Heart-to-Heart

A Hearty Conversation With Cardiologist Gerald Pohost Gives His Personal Perspective on Keeping The Heart Healthy

by Lori Oliwenstein

Health advice is everywhere: Doctors are on television, on the radio and in magazines, dispensing advice and offering opinions to keep people healthy from head to heels. Conventional wisdom says, if you want to know which therapies doctors believe really work and which lifestyle changes they think are worth the time and effort, then ask the doctors themselves what they do.


Gerald Pohost, M.D., is a professor of medicine and chief of the division of cardiovascular medicine at the Keck School of Medicine of USC. Pohost, a nationally recognized expert in cardiovascular medicine and a pioneer in cardiac imaging, joined the Keck School’s faculty in 2002. Here, USC Health presents a peek at the lifestyle choices he has made with regards to boosting cardiac health—and the reasoning behind those choices.


When people think about how to stay heart-healthy, the first thing they think about is food. So, what sort of diet do you recommend to the average American, and what sort of diet do you yourself follow?
I believe that a low-fat diet is the appropriate approach for health and to lose weight. I stick to the easy methods of lowering fat: switching from regular to non-fat dairy products, eliminating beef or restricting it to low fat forms—like filet mignon—twice a month. I even go to the trouble of taking the yolk out of eggs, and just eating the high-protein whites. And if you want to have dessert, have fruit. Fruit is healthy. Fruit is good.


Actually, if you were looking for the best of all possible worlds, you’d be a vegetarian.
Are you a vegetarian?
No. [He laughs.] All of my family is, but I’m not. I do follow a low-fat diet, though, and I do restrict my red meat intake.


What about salt? Do we all need to be careful about our sodium intake?
Salt is generally not a problem, unless you have salt-sensitive hypertension or suffer from congestive heart failure. But salt-sensitive hypertension is a lot less common than once thought.


We used to hear a lot about how we needed to switch from butter to margarine. Now we hear that the trans-fatty-acids in margarine are not good for us. What should we be using?
It’s a good question. Both margarine and butter are bad, though certain brands of margarine are preferable. What I do is read labels. You’re looking for those with the highest levels of non-saturated or monounsaturated fats.But really, the best thing is to forego both butter and margarine. You’re better off using corn oil, olive oil or canola oil. Despite their beneficial effects, you should limit intake to two to three tablespoons a day.


What do you think about the purported benefits of red wine?
I go with the theory that one glass of wine each day can be helpful. It has actually been found to raise HDL cholesterol, the ‘good’ cholesterol, and at that level, it’s not yet bad for your liver. Over a glass a day, you might be trading heart benefits for liver disease, so you don’t want to do that.


So should we only be drinking red wine? What about other types of alcohol?
Most of the studies have been done on red wine, but I’m not convinced that it’s any more beneficial than white wine—or, for that matter, other types of alcohol. There isn’t enough information yet, but I believe that most forms of alcohol have some heart benefit, so long as they’re consumed in true moderation.

Diet is not the only part of keeping the heart healthy. Clearly, exercise has major benefits. How much do we need to do to stay healthy? What kinds of exercise do you do?
For cardiovascular fitness, you want to do a minimum of 20 minutes of exercise three times a week, working hard enough that you break a sweat or are out of breath. I do my exercise on a treadmill, and I keep it level and walk at a speed of at least four miles per hour. If it’s on an incline, you can go a little more slowly.

Swimming is also a good form of cardiovascular exercise. But weight lifting or other isometric exercises, while they may have other health benefits, are not beneficial for your heart health.
What sort of impact do genetics have on heart health?
You can’t do anything about your genes just yet—some of us are going to be predisposed to heart disease no matter what—but you can lower that risk through lifestyle changes. Diet, exercise, regular physical checkups—all of these can help. If you have diabetes, you need to maintain a stringent treatment plan. If you have high blood pressure, you need to control it. And no matter what your genetics or medical history, nobody should smoke. It doesn’t do a single good thing for your health or that of those around you. In fact, if you see someone smoking, you should just turn around and walk in the other direction. I feel that strongly about it.


