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Michael Dunne: I’m Michael Dunne. I have a dentist appointment tomorrow, and I hate going to the dentist. But I’d take an excruciating visit to fill a bunch of cavities over having to visit a cardiologist. And today, you’ll meet two local cardiologists who want to help you avoid seeing them as well. They’re two PeaceHealth doctors who are part of a growing trend in preventative care: treating lifestyle and other factors before they lead to serious heart challenges. In some ways, their advice and counsel is simple, like getting more exercise and eating healthier. But as you’ll hear, sometimes working with a doctor is key to getting motivated to make major life changes, and in this era of bogus health claims, getting counsel from trained professionals is key. Dr. Eric Muller and Dr. Kristin Linzmeyer are both cardiologists at PeaceHealth’s Oregon Heart and Vascular Institute. Doctors, thanks so much for coming on. Welcome.
Both: Thank you.
Dunne: Boy, I’m going to start with you, Dr. Linzmeyer. I think it’s safe to say that most people don’t want to see a cardiologist, but give us a sense of why most of your patients do end up needing to see you.
Dr. Kristin Linzmeyer: Well, it does vary from one cardiologist to the next why someone might be seeing that particular clinician. For Dr. Muller and myself, most people are seeing us for preventative purposes, so we focus on treating the risk factors that lead to cardiovascular events. Some of the biggest risk factors are high cholesterol, high blood pressure, diabetes and other metabolic problems, as well as the other typical risk factors like smoking and family history. A lot of people don’t want to see doctors, and they don’t want to take medications, but many people are being very proactive these days in trying to get an assessment of “What’s my risk, doc? What am I looking at here based on my numbers?” and that sort of thing.
Dunne: Well, Dr. Muller, I’ll switch to you. Maybe take us back to when that transition happened, because preventative care, I know, has been around for quite some time, but it sounds like this is a somewhat newer phenomenon of people seeing a doctor not necessarily because something is wrong, but to make sure they’re on the right path. Talk a bit about that.
Dr. Eric Muller: I think that’s an important concept, and I would say it’s changed a lot, especially in the last 10 years. Before, you sort of just got your cholesterol checked, and if it was abnormal, you got a medicine thrown at you. We’ve really had an explosion both in the types of therapies we can give people and in the different ways we can risk-stratify them, both with blood work and with imaging techniques. So when we see a patient now, it’s really more about having a conversation, just like Dr. Linzmeyer said, about their overall composite risk. We can go through all the different things that move that risk up and down, whether they’re controllable or not, and we have a lot of different options to treat them, whether it’s more lifestyle-type things or more medicines or pharmacotherapy. I think that’s really allowed us to have a more informed discussion with patients and give them much better options.
Dunne: OK. Dr. Linzmeyer, are patients getting smarter about their health care needs, about preventative medicine, about risk factors, than maybe they were a generation ago?
Linzmeyer: Absolutely. They are definitely more aware of risk factors, including ones that are more up-and-coming or more newly recognized compared to 10 or 20 years ago. For instance, a calcium score and how that might help adjust somebody’s risk, or certain types of cholesterol particles that can affect somebody’s risk, like lipoprotein(a). With all of the information out there that people can research themselves, they often come in with really appropriate questions. That being said, I can’t tell you how many times people have said to me, when I see them in the hospital having their first heart attack, “I was fine until this happened. I was healthy until this happened.” Well, knowledge is power. They may have felt well until their first heart attack, but I guarantee you they had some risk factors that likely were not identified.
Dunne: I see. Dr. Muller, I imagine part of the job of a cardiologist is motivating a patient to get better, to help them both in physical ways and in that conversation you both were talking about. Is it easier or more difficult to motivate a patient because they’ve had a health scare? Or do people come into the clinic healthy, maybe not as concerned about an imminent heart attack, but wanting guidance to change certain behaviors to keep them healthy and perhaps make them even healthier?
