Heart experts Steven Nissen, M.D. & Marc Gillinov, M.D.

Two of the leading heart experts in the U.S. and authors of Heart 411 describe the burden heart disease places on America’s healthcare system and ways heart health can be improved.

Cardiologist Steven Nissen and heart surgeon Marc Gillinov are two of America's most respected doctors at Cleveland Clinic, the number one hospital for heart health in the U.S.

Nissen chairs the Clinic’s cardiovascular medicine department and works closely with pharmaceutical companies on developing new therapies—requiring them to donate all related honoraria directly to charity. He’s also known for his role in public policy discussions. He’s written extensively on drug safety and is senior consulting editor to the Journal of the American College of Cardiology.

Instrumental in the development of medical devices and treatments that enhance the care of cardiac patients, Gillinov is a recognized expert in mitral valve repair surgery and in the study and treatment of atrial fibrillation, a common irregular heart rhythm. He’s the medical editor of the Clinic’s Cardiac Consult and has served on numerous editorial boards.

The two renowned experts have collaborated on the consumer text Heart 411: The Only Guide to Heart Health You’ll Ever Need.

Sponsored by:


Tavis: In case you didn’t know, February is American Heart Month. Almost all Americans either experience heart disease firsthand or through the struggle of a friend or family member. It remains the leading cause of death in this country, believe it or not.

As we continue, then, our “Road to Health” series, I’m pleased tonight to be joined by two of the leading heart health experts in America – Dr. Steven Nissen and Dr. Marc Gillinov. Both are based at the Cleveland Clinic and are co-authors of the comprehensive new text, “Heart 411: The Only Guide to Heart Health You’ll Ever Need.”

Dr. Nissan and Dr. Gillinov, good to have you on the program.

Dr. Marc Gillinov: Thank you.

Dr. Steven Nissen: Great to be here.

Tavis: Thanks for accepting our invitation. Why is – and I know that it is, reading the text – why is heart disease so rampant today? Why is the risk so much greater now than at some prior point?

Nissen: We think it’s a disease of modern society. If you go back a hundred years, we didn’t drive our cars everywhere, we exercised, we ate natural foods that were high in fiber and low in fat. Our modern lifestyle has made us very vulnerable to heart disease.

Over the 20th century, heart disease went from a not-very-common cause of death to the number one cause of death not just in men but in men and women.

Tavis: I guess I’m always troubled when I have these conversations, because it’s sad to listen to that reality when this is one of those things that is, for the most part, preventable, yes?

Gillinov: I think that the most amazing thing is that we actually understand the causes. You’re completely right. We’ve got this one scientifically nailed. We know the causes yet they’re rampant in our society. That’s the most frustrating thing.

I’m a heart surgeon. I operate at the end of the line, when people have already got it, but it’s preventable.


Nissen: But if you think about the big causes – smoking; no one needs to smoke, and yet today our young people, they’re taking up smoking. Not as frequently as they did 20 years ago, but there are a lot of people smoking.

Obesity is on the rise in America, leading to diabetes, a major cause of heart disease.

Our diets are not healthy and people are not exercising. If people would just pay attention to those things, we would be out of business.

Tavis: What kind of burden – I think that’s the right word – what kind of burden does this put on our healthcare system? Over the last couple of years, of course, we’ve had a great debate about healthcare, and we’ll come back in a moment to whether or not you think that’s going to be overturned and how the politics plays out, but what burden does heart disease put on our healthcare system

Gillinov: Well, the cost, the cost of treatment is enormous. It is $200 billion to $300 billion a year, every year, to treat established cardiovascular disease. The cost of prevention would be so much less, both on the economic side and on the tragedies of people dying of heart attacks and strokes. But it’s a huge economic burden.

Tavis: What prevents us from getting traction on an issue like this? My grandmother had a saying all the time. You’d say something to her and she’d say, “It’s just too much like right.” It just makes too much sense for it not to be the case, and yet it is.

What keeps us, prevents us from getting traction on this issue?

Nissen: Well, there are many barriers, and certainly the modern society, the modern life that we live, the availability of fast food, which is cheap and easy to obtain but very unhealthy, the ability of transportation everywhere, to be able to drive even to visit your neighbors a few blocks away, we have adopted a lifestyle, and changing those habits is very hard.

