September 17, 2024 • 31 mins
On this episode, cardiologist and integrative medicine physician, Vivian Kominos will explore the overlap of risk factors and prevention strategies between heart disease and cancer. We will also talk about how cancer treatment increases cardiovascular risk and what we can do about it.
Five To Thrive Live is broadcast live Tuesdays at 7PM ET and Music on W4CS Radio – The Cancer Support Network (www.w4cy.com) part of Talk 4 Radio (www.talk4radio.com) on the Talk 4 Media Network (www.talk4media.com).
Five To Thrive Live Podcast is also available on Talk 4 Media (www.talk4media.com), Talk 4 Podcasting (www.talk4podcasting.com), iHeartRadio, Amazon Music, Pandora, Spotify, Audible, and over 100 other podcast outlets.
Five To Thrive Live is broadcast live Tuesdays at 7PM ET and Music on W4CS Radio – The Cancer Support Network (www.w4cy.com) part of Talk 4 Radio (www.talk4radio.com) on the Talk 4 Media Network (www.talk4media.com).
Five To Thrive Live Podcast is also available on Talk 4 Media (www.talk4media.com), Talk 4 Podcasting (www.talk4podcasting.com), iHeartRadio, Amazon Music, Pandora, Spotify, Audible, and over 100 other podcast outlets.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Any health related information on the following show provides general
information only. Content presented on any show by any host
or guests should not be substituted for a doctor's advice.
Always consult your physician before beginning any new diet, exercise,
or treatment program.
Speaker 2 (00:25):
This welcome to five to Thrive Live, a podcast about
thriving for those who have been affected by cancer and
(00:46):
chronic disease. I'm doctor Lisau Schuler and I co host
with my good friend Carolyn Gazella. You can find all
of our past show podcasts on any major podcast outlet,
and a schedule of our shows on ithriveplan dot com.
So tonight, I'm going to be talking with my colleague,
doctor Vivian Caminos about cardiovascular or heart disease and cancer,
(01:11):
and specifically we're going to explore how these diseases overlapped
and intersect with each other. It's quite fascinating. So doctor
Vivian Caminos is a nationally recognized clinician and educator and
integrative cardiology. She's a graduate of the Saint Louis University
School of Medicine. She completed her internal Medicine residency and
cardiology fellowship at the Robert Wood Johnson University Hospital in
(01:35):
her home state of New Jersey. She's board certified in
both integrative medicine and cardiology. She's been practicing as a
cardiologist for over thirty years and for integrative medicine and
integrative cardiology for the past fifteen years. And I have
the pleasure of working with her at the Andrew Wild
Center for Integrative Medicine, where she is a Clinical Professor
(01:58):
of Medicine and where she also completed her Integrated Medicine Fellowship.
So before we get too doctor communist, I want to
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learn more at doctor ohro probiotics dot com. So with that,
I want to welcome doctor Caminos to five to Thrive Live. Hello,
Vivian Helloly, I'm happy to be here. Well, I'm happy
(03:25):
to have you, and I'm happy to talk about this
very interesting topic. So you are a Board certified cardiologist,
you're not a cardio oncologist, which begs the question is
cardio oncology a new subspecialty?
Speaker 3 (03:41):
Yeah, that's a great question. Cardio Oncology is a new,
relatively lease recent subspecialty in cardiology and it deals with
prevention of heart disease, diagnosis of heart disease and treatment
of heart disease disease of patients with cancer, and it
(04:03):
also deals with the cardiac complications of cancer treatments, and
it emphasizes the risks that both heart disease and cancer share.
So because there's so many new cancer drugs and cancer treatments,
and because heart disease is quite prevalent in people with cancer,
and because risk factors are shared, there's now this new
(04:26):
sub subspecialty. And there's one in two year fellowship programs
for cardiologists that are interested in specializing in this, and
you can either specialize in either a clinical.
Speaker 4 (04:38):
Or research modalities.
Speaker 3 (04:42):
There's even a journal that's just basically published for cardio
oncology by the American College of Cardiology. So I'm really
happy that this new field is getting a lot of
attention and it's growing by leaps and bounds because cardiovascular
disease is one of the major diseases that people with
(05:02):
cancer can face.
