Heart Health Doesn’t Start at 40, It Starts in Your Teens. No… I am NOT Kidding

You are listening to Spot on, a nutrition and health podcast that breaks through the latest headlines to provide you with accurate and usable information that is, well, Spot on! Spot on to meet your needs. I am your host, Dr. Joan Salgy Blake, a dietitian and nutrition professor at Boston University, and the author of the book Nutrition in You. Then you kindly subscribe to Spot on and follow me on Instagram, Facebook, and TikTok at Joan Salgy Blake. You can also find Spot on on my YouTube channel, Spot on with Dr. Joan Salgy Blake. Hi Spot on listeners and viewers, today we are going to be talking about heart disease. And listen, if you think heart disease is something you worry about when you get older, like your grandmother or your mother, your grandfather, father, uh-uh. Guess what? New research came out that you need to start thinking about heart disease now when you're young, especially in your teens and early 20s. Oh my goodness, stay tuned. Okay, so I am back now and I brought the man. So Dr. Lloyd Jones received, um, his MD from Columbia University School of Physicians and Surgeon. And then guess what? He then went out and got a Master's of Science in Epidemiology from Harvard. You could kid me. And then he then, he trained here at Mass General Hospital. So he's a Bostonian. He was in Chicago, then he came back and he came back to be you, which we are so lucky. But most importantly, he's the big corner for the Framingham Heart Study, he leads it. And this is unbelievable. He's going to tell you more about this, but this is, when you talk about heart disease, this is where all the research is. And he's a past president of the American Heart Association. Hello. So Dr. Lloyd Jones, thank you so much for coming on Spanon. Thank you so much, Sean. Thanks for having me. And of course, please call me Don. Okay. But I'm really excited. We're going to talk about some great stuff today. We are. All right. So I live in the burbs and I live, excuse me, a stone's throw from Framingham, Massachusetts. And could you just explain to people what the Framingham Heart Study really is? This is amazing. Yeah. So the Framingham Heart Study, which as you said, I now have the honor to lead, is the best known study of heart disease. And in fact, one of the most famous studies based on a population in the world. So coming out of World War II, there was this epidemic of heart disease that was being recognized and was emerging. And there were a lot of reasons for that. More people were smoking, you know, our diet wasn't particularly good back then. Not much better now. But nobody really knew what the underlying causes were of this heart disease epidemic. It had never been studied in great detail. And so in its wisdom, the government created the National Heart Institute as part of NIH. And they directly funded this study to understand the origins and causes of heart disease. There were hypotheses that, you know, maybe blood cholesterol, maybe blood pressure, maybe certain things about our diet, maybe smoking were driving this. But nobody had ever really studied it in a population of people over time to understand whether those things could be contributing to this epidemic. So framing him was chosen as the site for this because of its proximity to Boston, but also because it had successfully participated as the whole town in a study of tuberculosis a couple decades earlier. So the town was sort of motivated to contribute in this way. What happened then is quite remarkable that about 20% of the town actually enrolled in this study. And the number of the people who enrolled were actually families. And the original plan was to study the development of heart disease over the next 20 years. And in fact, that's what happened. We'll talk about what the findings were. But at the end of the 20 year period, the NIH said, you know, well, we think we might be done with this study. At that point, investigators from Boston University, including Dr. William Cannell, Dr. Bill Castelli, really leading lights in this field, said, no, we have more work to do. We need to understand more, follow these same individuals further. But let's now enroll their offspring and let's understand whether there's a familial transmission of risk for heart disease as well. So in 1971, with renewed funding now based through Boston University, they enrolled the offspring and the spouses of the offspring of the original group of people. And then that study has continued to this day. So 78 years later, we're still going strong, and we've also enrolled the third generation of individuals. So the grandchildren of the original participants, their spouses, and a couple other groups of people who are more representative of the current makeup of the town of Framingham. So in total, more than 15,000 people from Framingham have been a part of this study. They've been followed for decades to understand what environmental factors, what behaviors, what other things that we can measure about people contribute to the onset of not just heart disease now, but we also have a look at stroke, we look at cancer, we look at kidney disease, lung disease, all of these sort of chronic diseases of aging. And I think as we're going to talk about in a second, Framingham is really what put on the map, what we now call the risk factors for heart disease. I mean, this is amazing. Absolutely. You must love this. It was a doctor and a researcher because she got all this data and they keep coming in this January. Like, this is