Hidden Epidemic: Heart Disease in America
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Chapter 6 - Medication, Exercise and Disparities [5:36]

The drugs work, but lifestyle change is the key. Race and economics do play a role. What Bill Clinton learned.

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Transcript: Chapter 6 - Medication, Exercise and Disparities

The drugs work, but lifestyle change is the key. Race and economics do play a role. What Bill Clinton learned.

LARRY KING: Medications, Dr. Johnson. That's big. I take seven different medications a day. Why do people not take them? They're the wonders of the modern century.

DR. PAULA JOHNSON: They are. I mean, medications are extremely important, especially when you have various diseases, especially heart disease. You know, medications though come with side effects, and people sometimes instead of talking with their physicians about alternatives will stop medications. Once again, it's about that relationship and talking about those issues. And also on the medical side, it's very important to explain to patients exactly why you're prescribing different medication so that they understand that it is critical that if something happens that we talk about an alternative.

LARRY KING: Why do they give me so much? I take Altace, Plavix, Tenormin, Glucophage--

DR. MARIANNE LEGATO: Well, you're taking all the right stuff.

LARRY KING: Lipitor. But I've never had a side effect.

DR. MARIANNE LEGATO: You've never had a side effect? That's amazing. You are an amazing survivor, I have to say. Most--

DR. MICHAEL ROIZEN: You probably take them the way they're prescribed--

LARRY KING: Exactly.

DR. MICHAEL ROIZEN: --because it's a partnership of you and the physician, and you got reality. It turns out that almost 60% of the people we write scripts for don't take them the way they're prescribed. There's not that partnership or collaboration between the patient and the physician. And it's really important. As he said, talk about side effects with your doctor. If there's a sexual one, talk to him or her and find out what you can do to avoid it.

DR. MARIANNE LEGATO: I also want to say that-- [simultaneous conversation]

LARRY KING: Hold on.

DR. PAULA JOHNSON: Money. I mean this is a very big issue in our country. Drugs are expensive. And even when you have coverage, you have to pay a co-pay. And co-pays, when you add up all those medications together, co-pays can be an extremely significant burden. So I think that there's an economic issue, there are side effects. It's complex.

DR. STEVEN NISSEN: But even when there's not an economic issue. We have a famous story of our ex-president Bill Clinton. Found out he had high cholesterol, was put on a statin, a drug to lower cholesterol. Took it for six or nine months and decided after he lost a little weight he didn't need it. Stopped it, and then he had a heart attack and bypass surgery. So people need to understand that if you have high blood pressure and high cholesterol, those are lifetime disorders. You don't want to be going off your medications.

LARRY KING: Is it an all-out fight? In other words, are medications equal to exercise, equal to diet?

DR. MARIANNE LEGATO: No. I think that it is said now that 80% of coronary disease can be prevented by changes in lifestyle, without any medication. However, once you've gotten, once you've had a heart attack, there are medications which clearly improve your situation and your survivability.

DR. STEVEN NISSEN: You know, Larry, a lot of people don't realize it, but in the year 1900 heart disease wasn't even in the top ten causes of death. This is a disease of modern civilization. This is what tells us that lifestyle is the driver.

LARRY KING: We brought it to other countries too now.

DR. STEVEN NISSEN: Oh yeah, we've exported it now, along with our fast food restaurants and so on. But the reality is that our ancestors didn't have this disease. They more often died of infectious diseases rather than a heart disease.

LARRY KING: Dr. Johnson, we know minorities are at a higher risk for heart disease. First, why? And what can we offer them?

DR. PAULA JOHNSON: Well, there are a number of minority groups that not only have more risk factors but they develop those risk factors earlier. So if you look at African-Americans, for example, more hypertension, more diabetes, more obesity, less exercise. And these tend to happen earlier and they're more severe. If you put that all together, you absolutely get heart disease earlier and you have more of a risk of death.

The other thing that we have to recognize in our country is that even when you present to your physician or to an emergency room with particular symptoms, we have pretty good data that says you may not be treated equally. So that's why really not only raising awareness amongst physicians and hospitals but also amongst patients to be their advocates is very important.

LARRY KING: What advice, Dr. Roizen, do people of lower socioeconomic status who are not granted access to medical care? What can we do for them?

DR. MICHAEL ROIZEN: We need to reform the healthcare system in America. We've got this horrible healthcare system. We're great if you're really sick and insured, and we're actually pretty good if you're on Medicaid, the lowest, if you will, insurance form we have. But there are a lot of people who fall in those cracks, as you said, the working poor. And those are the ones we need to help most. There are plans for getting drugs for them. A lot of the pharmaceutical firms now provide them.

But there are a whole bunch of things you can do yourself. One walk 30 minutes a day. No matter what. And call someone, so you have someone who is your support group. Two is, if you will, dump your fridge. Get rid of everything with sugar in it, saturated fat in it, trans fat, enriched flour, and just eat, if you will-- don't buy those things. And people have said, well if I dump my fridge, should I give it to a homeless shelter? No! Why do you want to kill those people? [laughter] What you want to do is really eat just healthy. If you don't get it in your home, you're going to do a lot better.

So a little bit of exercise and nutrition will go a long way.

LARRY KING: Dr. Foley, what's the best advice you give someone after a heart attack?

SALLIE FOLEY: For healthy sexual function, I use the phrase ACE disinhibitor. So A: ask, ask, ask. Ask your physicians whether or not you are capable of and able to have ongoing sexual activity. C: communicate with your partner. And E: exercise. Exercise is not just the fountain of youth, it's the elixir of love. And people who exercise regularly have better sex lives.

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