Preventive cardiologist Dr. Heather Johnson joins us this week to discuss how keeping a healthy cardiovascular system can reduce chances of developing dementia. She also discusses her MyHEART study, which aims to help young adults live heart-healthy lives.
Guest: Dr. Heather Johnson, cardiologist with special interest in preventive cardiology, University of Wisconsin School of Medicine and Public Health
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Show Notes
Dr. Heather Johnson is the principal investigator of the MyHEART study, which aims to help young adults improve and maintain heart health. Learn more about the study on the MyHEART website.
Transcript
Introduction: Welcome to Dementia Matters, a podcast presented by the Wisconsin Alzheimer's Disease Research Center. Our podcast is here to educate you on the latest research, caregiver strategies, and available resources for fighting back against Alzheimer's disease. I'm your host, Nathaniel Chin. Thanks for joining us.
Nathaniel Chin: Welcome back to Dementia matters. I'm here with Dr. Heather Johnson. She is a preventive cardiologist at the University of Wisconsin School of Medicine and Public Health, who treats patients of all ages with risk factors for heart disease. Her research focus is in finding better ways to help patients control high blood pressure and other heart disease risk factors. Thank you for being here, Dr Johnson.
Heather Johnson: Thank you for having me. I appreciate it.
Nathaniel Chin: Often we think of cardiologists as the physicians who save us when we have a heart attack, but your focus with cardiology is different. Share with us how a preventive cardiologist views our health and what cardiovascular factors you address.
Heather Johnson: Well, that's a great question. So as a preventive cardiologists, our role is to be able to hopefully help you prevent your first heart attack or stroke, but also walk with you and your family as far as preventing another heart event or another stroke. So as cardiologists, yes, we do work with patients in the ICU and the hospital, but also in clinic as far as trying to determine what may be contributing to or cause to having heart events. So for example, when we say cardiovascular risk factors, we're trying to determine what are some things we may or may not be able to change that may increase our risk for having a heart event. Things we cannot change is our age, our family history, but we do work together on managing high blood pressure, high cholesterol, and diabetes -- those important risk factors for heart disease -- to lower risk.
Nathaniel Chin: And speaking of which some of your research focuses on high blood pressure and the best ways to reach desire targets. So first, what are the targets for blood pressure in young adults and do these targets change for people as they get older, into middle and late ages?
Heather Johnson: Well, this is an exciting time to talk about that. In fact, there were new blood pressure guidelines released in 2017 and it applies to all ages, 18 years of age and older. For anyone with the top number of 130 or higher or bottom number called the diastolic of 80 or higher, so basically 130 over 80, that's what we call high blood pressure or hypertension. So that's with all ages now, and it's very new. So overall for the population goal regarding all ages, males and females, our goal is now to treat blood pressure so that it's less than 130 over 80. It's no longer divided by age groups. However, we do understand that some patients cannot tolerate having their blood pressure much lower, for example, having a risk of falls or dizziness. So we always work with each patient independently and individually as far as being able to make sure that they're at the safest blood pressure.
Nathaniel Chin: And so that came because of research findings in the past few years that led us to make such pretty dramatic changes.
Heather Johnson: Exactly. And the interesting thing about it is that although the blood pressure numbers are lower, we realized that it doesn't change how many people actually need to start medications in the population and that's important. It's a key as far as identifying who has blood pressures at a certain range that may increase their risk over time for heart disease and stroke. But it doesn't mean that a large number of people now need to start taking medications. It's more of a focus as far as lifestyle.
Nathaniel Chin: So you're touching on things that we like to talk about on this podcast, you know, diet and exercise. So what amounts and types of exercise do you recommend to your patients, and what do you tell them about diets specifically?
Heather Johnson: Great question. So for example, the American Heart Association recommends that everybody obtain 150. That's one-five-zero minutes per week of aerobic exercise. Moderate intensity. You don't have to go all out and become dizzy or symptomatic or lightheaded. So when we say moderate, basically you're still able to hold a conversation but not able to sing a song. And you can divide it up. It can be 30 minutes, five days a week. It can be broken into 10 or 15 minute increments. In addition to that, it's also important if you can, to do light weight lifting just for overall health as far as muscle and bone strength, so that's key. The dietary, I know that there's been a lot of discussion about different types of diets, but still the American Heart Association and our program supports what's called the Dash Diet. That's d as in dog, a s, h dot stands for dietary approaches to stop hypertension. And what is nice about it is that it focuses on the fact that you can make small changes in your diet -- nothing drastic -- that you can build into everyday life. However, we do caution that you discuss this with your doctor if you have any history of kidney disease or high potassium levels.
Nathaniel Chin: And the dash diet does emphasize low salt intake.
Heather Johnson: Exactly.
Nathaniel Chin: Which really speaks to what you're just saying about blood pressure. That we know that with a higher intake and salt, that our blood pressure can get higher.
Heather Johnson: It can get higher. We're noticing more and more than it affects a lot of people. So overall, if you wanted to make one change by just limiting your sodium or salt, we say to gradually work to therefore you're taking less than 2000 milligrams or two grams of sodium per day. And so that's something that you can begin to track on the labels on the food packaging.
Nathaniel Chin: One of the diets that we talk about at the research center is the MIND diet, the Mediterranean dash intervention for neurodegenerative delay. And that really speaks to this combination of very popular Mediterranean diet which is believed to be helpful for the heart but also not what you're speaking about, low salt.
Heather Johnson: Exactly. And there is quite a bit of similarity that's there, but it really depends as far as what's best regarding your underlying medical conditions and um, but overall you notice recurring themes as far as low sodium.