like you won the lottery here. No doubt about it. And in fact, you mentioned we had been at Boston and we moved to Chicago for a bit, but I actually cut my research teeth at Framingham. I was fortunate enough to be a fellow and started my research career at Framingham, getting incredible mentoring because the investigators at Framingham have been doing this so well for so long. And so I feel really blessed to have trained there, you know, gone away, but actually to come back in full circle, be able to lead this study now. It's remarkable. I mean, I'm incredibly proud to be tapped to do this work, but the real heroes of this study are the participants across generations for 78 years have come in every two to five years and let us ask, you know, prying questions, measure different things about their body, draw blood, check their blood pressure, sometimes put them on treadmills and make them do stress tests, do a lot of different imaging, all sorts of things that, you know, they take pride and they really have passion for doing this because they understand that because of the things we've discovered in Framingham, they have changed the world and they have literally saved the lives of millions of people. What a legacy. And they, they've drilled that into their children and to their children's side. And so, you know, for people that don't do research, to have this many people stay in so long. I mean, you always have dropouts from studies and, you know, we're saying just like, "This is amazing, just absolutely amazing." So what we got from this was certain risk factors. So certain risk factors, can you explain what the risk factors were that maybe increased your risk with heart disease? Yeah. So, honestly, it took about 10 years before Framingham could publish its first paper because even though 5,209 people initially enrolled in the study, you know, it just took a while for enough events to occur so that we could actually see the patterns that were emerging. I wasn't alive at the time, but I'll, I'll use the Wii sort of generically. What they found very early on, big signal that things like blood pressure, blood lipid levels, you know, cholesterol, particularly. And smoking emerged very quickly as clear things that put one at higher risk for heart events. Over time, they could then start to see that diabetes was a very strong risk factor as well. And shortly thereafter, adverse aspects of our diet and also a sedentary lifestyle. So really, the big risk factors that we now understand, and of course, weight as well being a risk factor, you know, all those things within the first 15 to 20 years were crystal clear because they have such a strong signal in their relationship to heart disease and different types of heart disease. One thing, John, if I, if I might, just to say about Framingham that's also special from the beginning and with each successive group of people that we've enrolled there, we've always enrolled more women than men always. And that, you know, even to this day, that is unusual in medical research. What's fascinating about the early papers, if you go back and read the early papers from Framingham from 1957, 58, 1961, what they saw was what we now know to be, you know, typically true. That is that in younger ages and in middle age, more men tend to develop heart disease earlier than women, not that women don't, but they just tend to develop it a little bit later. And they describe this that in middle age, more men were getting it than women. By older age women were starting to catch up, but they also made a really important observation. And that is, there's something different about the way heart disease presents in women. The symptoms are different. The manifestations are different. And they instantly, you know, even back in 1990s. if seven said, we need to study this more. It took the scientific community decades to really take that seriously and catch up, but I'm really proud and kind of framing him, sort of understanding this early on and calling out, we can't just think that men or women are the same because they're not. You know, you're so spot on because, you know, when I was training in dietetics early on, we just worried about men and heart disease with women breast cancer. Oh, we were worried about, you know, and then we learned over time that postmenopause women, like you just said, are back up high risk of heart disease. And I'm so glad that you're looking into the differences because that is number one cause of death among postmenopause women is heart disease. And so we got to stay on top of that. Okay, now you put out a brand study, but this is the one where I read this, and we're going to put this on the spot on Facebook page for people to read, but I read this and said, what? So, you know, you think heart disease. Okay, you have to ring and say, okay, so well, to try to do good things, I'm going to worry about that in my 50s, you know, and then you come along and with this paper, it's called cardiovascular health changes in young adults and risk of later life heart disease. And what did you show? Cause I'm like speechless. Yeah. Well, you know, I think we we ask this question because we understand now that cardiovascular disease, that is things that affect our heart and our arteries. It's a life course disease. So, you know, we think about plaques forming inside the arteries. Those plaques can grow over time. The plaques are made up of cholesterol and other elements that ultimately can block an artery and can do so actually on the spur of the moment. It's not like a slow, you know, growing