VIDEOCAST Zdrowie Lidera - Anna Słowikowska w rozmowie z Klaudia Knapik_1.mp3

Speaker1: Good morning. My name is Klaudia Knapik. I am a doctor, and I work every day in the Hospital Emergency Department, the place where I meet people at the most crisis moments of their lives. Increasingly among them are managers of various levels, successful leaders who manage companies brilliantly. However, for some reason they are losing the battle for their own health and sometimes their lives. I am also the editor of Myth Sloan Management Review Poland, where I host the Health of the Leader podcast. Where did the idea for this format come from? That's because even the best managers forget that health is not an add-on to their careers. To fundament. Can you imagine an effective manager who does not take care of himself? Who forgets about their own health in the short term? Perhaps, but in the long horizon certainly not. That's why prevention, or disease avoidance and better health, will be our focus. We will invite interesting experts who can present the results of the latest scientific research and give effective advice to our listeners and our readers. We will only invite guests we can trust, who work with an evidence-based approach. It's also worth saying that the new technologies that are the focus of the Mit Sloan Management Review have a huge impact on prevention and on medicine. We will also talk about them, new methods and technologies. Our mission is to make sure you don't end up in the ED. Instead, let's meet here in the podcast. You are cordially invited. 9:10 am. The doors of the Hospital Emergency Department are opening. Standing in front of me is a man, about 44 years old. He is dressed in a white shirt and holds a laptop in his hand. He tells me he needs to send one more email. He is pale and sweaty and later says nothing. Diagnosis acute myocardial infarction. And this is not a description of a scene from a movie, but it is an everyday reality. My daily routine is Monday morning. He is a manager. Perhaps someone like you. In today's episode we will talk about the heart. Literally and figuratively. As is well known, cardiovascular disease remains one of the leading causes of death in Poland and around the world. That's why my guest today is Dr. Anna Slowikowska. Experienced cardiologist specializing in the prevention and treatment of heart disease. Thank you very much, doctor, for agreeing to accept the invitation.

Speaker2: This is me thanking you very much for inviting the doctor.

Speaker1: So before we talk about how to take care of the heart on a daily basis. How about asking something that is sometimes far more disastrous than an unhealthy diet or lack of exercise? On misconceptions. Because myths have it that they are repeated for years and sometimes they even sound very logical. And they can cost someone's health or even life. Are there any that you face on a daily basis that you have to fight against?

Speaker2: Of course. These health myths are plentiful, but I would like to mention one in particular that is devastating. Namely, that taking care of one's health, including heart health, takes the joy out of life.

Speaker1: I haven't heard that one.

Speaker2: It goes like this. I hear this very often in my own, in my practice, very often from managers. What is the further logic of this argument, if taking care of health takes away the joy of life? Well, why take care of your health at all, to destroy your life makes no sense. Therefore, it is better to avoid all these recommendations of doctors. Well, because all in all, you have to die of something at some point anyway. Only there is one catch. In her practice in the ED, has your doctor ever heard this statement Don't save me, I want to die!

Speaker1: Oh, of course. That's how often I disagree with coronary angiography. Leave me alone already. Branch.

Speaker2: I, however, in spite of everything among young people have always heard the phrase I don't want to die in cardiac surgery. Anyone who arrives in a life-threatening situation, however, says Save Me!

Speaker1: I want to live.

Speaker2: Yes, there are different views on this issue.

Speaker1: You know, young people, young people say yes What is happening to me? I have been healthy all my life. As if it were a subscription, as if health were a purchased subscription. And they are surprised that it suddenly ended. And so they actually then say save me. On the other hand, my patients, a group of elderly people often say already, I've had enough of this suffering, Well, these are the so-called frequent losers who have advanced heart failure and are already after treatments and they are really tired.

Speaker2: Yes, here I agree. On the other hand, this group we are talking about, the group of people in managerial positions, that is, but well, these are relatively young people. Today a young person about a young person, we are talking about 60-year-olds.

Speaker1: Of course, the aging population.

Speaker2: I have never heard anyone say I want to die, just save me. And this kind of myth that taking care of one's health takes away the joy of life is really devastating, because then one doesn't want to follow any recommendations, which is completely the opposite. There is a message from me to everyone that 80% of all adverse cardiovascular events are preventable. And I have to admit, as I tell many people. This is such a disbelief, and it is. This is all hard data.

Speaker1: Health is often not tangible if we have it all the time.

Speaker2: If we have them, it seems, it will go on and on. There is also one catch in this thinking that since taking care of health takes away the joy of life, well, we won't take care of it, because we have to die of something anyway. And when you have to die of something the advice is not there, well it is better to experience all these pleasures for yourself. And for life to end when it is so called. The time will come, that is, when fate decides. And that's not so, and that's not so, because health is in our hands to a large extent and following the recommendations does not take away the joy of life. There is also a myth when I recommend patients to stop smoking. This is such a myth among managers always, practically always is the same story. Well, I will tell you such a story. My friend Kasia, who is on the board of directors of Company X, did not smoke cigarettes and has lung cancer. In contrast, my friend Gregory, who heads Company Y, smokes and is doing well. What's the catch? Such is the danger of thinking about risk factors for cardiovascular disease, but generally all on the basis of observing a narrow group of people. I call it stairwell observation, observation of one's immediate surroundings. Where is the catch? Because if we look at the entire group of people with lung cancer alone, it turns out that 95% of the people in this group are tobacco smokers. That is, if we persuaded all tobacco smokers to stop smoking, we would only have about 5% of lung cancers. Note how gigantic money on this occasion could be used to treat diseases that we cannot prevent. That is, we have influence. But I will still return to this Mr. Gregory, who smokes and is doing well. Probably Mr. Gregory, who smokes and is doing well, will not admit to a colleague that, for example. He has erection problems. And this is the first syndrome of endothelial dysfunction, which indicates that we are dealing with the onset of atherosclerosis.