Nathaniel Chin: So what is the link between blood pressure and dementia?
Heather Johnson: Well, that is an area of focus that is a key area of research on it's nice here that the Alzheimer's Disease Research Center and I'm collaborating as far as learning what that relationship is. What we are beginning to notice more and more is that having high blood pressure that is untreated or even if it's treated still at higher levels, can begin to result in progression of cognitive impairment and dementia.
Nathaniel Chin: And recently a study came out called the SPRINT MIND trial and they had some interesting findings and they made a lot of news. Could you tell us about this?
Heather Johnson: It did. It made quite a bit of news and very, very briefly just to be able to share. So the SPRINT MIND trial looked at over 9,000 adults that included men, women, races including whites, African Americans and Latinos, at least 50 years of age and older. And what they demonstrated is that for someone with high blood pressure, lowering the blood pressure to less than 120, that's that top number, the systolic, to less than 120, actually had a 19 percent reduction as far as a progression or development of mild cognitive impairment. So that really lowers the risk as far as one of those key factors that we talk about as far as some of those earlier signs regarding dementia. But then also what was interesting is that although it didn't quite meet what we call the significance in statistics, it was still a trend where even a 17 percent lower risk of developing dementia, of all causes really. So the big takeaway is that regardless, male, female who we are, anyone at least 50 years of age or older, trying to get the blood pressure as low as tolerated. Not everyone can be less than 120, but we're learning that lower is better.
Nathaniel Chin: So when you think about cardiovascular health and brain health, other than blood pressure, what other risk factors should we consider?
Heather Johnson: So consider high cholesterol, for example, high bad cholesterol. You may see the LDL cholesterol in your lab panel. Another key one is diabetes. So working with your healthcare team as far as keeping the blood sugar low and stable as much as possible too. Things we don't think about as far as getting routine exercise -- so we know that even if we are at a healthy weight or maybe trying to get to a healthier weight, just being active is extremely important. It allows our blood vessels to release healthy chemicals to really help stabilize the blood vessels, lower blood sugar, lower blood pressure, and manage our cholesterol values.
Nathaniel Chin: Now you have a program called My HEART which incorporates health coaching to address high blood pressure and touches on this important issue of how do we motivate people to make change. What have you found works and what have you learned from your study thus far?
Heather Johnson: So this is a great question. My HEART is actually an ongoing research study currently funded by the National Institutes of Health, or the NIH, and it is focusing on that younger population, those 18 to 39 year olds, that have not been included in these larger trials such as SPRINT. Earlier studies have already shown that as with many people, they like to have health coaching really tailored to what their goals are, so maybe your goal is to focus on dietary changes. Not quite exercise yet, but maybe dietary. How do we begin to work with you as far as what needs to be done regarding grocery shopping lists, budgeting, making small changes week to week, month to month. The other thing is that we realized that going back and forth to the clinic just for blood pressure checks may not help you reach your goal, so we've learned that monitoring your blood pressure at home in addition to you going to your routine clinic appointments and with key telephone follow-up regarding your medications, your physical activity, your dietary goals, whatever they may be, are important. What we are studying is how this approach works in this particular younger population, which they may move around a bit more, change jobs a bit more, and begin to some young adulthood, you know, milestones as far as starting a family, new jobs, etc. And so we have a lot to learn. We have been working quite a bit with a lot of community centers, what the other institutes throughout the university and across the state also with the website called myheartmychoice.org as far as being able to really be able to help educate people regarding high blood pressure.
Nathaniel Chin: I mean it's such an important issue and it's very complex. So you're trying to address it in the most thorough and multidisciplinary way.
Heather Johnson: We definitely are. We definitely are.
Nathaniel Chin: So what do you do on a daily or weekly basis to address your own heart and brain health?
Heather Johnson: Well I love that question because it's actually something that I share with my patients in clinic. So usually at the beginning of the week -- and I actually just did it recently a few hours ago -- I look ahead to see where I'm going to schedule my exercise time for the week. Sometimes I do it out as far as the next four weeks out I do enjoy exercising. I try and make sure that I get my 150 minutes per week. Some people prefer aerobics over weight lifting or vice versa, and again, as I mentioned, the combination is important, so I try and make sure that I do a little bit of both also and still get my 150 minutes a week of aerobics. I also believe that stress management is important and I've worked very closely both personally and professionally with the UW Health Mindfulness Program, and that's key, but really being and then as a family we really focus on healthy dietary choices. But of course life is important and we still have our family pizza nights.
Nathaniel Chin: So really planning, having these set goals, working with your family to do it, and stress management, which I think is a very important issue. Also dealing with blood pressure and dealing with our heart. With that, I'd like to thank you for being on Dementia Matters and we hope to have you back in the future.
Heather Johnson: I greatly appreciate it. This was a lot of fun. Thank you.
Nathaniel Chin: Dementia Matters is brought to you by the Wisconsin Alzheimer's Disease Research Center. The Wisconsin Alzheimer's Disease Research Center combines academic, clinical, and research expertise from the University of Wisconsin School of Medicine and Public Health and the Geriatric Research Education and Clinical Center of the William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin. It receives funding from private university, state, and national sources, including a grant from the National Institutes of Health for Alzheimer's Disease Centers. This episode was produced by Rebecca Wasieleski and edited by Bashir Aden. Our musical jingle is "Cases to Rest" by Blue Dot Sessions. Check out our website at adrc.wisc.edu. You can also follow us on Twitter and Facebook. If you have any questions or comments email us at dementiamatters@medicine.wisc.edu. Thanks for listening.