Speaker 2 (05:05):
Yeah, and in fact it's a one too, right. Cardiovascular
disease still the number one killer of both male and
female adults and cancer number two, So I could imagine
there's quite a need for this subspecialty for sure. Absolutely,
So There are a lot of risk factors for cancer
which also increase the risk for cardio vascular disease. So
(05:27):
many in fact, that I'm sure we cannot cover all
of them. But let's explore this a bit. Let's start
with diet and nutrition. So are there diet related conditions
that increase the risk for both cardiovascular or heart disease
and cancer. Oh?
Speaker 3 (05:46):
Absolutely, you know that's a great question. But I just
want to just say a few words about nutrition, because
what I tell all my patients is that eating a
heart healthy diet, one that's high in whole grains, plants,
plant based, healthy fats, is a good way to prevent
most chronic disease. And it doesn't only decrease your risk
(06:06):
for cardiovascular disease, but also the cancer risk. We know
that diets that are high in salt, for instance, and
a processed red meat, sugary drinks, they're low in fiber.
Speaker 4 (06:17):
What do they do?
Speaker 3 (06:18):
They generally cause an anti inflammatory a pro inflammatory condition.
Speaker 4 (06:26):
And what happens is when you're eating.
Speaker 3 (06:29):
That diet, you're more prone to develop hypertension or diabetes
or obesity.
Speaker 4 (06:33):
And these are all of.
Speaker 3 (06:34):
Risk factors that cancer and heart disease share, So I
think that we can all eat a heart healthy diet
and will be healthier all around.
Speaker 4 (06:47):
Yeah.
Speaker 2 (06:47):
So, you know, we talk a lot on the show
about the importance of an anti inflammatory Mediterranean style diet
as a strategy for reducing the risk of cancer, the
risk of cancer occurrence. Sounds like that's the most evidence
based strategy for reducing the risk of cardiovascular disease kind
of across the board as well.
Speaker 4 (07:08):
It is. It is.
Speaker 3 (07:09):
When you look at the diet studies, most of them,
the greatest majority has been in the Mediterranean style diet.
That's not to say that there's not other diets that
are healthy also, like the DASH diet and dietary approaches
to stop hypertension. What they share though, is they have
a lot of anti inflammatory you know, nutrients in them. Yeah,
(07:32):
you know what the Mediterranean diet extra virgin olive oil.
Speaker 4 (07:36):
Very right, important?
Speaker 2 (07:37):
Yeah, very important. And yeah, it's true DASH diet and
Mediterranean diet overlap I think more than they don't, so
some nuances. But yeah, okay, so let's take a slightly
different look at this. Are there cardiovascular conditions or issues
that themselves are associated with an increased risk of cancer?
Speaker 4 (07:58):
Absolutely?
Speaker 3 (08:00):
I think I should talk about the most common cardiovascular
disease risk, hypertension, because almost fifty percent of our population
in the US and even globally has hypertension. Some people
don't even know that they have it, and studies have
shown that there's a significant association between hypertension and kidney cancer.
Speaker 4 (08:23):
We've known that for a long time.
Speaker 3 (08:25):
In fact, in a recent meta analysis, a study that
looked at many many different studies and put them together,
people with hypertension have approximately forty percent increased risk of
kidney cancer compared to people that don't have hypertension. But
besides kidney cancer, hypertension has been linked to an increased
(08:47):
risk for other cancers. If you have hypertension, you have
a higher risk for esophageal cancer, coorectal cancer, and hypertension
is associated with worse outcomes and people that have cancer.
So you know the question, what is it about hypertension
that is increasing the risk for cancer? And there's several mechanisms.
(09:12):
Because hypertension itself does what It increases inflammation, It increases
growth factors for cells that make them abnormally. There's insulin
growth factor, there's certain proteins called matrix metalloproteinases, and this
may promote cell growth and cause cancer. So if you
(09:35):
have cancer, you need to make sure that your blood
pressure is well controlled. And if you have high blood pressure,
you need to make sure that you bring your blood
pressure down.
Speaker 4 (09:45):
And there's one other risk. I want to talk about
type two diabetes because.