Speaker1: That's right.

Speaker2: These are such traps in thinking. That's why I think we should teach everyone from an early age about the processes that happen in the body, talk about the real risk factors, diseases, in order to prevent these diseases, so as not to fall into traps in thinking.

Speaker1: This is also the purpose of our podcast. Because I also observe from my perspective that misinformation is huge.

Speaker2: Branch.

Speaker1: And what the doctor said is such a statistic drawn from the staircase. I really like this term in the context of longevity, because you mentioned if. Have you heard of such a concept marginal decade, doctor? Do we really have a say in these last 10 years of our lives? Can we take such steps at the age of 30, 40 50, to design this last decade of our lives in such a way that it does not take away our joy, that we are not doomed to suffer from chronic diseases, that we are not confined to bed.

Speaker2: I in my practice came up with such a word efficient eternity. That's why I very often heard patients' stories and why will I live so many years? Because my grandmother was lying down and twenty years she was in pampers. And what was her quality of life? So I encourage everyone to fight for a fit eternity, that is, to be as fit as possible for as long as possible. Today we are in such a fantastic era when it comes to heart health. Why? Let's go back 100 years ago. 100 years ago the American Society of Cardiology was founded. 70 years ago the Polish Society of Cardiology. 100 years ago, heart disease was a sentence. No one knew how to prevent them, what are the risk factors for diseases. Today we have this knowledge, we have knowledge of risk factors and we have fantastic treatments. And we can take advantage of that. And it's ideal today to be the kind of 20-year-old who can find out, can read up on what the risk factors for cardiovascular disease are and start putting them into practice. And I would even say even differently a mom who is pregnant may think to herself I want to give my child fantastic capital for the future. This capital is health and fitness, Because a healthy person, a person who is fit, can realize his goals. A person who is fit decides for himself, He is not at the mercy of others. And since we know so much about these risk factors, we know that we can easily prevent heart disease in a different way. Then why not do it? It is to make this last decade of life an efficient one. Let's at least look at. I recently watched an interview with Captain Baranowski. He said he gets up at 4 a.m., goes to the pool, and is over 80 years old. Can you? You can.

Speaker1: You can. When asked when he also started taking such care of himself. The earlier.

Speaker2: Tym.

Speaker1: Better. He could have gotten up at four o'clock, gone to the pool, right? But what the doctor said, well it gives you the idea that this concern starts much earlier, as I said 30 years 40. And in fact, we can, we can prevent much earlier than we can treat.

Speaker2: Taking care of your health takes the joy out of life, but it doesn't. Why? I very often meet patients who tell me Doctor, I'm terribly sorry that I am carrying on this coffee. When I was back, I often worked in the cardiac surgery department, it was very common for patients returning with coffee from the hospital buffet to hide such coffee, so that they were able to burn themselves, burn themselves with this coffee, so as not to show that they were drinking something forbidden. But this is a myth. According to all studies, coffee is healthy when it comes to the cardiovascular system. It is healthy for our body. Of course there are, and there is always some, but there are some people who are extremely sensitive to caffeine. If coffee causes an accelerated heart rate or irritation of the gastric mucosa in someone, well, they really don't need to drink coffee. But someone who loves coffee has no reason, So does healthy food. Sorry, but we are talking about the Mediterranean dietary model. Everyone who returns from Italy and Greece does not complain about the food there. So seasonal, low processed stuff, Olive oil. Quality is important, so here we are talking about such things belonging to the lifestyle.

Speaker1: It's true. I think in what you said, the problem is also the rush, because we don't overeat, and then we overeat. Branch. I myself often fall victim to the fact that on call for 12 hours I don't have time to eat. Later when I get home, I can't help myself. I eat everything without thinking about what I can actually eat and what would delight me well and that I can go to sleep and not be overeaten and not have such heaviness on my stomach.

Speaker2: In Western hospitals, where there is good management, such things are taken care of. There are hospitals in France, in the United States, where there is a special break and the doctor has to go to that break and he can get the food he likes. Food healthy, prepared fresh, because it is in the interest of this hospital that the doctor, who will have a break, will not have to think about running to a nearby store, grab something there or.

Speaker1: For the vending machine.

Speaker2: To a vending machine where you know what you can get. Yes, nothing healthy. He can go and eat a healthy salad. Fantastic. There is really no that the doctor, for example, about her grandmother's salad to.

Speaker1: Well, of course, I would like it very much, but I think we still have to wait a while.

