WHEN I COUNSEL A PATIENT
ABOUT THIS IS ONE, WE GO THROUGH
THAT KIND OF PROCESS TO REFLECT
BACK, WHAT'S THE IMPORTANCE OF
THESE THINGS, WHAT'S THE
IMPORTANCE OF YOUR BLOOD
PRESSURE, WHAT'S THE IMPORTANCE
OF YOUR CHOLESTEROL NUMBERS AND
WHAT CAN WE DO ABOUT THEM TO
CHANGE THAT RISK?
ANOTHER WAY OF LOOKING AT THIS
IS TO KIND OF MAKE IT INTO A
CATEGORICAL THING.
MOST OF US COME IN AT A LOW
CATEGORY, A LOW RISK CATEGORY
AND OUR, OUR 10-YEAR RISK IS
GONNA BE UNDER 10 percent AND I THINK
THAT'S TRUE FOR MOST PEOPLE IN
THE AUDIENCE, IT SEEMS LIKE.
THERE ARE SOME PEOPLE, CERTAINLY
THE ONES IN MY PRACTICE, WHO
COME OUT IN THE TOP TIER, WHERE
THEIR RISK, UH, IS, IS TANGIBLE
ON A DAY TO DAY BASIS OF
SOMETHING BAD HAPPENING TO THEM.
AND AGAIN, THE REFLECTION I GIVE
BACK TO THEM IS WHAT CAN WE DO
TODAY AND OVER THE NEXT MONTH
AND OVER THE NEXT SIX MONTHS TO
CHANGE THAT RISK, TO BRING US
DOWN, DOWN THESE LEVELS IN TERMS
OF CATEGORIES?
OKAY, SO.
YOU'VE DONE YOUR OWN RISK
PROFILE, LET'S, LET'S GO THROUGH
A FEW PATIENT PROFILES AND
CALCULATE THE RISKS, OKAY?
IF WE GO BACK TO MY ORIGINAL
FRIEND, WHO IS A 56-YEAR-OLD MAN
WITH THAT KIND OF CHOLESTEROL
PROFILE, THE LDL CHOLESTEROL IS
TOO HIGH, THE HDL CHOLESTEROL IS
TOO LOW, THE BLOOD PRESSURE
NUMBERS ARE T -- ARE, ARE TOO
HIGH, HE HAS DIABETES, HE
SMOKES, HIS BODY MASS INDEX IS
HIGH AND HIS SUGAR IS HIGH.

A slide under the title “Case 1: What’s the risk” appears.