Speaker 3 (09:50):
That's also very very common in our heart disease patients,
and about twelve percent of the US population has full
blown type two diabetes. And diabetes has been linked to
increased risk for quite a few cancers, with the highest
risk for colorectal, pancreatic, goldbladder, liver cancer, and people with
(10:11):
cancer who have diabetes have worse outcomes. So there's many
risks that these two conditions share. You know, there's there
could be genetics obesity, but like hypertension, diabetes causes what
it causes increased inflammation, stress, oxidative stress, and you form
(10:33):
these if you have a lot of uncontrolled blood sugar,
you form these advanced glycation and products and they interact
with specific receptors that activate some of the inflammation that
we're seeing in people with diabetes and with cancer. So again,
if you if you have cancer or you have diabetes.
(10:57):
We have to control the diabetes to help to reduce
the chance that the cancer will come back or that
it won't be treated.
Speaker 2 (11:06):
Well, yeah, I'm glad you mentioned that because I want
to go back to hypertension and or high blood pressure
and various cancers, including kidney cancer.
Speaker 4 (11:16):
Strong association.
Speaker 2 (11:17):
But would you say that it's the high blood pressure
that itself is causing the increased risk, or that things
that lead to high blood pressure also lead to kidney cancer,
So it's almost serving as a marker of those olders.
Speaker 3 (11:35):
I think it's possibly, you know, both, But as I mentioned,
hypertension itself actually causes changes you know that increase inflammation,
You have higher insulin growth factors, higher of these dangerous
proteins that actually can promote cell growth. So, you know,
(11:57):
hypertension is interesting because even though it's so common, when
we can treat it and reduce the risk for hypertension.
So is it just a marker. I don't think it's
just a marker. It's certainly, you know, a risk factor,
but I think that it is somewhat if I can
(12:18):
say it causing neoplastic changes in some people, there could
be a genetic predisposition there could be other risk factors,
like if you have hypertension and obesity, or hypertension and
you smoke, or hypertension and diabetes.
Speaker 4 (12:33):
Yeah, okay, just learning more and more about this.
Speaker 2 (12:37):
Yeah, So, I mean, I think the takeaway here is
that if somebody has high blood pressure, it is important
to control that high blood pressure through whatever means that
person decides to utilize. And at the same time, I
would say, also maybe seek an integrative consult so that
the underlying factors that contributed to that high blood pressure
(12:59):
are addressed as well. So I think that would be
kind of the most comprehensive way to reduce the risk
both of the high blood pressure and the cancer, and
the same for diabetes. You mentioned, you know, the mechanisms
underlying those, So I guess I'm wondering, you know, given
this research that you've done into these connections, how important
is optimizing cardiovascular health to cancer prevention.
Speaker 3 (13:21):
Oh, you know, a lot of the data is telling
us that we can certainly decrease our risk for cancer
by optimizing a heart healthy lifestyle. You know, it's important
that if you are a cancer survivor, you are at
higher risk for cardiovascular disease, and that by decreasing all
your cardiovascular risks like getting enough physical activity, reducing your stress,
(13:47):
eating healthy, having a normal blood pressure, not smoking, all
of sleeping well, all of these reduce risk for recurrence.
They improve not only cancer outcomes, but also help prevent
cardiovascular disease.
Speaker 2 (14:03):
Right, And in fact, you know, people who are treated
for cancer are understandably most concerned about doing things to
reduce their risk of recurrence. Yet heart disease is the
leading cause of death among cancer survivors.
Speaker 4 (14:18):
So let's take the reverse.
Speaker 2 (14:19):
What is it about the disease of cancer or its
treatments that specifically increase the risk of cardiovascular disease.
Speaker 3 (14:28):
So, going back to what you said the leading cause
of death, I think it has to do with heart
disease is common, but you know it has to do
with the type of cancer you have, the stage of
the cancer, so that cancer may still be the leading
cause of death, followed closely by cardiovascular disease, and for
some cancers, cardiovascular disease.
Speaker 4 (14:49):
May be the leading cause of death.
Speaker 3 (14:51):
Let's take breast cancer, right, Your chance of dying from
breast cancer, thankfully now is rare with proper treatment, and
yet women with breast cancer for eight to twenty years
after their treatment have a much higher risk for cardiovascular
disease than women who haven't had breast cancer. So both
(15:14):
the cancer itself and the treatment for cancer can increase
heart disease all cancer, you know, getting away from breast cancer.