It’s hard to get people to exercise. We’re all working hard, we have a lot of responsibilities, many people in our society, and they don’t find time to do these things. They ultimately pay a very big price.

Tavis: Who pays the largest price? When I say the biggest price, I’m asking specifically now demographically, who pays the highest price here?

Nissen: Well, it’s actually interesting, but poverty and health are interrelated.

Tavis: Mm-hmm.

Nissen: Poor people tend to have worse diets because the availability of these inexpensive foods is a major driver of why they’re so popular, and the lack of access to healthcare means that people are presenting much too late in the course of their illness.

It is really true in this case that an ounce of prevention is worth a pound of cure. If you can identify somebody with high blood pressure before they’ve had that first stroke and lower their blood pressure, all the costs, both human and economic, can be prevented.

So this is why this issue of universal healthcare, healthcare for everybody in America, is so critically important, because it is the most important thing we can do, since the burden is heavier on people that have the least economic strength in our country.

Tavis: Because you’re physicians, I don’t mean to make you political, so don’t let me do that, but to your point about the need for universal healthcare, so President Obama advanced the ball further down the field than any other president has, and not far enough for some of us, but farther down the field.

Yet we know full well that if the other party, the Republican Party, has its way, and certainly if they were to win the White House, we’re going to see an all-out retreat on that.

Sidestepping the politics of that, what does that do to this conversation about these kinds of diseases that kill too many Americans to see this issue become, shall we say, a political football?

Nissen: Well, this tragedy we see, in a city like Cleveland, every day. People who don’t have health insurance, and there are now 50 million Americans that don’t have health insurance, those people are suffering a terrible toll.

The healthcare reform efforts are an attempt to begin to narrow that gap, so most physicians that I know want to see no patient ever have to suffer from disease simply because they’re poor or uninsured.

One way or another we’re going to have to solve this problem and my hope is that at least in the very near future we will solve the problem, and I’ve been a supporter of healthcare reform, because I think it’s pointing us in the right direction.

Gillinov: Meanwhile, I think we can help in part by educating people. Things like blood pressure checks are not expensive, and there are some foods and some diet plans that are both good for you and relatively inexpensive.

Of course, to get out and walk for five minutes at a time, a few times per day, that’s not going to cost money.

So as we’re waiting for the politicians to figure out the larger societal problem, perhaps we can get some good, healthy messages to everyone in America.

Tavis: While we’re waiting for the politicians, to use your phrase, Doctor, to get their act together, what kind of advances have we made, and you two are obviously at the forefront of this line, but what kind of advances have we made medically for treating these kinds of ailments vis-à-vis heart disease?

Gillinov: I’d have to say the biggest medical advance, and this is your topic more than mine, the biggest medical advance is the statin class of drugs. They are so powerful at preventing recurrent or another heart attack or a stroke in appropriate people, and also help those of us who have risk factors for heart disease to avoid developing heart disease down the road.

This was a controversy we were just talking about – there are a lot of Americans who are afraid of the statin drugs, but we feel when used appropriately, they save lives.

Nissen: Even though heart disease is the number one killer of men and women, the progress that we’ve made over the last 25 years is just unprecedented. The rates of heart disease for anybody of a given age have dropped by as much as 50 percent. It’s many different things.

It’s better health consciousness and some improvements in reducing saturated fat in the diet. People are more knowledgeable about that. It’s better control of blood pressure, we’ve certainly done a good job there. We’ve cut smoking rates in half in America, those are key. We’ve developed these new medications, like statin drugs.

It wasn’t until 1987 that we had these powerful drugs to lower cholesterol levels, and now we have 25 or 30 million Americans who are able to lower their cholesterol by a third or more and prevent many heart attacks and strokes.

We haven’t come far enough; we’ve come an enormous way. But we’re looking like we may start to lose ground in the next decade.

Tavis: Lose ground why?

Nissen: It appears that the progress has been halted by a new epidemic, and that epidemic is the epidemic of obesity and diabetes. Rates of obesity in America are rising at frightening rates. In certain states it’s worse than others. It’s particularly bad in the South.