He continues HOW DO WE PUT THAT IN A
QUANTITATIVE FASHION?
WELL, HE WOULD SCORE FOUR POINTS
FOR BEING A 56-YEAR-OLD MAN, HE
WOULD SCORE THREE POINTS FOR HIS
CHOLESTEROL VALUES, BOTH HIS LDL
AND HIS HDL.
TWO POINTS FOR THE BLOOD
PRESSURE, TWO POINTS FOR THE
DIABETES, TWO POINTS FOR BEING A
SMOKER.
AND HIS 10-YEAR RISK IS 45 percent OR
GREATER.
IF WE WENT THROUGH OUR TABLES,
THIS IS WHERE HE COMES OUT WITH
13 POINTS, 45 percent AND COMPARED TO
AN AGE MATCH NORM, HE IS ABOUT
THREEFOLD HIGHER THAN OUR AGE
MATCH NORM.
SO THERE'S NO DOUBT WHAT WE
WOULD DO WITH THIS GUY IN TERMS
OF BEING AGGRESSIVE AND
ATTACKING ALL OF THESE THINGS.
IN CONTRAST, WE MIGHT HAVE
SOMEONE WHO ON SURFACE LOOKS
LIKE THEY'VE GOT A SIMILAR RISK
PROFILE, THIS WOMAN IS ABOUT THE
SAME AGE, HER CHOLESTEROL
NUMBERS, IF YOU LOOK AT THE
TOTAL, IS EVEN WORSE.
THE TOTAL CHOLESTEROL'S NINE AND
A HALF IN THIS CASE.
THE SYSTOLIC PRESSURE IS EQUALLY
HIGH.
YOU KNOW, SHOULD WE JUMP IN AND
THROW A WHOLE BUNCH OF DRUGS AT
THIS WOMAN?
OKAY.
IF WE LOOK THROUGH THE RISK
CALCULATION, SHE SCORES SIX
POINTS FOR BEING A 52-YEAR-OLD
WOMAN.
HER LDL IS HIGH, BUT HER HDL IS
ALSO VERY HIGH, THEY ACTUALLY
CANCEL OUT EACH OTHER.
SO SHE DOES NOT ACCRUE ANY EXTRA
RISK FOR HER CHOLESTEROL.
A COUPLE OF POINTS FOR THE
SYSTOLIC BLOOD PRESSURE.
AND HER 10-RISK IS ACTUALLY ON
THE LOW SIDE OF THINGS, COMPARED
TO OUR, OUR FIRST CASE AND, IN
FACT, AGAINST THE AVERAGE PERSON
OUT IN THE COMMUNITY, HER RISK
ACTUALLY COMES IN LOW.
SO APART FROM SAYING, MAYBE YOU
SHOULD WATCH WHAT YOU'RE DOING
IN TERMS OF SODIUM INTAKE, MAYBE
YOU SHOULD WALK THAT EXTRA MILE
PER DAY, I WOULD NOT LEAP IN AND
THROW A WHOLE BUNCH OF DRUGS AT
HER.
IN THE, IN THE JARGON ABOUT
RELATIVE RISK VERSUS ABSOLUTE
RISK AND NUMBER NEEDED TO TREAT,
FOR OUR FIRST CASE, WE WOULD
ONLY HAVE TO TREAT A FEW OF
THOSE GUYS TO PREVENT A HEART
ATTACK.
FOR THIS WOMAN, WE WOULD HAVE TO
TREAT HUNDREDS OF WOMEN LIKE HER
TO DERIVE ANY BENEFIT
WHATSOEVER.
OKAY?
THAT'S WHERE THE NOTION OF RISK
STRATIFICATION IS REAL, REAL
IMPORTANT.
OKAY, SO GIVEN THAT WE CAN
CALCULATE RISK FOR OURSELVES AND
THOSE AROUND US, WHAT SHOULD WE
DO ABOUT IT, GIVEN THAT YOU'VE
DEFINED SOME KIND OF RISK?
SO IF WE LOOK AT ANOTHER ONE OF
MY FRIENDS, WHO'S A 51-YEAR-OLD,
WHO HAD A HEART ATTACK AND IN
ANATOMY THIS IS, UH, HE HAD
SOMETHING CALLED AN ANTERIOR
HEART ATTACK, THE FRONT PART OF
HIS HEART, THE MAJOR PUMPING
CHAMBER WAS AFFECTED.
HE DID NOT CHOOSE HIS PARENTS
WISELY, THIS IS ONE OF THE
REASONS THAT HE DID HAVE A HEART
ATTACK, HE GAVE UP SMOKING 20
YEARS AGO, PROBABLY A NON-PLAYER
IN TERMS OF HIS DISEASE NOW.
HE'S A LITTLE BIT ON THE HEAVY
SIDE WITH A BODY MASS INDEX OF
30 AND HIS CHOLESTEROL PROFILE
LOOKS NOT TOO BAD ON THE
SURFACE.
SO WHAT CAN WE DO WITH THIS?
WELL, LET'S DIG IN A LITTLE BIT
FURTHER AND LET'S THINK ABOUT
THE CHOLESTEROL FIRST OF ALL.
HERE IS ONE SIMPLE APPROACH TO
THINKING ABOUT CHOLESTEROL
NUMBERS.
AND THINKING ABOUT TARGETS IN A
ONE THROUGH FIVE FASHION.
OKAY, STARTING OFF WITH ONE,
ONE, WE LOOK AT HDL AND WE WANT
HDL, A HEALTHY CHOLESTEROL
GREATER THAN ONE.
HIGHER IS BETTER AND WE KNOW
FROM OUR RISK CALCULATIONS, IF
YOU GET IT UP ABOVE ONE AND A
HALF, FOR INSTANCE, THAT'S VERY
PROTECTIVE.
ONE, HDL.
TWO, TRIGLYCERIDES, THE FATTY
SUBSTANCES FLOATING AROUND IN
YOUR BLOOD.

Slides continue to show what he mentions.