I just use that as an example of you know,
in breast cancer survivors, cardiovascular disease is going to be
their major cause of death, not cancer. Maybe in something
(15:34):
like you know stage or pancreatic cancer, cancer is going
to be the leading cause of death. In any case cancer,
What does cancer do? Cancer? The tissue in cancer is inflammatory,
and this we know that inflammation is a common pathway
for many chronic diseases, especially for heart disease and for cancer,
(15:55):
and many of the treatments used to treat cancer it
can also cause heart disease. You know, found out that
it first became apparent that radiation to the chest caused
changes in the heart muscle in nineteen twenty nine. This
was that was the first report published that a cancer
(16:16):
treatment can also affect the heart in a bad way. So,
you know, we say that cardio oncology is a new field,
and yes, as a subspecialty, it's organized as a new field.
But we've known about this for almost for one hundred years,
and we know that radiation therapy that's used can cause
(16:39):
heart disease. We know that some of the chemotherapy that's
used can cause heart failure. Hindess inhibitors, for instance, they
cause hypertension, they can cause heart failure. Immunotherapy can cause
an inflammation around the heart muscle micarditis. So with newer
(16:59):
and better drug for cancer, it's important that we treat
patients with a multidisciplinary approach. So a patient should be
cared for by both an oncologist and a cardiooncologist. I'll
go so far to say that I don't know if
everyone increes with me on that, but you know when
(17:19):
I when you look at the data of how extensive
cancer is and how extensive heart disease is, a cardiologist
and a cardiology a cardio a cardiooncologist isn't going to
treat the cancer, right, It's not going to It's only
going to treat the heart disease. An oncologist isn't going
to treat the heart disease that develops. It's only going
(17:41):
to treat the cancer. So we need to work together.
We need to we need to have this this multidisciplinary approach,
and I'd love to say that integrated medicine should be
involved also. And you know, the other thing I want
to mention about this, sometimes the effects of the treatment
(18:02):
may not be obvious immediately. You know, the heart disease
can come up eight to twenty years after a cancer therapy,
So it's important that even if you see a specialist
during your cancer treatment, I think it's important to continue
to see the cardiooncologist or the cardiologist who knows enough
(18:24):
about the side effects of treatment because it can heart disease,
you know, can be ten twenty years after your treatment.
Speaker 2 (18:35):
Yeah, so I agree with you, and I cancel my
patients often about the cardiovascular risks, and sometimes I'm the
only person that said anything to them. So I think
that this is an important topic for people who are
going through treatment to be aware of, so they can
inquire with their own collogists, get a referral to a cardiologist.
They may not be able to find a cardiooncologist, but
(18:58):
depending on where they live, but at least a cardiologist,
if not a cardio oncologist, to just get monitoring to
make sure that if something shows up, it's seen as
early as possible, so treatments can be implemented. And of course,
from an integrative perspective, we have some strategies to reduce risks.
So let's talk about that, Like, what would you say,
I know this is a bit generic. You've talked about
(19:20):
a lot of different medications, and there's different cancer types,
but sort of in general, what steps would you advise
a cancer survivor or somebody undergoing treatment to take if
they've either had signs of cardiovascular disease, blood pressure's going up,
maybe they have a little tightness in their chest occasionally,
or they're just concerned about it.
Speaker 3 (19:43):
Well, I think that you're right that some oncologists may
not be sending their patients to cardiologists, but I think
that more and more now know the shared risks, and
I would say that everyone with cancer should be at
a cardiovascular disease risk assessment to determine if they're at
high risk for heart disease. You know, there's some simple
(20:05):
tools or calculators that any primary care provider can use
to just plug in a few numbers, your blood pressure,
your cholesterol, your age history to determine if you are
at risk. And if you are at risk, then you see,
you know, you should be referred to a cardiologist. But
(20:26):
you mentioned symptoms, you know, hypertension. If you're a cancer
patient with hypertension, with chest discomfort, with fatigue, with shortness
the breath, how do we know if some of these
are coming from cancer itself or the cancer treatment, or
from heart disease.
Speaker 4 (20:42):
We don't. That's why you need to be.
Speaker 3 (20:45):
Evaluated by a cardiologists who could do some testing. You know,
they may want to do some imaging or some other
diagnostic tests and then you know figure out, hey, you know,
do you have any underlying heart.
Speaker 4 (20:57):
Disease and if you do, let's treat it.
Speaker 3 (21:01):
But I think you also asked what's the evidence for
integrated if you mentioned integrated medicine.
Speaker 2 (21:08):
Yes, yeah, let's maybe break it down because that's a
big topic.