process when a heart attack occurs. It's a slow growing process that suddenly transforms into a completely blocked artery. So, that plaque formation though starts in children and accelerates through young adulthood and then manifests most commonly in our 50s, 60s and 70s, right? Some people earlier for sure, but for most people, they have the heart attack or the stroke in their 50s, 60s or 70s. By the time you get to those ages, we know we can't put the horse back in the barn. If you've already got a lot of plaque, we've got things that can reduce your risk, but we can't restore low risk. And so, pretty clearly, we have to start further upstream and that was the nature of this question, was does it matter what young adults are doing in their 20s and 30s in terms of their cardiovascular health status? And if it does, you know, what are the things that they should really focus on maintaining at high levels or improving so that they can avoid later life events? And so, what did you find out? Yeah. So, what we found was we used a study called the Cardius study, which is just like the Framium study. It's a little bit later in terms of its, when it enrolled people, but it enrolled people at the ages of 18 to 30. So, about 5,000 young men and women, half of whom are black, half of whom are white, half men, half women. And it's now followed them for about 40 years. And what we saw there was when we accounted for something called their life's essential aid score, which is a way to measure their cardiovascular health. We found that there were about kind of four different groups of people. There were people who had high cardiovascular health, that's good, in early adulthood, and they maintained that. And then there were some kind of two groups in the middle, and then there was a group that had low cardiovascular health to start with, and it only declined. So, those four different groups of people acted very differently, which is to say that after age 40, when we looked at who had heart attacks and strokes, the people with high cardiovascular health, three young adulthood, very rare. The people with low cardiovascular health and young adulthood, 10 times more likely to have a heart attack in their 50, 60s and 70s. So, it really mattered what was happening upstream in the 20s and 30s in terms of what the ultimate outcomes were for those people. And, you know, I know we're going to get into the details of what does that mean, what is the life's essential aid, you know, and how can I maintain my high cardiovascular health? But I think what was striking for us was that not only sort of where you started, but if you could improve your cardiovascular health, you could dramatically reduce your risk for those later life events. And I think that's what's really good news here is that this is within people's power. That's right. And, you know, okay, maybe you're 40 right now, it's still good to start. If you're 20, it's a real good to start. And I want to tell you something because I, after I read your paper and then invited you to come onto this podcast, guess what gets released this week. There you go. At the 2026 Dietary Guidance of the American Heart Association. So, I'm reading this and I look at, look, I highlighted it, okay. And it says that consume heart healthy, diet patterns across the life cycle. And it goes on to say what you just said. And I'm like, I knew that. I knew that because I read the other paper. Okay. And for once I love when I know something before people know something, but I'm so excited. So now this is what I talk about because, you know, as I teach nutrition at Boston University, it's a, I'll see your process. I worry about that when, you know, when I get there, you know, hard, now hard to see. You're not waiting, you're waiting, you got to take care of it now. And what I find on is that, you know, I teach non majors. And these students, they're getting worried about, I mean, they're concerned. They are aware now, they see their grandparents, they want to do better than the grandparents live longer, but live better, not just longer because we can keep them living, but live better. And so, they're really into this. So I wanted to get out. Oh, how important this was to look at these, what you, what you studied as risk factors and how to reduce them, the earlier, the better, for a better outcome later in life. And the American Heart Association has something called the Life Essentials Eight. And so, and anybody who's watching this on YouTube, you see the eight, that's a pin. Okay. And he promised to send me one, but we'll see you in that comes in my way. So there were eight things that you want to do. And the first one, of course, is eat better. I suspect my world. Okay, this is everything. I always say that, you know, of leading causes of death among Americans, heart disease, certain cancer, stroke, diabetes, you can fight them with a fork in a knife. Okay. And so when I saw the eat, better came first. And, you know, so give us a little bit about what this means about when you say eat better, what does that mean? Yeah. Well, let me back up for one second just from 10,000. What is life essentially? Why do we need this score from the American Heart Association? You know, we can talk about your future risk of heart disease and stroke like we've been talking about. But how do people measure their health today? I think that's actually much more relevant, especially for a young person, right? Because they don't yet have usually high blood pressure or, you know, or high cholesterol or diabetes. So how can they track their