He continues WE WANT THOSE LESS THAN TWO.
GUESS WHAT'S COMING NEXT.
THREE, THE LDL CHOLESTEROL, THE
LOUSY, LOW-DENSITY, LIPOPROTEIN
CHOLESTEROL, LET'S KEEP THAT AS
LOW AS POSSIBLE AND FOR A HIGH
RISK POPULATION, LET'S KEEP THAT
EVEN LOWER, SAY LESS THAN TWO
AND A HALF.
FOUR, FOR THOSE WHO ARE AT LESS
RISK, YOU DON'T HAVE DIABETES,
YOU DON'T HAVE HIGH BLOOD
PRESSURE, YOU HAVEN'T HAD A
CARDIAC PROBLEM, FOR THE GENERAL
POPULATION, AN LDL LESS THAN
FOUR IS QUITE REASONABLE, QUITE
ACCEPTABLE, QUITE HEALTHY.
AND FINALLY, LOOKING AT A RATIO.
HOW MUCH OF TOTAL CHOLESTEROL DO
I HAVE VERSUS HOW MUCH
PROTECTIVE CHOLESTEROL DO I HAVE
AND IF THAT RATIO COMES OUT
UNDER FIVE, THAT'S PRETTY GOOD,
OKAY?
ONE THROUGH FIVE AND THAT'S HOW
WE CAN INTERPRET SOME NUMBERS.
OKAY, GIVEN THAT THERE ARE SOME
PROBLEMS WITH CHOLESTEROL OR
SUGARS OR WEIGHT, WHAT CAN WE DO
ABOUT IT?
FIRST STEP IS TO LOOK AT WHAT WE
DO IN TERMS OF DIETS.
2300 CALORIES PER DAY FOR THIS
MAN.
COMMENTS, IS THAT GOOD, HIGH,
NORMAL, BAD?
NOT SURE?
NOT SURE, MOST PEOPLE AREN'T
SURE.
ASK MOST DOCS, NOT SURE.
UM, I THINK EVERYONE IS AWARE,
THOUGH, AND CERTAINLY THIS HAS
BEEN IN THE PRESS LATELY, ABOUT
EPIDEMICS OF NOT SARS, LIKE
RESPIRATORY THINGS, BUT
EPIDEMICS OF THINGS LIKE
CHILDHOOD OBESITY.
EPIDEMICS OF DIABETES.
AND THE REAL PLAYER HERE IS HOW
MUCH WEIGHT WE'RE PUTTING ON,
HOW MANY CALORIES WE'RE
CONSUMING, YOU KNOW, THIS WHOLE
THING OF MAYBE THE TRAJECTORIES
FOR HEALTH CAN NOT ONLY BE
RELATED TO WHERE WE LIVE, HOW
OLD OUR HOUSE IS, BUT THE SIZE
OF THE DINNER PLATE.
AND WHEN WE GO OUT FOR LUNCHES
WITH OUR FAMILY ON THE WEEKENDS,
IT'S, IT'S STRIKING THE SIZE OF
THE KID'S DINNER PLATE IN
PARTICULAR.
YOU KNOW, MY SON WILL ORDER THE
GRILLED CHEESE SANDWICH AND IT
COMES ON A PLATE ABOUT THIS BIG
AND MOST OF THE REST OF IT IS
FILLED UP WITH FRENCH FRIES.
WHICH IS REAL GREAT, NOW
FORTUNATELY MY LITTLE ONE
DOESN'T LIKE FRENCH FRIES, SO
HE, HE WON'T EAT ANY OF THAT
STUFF, HE WON'T EAT THE LETTUCE,
EITHER, THAT'S ALSO ON THE
PLATE, HE THINKS THAT'S
POISONOUS, SO WE'RE WORKING ON
THAT PIECE, BUT, BUT FACT IS, WE
HAVE TOO MANY CALORIES AVAILABLE
TO US.
YOU KNOW, THE OTHER THOUGHT THAT
STRUCK ME THE OTHER DAY, AS I
WENT THROUGH A DRIVE-THROUGH
WAS, YOU KNOW, YOU CAN GET THE
SUPER-SIZE CHEAPER THAN YOU CAN
GET THE SMALL FOR AND IT'S A
REAL TWISTED THING THAT WE'VE
DONE IN OUR SOCIETY, ENCOURAGED
TO HAVE MORE.
SO CALORIE INTAKES IN GENERAL
ARE, ARE TOO HIGH, ALTHOUGH
THESE NEED TO, NEED TO OBVIOUSLY
BE GEARED TO WHAT OUR ACTIVITY
LEVELS ARE.
2300 CALORIES MIGHT BE QUITE
FINE IF WE'RE VERY ACTIVE.
SO IF WE'RE GONNA TAKE ON THAT
THIRD AND FOURTH MILE PER DAY,
THIS MIGHT BE ALL RIGHT.
BUT IN GENERAL WE EAT TOO MANY
CALORIES, AND WE EAT TOO MANY
CALORIES FROM FAT.
AND WE EAT TOO MANY CALORIES
FROM THE WRONG KIND OF FAT.
SATURATED FATS.
THE STUFF THAT TURNS HARD AT
ROOM TEMPERATURE?