Speaker 4 (21:12):
So maybe we will.
Speaker 2 (21:13):
Go for the two for one strategy first. So, are
there any integrative medicine strategies that, from what you know,
can improve outcomes in both cardiovascular disease and cancer.
Speaker 3 (21:28):
Yeah, I think it's not rocket science. I think lifestyle
is the most important approach, you know, since stopping smoking,
eating healthy, moving more, getting enough sleep.
Speaker 4 (21:39):
All of these are.
Speaker 3 (21:42):
Decreasing risk for either recurrent heart disease or recurring cancer.
The other thing I like is mind body medicine. You know,
it's very important because we have evidence that many different modalities,
whether it's hypnosis, guided imagery, meditation, they reduce inflammation and
(22:02):
they have been studied as some of these have been
studied in populations with cancer. And acupuncture. You know, acupuncture
might be an approach, but I think the most important
approach is basically a healthy lifestyle, because that's something that's
at the crux. I think an unhealthy lifestyle is at
(22:23):
the crux of why we have a lot of these diseases.
There's also, you know, people that specialize in like yourself,
in the optimization of cancer treatment through the safe use
of botanicals and supplements.
Speaker 4 (22:37):
You know.
Speaker 3 (22:38):
And one that is pretty well known and comes to
my mind because I've used it a lot is coq ten.
You know, we could use coq ten in the treatment
or heart failure. Coq ten has been studied in some
populations with cancer to prevent heart failure. I'm not saying
that everyone should go out there and start taking coq ten.
You should talk to your physician, but there are there
(23:02):
are strategies that can improve outcomes in both cardiovascular disease
and cancer.
Speaker 4 (23:09):
Yeah, for sure.
Speaker 2 (23:10):
And I think you've highlighted the importance of lifestyle, which
really can't be understated or overstated because it's just so critical.
So what about let's get a little bit more specific.
And I think you've already identified one of your favorite
go to strategies to optimize cardiovascular health. I'm sure that's
just because you're Greek and you like olive oil, but
(23:31):
it is actually a very helpful, uh you know. Interestingly
you talk about it as a way to optimize cardiovascular health.
It also has some very unique and important anti cancer properties,
So that's a nice two for one. What are some
of your favorite go tos for cardiovascular health?
Speaker 4 (23:50):
Yeah, you mentioned it. You know, you meant nutrition. I
think I think.
Speaker 3 (23:56):
I love nutrition and movement the most. And maybe I'm
prejudiced because I am the daughter of a chef and
I am Greek, so food in my family has also
always been a way to get together and show our love,
you know, and I love to cook, right, so I
grew up with the Mediterranean diet I still needed. And
the other favorite thing that I is exercised because it
(24:17):
just makes me feel good. I mean, you need to
move in order to be healthy.
Speaker 1 (24:22):
You know.
Speaker 3 (24:22):
There was this interesting study that took healthy young people
and they divided them, they randomized them, and half of
them were told you can't and these were very active,
these young people, and half were told you can't really
move a lot, just five thousand steps a day, and
the other the other group could do all their exercise
and their hiking and their running and whatever they did.
(24:45):
And in the group that wasn't allowed to exercise, their
mood and depression scores went up after one week or
two weeks, even though they knew that this inability to
exercise was temporary. So, I mean movement, physical exercise, and
physical activity have such important important uh you know, uh
(25:09):
modalities for it, so that it's it's absolutely amazing.
Speaker 4 (25:13):
Olive oil, olive oil. What I love about olive oil.
Speaker 3 (25:17):
You know, there's there's so many incredible, incredible nutrients in
olive oil. It even besides being having I think anti inflammatory,
anti carcinogenic, antiathogenic properties, it also improves your gut bacteria.
I mean, it's it's absolutely amazing. So for me, the
(25:37):
most important go to strategies for everyone would be eat
well and move, move a lot, and don't need much
and move more.
Speaker 2 (25:47):
So yes, absolutely, I know you're also a big fan
of and actually have relatively recently dived into the body
of literature on mind body medicine, And I'm wondering if
you could just talk a little bit about stress and
heart health because stress also is linked to an increased
(26:10):
risk of cancer. The data is a little hard to get,
but definitely increase risk of cancer recurrence, possibly increase risk
of cancer diagnosis.