Speaker2: I even had such notions to persuade some good chefs to come up with such food trucks under hospitals. I'm sure plenty of doctors would go there with healthy food.

Speaker1: I agree. Doctor, and how about myths such as heart attack? Doesn't it hurt? If I'm not in pain in the cage, everything is fine. Or that slightly elevated blood pressure is nothing. Do you hear such phrases?

Speaker2: That's right. In the case of heart disease, we have the misfortune that these risk factors don't hurt. Very often, elevated blood pressure does not cause pain, headaches or chest pain. Of course, these are individual variations, but in many people, elevated blood pressure, elevated lipidogram values, high triglycerides do not hurt. They hurt when it is very late. And that is why it is so difficult to convince. A groundbreaking study when it comes to cardiovascular disease. There was the Framing Heart Study. I mean I really like to talk about this study so briefly, because it is insanely illustrative. In 1945, President Roosevelt died. He died of hypertension. A hemorrhagic stroke occurred, and most likely President Roosevelt had a blood pressure above 320x200 at the time. And then President Truman decided that he needed to conduct such a major study in consultation with scientists and doctors from Harvard University. Such population-based, to assess what the risk factors for cardiovascular disease really are, because then lots of people in the United States were dying from heart attacks. Really back then, people didn't yet know that elevated cholesterol, that abnormal glucose values, that elevated blood pressure negatively affects the cardiovascular system. And such a factory town was subjected to observation, which was just near Boston, the home of Harvard University. Well, and we are still using these conclusions today. But we can use them. We don't have to follow in President Roosevelt's footsteps. This is a gigantic benefit. Just knowing the risk factors.

Speaker1: How about the genes? We are doomed to our genes, because I also often hear you know, such genes are already nothing, nothing I can do about it. Are cardiovascular diseases genetically inherited? Is there a predisposition and do we kind of already agree on that Basically, that we have an influence. But how is it with genetics?

Speaker2: Genetics in cardiology is an extremely, extremely interesting topic. Unfortunately neglected in Poland. I won't be alone in this assessment spoken on the subject recently by the PTK president himself, Professor. Gil. We have a lot of work to do here. Why? We have come to the conclusion that it is worth testing the lipidogram of six-year-olds. Already such a screening program is about to enter. There are people who, despite having the best lifestyle, the best diet. They can. They have a high risk of adverse cardiovascular events, including myocardial infarction. For the reason that their liver produces excess cholesterol, and it is necessary here to act very early with the appropriate drugs. Of course, health in general is all about risk management. The more risk factors we control, the better. But genetics, for example, just unfavorable in this, in the form that produces excess, the liver produces excess cholesterol, but there is also a narrow group of connective tissue diseases, for example, Marfan syndrome. And these are people who are not guilty of anything that they have inherited in their genes, or as a result of spontaneous mutation. Because it sometimes happens that the so-called Marfan appears in the family, that is, there is a spontaneous mutation. We will not bore you with such details here. What does it consist of? But the point is that it comes to building connective tissue, which is everywhere, including in the vessels, in our bones. To the defective protein and are those who should undergo genetic testing in order, for example, to be subjected earlier to heart surgery, replacement of the ascending aorta with a prosthesis. Why? That's because in their case, we know that the criteria for replacing the aorta with a prosthesis are stricter. We need to get out earlier, get in earlier with this exchange. That is, cardiac surgery is the prevention of sudden death. That's what modern medicine is, a look that's not just diet. There are genetic defects and therefore we must be very attentive to this good.

Speaker1: I would like our listeners to understand that Ok, that is, there are genes over which we have no control and with which we can no longer do anything. But then there is epigenetics. Yes, this is something we have influence over.

Speaker2: Here I will give a very interesting example. Recently there has been a lot of talk about lipoprotein, a. Yes, yes. This is a lipoprotein, or conglomerate of proteins and lipids, that indicates high gene-related cardiovascular risk. And there are such works that researchers have examined. People who live long lives are doing well despite this elevated lipoprotein a. But what does it turn out to be? They had other risk factors under control. That's it. This is the clue of the matter.

Speaker1: Mhm. Well, doctor, but before we start to change something, well, that's what we should know what to change. So what tests are worth doing? We already know that it would be good to do lipoproteins. I guess each of us once in his life should perform such a test for himself, right?

Speaker2: Definitely yes.

Speaker1: Well, and cholesterol? What is cholesterol? How to read a lipidogram? Should screening be done annually or more frequently? Could you give us a little background on this topic?