Muller: I would say we get a lot of both of those patient populations. With the people who have an event, you have this window right after to really aggressively change behaviors, install healthy lifestyle habits and get them on medications they’re much more willing to try. There’s a whole other group of patients who want to advocate for their own health and come in before they have problems. I recently had a 20-year-old patient come in because her father died of a heart attack at 48, and she had a little bit of abnormal blood work and just wanted to discuss it. I think that’s really the message we want to get out there: We should be seeing everybody. You don’t need a problem to come see us. And like Dr. Linzmeyer said, we have a lot of tools to find risk that patients might not even be aware of, and the earlier you make changes, the more significant the effects can be down the road to lower their risk and really prevent events.
Dunne: Dr. Linzmeyer, this is similar to a question I asked earlier, but are patients also getting smarter about family history and hereditary risk factors? That’s from people being better about asking Mom and Dad or Grandma and Grandpa about family history, but also a lot of people take those hereditary tests to find out where they come from and what risk factors exist. Talk about understanding the hereditary aspects of illness and disease.
Linzmeyer: Well, yes, I think people are asking the right questions. We really do tend to focus more on first-degree relatives for a number of reasons. One is that the sharing of genetic material is more similar in first-degree relatives. And in previous generations, there was not as much knowledge, or as many therapies, to treat some of those risk factors. It wasn’t that long ago that doctors were smoking alongside their patients, right? That’s one of the reasons we really focus on first-degree relatives. I do want to point out, though, that family history is very important, and it is something to always keep in mind and account for. However, it’s estimated that less than 20% of somebody’s individual risk is actually based on genetics. Obviously, there are some exceptions. Upwards of 80% is based on lifestyle and behaviors: the choices we make every single day with the foods we eat, the physical activity we do, the decision to consume certain substances, what kind of restaurants we go to, how we manage stress and how much restorative, good-quality sleep we’re getting. There are a lot of other factors that play a role, and I think people are really unaware of their importance. So family history is important. It’s not the only thing that’s important.
Dunne: OK. Dr. Muller, we’ve been talking about patients arming themselves with better information, or more information, and I’m going to take the other side of that. Is there just so much information available to people? And I say information, not correct information or peer-reviewed scientific information. There’s a lot out there. Does it create problems for a doctor such as yourself when a patient comes in and says, “I saw this on the internet. Should I be doing this?” or “I trust this source on YouTube. Should I be doing this?” How does that factor into the kinds of conversations you both have with patients?
Muller: Yeah, I think we see that in clinic every single day, where people come in with something they’ve read or heard, and unfortunately, there’s no filter on the internet. Every once in a while, someone hears something that’s true, but I would say probably the majority of the things I hear are incorrect. The first thing I tell the patient is to really just try to screen your sources. If you go to well-reviewed, major-center academic sources, you end up with good information. Those could be the American Heart Association, the Mayo Clinic or Cleveland Clinic. A lot of people also find the Family Heart Foundation, which is part of the National Lipid Association, the area I most focus on, to be helpful. In general, you can trust those websites to a much greater degree than anything you’re just going to find on Google or with a chatbot. So I would say I spend a significant amount of time unwinding what people have read. When we get into those situations, I really go backward, start with the basics of knowledge for them and try to address their concerns, so we can move forward in an evidence-based manner that’s more in line with current understanding.
Linzmeyer: I’d love to just jump in, if it’s OK. You also get a lot of information from influencers and other sources online, and it’s debatable whether it’s correct. Maybe it’s just not research-based. It’s not science. We don’t know. From a lifestyle standpoint, which is what I often focus on with my patients, including the nutrition we should be eating, I actually have a list of resources I give people on their after-visit summary, along the lines of what Dr. Muller just said. These are things I have vetted: I’ve read them, I’ve listened to them, I’ve watched the documentaries, and I know they’re evidence-based and science-based. I tell people these are great resources, and they can rely on the information being correct.
Dunne: Take us through the overall mission, objectives and strategies you employ at PeaceHealth’s Oregon Heart and Vascular Institute, and in your answer, maybe color in this idea of prevention versus treatment after the fact. Dr. Muller, I’ll go with you first.