He knocks on the podium and continues
TASTY, BUT NOT GOOD
FOR YOU, OKAY?
AND WE EAT TOO MANY, TOO MU --
TOO MANY MILLIGRAMS OF
CHOLESTEROL PER DAY.
ALL RIGHT, WHICH LEADS, FOLKS,
TO ALL OF OUR SMART DIETARY
POWERS THAT BE TO DERIVE
INTERESTING SORTS OF DIET PLANS
FOR US.
AND THE CANADIAN RECOMMENDATIONS
OR THE AMERICAN RECOMMENDATIONS
FOR A HEART HEALTHY KIND OF DIET
WOULD TAKE US THROUGH REDUCING
THE AMOUNT OF FAT THAT WE EAT
FROM OVER 30 percent DOWN TO ABOUT 25,
EATING MORE OF THE HEALTHY KINDS
OF FATS AND REDUCING THE AMOUNT
OF CHOLESTEROL THAT WE EAT.
AND THIS WOULD BE THE
RECOMMENDATION FOR ALL OF MY
PATIENTS THAT HAVE HEART
DISEASE, FOR INSTANCE.
HOW DO WE GET THERE, SOME REAL
SIMPLE THINGS.
AND, AND HOPEFULLY EVERYONE IN
THE AUDIENCE IS ADOPTING THESE
THINGS ALREADY, YOU WOULD
COUNSEL YOUR FRIENDS AND
FAMILIES AND YOUR FUTURE
PATIENTS TO DO SOMETHING LIKE
THIS AND THERE ARE SOME REAL
SIMPLE THINGS THAT WE MAY NOT
EMBRACE ALL THAT WELL.
OKAY, WE'RE GONNA LIMIT RED
MEAT, WE'RE GONNA LIMIT POULTRY
TO SIX OUNCES, WHICH IS NOT THE
SIZE OF THE DINNER PLATE, OF
COURSE, WHICH IS THE SIZE OF
YOUR FIST, INSTEAD.

A slide reads “Dietary Recommendations for Secondary Prevention: Limit meat/poultry (6 ounces): substitute with vegetarian proteins. More fish. Quality fats: unsaturated versus saturated and hydrogenated. Consume low fat dairy products (2-4). Fresh fruit and veggies.”

He continues AND AGAIN, THE THINGS THAT ARE
AVAILABLE IN STORES OR
RESTAURANTS JUST DOESN'T FIT
THAT BILL, UNFORTUNATELY.
UM, ON THE ENCOURAGING SIDE,
THERE ARE A LOT MORE VEGETARIAN
TYPES OF PROTEINS THAT ARE
AVAILABLE, UH, THE, THE SIZE OF
THE TOFU SECTION IN, IN THE
LOCAL DOMINION'S HAS GROWN
ENORMOUSLY.
UH, IT'S A BIT CHALLENGING
FINDING THE RIGHT THINGS THERE,
BUT, BUT THEY ARE OUT THERE.
AND BEANS AND LENTILS WILL BE ON
EVERYBODY'S FAVOURITE HIT PARADE
WHEN YOU READ ABOUT THE DIET
PLANS.
HAVING MORE FISH IS PROBABLY A
GOOD THING AS WELL.
AS LONG AS IT DOESN'T COME FROM
LAKE ONTARIO, I GUESS, UH,
YOU'LL TRADE OFF LEAD POISONING
INSTEAD.
UH, AGAIN, WE TALKED ABOUT
HAVING LESS, LESS OF THE HARD
FATS, BUT HAVING MORE, UH, OF
THE, UH, OF THE POLYUNSATURATED
FATS, THE LIQUID, THE OLIVE OILS
AND THE SAFFLOWER OILS AND-AND
THOSE GOOD THINGS, ALSO TO
REMEMBER NOT TO COMPROMISE
CALCIUM INTAKES, OKAY, SO THIS
IS WHY HAVING A BALANCE WITH
LOW-FAT DAIRY PRODUCTS IS REALLY
IMPORTANT, MILK, CHEESES,
YOGHURTS, FOR INSTANCE, TO MAKE
SURE WE HAVE ADEQUATE CALCIUM
INTAKE, NOT TO GET OSTEOPOROTIC
OVER TIME.
AND PROBABLY THE, THE SIMPLEST
THING, BUT ALSO THE, THE MOST
POORLY DONE, FROM THE INFORMAL
SURVEYS I'VE DONE OF OUR PATIENT
COHORTS, IS THE FOLLOWING THE
SIMPLE GUIDELINE OF HAVING FIVE
TO 10 FRUITS AND VEGGIES PER
DAY.
WHO'S DOING FIVE TO 10 FRUITS
AND VEGGIES PER DAY, UM, WELL,
MOST OF YOU ARE SAYING IT, GOOD
FOR YOU, TRUTHFULLY WE'RE GONNA
FOLLOW YOU AROUND WITH CAMERAS
NOW TO SEE IF YOU'RE REALLY
DOING IT.