Speaker2: That's all. It all depends on individual factors, additional risks. At least once in the beginning, everyone should. I said a while ago about six-year-olds. Branch. To catch this group of people, a narrow group of people with familial hyper cholesterol, where these are the people who are at risk for heart attack, for stroke at a young age. We're talking young by as much as 20 years, but in general everyone should screen for fasting glucose, a full lipidogram and blood pressure measurement. These are such the three most important things in evaluating the cardiovascular system. How do you look at cholesterol? I stopped telling patients about bad and good cholesterol. This is, unfortunately, our medical error that we use this kind of oversimplification. We should talk about bad and good lipoproteins. Because cholesterol in our body, cholesterol is fat, right? Why did I just start talking about this bad Cholesterol that we shouldn't be talking like this? It happened to me because my hospital where I worked for many, many years, the hospital on Banach Street, across the street we have a friendly Warsaw University. Lots of very educated people in physics and chemistry. They always told me What are you doctors diming with this bad and good cholesterol? After all, it is the same substance. And of course they are right. Cholesterol. This is the same chemical. There is no bad cholesterol and no good cholesterol. We used this as a simplification. There are good and bad. Lipoproteins, lipoproteins, a combination of lipids and protein. Lipids in the body are carried this way because it is known that they do not dissolve in water or dissolve in the blood, so they must be. Nature figured it out so that they are packed with proteins and those beneficial lipoproteins, namely high-density lipoproteins HDL. That, in a nutshell, is how they pick up excess bad lipids from the walls of the arteries and lead them to be disposed of in the liver. On the other hand, these low, these low-density LDLs are the bad lipoproteins that transport under the vascular endothelium of the arteries. Lipids promote atherosclerosis, so we have good and bad lipoproteins. Of course, the topic is more complex, but here we would run out of time, we would have to reveal the secrets of biochemistry.

Speaker1: Yes, I agree. On the other hand, if we do a lipidogram and look at the results for our managers, what should concern them? Triglycerides. Not HDL, LDL so they can see. Ok, fine, then I'm at this particular starting point.

Speaker2: I would encourage them not to look on their own, but to go to the doctor and have the doctor interpret in the context of the whole clinical situation. As we know the targets are, first of all, whether to treat or not to treat is a matter for the doctor. Doctors do not always prescribe specific drugs. Sometimes we recommend a change in lifestyle, a change in diet. That's why it's important to see a doctor, because if someone has already had an incident, a heart attack, a stroke, and compare their lipidogram with a colleague in the office. And this office colleague's lipidogram may be paradoxically better, so to speak. I mean here there are many, many certain variables. Sometimes a person with normal lipidogram values needs to get the right treatment, because it is not de facto lipid-lowering treatment. This is a treatment that reduces the risk of further cardiovascular incidents.

Speaker1: Tak? That is, you have to look.

Speaker2: More broadly, don't make such an office diagnosis for yourself.

Speaker1: So it depends on the cardiovascular risk that our doctor will already determine, Yes?

Speaker2: It is necessary to look multifactorially, for the reason that this is what can bring us down, lead us astray such self-diagnosis.

Speaker1: Okay, well we have a lipidogram, we have this lipoprotein what about homocysteine?

Speaker2: I this homocysteine today we do not recommend, because it turned out that there was a little work on homocysteine. There were problems with lowering concentrations, but it turned out that this did not translate to the clinic. It wasn't. Despite the treatment of high homocysteine values, satisfactory clinical values were not obtained, as this should also be emphasized. It's not like we doctors are treating test results. It's all about human gain.

Speaker1: Context all counts, yes.

Speaker2: So that it gains a person. Is clinically Just as there have been studies with statins. What began to convince us most was that they reduced mortality, reduced the risk of adverse events. There is no point in treating the parameters themselves. It's a question of whether this translates into a tangible clinical benefit, a reduction in strokes, a reduction in brain attacks and a reduction in mortality. This is hard data. So it's not like executives rely on numbers and hard data, and we doctors don't just rely on us. This context is very broad.

Speaker1: And if you could pick that one habit that could be considered a long-term investment for our listeners and our readers, what would it be?

Speaker2: I for one would not want to talk about a single habit.

Speaker1: Ah, I knew you would say that.

Speaker2: No, because one does not exist Holy Grail. I would perhaps say one prescription with several points on it. First, non-smoking. Really, no one today will defend the thesis that smoking in any way can positively affect health? Absolutely not. Quitting smoking is the bottom line. Secondly, such a habit is worth having so that junk food is not stored at home. That's what it's all about when a person comes home from work tired. It's to make him throw himself into healthy food, Healthy and good? Branch. If we don't store, If we don't store some highly processed bakery products, stuffed with trans fats, hydrogenated, hardened palm oil, saturated with glucose-fructose syrup, then even if we eat a cake with a scone of our own making one piece plus jam from grandma, that's really it. This is the difference when it comes to the impact on our health. That is, smoking, low-processed food not behind, not hoarding at home as we go back.

Speaker1: At home, junk food is thrown in so as not to be tempted.

Speaker2: So as not to be tempted. Point three bathroom scales. To have this habit of controlling this weight, have we not exceeded, Are we not starting to cross a dangerous line? Yes, because it's easy to correct a kilogram two than later 20 30, so this weight matters to stand somewhere in the bathroom.

Speaker1: That is, not only does the doctor suggest that one may not notice in the mirror, however, how one looks at oneself every day, and somewhere that boundary may elude us.

Speaker2: Well, unless it's pants or a dress, then sometimes. Sometimes it's such a good barometer, too. Does anyone fit in.

Speaker1: In this context, it is easier, or even more difficult?

Speaker2: This I can tell an anecdote. One of my colleagues, as he wanted to reduce weight, bought his favorite suit, a size too small, and was motivated. He spent a lot, so he wanted to. He wanted to fit into a suit. Such an anecdote. Now point four of our habit. Visiting a doctor once in a while just to control these risk factors.