Speaker 4 (26:22):
There's clear and you know clearly.
Speaker 2 (26:24):
People who have a lot of stress don't have this
high quality of life while they're going through the treatment.
So what would you say about stress in terms of
a strategy and how does it link in with cardiovascular health?
Speaker 3 (26:36):
Yeah, so you know what happens when you're stressed, You
have cortisol goes up, your blood pressure goes up, your
heart rate goes up.
Speaker 4 (26:44):
And it's so easy to reduce our stress.
Speaker 3 (26:48):
People don't think it is, you know, because they feel
that they can't control stress, but you know, just doing
some breath work or doing some meditation reduces it.
Speaker 4 (26:58):
We have evidence that people that meditate.
Speaker 3 (27:01):
Have lower heart disease, recurrent lower heart failure, even.
Speaker 4 (27:07):
If they've had heart attacks.
Speaker 3 (27:10):
We have evidence that people that meditate all their genes
that are associated with anti inflammation and anti viral get
you know boosted. You know, so this is epigenetics. This
is you know, these genes are are turned on, whereas
the pro inflammatory genes, the genes that are going to
(27:34):
allow you to get heart disease, cancer infections, they are
turned off. And this is just with meditation. So you know,
you don't have to meditate. There's so many different other
things you could do. You could do progressive muscle relaxation, hypnosis, movement,
you know, meditative movement like tai chiat chee goung yoga.
(27:57):
I mean, you know, we can have a whole other
session on this. It's just absolutely amazing because the data
is there for heart disease and the data is also
becoming more apparent for cancer.
Speaker 2 (28:09):
Yeah, well, yeah, good stuff. We could do a whole
other show and it maybe we will. You know, any
bundle thoughts you'd like to leave with our listeners.
Speaker 4 (28:19):
Yes, I do.
Speaker 3 (28:21):
Recently, I had I had a skin cancer and I
was treated by the worst physician in the world.
Speaker 4 (28:30):
I think and what I.
Speaker 3 (28:33):
Learned, and I mean I knew this anyway, but what
I'm going to tell everybody is take care of yourself
and get the help you need. Make sure that you're
partnered with a provider healthcare team you trust and that
listens to you and that respects you. If your physician
makes you feel bad, get another one. And I say
(28:53):
that because you know from my own personal experience. So
now I have a really.
Speaker 4 (28:58):
Great person I work with. But I think that's so important.
Speaker 2 (29:02):
M h Yeah, such good advice and from a physician,
So that kind of says something right there. Well, Doctor Communis,
thank you so much. This has been such a great show.
Where can our listeners find out more about you and
your integrated medicine services.
Speaker 3 (29:20):
So I recently closed my practice, but I am volunteering.
I'm volunteering at a clinic for the uninsured, and I
teach and you know, I'm writing, so you know I'm
on I'm on Facebook, Vivian comunos m D. But yeah,
(29:42):
so you know I'm not seeing patients privately anymore, but
I'm continuing to hopefully treat even more patients by helping
to educate the doctors of the future. The integrated medicine
doctors of the future. So you know, I love I
love working with you and with the university, and I
(30:04):
just love what I'm doing right now.
Speaker 2 (30:06):
Yeah, well, we love having you and thank you so
much for all that you contribute to the field. And
that concludes this episode of five to Thrive Live. So
again we thank our sponsors Cognizance Andticoline to enhance memory,
focus and attention, immuse of post biotic for immune support,
doctor Hir's Probiotics award winning pre and probiotic formulas and
(30:27):
pro thrivers wellness supplements designed specifically for thrivers. May you
all experience joy, laughter and love. It's time to thrive everyone,
Any health related information on the following show provides general
information only. Content presented on any show by any host
or guests should not be substituted for a doctor's advice.
Always consult your physician before beginning any new diet, exercise,
or treatment program.
Speaker 2 (00:25):
This welcome to five to Thrive Live, a podcast about
thriving for those who have been affected by cancer and
(00:46):
chronic disease. I'm doctor Lisau Schuler and I co host
with my good friend Carolyn Gazella. You can find all
of our past show podcasts on any major podcast outlet,
and a schedule of our shows on ithriveplan dot com.
