Nutrition as a Pillar of Preventive Cardiology and Other Highlights from ASPC 2021, with Martha Gulati, MD

Martha Gulati, MD

While the COVID-19 pandemic has dominated the landscape of healthcare and society in the last year and a half, the ongoing cardiovascular epidemic has not disappeared. Now, possibly more than ever with the crossover between cardiovascular and severe COVID-19 risk factors, the topic of preventive health has begun to take center stage.

Ahead of the American Society for Preventive Cardiology (ASPC) 2021 Virtual Summit, Practical Cardiology reached out to ASPC President-Elect Martha Gulati, MD, to discuss the upcoming conference and hot topics in preventive cardiology. In addition to her role as President-Elect, Gulati is leading a session on ischemic heart disease without obstructive coronary arteries and serving as moderator for a session titled, “The Great Diet Debate”. Set to last from 11:10 AM until 12:10 PM on Saturday, July 24, the 2-hour session featuring Danielle Belardo, MD, Arthur Agatston, MD, Carol Kirkpatrick, PhD, RDN, and Tracy Severson, RD, is among the most anticipated at this year’s meeting.

For more on the topic of nutrition as a pillar of preventive cardiology, ASPC 2021, and cardiovascular medicine, check out our Q&A with Gulati below.

Practical Cardiology: When looking at ASPC this year, the Great Diet Debate stands out. How important is being knowledgeable on the topic of nutrition when it comes to preventive cardiology?

Martha Gulati, MD: This is a question that comes up clinically for us all the time. Patients are always asking us, 'What should I be eating for heart health?', but sometimes it has to do with weight loss too. Certainly, the two are tied together, but, in general, people want to know what kind of food they should be eating for overall health.

So, clinically it's highly relevant. But, often, our patients they come with the latest diet that they see online, in a book they bought, or that has been talked about on television. So, all of those make us need to know what's truly the evidence behind specific diets and what's just a fad diet or what isn't based on evidence. Despite the fact that you hear people spouting out things about the latest diet fat, a lot of it, I believe, is some of the books that come out. They are just marketing tools and not necessarily based on evidence. We need to tease that out and we need the experts to help us with that—in this particular session, we'll be having one person is presenting on the Mediterranean diet, one person is presenting on plant-based diet, one is presenting on the South Beach diet, and another person is presenting on the keto diet.

PC: What kind of changes are needed to address systemic issues in proper nutrition in the US and elsewhere?

MG: Well, we need to make things that are good for you more accessible and less costly, rather than the bad things that are out there that are cheaper than good food. When you just look simply in a grocery store at what is affordable, how many people can you feed on this, or certain food versus fruits and vegetables, you see there's a big difference in affordability but also the availability to people.

At the moment, we don't grow enough fruits and vegetables in this country. If everyone followed the guidelines and ate the way they were supposed to, we wouldn't have enough fruits and vegetables grown to feed our population. These are things that our policy really needs to address. We can say eat healthily and our government can say eat healthily, but we're not really making it possible for patients. So, there are things that we really need to do as a society to address this. Dairy food, for example, is supplemented by the government and there is a lot of dairy available—and this is not to say that dairy is bad for you, but anything in anything in excess is not good for you. We can probably provide dairy products to the entire United States, but we can't provide vegetables and healthy fruits to all the United States. That's a problem.

That is a problem with our policy and that, ultimately, is going to determine the cost of things that we see on our shelves. I hope that one day we can get to a point you know, I'm a big believer in also trying to teach ourselves to be sustainable. I'm a gardener myself and I often talk to my patients about how they can do gardening and how cheap food can be if you're lucky enough to have some space where you can grow fruits and vegetables. Of course, I'm into the community gardens where people share their foods, grow their foods, and take care of the gardens together.

I think that these are some of the things that we need to try, as a society, to improve it and improve the dietary components that we're bringing to our table every day. But, again, this takes work, takes the right space, and is not available to everyone. We've got to think and be creative about this.

PC: Aside from The Great Diet Debate, what are one or two other sessions at ASPC 2021 you would like to highlight?

MG: One of the sessions I'm very excited about is related to our strategies of care and a lot has changed in healthcare in the last year due to COVID-19. I think telehealth has been an area that has transformed medicine and preventive cardiology. I'm very excited to be listening to Dr. Amy Bhatt's talk on telehealth because I really think this is something that is not going to go away. COVID-19, hopefully, will go away, but telehealth is here to stay; however, we need to refine it for our clinical practices.

Then, the talk that follows is Dr. Seth Martin's talk on technologies and wearables, which is tied in my mind to telehealth—meaning, we can use some of these technologies when patients are at home and we're not seeing them in ways that we never had before. Even if it's just simply checking blood pressure at home, maybe they don't need to come in for that. But even with other technologies and those on our phones, we need to know which ones we can reliably use and the wearables that we can reliably use that can help us measure overall health for our patients. So, I think that's one session.

There is a lot of great sessions on other topics, that I think that prevention usually doesn't cover. For example, we have a session focusing on the health transgender patients. We're seeing more and more of these patients and the effects of hormone replacement on cardiovascular disease is still an area that we don't know as much about, and we need to. I think that this is a great conversation and Dr. Chrisandra Shufelt is one of the leaders in that area. So, we're very excited to have her speaking on that.

Another group we don't talk too much about is patients with physical disabilities and their issues with accessibility, diet, and risk assessment—how do we advise them? I think we really need to know more about that group as well. Our theme this year is protecting the heart of one and all we tried to really bring in some of the areas that we don't always focus on when we talk about prevention.

PC: What do you think is the most exciting area in cardiology right now and why?

MG: It's so hard to choose just one thing that is exciting. There's so much transforming in cardiology right now, but I'd probably say the one thing that's really exciting is related to diabetes and SGLT2 inhibitors. These were medications that were intended to control diabetes, we're finding may be preventive therapies in heart disease, specifically related to heart failure, and I think that this is really transforming not just the care of patients, but also the practice of cardiologists.

In the past, nobody really wanted to tread on diabetes control in the cardiology community; we felt that was really something that the endocrinologist did or the family physician or the internist did, but not us. Suddenly, we have this amazing medication that we, now, also need to be able to know how to initiate and I think this is really transforming care. Maybe, in a few years, we'll be talking about how we hesitated, but now it's our drug.

I think nephrologists are having the same discussion because these medications appear to also be beneficial for patients who have chronic kidney disease in reducing the advancement of kidney disease. So, I think these drugs are really game-changers.

Something else really exciting on the horizon is obesity and the medications that we have for that. We have a medication that just received FDA approval—semaglutide. I'm really excited by it because we haven't been able to offer a lot to patients to help them lose weight, in terms of medications. I really think this medication can be a game-changer for our patients. Losing weight is probably the most challenging thing for patients, probably just as difficult as when we ask patients to stop smoking and, even with smoking cessation, we actually have some medications there. So, this is a really exciting time to help our patients with cardiovascular disease prevention and with these new therapies.

Editor's note: This transcript has been edited for space and clarity.