The Effects of Stress on Heart Health [Interview][Transcript]

Dr_Robert_Vogel_Heart_HealthGuest: Dr. Robert Vogel
Presenter: Neal Howard
Guest Bio: Dr. Robert Vogel, MD, Clinical Professor of Medicine at the University of Colorado Denver, co-author of The Pritikin Edge, and active advocate for Pritikin ICR.

Segment overview: Dr. Robert Vogel, cardiologist and co-author of “The Pritikin Edge”, and active advocate for Pritikin Intensive Cardiac Rehabilitation (ICR), discusses the effects of stress on heart health.

Health Professional Radio – Effects of Stress on Heart Health

Neal Howard: Hello and welcome to Health Professional Radio, I’m your host Neal Howard. Our guest is Dr. Robert Vogel, he’s worked as a Clinical Professor of Medicine at the University of Colorado, Denver. He spent 14 years as Director of Cardiology at the University of Maryland and was past President of the Association of University Cardiologists. Now in addition Dr. Vogel pioneered tomographic myocardial perfusion imaging, discovered acute vascular effects of food, physical activity and media and he’s also the author of more than 250 publications and Co-Author of The Pritikin Edge. He’s a Dietary Consultant to the NIH and works as a Preventive Cardiology Consultant to the NFL. Welcome to the program today Bob.

Dr. Robert Vogel: Nice to be with you Neal.

N: Talk a little bit about The Pritikin Edge, what was your audience, what’s the book about and… ?

V: …Americans really don’t live a very healthy lifestyle, by that I mean we don’t have a very good diet, we don’t exercise enough, too many of us smoke and in general we have the ravages of daily stress. Pritikin is a program that has been in existence since 1975, it’s a lifestyle program, it was founded by an individual, not a physician who was diagnosed with heart disease and simply have looked around the world and saw that societies, countries which had better lifestyles had far less heart disease and he started The Pritikin Lifestyle Program. About 8 years ago I wrote a book, I’m very interested in healthy lifestyle, I saw that Pritikin had a very good program and I wrote a book about how to live a healthy lifestyle.

N: So you’re basically advocating this Pritikin intensive cardiac rehabilitation lifestyle, yeah?

V: Well the Intensive Cardiac Rehabilitation Program is a little bit more recent. It extends the in-house program that Pritikin has and is now applicable to people in hospitals who’ve had a heart attack or undergone angioplasty or bypass surgery so that they can get on a better lifestyle program.

N: Now it’s safe to say that you are an expert in heart health, in treatment of some heart ailments. Let’s talk about this silent heart attack, how does it differ from I guess the average everyday heart attack that we hear about? We hear about heart attack, massive heart attacks, heart attacks in your sleep. What is a silent heart attack?

V: Well it’s important for everybody to know the symptoms of heart attack, and traditionally or characteristically heart attack has chest pain or jaw pain or back pain or left arm pain and it’s kind of crushing in quality and it comes on generally without doing any unusual physical activity. So it’s that when you experience that it’s time to call 911. But 20 to 30 percent of individuals, a higher percentage in women really don’t have characteristic symptoms, they may feel tired, they may be a little short of breath but they may have what they think is heartburn or they have no symptoms at all and we think of those as silent and they may be silent because they have no symptoms or the symptoms are not characteristic or even the individual experience symptoms goes to a doctor and the doctor doesn’t recognize or the emergency room doesn’t recognize them as being caused by heart trouble and so this is the whole spectrum of silent heart attacks.

N: When I think of a heart attack, I’m thinking of you’re mowing the lawn, you grab your chest, you keel over and maybe you make it to the hospital, maybe you don’t. This silent heart attack having little or no symptoms and you say sometimes doctors don’t recognize that this has happened is a person who’s never had any type of heart attack at risk or is a person who’s had a heart attack or maybe a couple more at risk for this asymptomatic type of heart attack?

V: Well it could happen in neither case, certainly if you’d not have a heart attack before you don’t know that your heart trouble whatever symptoms you’re feeling maybe confused, it may be not typical, the typical crushing chest pain with radiation down the left arm, shortness of breath and all the things that are quite characteristic but even if you do have heart trouble, I have a number of patients who have heart trouble and some sort of a gastrointestinal problem, so they have heartburn and they have a heart pain as well and it’s hard for them to distinguish one from another. And so it can, these silent heart attacks maybe truly silent but also they can just be confused with other things. Sometimes and this is a specially true in women, the symptoms are not characteristic and you just feel tired, you’re having an off day, you may be a little short of breath, you have trouble walking upstairs or whatever and it’s nothing more than that and you may say “Well I’ll go see my doctor next week.” Well that has to be recognized as potentially heart trouble as well.

N: Is lifestyle the contributing factor to silent heart attack or can you be genetically predisposed to have a silent heart attack just like someone is a genetically predisposed for maybe Alzheimer’s or stroke?

V: Well it’s not that we’re genetically predisposed to have silent heart attacks. We certainly have a genetic predisposition to heart disease in general. About 50% who have risk of having heart problem comes from our genes, we didn’t select our parents as well as we might have. The other 50% comes from what we can correct and that is lifestyle, it’s diet, exercise, smoking cessation, stress reduction, etc. and then also knowing that our numbers are right, what’s your blood pressure, what is your blood sugar, what is your cholesterol, these are very important facets in preventing heart disease.

N: In addition to your regular normal healthy eating habits in order to prevent heart disease, are there things that we can do differently to prevent silent heart attacks specifically or does a healthy lifestyle prevent those as well as your traditional heart attacks?

V: It prevents both. That’s the good news and I’d like to add at this point that patients with diabetes, diabetes of course is really a lifestyle problem because it comes from over eating and obesity and lack of exercise. Diabetics have more frequent silent heart trouble and silent heart attacks in addition women as mentioned also have more silent heart attacks but that can be prevented with lifestyle as well as the traditional painful heart attacks prevented with a better lifestyle.

N: Should someone realize that they’re experiencing a heart attack or someone that they’re with recognized that they’re experiencing something like a silent heart attack, what is the most important treatment to begin with in a silent heart attack?

V: Call 911. The big mistake that people make whether it’s a silent or a very typical heart attack is they call their doctor or they say “I’ll drive myself into the emergency room” or whatever. You have to call 911. The risk of something catastrophic happening is highest very early after a heart attack starts, so you can pass out and you don’t want to be driving the car and pass out. So call 911, it’s a critical thing and do it quickly because time is muscle. We now open up arteries, we understand and that really prevents a lot of the damage that traditionally had been done before we were able to do these procedures so call 911 and do it promptly.

N: Great. You’ve been listening to Health Professional Radio, I’m your host Neal Howard. And we’ve been in studio talking today with Dr. Robert Vogel, Cardiologist and Co-Author of The Pritikin Edge. It’s been a pleasure having you in studio today with us Bob.

V: Very nice to talk with you Neal.

N: Transcripts and audio of this program are available at and also at and you can subscribe to this podcast on iTunes.

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