health status today and be assured that that's going to have good long term outcomes for them? And that's really what the life's essential eight construct and score are designed to do. And so it is made up of these eight metrics, eat healthier, be more physically active, get good quality sleep, and avoid nicotine in all forms. And then know your numbers. What's your body mass index? That is your weight indexed your height. What's your blood pressure? What's your blood sugar? And what are your blood cholesterol numbers? And again, those things you won't know unless you directly measure them and talk to your doctor about them. So those are the eight things. And, you know, they are all interrelated. But just knowing what the score is on those, you can actually calculate your cardiovascular health status today. And it will be associated with your long term outcomes. There's a great website from the American Heart Association. If you Google my life check or if you Google life's essential eight, you'll get right there. You can do your score within five minutes. Thank you for summarizing this because, by the way, me, I get so excited. I go right to the diet because I think the diet is everything. So all right, all right, so you corrected me. Okay, it's eight. Okay, John, stop. All right. So what is eat, when you say eat better? I mean, I know with this, but help help them. What does eat better? What do you mean? Yeah, you know this well. And the truth is, while I think there's a lot of noise these days about what a healthy eating pattern looks like, there's not really much disagreement about what a eating pattern looks like, right? It starts with lots of fruits and vegetables. It must start with that. It also starts with trying to minimize the simple carbohydrates, the simple sugars, like avoiding white flour and sugar sweeten beverages and things like that. And any carbohydrates that you are getting trying to make them as whole grain as possible. And whole fruits and vegetables, right? Absolutely. Yep, whole fruits and vegetables rather than processed or juiced fruits and vegetables would be ideal for sure. And protein, a really important part of the diet for sure, but the protein should be as lean as possible. So things like chicken and fish are better choices than red meats and processed meats. No question about it. And then, you know, around the edges, there are very healthy things. about fat. Nuts and seeds contain healthy fats. When we're cooking, we should use healthier fats. So things like canola oil, which for whatever reason seems to have gotten a bad rap, but it's actually a pretty healthy way to cook. If you're having raw oil, olive oils are really healthy fat and should be part of your, you know, what you're consuming. So again, starting with a plate that's filling up with whole fruits and vegetables, lean protein, whole grain carbohydrates are okay, and, you know, and filling around the edges with nuts and seeds for your snacks. That's a really, really healthy way to eat and to think about organizing your life. I'm so glad you talked about the oils because the vegetable oils are very healthy and you want to, you want to get the saturated fat down in your diet and the vegetable oils are higher in the unsaturated. So, you know, soybean oil canola, you said olive oil, you know, not beeftallow. No, no, no, no, no, no, no, no, see, see what the man said, please not beeftallow. Okay, so let's go to those vegetable oils. Okay, being more active, I think, you know, we know that we need to be more active and my goodness with Netflix, you could binge watch for days and get off the couch. So when your activity, we did a whole podcast, you'll love this episode on walking, which is great, some move of movement. And the take home is that you, you, it's cumulative, like you don't have to do like an hour day, you know, in one club. Right. No, that's right. You know, so I think the mantra about physical activity is if you're doing nothing, do something, if you're doing something, do more because there's, there's gain for every minute of activity that you do. Now, the biggest gain does come from getting off the couch and just doing 10 minutes per week. Like, that's where the steepest improvement in health comes. And above that, you still get more and more gain that sort of tops out around 150 minutes a week of modern figure activity. Now, that can be a brisk walk. It could be swimming. It could be biking. It could be something more intensive, like jogging or running. You know, something more competitive. But just doing something is where you really, really get the benefit. So simple walking doesn't have to be all at once. You can do it in 10 minute chunks. And just do it, you know, and whatever you enjoy is the most important answer. Yeah, you know, maybe like less ubers and more walking, you know, if it's saying everything, if you're like, there we go. All right. Now this one I can pick your brain about because this is interesting. I know tobacco, you know, smoking and heart health. And well, you talk about that, but I'm going to ask you know what I'm going to ask you. What's what's with the vaping? Yeah. Well, so, you know, we know combusting anything and breathing into your lungs is a really bad idea for your health, right? Particularly true of combustible cigarettes, because of all the other things that are in cigarette smoke that are hugely bad for our lungs. And the first thing downstream for our lungs is our heart and our heart arteries. So really tough on the heart. But you're right, you know, vaping is touted as a