What about vitamins? Which ones should we be taking?
Aspirin.


Aspirin? But I was asking about vitamins.
As far as I’m concerned, aspirin is a vitamin. It’s that important: Everyone over age 40 needs to be taking aspirin. You need a minimum of 81 milligrams—a baby aspirin a day. I actually started taking aspirin myself when I was around 30, because we already knew then how useful it could be. Since then, we’ve started learning more about how cardiovascular disease develops in the body, and have found even more ways in which aspirin can help prevent heart attack and stroke. Take c-reactive protein, or CRP, for instance. It has become clear that elevation of CRP is a significant risk factor in cardiovascular disease—and that aspirin can reduce some of its effects.
Next on the list are B vitamins—specifically, B6, B12 and folic acid, all of which reduce the levels of homocysteine in your blood. High levels of homocysteine (a type of amino acid—amino acids are the building blocks of proteins) are a major risk factor for heart attack and stroke. But in order to get enough B vitamins to really have an effect on homocysteine, you need to take a fairly large amount. I take a vitamin preparation called B-100 twice a day.
There have been some questions about vitamins C and E and whether or not they’re useful in keeping the heart healthy. Howard Hodis, director of the USC Atherosclerosis Research Unit, has shown that when patients taking a statin drug to reduce elevated cholesterol levels also take vitamin C, it renders the statins less effective. That’s why I personally don’t take vitamin C. I do, however, take 400 IU [international units] of vitamin E along with my B vitamins, as well as 75 mg of coenzyme Q10, a potent antioxidant that is thought to be beneficial in reducing cholesterol. Even though there aren’t definitive studies proving coenzyme Q10’s effectiveness in controlling cardiovascular disease, I think it’s one of the supplements that are worthwhile to take.


What about non-vitamin supplements—herbs, homeopathic remedies, other alternative treatments? Do you include any of them in your regimen or recommend them to patients?
No. Well, some people might consider coenzyme Q10 in this category and think it is inappropriate to talk about it at all. But other than that, I don’t find there’s sufficient evidence or, really, any evidence for most of the other alternative remedies to support or even mention them.

Hormone replacement therapy has never really been in question as to its benefits to the heart. Yet studies have raised concerns about increased cancer risks in women taking HRT. What would you tell postmenopausal women about HRT?
It’s too bad, really, because HRT really does have a significant positive effect on the heart, but the risks have made themselves so clearly known that I would not recommend it to any woman I know or to my patients unless severe menopausal symptoms justify it.


So what should postmenopausal women do?
Be especially careful. Exercise, eat well, take aspirin and take those B vitamins. And make sure you have a good gynecologist who you can talk over these issues with.
Oh, and never forget that if you’re not convinced by what your doctor tells you, you should always get a second opinion. I’m a huge fan of second opinions, especially when you’re seeing a specialist for a significant medical problem.


What are our goals, test-wise, for keeping our hearts healthy?
Ideally, you want your systolic blood pressure (the top number in a blood pressure reading) to be 120 or less. Lots of people say 140 is OK, so when they have a blood pressure reading of 150, they think, ‘Well, not too bad. I’m close enough to 140.’ A blood pressure of 120/80 or even less would be best: You can do that through diet, exercise and, if necessary, medication.
As for cholesterol, you want an LDL (the so-called bad cholesterol) of less than 100 and an HDL above 60. People should not focus on total cholesterol, because someone can have a relatively high LDL and a very low HDL and still have a total number below someone with a healthy LDL and a good, high HDL.
You can’t do anything to guarantee that you’ll never develop heart disease or have a stroke. But if you make an attempt to eat well, exercise and get regular checkups to spot and treat any developing problems, you’ll maximize your potential not to have to deal with any of these problems. And that in itself is certainly worth the effort.