But it’s true all over the country, and because it’s bringing on this epidemic of diabetes, we’re beginning to lose the momentum that we gained over the last 25 years or so.

Gillinov: So today, two-thirds of Americans are overweight or obese. That means we may look at my children’s generation as the first generation ever that’s lost ground in terms of longevity.

Tavis: If you know, how do we stack up against other countries? Two-thirds sounds like a pretty huge number. How much worse off or – I hate to think better off – than other countries – we can’t be better off than anybody.

Gillinov: We’re not, yeah.

Nissen: It’s worldwide.

Tavis: Yeah.

Nissen: But we’re worse than other countries. It’s happening everywhere. It’s happening even in India and China and other countries. What happens is that throughout human history food was not in abundance. Now with modern society, with all the advances and the availability of agriculture and other ways of bringing food to people, food is more plentiful and we are not able, at least at this time, to control our consumption.

So obesity is rising even in countries we never saw it before, and so there is a global epidemic of diabetes that’s occurring that’s frightening when you think about down the road 10, 20, 30 years, what’s likely to happen.

Tavis: I believe in personal responsibility as much as the next person, and yet I’m always troubled, doctors, by the reality that the consumer really doesn’t have a chance.

By that I mean that there are so many things coming at you through advertisements, through specials, through rebates – you name it. We have become a consumer society, no doubt about that.

I just wonder sometimes whether or not the average American even has a shot at being healthy, for all the consumption that’s being – or potential consumption that’s being aimed at them.

Gillinov: Well, that even starts with five-year-olds. You see a mother and a child in the grocery store, and what is the child reaching for? That cereal that is just filled with sugar and calories. It’s ingrained.

We need to change our ways in fundamental ways from the very beginning. We need to make the healthy choices the desirable choices, and perhaps that means in some way we need to reward them, because it looks like the reward that’s the thought I’m going to make myself healthier, that just isn’t enough to motivate behavior today, is it?

Tavis: The question I’m raising is, how do you – for lack of a better word; let me just use your phrase – how do you reward those companies who do the right thing when doing the wrong thing is what makes them all the money?

Nissen: Well, that’s really a tough part of the problem.

Tavis: Yeah.

Nissen: First of all, that’s one of the reasons why we wrote this book, “Heart 411,” is we wanted to equip consumers with the information they need so they can pick up a can of soup and find out that it has 50 percent of the salt content that they should get in an entire day from just one can of soup.

Why is there so much salt in soup? Somebody figured out a long time ago you can sell more soup if you make it salty. Why are French fries cooked to be fatty? It’s because apparently, they sell better.

So this is, in fact, you’re quite right that a lot of these unhealthy things do sell well. We need to reward this, and the other thing we need to do is we do need regulation.

Now, regulation has now become a dirty word in America, but it’s not to people like us. There are, for example, cities where trans-fats – we talk about that in the book – trans-fats lower levels of your good cholesterol and raise levels of your bad cholesterol, and some cities have banned them. They are banned at the Cleveland Clinic. You can’t sell foods with trans-fats at the Cleveland Clinic.

Now it’s regulation, and not everybody likes regulation, but I think regulation, when it’s done wisely, can help consumers and protect them from these kinds of things in their environment.

Tavis: I want to go back to the point you raised a moment ago, Dr. Gillinov, and just for a second think outside the box, because I think you may be on to something here. When you suggested that we may have to figure out a way to reward consumers who do the right things, what might that look like? How do you reward everyday people for making healthy choices?

Gillinov: Well, one way is in the workplace. For example, there are some corporations, the Cleveland Clinic included, that will actually reward you economically if you improve your health profile.

So if you lose weight, if you start overweight, if you take up an exercise program and confirm attendance, you actually get a lower healthcare premium through our insurance policy, and other companies are taking this up.

So it becomes advantageous for you, the employee, in many ways. You’re going to pay less for your healthcare premium and hey, guess what? You’re not going to get sick. You’re going to live longer, you’re going to feel better, you’re going to lose weight. It’s a win-win-win-win.