Speaker1: And what does it mean once in a while?

Speaker2: It also just depends on what stage of life someone is in. Now there is a former balance sheet of 40-year-olds and it was a big fiasco. Yes, for several years the research was available, and lots of people didn't sign up. This is such a good example. All you had to do was come forward to investigate.

Speaker1: Although that's when I have some symptoms. I definitely report. Good morning doctor. It's been a long time since I've been to any checkups. Please check that everything is in order.

Speaker2: Or patients come forward because, for example, my father had a heart attack at 40, I'm 35, and I don't want to go down that road. I have children, I have a wonderful family or I have my work, my passion. I want to be fit, nothing is happening, I want to check and then glucose, lipidogram, blood pressure values. Why do I bring this up? These are very simple things. In Poland, one million people do not know that they have diabetes, that they have elevated glucose levels. How trivial is this study As much as we would complain about the health care system in Poland, believe me, no one is satisfied. English people are not satisfied with their time either, but at the same time, don't we sometimes want to do really something small for ourselves, which can absolutely change the functioning. Glucose. Borrow a glucometer from a friend, a grandmother, an aunt who has diabetes. This is such a screening test, and then, you know, full diagnostics. This is already in the doctor's office. Three million people do not know they have hypertension. I once even in the media said maybe let's do such an action, measure your neighbor's blood pressure. And it turned out, and it also turned out to be an anecdote, but actually a real event. An acquaintance told me that in her village store all the ladies of the housewives' circle ran to get batteries, because it turned out that the blood pressure monitor at home was there, only the batteries didn't work.

Speaker1: Well there is a saying even. You can't improve what you don't measure. That is to say. Is it pressure? How to measure every day three times in a day? Once a week. How do you chalk it up to catching that moment when I'm hypertensive?

Speaker2: A few times at random and see if it repeats after all. I had an engineer patient recently who said Ha, I caught my orthopedic colleague. My wife told us to get going, so I took a blood pressure monitor. A friend of the orthopedist came and I tell him Well, man, you're 160 out of a hundred. The orthopedist didn't know he had hypertension either. Sometimes doctors don't want to know either. The shoemaker walks without shoes. I always do, too. On the issue of glucose, I give the example of Michal Figurski, who is now doing much, much good work. And he himself is not breaking medical confidentiality, as he himself has been talking in the media about entering incorrect blood glucose values. He was pleased that doctors were satisfied with his treatment results. These were absolutely false glucose values. He suffered from type one diabetes. Well, and ended up with kidney failure, the need for dialysis and a hemorrhagic stroke. This is such an example. Second example. The Tiloff leader also told that he has been talking about it in the media for some time. He was taking medication for high blood pressure, as doctors had diagnosed his hypertension. But that's how he felt, that when he takes these pills, well, somehow he feels so old. Maybe, maybe there is no point. And he also woke up with a hemorrhagic stroke in London.

Speaker1: Well, that's what I don't quite understand about this question. Will I have to take these drugs for the rest of my life already? You know, doctor, then I have such a feeling as if I am proposing to cut off a patient's leg.

Speaker2: Yes, I also have this feeling very often and what? And that's now, for the rest of his life. That's when I talk about this Framing Heart Study. Let's be glad that, first of all, we know that this is a risk factor, and secondly, let's be glad that we have such a wide choice of drugs when it comes to hypertension and diabetes. We live fantastic times and problem in this regard. And while the problem a hundred years ago was because it was more or less there, a hundred and two or three years ago insulin was synthesized and people who had diabetes were dying because there was no drug. Today we have the whole spectrum of drugs, the whole spectrum of knowledge on how to prevent type two diabetes. And when someone receives a prescription that they need to treat their diabetes, suddenly there is such a frowning face. And what are you doing to me here?

Speaker1: Well, what the doctor says is.

Speaker2: Health Awareness.

Speaker1: This is health ignorance. But the way the doctor explains it to me, it's kind of coaching for that patient. We don't always have. I for one don't always have that much time for one. Per patient, but I assume that you do as well. Well, and just how is it in this study? Czy. Does your doctor integrate different approaches, or is she rather short of time, towards which only conventional medicine I mean. Maybe I'll make it more specific integrating different approaches. I have in mind not only the kind of coaching I mentioned, but perhaps mindfulness, maybe some meditation.

Speaker2: I have a license to practice, a specialization in internal medicine and in cardiology, and my approach is absolutely based on the guidelines of scientific societies, cardiology societies, the European one, and part of the European one is the Polish Society of Cardiology plus all these world recommendations. And here I will surprise everyone the right way to eat is in the guidelines there is nothing. This is no unconventional medicine. Moreover, cardiovascular disease prevention guidelines. We have a phrase that says that the right nutrition model most known here is the Mediterranean model, very simple to implement. We could get gigantic benefits at the population level if everyone implemented the right way of eating. This is evidence-based medicine.

Speaker1: That is, diet. Ok.