Muller: I would just say that one thing we want to stress to patients is that we have a wide variety of preventive tools in-house here. Even though Eugene is a midsize town, we have a lot of resources here at PeaceHealth, both in our preventive department and in other areas like vascular surgery, our interventionalists and our structural heart doctors, so we can cover a wide variety of patients’ needs. When I see a patient, I really try to use as many of those different resources as we can to give them the best risk stratification and then the best plan to move forward and treat them in line with their wishes.
Dunne: How about you, Dr. Linzmeyer?
Linzmeyer: Yeah, I agree with everything Dr. Muller said. I would just add that many patients come in, understandably so, wanting to avoid being overmedicated and wanting to avoid prescriptions. So along with all of the imaging techniques, stress testing and various labs we can order to help calculate or estimate somebody’s risk, I talk to them a lot about how they can take agency of their health through the other decisions in their life, related to the behaviors and choices we make on a day-to-day basis that we don’t even think about, which can affect our cardiovascular risk factors and our overall risk of having an event. I really love incorporating that into my visits, because many patients have never heard that they have these options. They have the ability to take their health into their own hands, and it’s often a multipronged approach. It may involve ordering some studies while we’re estimating their risk. It may involve starting various pharmacologic therapies, but also making major strides in their lifestyle. I think they really love that approach.
Dunne: OK. Dr. Muller, I know you see individual patients, and your charge is to help individual patients, but maybe we can pull the lens out a little bit. How does what you do at PeaceHealth fit in with overall community health? I think of a patient who’s getting education and having a good conversation with you, but what’s your hope for an overall community message about preventative health?
Muller: My overall message is that we want to prevent every bad outcome that’s possible over the years we’re here and use every resource we have to improve the health of the community, whether that’s more on the lifestyle side or more on the diagnostics side. The way I look at it, I’m getting into the back half of my career, and I just want to reduce as much risk and prevent as many heart attacks as possible. There’s so much more we can do that’s not being done. Dr. Linzmeyer and I both see patients literally every week where we had so much opportunity to reduce their risk years and decades before. Our goal is to keep all of them away from us. We don’t want you to come into the emergency room. We don’t want you to need advanced procedures. We succeed if you never see us again.
Dunne: Last question for you, Dr. Linzmeyer. I totally hear that, and it makes sense. But of course, like you talked about earlier, there are times when it helps to have somebody come in to get better education. Maybe talk about that, because someone’s listening right now thinking, “OK, I’m not sure about my risk factors. I’m not sure about my immediate family’s health. I have concerns, or I just have general questions.” What’s your message to them?
Linzmeyer: Well, first of all, once in a while we do want people to come back, even if we feel their risk factors are under control, just to help remind them how to stay on the path not just to longevity, where they can live long, but to a really good health span. Having people come in for a checkup every once in a while, like, “Hey, are we still all on the same page?” can be really beneficial. However, to what Dr. Muller was saying, if we never see them again because we’ve given them the tools they need to take their health into their own hands, that’s a success right there. We may never see them again, and that’s wonderful. The message I’d put out to people is that their health doesn’t have to be just about seeing physicians when they’re sick or not feeling well. It sometimes involves a pharmacologic approach. It involves a food-is-medicine approach. It involves a movement-is-medicine approach. All of those things can help people really take control and take agency of their own health.
Dunne: Very true. He is Dr. Eric Muller, and she is Dr. Kristin Linzmeyer. They’re both cardiologists at PeaceHealth’s Oregon Heart and Vascular Institute. Doctors, thank you so much for coming on and talking with us.
Both: You are so welcome.
Dunne: That’s the show for today. All episodes of “Oregon on the Record” are available as a podcast at klcc.org. Tomorrow on the show, you’ll meet a Democratic political strategist who has some very interesting ideas about artificial intelligence. He fully believes in the dangers of AI, but he argues slowing Western AI development could make us less safe. He also has insights into how AI could influence the midterms. I’m Michael Dunne, host of “Oregon on the Record.” Thanks for listening.