Tavis: As I think about this issue, oftentimes corporate America does what it should do because the government forces it to do so. To your point earlier, Dr. Nissan, regulation has to be forced on corporate America to do the right thing.

Then there are instances and cases sometimes where it’s the other way around, where it’s corporate America that actually is ahead of the government. I think, for example, the issue of affirmative action. In many respects, there are certain institutions that started to advance the notion of a diverse workplace because it was in their best interests to do so.

You tell me if I’m right or wrong about this – I am starting to see examples of companies, and again, sometimes folk do the right thing for the wrong reasons, but I’m starting to see companies do the right thing now because bad health, disease, is so negatively impacting their bottom line as a company that they have to figure something out before healthcare cost ends up bankrupting their company.

So how much of this fight will be led, you think, into the future by corporate America and not even government, necessarily?

Nissen: It’s absolutely true, but I think it takes a village. I think it takes government and wise government policy, it takes healthcare reform, which we’ve talked about, and it takes an enlightened group of corporations that understand that if they can make their employees healthier they’ll be more productive, they will lower the healthcare costs for the company, and that it’s in their own best interests.

There are companies now that are putting in fitness areas in the workplace and encouraging their workers to use those, and they’re able to show a very good return on investment. This is what we have to do to turn this around. We’ve got to do it, however, at a younger age, because the problem is if our children have bad health habits, by the time they get to be adults it’s very hard to reverse it.

Tavis: I hear that point and I think we all accept that. The dilemma for me as I look at the most obese generation of Americans ever, young people we’re talking about now, the rub is this – that they are the most obese, and yet we still think of youth being connected to invincibility. So how do you crash through that?

Gillinov: I think it’s up to the parents. The parents have got to show some responsibility, and that’s not just setting an example. I think that parents have to exert some control over their kids’ habits, and that means starting with a good, healthy diet from the get-go.

You can do this. My wife has done it in my family. My kids will routinely choose broccoli over French fries when we eat out, and that’s what they like because that’s what they’re used to. You exercise with your kids. Hey, what about playing tag with your kids?

It’s a lot better for you and your kids than sitting in front of a little screen all the time playing on your Gameboy.

Tavis: Dr. Nissan made this point earlier, and it is so clearly the case, the link between poverty and bad health. That’s been well documented for a long time now.

To your point, Dr. Gillinov, I know too many parents, I see them all the time – we’re in a nice studio now up in the Hollywood area of Los Angeles, but I work, my office building is in South Central Los Angeles, so I see this all the time and I’m certainly around poor people and people of color all the time in what I do, and I choose to be there, so I’m not chagrined by that.

But I see this all the time. I was at a restaurant the other night and I saw this happen, where people who happen to be poor already are parenting kids who they wish they could do more for anyway. They wish they could do more for them, they wish they could provide more for them – you know where I’m going with this – so that so often, parents don’t like to tell their kids no.

They don’t want to deny them a trip to McDonald’s, and I’m not trying to bash McDonald’s. But whether it’s a trip to McDonald’s, whether it’s X, Y or Z, they don’t want to deny those kids.

So I know too many parents, see too many parents, often who think that denying their kids is hurting their kids when they’re already in poverty to begin with, so they don’t see that outcome that you’ve just suggested.

Gillinov: But that’s love.

Nissen: Yeah, but the greatest love that a parent can show is to teach their child the kind of habits that’ll make them a healthy adult who will live a long time and have a good life. The problem is if you raise your kids on fast food, then that’s what they’re likely to eat when they go off to college, that’s what they’re going to eat as adults and they will be one of our patients. We will see them in their forties or fifties with a heart attack, and Dr. Gillinov will see them in the operating room.

Parents need to know that if they can raise children with healthy heart habits, it’s the greatest gift they can give their children.

Gillinov: If you deny the French fries, you’re opening the door to good health. You wouldn’t send your kids out to ride their bikes without a helmet. It’s the same sort of thing.

Tavis: I’m curious here now – I’m always curious about people when they are passionate and they spend their life’s work on a particular cause, particularly when it’s in the good of the public sector or the greater public body.