Speaker2: That is, all these guidelines plus nutrition and mindfulness, that is, let's say, such focusing techniques, relaxation techniques, mindfulness training This certainly matters, because a person who is busy in the number of things, if he does not devote at least this minute to his own health, to reflection, then very soon he may not have the efficiency to control various things in a while, especially executives. If someone doesn't lean into all these habits, that is, this prescription I mentioned a moment ago, they may not stop to take care of their health. This may turn out to be a matter of time before it loses efficiency, and instead of running all those business affairs of its own, it will be at the mercy of others.

Speaker1: That is, I would like it to resound that mindfulness is also such an art of stopping. Yes, yes.

Speaker2: Such a reflection in my opinion, such a reflection on what we should do for ourselves to continue to lead a happy life. And this has nothing to do with any shamanism. What's more, for example, professional relaxation techniques are carried out in cardiac rehabilitation units for people after heart surgery or heart attacks. Why? That's because it turns out that roughly 40-60% of people experience anxiety after heart attacks or surgeries. And this fear is so paralyzing that it can lead to unfavorable behavior. Which ones? Such that, for example, someone, through the prism of anxiety, starts reading pamphlets and instead of taking drugs that are a boon, that stabilize atherosclerotic plaques, such as statins, i.e., prevent further adverse events, he or she looks into these drugs for all the side effects that may have happened in some narrow group of people and condemns oneself to the risk of further events if one does not control this anxiety. Sometimes it is even necessary to consult a psychiatrist. If this anxiety is so severe, sometimes entering even for a short time with pharmacology.

Speaker1: Well, that's the way it is for patients, the doctor said, those after cardiac surgery. And I wonder if there is a connection. Means certainly have, but with stress that can be harmful to us. How is stress in the cardiovascular context? Because we know that we all have stress. But is he harmful? If it is harmful, in what form or at what dose?

Speaker2: In general, we all know that life without stress does not exist and it is impossible to even get into a car to commute somewhere in a crowded city. Whether there will be a traffic jam or no traffic jam. Everyone is nervous about whether they will make it to any meeting just in time, even though they got up at the right time, so the stress is permanent. These days. But I would turn to the management team here. Unfortunately, he receives a great number of patients who complain that they live under excess stress, which is caused by poor management. That is, a lot of unnecessary tables to fill in tasks to be done yesterday or the day before yesterday. And this stress, chronic stress kills. Because it is a chronic stimulation of the adrenal glands to produce cortisol. And it's not healthy. And how about all this? Sometimes overlap some more on chronic stress, on fatigue, overlap some more incident at work, some extra trigger, well it can even end up with a syndrome. Yes, because of course it is a rare syndrome, but in people with some predisposition it can happen.

Speaker1: So have you experienced such a case of someone having a heart attack solely from stress, Doctor, Yes. So do you think that managers are potentially cardiac patients?

Speaker2: Managers have a two-way influence. There are individuals sometimes not. I won't give away any doctor's secret here, but very briefly there once a week or once two days a week, two days a month he accepts patients who have certain subscription cards. And I have to say that there are a lot of people coming in just talking about this stress generated by work. On the one hand, they themselves need relaxation, but on the other hand, they talk about this stress generated by either their subordinates who don't deliver certain things on time, or by cadres of so-called stop leadership who don't quite know what they want, how they manage the company. So the health of the people, the company where you work, but also vice versa, depends on the quality of management. This is such a dual relationship.

Speaker1: What convinced me, I believe, is that stress is not only due to external external factors, but to an internal conviction, and instead of suppressing it, you need to tame it. Because we have this research that exposing ourselves to gradual, controlled doses of stress triggers the Hermes effect in us. That is, we simply already know how to deal with this tension. And they even reportedly increase creativity. It's just that indeed, in order to manage it, you need to be in a certain homeostasis. Well, yes, we can't be perpetually sleep-deprived, we can't have fevers and private affairs, because we can't. If we have some kind of failure in every perspective of our lives, well, it's probably harder to put it together into some kind of working whole.

Speaker2: Definitely yes. Definitely yes. Short-term creative stress. Creative. The need to do something good, I don't know. To create something, to create something. Yes, at work, as a rule, my patients do not complain about it. They complain about poor organization.

Speaker1: That is, chronic stress.

Speaker2: Chronic chronic stress kills creative stress. Well, there is no creative work without stress. Let's not kid ourselves. But even then, such stress can indeed be managed. Does he agree? But it is difficult to manage permanent, chronic stress, such as that associated with some form of bullying at work.

Speaker1: Branch.

Speaker2: It is difficult to manage this if a person entering the workplace, and unfortunately very often share these thoughts with their own. My patients say they don't feel like taking medication anymore because they would rather. And that's the dangerous line, that if a person is so, crosses a certain line of this stress, that he is so bad or things don't work out at work, things don't work out at home, how many things roll up on a person, some kind of bereavement, having to take care of parents or loved ones who have all kinds of dysfunctions. Exactly what the doctor said If there are too many of these things, then at a certain point a person does not feel like taking medication, does not feel like taking care of himself, does not pay attention to his health. And it's a tipping point.

Speaker1: Mhm. And this chronic stress, does it have a direct effect on cardiovascular incidents, for example, on the endothelium or vessels?