safer way to do this. And for sure, it doesn't usually have all the bad things we see in cigarette smoke. However, what you think is in your vape is not the only thing that's in your vape. There are plenty of other chemicals that we know also damaged the lungs, also damaged the heart. And too often vaping is used as a way to get young people hooked on nicotine. Nicotine, one of the most highly addictive substances known to man, it changes the chemical structure of your brain and gets you hooked for life. So avoiding nicotine in all its forms, including baking is vaping is really crucial. Don't even start because again, then it creates that dependency on nicotine. And you know, nicotine itself actually is harmful to the body. But the real harm, of course, is the addiction. And that someday that, you know, you may combine it with combustible cigarette use and/or the other chemicals in the vape and cause damage to your body. I read an interesting statistic on the CDC. Seven in ten high school students reported being exposed to e-cigarette vaping marketing. So, you know, you and I are old. You know, we've had the Mara Brown man, you know, and everything. But that was unbelievable to me. And they think it's, oh, it's vaping. It's just not smoking. I'm not smoking. You know, and that's why I think that's important that we get out that it's not just, oh, I'm just vaping. There's problems going on. Well, and you know, I would say we've seen this playbook before. Yes. Yes. That big tobacco, big food, big soda. They know exactly how to market this so that they will get people hooked on their product. And then they'll keep them hooked. And that's how they make money. That's right. They don't care about your health. They care about making money and making money from you. And that's I think of the message that the two few young people are getting. Right. And that was a bad movie. That was a bad movie that we had to watch. Okay. Getting sleep. That's what I thought. That's what I thought was interesting. Because you always hear you need to get more sleep. But tell me about what's the story with sleep in your heart disease. Yeah. So just a bit of background, you know, when we initially created the construct of of cardiovascular health in 2010, there were only seven metrics. And sleep was not one of them. The other seven were. We thought about sleep. But at the time, we couldn't measure it very objectively. You know, now thanks to things like this. We can. And also, we just didn't have the scientific base to say what about sleep and, you know, how much is enough and things like that. By the time we read it this and created Life Central Aid in 2022, the data were there. And we could, you know, kind of confidently point to, you know, an objective measure of sleep that if you are getting as an adult, seven to nine hours of sleep per night, that is really the optimal sweet spot. It's sort of like Goldilocks. Above that actually, health tends to decline a little bit if you're sleeping more than nine hours per night. Below seven hours and sharply, you know, as you go down it to climb sharply, you know, you really need more to optimize your health. Because sleep is so central to what happens to your blood pressure, like what happens to your ability to handle sugar and what happens to your blood sugar spikes after you eat something. It's directly related to your ability to maintain weight. It affects your appetite. You know, all these things are interconnected. So sleep is really foundational to many other aspects of cardiovascular health. And consistently getting that seven to nine hours per night is really one of the best ways that you can keep yourself healthy. You know, I read that over a third of adult United States don't get the recommended sleep, but a higher percentage of high school students don't get it. You know, so it's really, again, bad habit to start early in life, you know, shut off the computer and go to bed. cholesterol. But the cholesterol watching a cholesterol, that was something that came out of the heart. I frame him hard study. So we got getting that monitored. And what age should you start looking at getting your blood work done? So would you believe it if I told you that for children who have a strong family history of early heart disease or a family history that's known of something called familial hypercholestrolemia, we should screen them at age two. Right. For all children, they should be screened at ages nine to 11. And for sure, anybody by age 21 should have had a complete lipid panel done. So that's the very, very latest that you should have your first cholesterol test. But ideally, ages nine to 11 are when the vast majority of people should be initially screened. I want to tell you something that, you know, when I was trained in school, it was 20, it was age 20. I didn't realize it has gone down to, oh my goodness, like, I'm not here. Okay, let's go to blood sugar. You know, we've done episodes on diabetes and prediabetes. And I probably have to redo them because the numbers have increased. And I checked out that more than 40 million Americans have diabetes. But everybody just take a breath. 