One at a time, you first, Dr. Gillinov, how did you get so passionate about heart health? What’s the back story here for you?

Gillinov: The back story for me, I’m 49, dates to when I was 16 and I watched a couple of my family members go through heart surgery. That was at the Cleveland Clinic. I’m from Cleveland originally.

The next summer I got a job working at the Cleveland Clinic in heart surgery. Really, all I did was watch, but the first time I saw heart surgery I thought that was just amazing, I have got to learn how to do that.

I did a little more family research and it turned out that my grandfather actually died at the Cleveland Clinic of a heart attack before I was born. So with a family history of heart disease, seeing heart surgery at age 16 and thinking that is incredibly cool, I thought, I’m going to become a heart surgeon. About 20 years later, I did. (Laughter)

It’s not something where there’s a heart surgery for dummies guide, read that and you’re good to go, but more recently the back story to this book is after becoming good at heart surgery and working with the best team in the world, I realized I am getting to people when they’ve already got it.

They’ve got the disease. They’re like my grandfather. It’s a little bit late. Can’t we arm people with the right information so that they don’t end up in the operating room?

Tavis: The Cleveland Clinic must love this story – you started out there as a 16-year-old kid and now you’re one of their leading physicians.

Gillinov: That’s a big circle.

Tavis: Yeah.

Nissen: But it really is extraordinary. A heart surgeon who’s as focused as a cardiologist on prevention, and it’s why this partnership works for us, is that we both have the same passion. I don’t have a family story like that, but I can tell you I spent many years as a fireman, putting out the fires.

Seeing that young man like yourself coming in with a heart attack at a relatively young age, having to go out and talk to their family, to their spouse and their kids and tell them that he’s never going to be the same again.

At some point, you say this is enough. Let’s prevent a preventable disease. So we wrote “Heart 411” because we want to get to people when we can, before they become our patients. If they are already patients with disease, we want to limit the disease so they can live normal and productive lives and raise their grandchildren and so on.

So if you watch the tragedies that we see, you must develop a passion for preventing this disease.

Tavis: One of the things that’s fascinating about the text, and there are many things that make it a great book, are the myths that you take on about heart disease – the truths, the falsehoods about this illness.

Gillinov: I think that’s our favorite part, and I can tell you that until we did the research for this book I was taking an aspirin a day, I was sure that red wine was better than white wine, I thought fish oil was the manna from heaven, and now I know each one of those statements is incorrect. (Laughter)

I can’t believe it took writing a book for me to learn that, because I’m supposed to be a heart doctor.

Nissen: You know what really struck me is that I went to the Internet one day and you type in “heart disease” and you get all kinds of information, and the vast majority of it is dead wrong scientifically.

It’s terrible. We have people now out on the talk show circuit telling you that their diet is going to make you heart-attack-proof. That some ultra low-fat diet will melt away the plaques in your coronary arteries, and they’re convincing otherwise thoughtful people to not take the medications that they need and to have this magical faith that some wacky diet is going to make them all better.

We knew that it was the right time to write a book that’s based not on myth, but on fact. We acted like a jury – two of us would sit there and weigh the evidence, look at the science and then come to a conclusion. There are things in there where we tell you science doesn’t have the answer yet.

We don’t have the answer, but in areas where we do have the answer, a lot of the information people are getting now from the popular press, popular television and a lot of the books is just wrong.

Tavis: Well, the truth is here. It’s in a new book called “Heart 411: The Only Guide to Heart Health You’ll Ever Need,” written by two of the best. They’re at the Cleveland Clinic – Marc Gillinov and Steven Nissen. An honor to have you on this program, and thanks for your life-saving work.

Nissen: Thank you.

Gillinov: Thank you.

Tavis: Good to have you both on. That’s our show for tonight. Until next time, keep the faith.

“Announcer:” Every community has a Martin Luther King Boulevard. It’s the cornerstone we all know. It’s not just a street or boulevard, but a place where Walmart stands together with your community to make every day better.

“Announcer:” The California Endowment. Health happens in neighborhoods. Learn more.

“Announcer:” And by contributions to your PBS station from viewers like you. Thank you.

Last modified: July 21, 2012 at 8:56 pm