Speaker2: It has, of course, because it is chronic cortisol stimulation of the whole body. This has an impact on resistance to everything. But also just referring to these ways of relaxation, there was a study that I keep citing in an Italian city there was this dome with frescoes, a church with a beautiful dome. And there they tested the cortisol concentration in the saliva of people who went in to admire these frescoes at the entrance, and it turned out to lower cortisol levels at the entrance. With that said, it was a very interesting study from the angle that people were invited who said they were generally not interested in art. These were not enthusiasts And it turns out that communing with art, with nature reduces cortisol levels, has a relaxing effect.

Speaker1: I have to say after myself that I tried the meditation technique and at first it sounded to me at all like some esoteric ritual, that I associated with soft pillows and candle burning and that I would now sit in the lotus flower position and do nothing. But a little out of necessity, a little out of desperation, I started practicing it. And the important thing is you don't have to do it in a static position, you can do it in motion. Because in the beginning I tried just sitting, and I know that these thoughts are like trains, that I should not stick to them, not get on them, but it did not work for me at all. An important point meditate can be done on the move, you can run in the woods, you can. You can go for a walk in silence. And this, too, is a form of meditation. And actually I may not have become a Zen monk, but I think it's such a soft power for the brain and it works.

Speaker2: Any physical effort.

Speaker1: Mhm.

Speaker2: Everything we do. With that said, physical exertion is associated very unpleasantly. And this is about any form of movement that is enjoyable. For someone it may be dancing. I always tell heart surgery patients with a cut sternum that tango is not yet, but salsa solo yes. Music + movement really has an extremely soothing, relaxing effect, so not even necessarily meditations. What's in it for everyone. Here you have to put on individual preference, because if we tell someone you have to go meditate because you will be better off, we will not achieve any good effect. Everyone must find some such suitable form for relaxation.

Speaker1: I wished, I wished, to be able to sleep better and it actually works. Also, I recommend it to everyone. I have one. I have such a certain uncertainty. How do I tell the patient if you have tried meditation? They always look at me with such a question mark, as if I were talking about things from outer space. But I can already sense who you can, who you can't tell, because it has to be explained. Branch. Well, even I really as if I talked to the doctor and 5 years back we would talk about meditation, I would say it's not for me at all. I have such a kinetic personality that no meditation. Excluded, but nevertheless, a person changes over time and we need to expose ourselves to various new experiences.

Speaker2: Experiment.

Speaker1: Experiment.

Speaker2: But I would also like to cite a very cool book by a British journalist. I can't remember the title of the journalist who struggled with anxiety disorders, and in her case, in addition to pharmacotherapy, in addition to classes with a psychologist, with a professional psychotherapist, she described day after day how much running helped her. This is absolutely justified from the point of view of physiology. That is, the movement, the effort makes sense. It reduces, reduces definitely the stress level, has an anti-anxiety effect, there are a lot of publications. As we doctors know, however, we must have this hard data. There is a lot of literature that says that adding any form of movement that is enjoyable and acceptable reduces anxiety and stress levels in people with anxiety disorders, and she also wanted to tame this topic of anxiety disorders right away, because it's such a stigma sometimes, right? According to today's research, I'm not, I'm not a psychologist, but I benefit from these gains. According to today's many publications, anxiety is something that is inherited, so it's not like women are sometimes tried to get such a patch, but men are too. And you're a nut, right? Nie. It's just that sometimes there are genetics that this one, that this anxiety has a higher level than in other people. And this is no one's fault, because such attaching a patch you are guilty, because you are probably some other, some strange.

Speaker1: It disagrees, that is. This is a very long topic, I think at least for one more episode. But doctor, innovations in cardiology. In your opinion, what has more weight, more importance pharmacotherapy or new devices?

Speaker2: And both. Working in cardiac surgery, one learns the benefits of minimally invasive techniques. Still as my older colleagues told me, it was unthinkable to treat a valve defect, and ortal by the transcatheter method. This was a method invented in 2002 by Professor Alain Criber in France. In Poland that year we celebrated the tenth anniversary of the method, that is, by catheter implantation.

Speaker1: That is, we do not need to cut the sternum.

Speaker2: It comes out even. The point is that the most important difference between classical surgery, that you do not need to stop the heart and connect to extracorporeal circulation. This is for people with a high postoperative risk, as it is often the elderly who suffer from steno za ortal. There is a degeneration of this valve and it needs to be replaced. Profs. Creeper was a big proponent of this method. Of course, in the beginning, he met with a lot of resistance from the cardiac surgical community, well, because no one imagined what it would be like without extracorporeal circulation, some sort of stab at the heart. Well, but it turns out that this method has spread and today has become the standard of treatment. Robotic techniques are also entering with great momentum. At the same time, I would like to calm the mood a little, not always non-invasive means better. Sometimes there are people to whom we should definitely suggest a method. At least we are talking about the state of knowledge here today. Yes propose a method that is perhaps more invasive, but may be more effective for the person. You have to match the right method to the right person. And I would like to make it sound, because sometimes patients will read something there about some news and I want it. Well, not necessarily, not necessarily.

Speaker1: It seems to work both ways. It's like some people are afraid of coronary angiography and sometimes coronary angioct can be done. The patient does not need to be referred right away.