[Laughter]

He continues BUT, YOU KNOW, IT-
IT'S EASY NOT TO, BUT ON THE
OTHER HAND, IT IS EASY TO DO SO,
THROW THE APPLE IN THE BAG AND
YOU'LL HAVE IT WHEN YOU GET
HUNGRY AT 3:00 AND THAT'S SUCH A
HEALTHY THING TO DO.
OKAY?
AND BY DOING THE FIVE TO 10
VEGGIES, THERE'S ACTUALLY LITTLE
ROOM FOR EVERYTHING ELSE AND
YOU'RE GONNA GET FIBRE AND LOTS
OF GOOD THINGS AND, AND IT'LL,
IT'LL ALL WORK OUT.
BY DOING SO, YOU'RE GONNA GET
YOUR ADEQUATE-ADEQUATE VITAMIN,
MINERAL AND ANTIOXIDANT INTAKE,
YOU'LL HAVE MORE FIBRE, BOTH THE
SOLUBLE AND THE INSOLUBLE STUFF,
SO NOT ONLY, NOT ONLY IS IT GOOD
FOR YA, I REMEMBER THE DUDLEY
MOORE, UM, MOVIE, UM, SOMETHING
PSYCHIATRIC WAS IN THE TITLE,
ANYWAYS, HIS TAG LINE, HE, HE
JUST BECAME UNBEARABLY TRUTH-
TELLING AND HIS THING WAS, EAT
BRAN, YOU WON'T DIE OF COLON
CANCER WAS THE WAY THEY WERE
GONNA LAUNCH THEIR ADVERTISING
CAMPAIGN, WHICH WAS ABSOLUTELY
TRUE.
YOUR HEARTS WILL BE BETTER AND
YOUR COLONS WILL THANK YOU, AS
WELL.
UM, INCREASE OMEGA-3 FATTY
ACIDS, THAT'S PART OF WHAT'S IN
FISH AND FLAX SEEDS AND THINGS.
AND LIMIT AND MODERATE SODIUM,
OKAY, SO THIS IS -- YOU CAN BUY
ALL KINDS OF BOOKS, UH, IN, IN,
IN THE BOOKSTORE, WH-WHENEVER I
GO TO CHAPTERS, UH, THE KIDS GO
TO THE KIDS SECTION, MY WIFE
GOES TO SOMETHING ELSE AND I
JUST LIKE TO PERUSE THE FOOD
SECTION, UM, JUST BECAUSE I'M
HUNGRY, BUT ALSO I LIKE TO SEE
WHAT'S THE LATEST IN FAD THINGS,
BUT IF YOU PULL OPEN THE FAD
THINGS AND LOOK FOR WHAT'S THE
SENSIBLE PART OF THAT DIET,
WHETHER THEY'RE TALKING ABOUT
PROTEIN POWER OR CARBO
RESTRICTION OR EATING TO YOUR
BLOOD TYPE, A LOT OF IT HAS
THESE COMMON ELEMENTS TO IT,
WHERE YOU FOLLOW REAL SENSIBLE,
HIGH FIBRE, EAT GOOD THING KIND
OF PLAN.
AND IF WE COULD STICK TO THAT,
WE'D BE DOING A LOT BETTER, SO
IN ADDITION TO WALKING THE ONE
TO TWO MILES, IF THE ONLY OTHER
THING WE TAKE AWAY IS LET'S EAT
A LITTLE BIT MORE SENSIBLY, THEN
WE'LL BE DOING PRETTY WELL.

A caption reads “To be continued next week.”

(music plays)

A slate pops up. It reads “For more information about Mini-Med School at the University of Toronto visit us on the web at: www.tvo.org.”

The end credits roll.

Mini-Med School Producer, Wodek Szemberg.

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A Production of TVO Ontario.

Copyright The Ontario Educational Communications Authority 2003.

Watch: Dr Paul Oh - Healthy Heart Part 1