150 million Americans have prediabetes. I don't just say, and you know, prediabetes, I always say you're on deck to get diabetes. You don't do something about it. But that number has just inflated just short time. I'm, I'm, I can't believe it. No, it is stunning. You know, now more than 10% of Americans have diabetes diagnosed. Another 3% or so have diabetes, but it is not yet diagnosed. And so, you know, that's a ticking time bomb that people need to make sure they get the numbers measured so that they'll find out as soon as possible. But as you said, we've got a huge pipeline of people who are going to become diabetes, you know, just within, within, you know, years to a decade because they already have prediabetes. And it tends to be kind of inexperably progressive. Unless you intervene and lose, typically losing weight is the best way to kind of arrest that and maybe even reverse it. And it honestly, we'll talk about weight I know, but it honestly does not take a drastic amount of weight loss to get the blood sugar only about 5 or 10% of your body weight and you'll have a really, really nice impact. on your blood sugar, on your blood pressure too, by the way. So this is something that, while it is really hard, you know, it is very important to focus on this because the ravages of diabetes I think will be well known to many of your listeners and it's, you know, not only do you need to take a lot of medications, you need a lot of medical monitoring and if it's not well controlled, you know, it can lead to amputations, blindness, kidney problems, dialysis and of course heart disease and stroke. Not something that you want to mess with if you don't have. No, you know, when I had a private practice for years and I specialized in weight management helping people lose weight and of course, you know, they say they always come, you know, increase body fat especially around the middle, you know, have high cholesterol and high blood pressure. So I used to say, well, let's just, you know, try to lose a little bit of weight and they would lose a little bit of weight and I say, let's take your blood pressure now and it would go down. And they thought, they thought I was like this magical person, okay? But so don't tell anybody that somebody, I said, oh, oh, dude, it's nothing. This happens all the time, you know, you know, you know, I mean, so, you know, it's true that if just a little bit of weight loss will lower blood pressure, the cholesterol and speaking about body weight, let's end with body weight, so tell us about that. Yeah, well, so, you know, this is really the story of the United States since 1985, we've seen less than 10% of our population being obese defined as a body mass index over 30. Now as you said, 40% of Americans are obese and another 40% are overweight. So they are on the journey to becoming obese typically. It's a dramatic, like we've never seen an epidemic in human history of a chronic condition like this ever before. We're now the heaviest nation that has ever existed. And that has real consequences for our health. As you said, in our blood sugar, in our blood pressure, in our, in our lipids, and, and by the way, disrupting our sleep, of course, as well. And, you know, I think too often we stigmatize obesity and put this on the individual. We have built the society that created this, you know, like, you know, we can't put this on individuals. We put this on an unhealthy food supply, a society that requires people to work two jobs and work night shifts, which really disrupts all the other aspects of their health. And, you know, doesn't allow people to have a living wage, so they are forced to choose high caloric, low quality foods just to kind of keep them and their kids, you know, functioning. So, so, you know, this is a policy problem more than an individual problem by a lot. And, and I, I hate, I hate to see this stigmatization that happens around obesity because we need to help people avoid this in the first place. Yeah. Hashtag, it takes a village. Yeah. A village has to come from a policies to improve the villages, the surroundings, everything together. That's a whole other podcast episode that we could talk about. But I, I was fascinated about this study that you did. I'm thankful that you did it to get the message out about, let's start sooner than later. And now with, you know, we're talking children, let's start now you again, whenever you start as good, but the early you can start the better and let's not wait and some I'm hoping the whole idea I have you on here was to get that message out after you published this fabulous paper. So, I, I can't thank you enough, I'm glad young, glad you moved, but I'm glad you came back. Okay, because I should go as nice, but, you know, Boston is lovely. So I'm so excited that you're here and you're heading this and you stay with the American Heart Association and I'm waiting for the pin in the mail. Okay, so we're Dr. Don Boyle Jones, he's laughing at me now. I can't thank you so much for being on spot on it. Well, listen, Joan, thank you for what you're doing because you're getting the message out to people at the time when they need it and when they can act on it. And, you know, I, I can write all the papers in the world, but if nobody hears about them, it's not, not doing anybody any good. So I really appreciate you amplifying these critically important messages and your listeners are, you know, they're blessed to have you. So thank you. Well, listen, you keep writing the papers and I'll keep talking, okay? Does that sound good? Sounds good. Okay. Thank you so much. You bet. [MUSIC] Thank you for listening to spot on. If you enjoyed this episode, don't forget to subscribe on Apple Podcasts, Spotify, or wherever you get your podcast, this way you'll get every new episode every week. And, by the way, leave us a nice review. And can you also like us on our spot on Facebook page and suggest topics for future episodes? 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