Speaker2: Of course. At the same time, today we can talk about it, but I don't know. 20 years ago this CT of the coronary arteries was of very poor quality, so it's all true. One must. In medicine, everything must be superimposed on a temporal context. These are the robotic, minimally invasive techniques, but also breakthrough drugs today in the treatment of obesity and in the treatment of diabetes, in the treatment of lipid disorders. But the biggest breakthrough it will be, is if we can convince people to follow the recommendations.

Speaker1: That is, no AI.

Speaker2: Branch. Following the recommendations of your doctor this year you probably remember. On March 27, we celebrated What Day, or Medical Adherence Day. We have the most trouble with this. It turns out that calculations have been made that some 120 billion euros or so are lost annually in the European Union due to non-compliance with recommendations on how to lose. I have an example of a patient who chose not to go to the ED with chest pains because a neighbor there convinced him that maybe he would swallow some kind of pill, that he was too young to have a heart attack, that maybe he would swallow some kind of pill for supplements, for beauty, for beauty, for beauty or metabolism. Tak? Well, and he felt that he should, that something was wrong, because these ailments were increasing, receding. He felt that something was wrong, but says Okay, if I have to wait in this ED, I might actually swallow something there. It ended up that in two days anyway he had to be in the ED ze, had a coronary angiography done. Moreover, treatment of acute heart failure, as the heart has been significantly damaged. It ended up with a left ventricular assist pump. A heart transplant is in prospect, sometimes a single decision. There is a professor in the United States. He was for many years the head of the FDA cardiologist, who said that the American public is being killed by mission, medical information. It's not about such intentional misinformation. The point is that someone who has no idea about the processes, advises a neighbor, a neighbor, someone advises someone in the office you don't know what, it's so swallow, something to alleviate the ailment and we waste precious time. Time is muscle.

Speaker1: We live in a world of pseudoscience and false authorities.

Speaker2: I agree and that is the most important thing. Me thinks this is the biggest challenge at the moment. Moreover, this is not just my thesis. This is the thesis that many scientists in today's world are making, that adherence to recommendations If we managed to convince as many people as possible to adhere to rational recommendations, for example, to treat hypertension, we wouldn't have so many heart failures in Poland. In Poland, roughly one million, 200, one million four hundred thousand people suffer from heart failure. Some of these people would not have had to suffer heart failure if they had started treating their hypertension in time. Time, understanding, understanding the processes is the key. There's also that largest public health study in the world, conducted by the University of Washington in Seattle. And from this study it is evident that a lot of people just in the 21st century are dying or dying prematurely or becoming disabled prematurely from preventable or treatable causes. 100 years ago, this was not possible.

Speaker1: Today there is something to remind us of this. For example, wearables. Those devices we wear on our bodies, watches, smartwatches that monitor our heart rate. Because the pressure probably isn't there yet. What do you think?

Speaker2: I would not be so attached to gadgets, for the reason that precisely the second sin of the management staff is. I know people who bring me 10 lipidograms, but they don't want to take medication. For example, they can do a lipidogram every six months. But this is not yet the moment. I would maybe for sure these devices. Many devices are great, such as continuous blood glucose monitoring. I think this is something fantastic for people with diabetes. In addition, you can check for yourself how the specific foods you eat affect your blood glucose levels. Is this fantastic dark bread actually whole wheat bread? Is it just low-value bread colored with caramel and added glucose-fructose syrup that will immediately cause glucose bursts. These devices are insanely important. I would rather advise sticking an American eight for the heart or a Polish ten over your bed. Whatever. If we stick to ourselves there and look at these important things to keep an eye on every day, then even if we don't buy an expensive watch, for example, while running we will even hook up with a pharmacy, measure our blood pressure. Really. The secret lies in simple actions. Sometimes it is necessary for someone to have such a terribly expensive gadget, but then he says E anyway, it seems to be misrepresenting.

Speaker1: So heading to the end, as if we had to sum up and pick three pieces of advice for our listeners and our readers, what would they be? Such three condensed.

Speaker2: First, for one piece of advice.

Speaker1: Listening.

Speaker2: About these many tips, we talked about prescription, we talked about learning to manage your own health, in other words, taking care of your own health. Why? If we look even in the fourth grade biology textbook of a child, nephew, grandchild of anyone, if I would advise to know the secret of the vascular endothelium. As one gets to know this most important organ in our, in our body, I will vouch that one will want to take care of the endothelium. Vascular, the vascular endothelium will take care of him, he proposes personifying the vascular endothelium. Briefly explain that it is a layer of cells that lining all the blood vessels in our body. We will leave you with such unsatisfaction, but better unsatisfaction than over-saturation. It's a powerhouse. Endothelium.

Speaker1: The power of the endothelium. Well, of course, for those who want to explore the topic in more depth, I heartily recommend Dr. Slowikowska's book Heart in Good Style. It is written based on hard knowledge, but in accessible language, as well as Ms. Dr. Slowikowska's Facebook channel. Heart in style.

Speaker2: This is my dream for everyone to fall in love with their heart, their blood vessels. Then he certainly won't care. But you need to know the few processes.

Speaker1: Thank you kindly, doctor.

Speaker2: I very sincerely thank you for the invitation.