So tonight, I'm going to be talking with my colleague,
doctor Vivian Caminos about cardiovascular or heart disease and cancer,
(01:11):
and specifically we're going to explore how these diseases overlapped
and intersect with each other. It's quite fascinating. So doctor
Vivian Caminos is a nationally recognized clinician and educator and
integrative cardiology. She's a graduate of the Saint Louis University
School of Medicine. She completed her internal Medicine residency and
cardiology fellowship at the Robert Wood Johnson University Hospital in
(01:35):
her home state of New Jersey. She's board certified in
both integrative medicine and cardiology. She's been practicing as a
cardiologist for over thirty years and for integrative medicine and
integrative cardiology for the past fifteen years. And I have
the pleasure of working with her at the Andrew Wild
Center for Integrative Medicine, where she is a Clinical Professor
(01:58):
of Medicine and where she also completed her Integrated Medicine Fellowship.
So before we get too doctor communist, I want to
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I want to welcome doctor Caminos to five to Thrive Live. Hello,
Vivian Helloly, I'm happy to be here. Well, I'm happy
(03:25):
to have you, and I'm happy to talk about this
very interesting topic. So you are a Board certified cardiologist,
you're not a cardio oncologist, which begs the question is
cardio oncology a new subspecialty?
Speaker 3 (03:41):
Yeah, that's a great question. Cardio Oncology is a new,
relatively lease recent subspecialty in cardiology and it deals with
prevention of heart disease, diagnosis of heart disease and treatment
of heart disease disease of patients with cancer, and it
(04:03):
also deals with the cardiac complications of cancer treatments, and
it emphasizes the risks that both heart disease and cancer share.
So because there's so many new cancer drugs and cancer treatments,
and because heart disease is quite prevalent in people with cancer,
and because risk factors are shared, there's now this new
(04:26):
sub subspecialty. And there's one in two year fellowship programs
for cardiologists that are interested in specializing in this, and
you can either specialize in either a clinical.
Speaker 4 (04:38):
Or research modalities.
Speaker 3 (04:42):
There's even a journal that's just basically published for cardio
oncology by the American College of Cardiology. So I'm really
happy that this new field is getting a lot of
attention and it's growing by leaps and bounds because cardiovascular
disease is one of the major diseases that people with
(05:02):
cancer can face.
Speaker 2 (05:05):
Yeah, and in fact it's a one too, right. Cardiovascular
disease still the number one killer of both male and
female adults and cancer number two, So I could imagine
there's quite a need for this subspecialty for sure. Absolutely,
So There are a lot of risk factors for cancer
which also increase the risk for cardio vascular disease. So
(05:27):
many in fact, that I'm sure we cannot cover all
of them. But let's explore this a bit. Let's start
with diet and nutrition. So are there diet related conditions
that increase the risk for both cardiovascular or heart disease
and cancer. Oh?
Speaker 3 (05:46):
Absolutely, you know that's a great question. But I just
want to just say a few words about nutrition, because
what I tell all my patients is that eating a
heart healthy diet, one that's high in whole grains, plants,
plant based, healthy fats, is a good way to prevent
most chronic disease. And it doesn't only decrease your risk
(06:06):
for cardiovascular disease, but also the cancer risk. We know
that diets that are high in salt, for instance, and
a processed red meat, sugary drinks, they're low in fiber.
Speaker 4 (06:17):
What do they do?
Speaker 3 (06:18):
They generally cause an anti inflammatory a pro inflammatory condition.
Speaker 4 (06:26):
And what happens is when you're eating.
Speaker 3 (06:29):
That diet, you're more prone to develop hypertension or diabetes
or obesity.
Speaker 4 (06:33):
And these are all of.
Speaker 3 (06:34):
Risk factors that cancer and heart disease share, So I
think that we can all eat a heart healthy diet
and will be healthier all around.
Speaker 4 (06:47):
Yeah.
Speaker 2 (06:47):
So, you know, we talk a lot on the show
about the importance of an anti inflammatory Mediterranean style diet
as a strategy for reducing the risk of cancer, the
risk of cancer occurrence. Sounds like that's the most evidence
based strategy for reducing the risk of cardiovascular disease kind
of across the board as well.
Speaker 4 (07:08):
It is. It is.
Speaker 3 (07:09):
When you look at the diet studies, most of them,
the greatest majority has been in the Mediterranean style diet.
That's not to say that there's not other diets that
are healthy also, like the DASH diet and dietary approaches
to stop hypertension. What they share though, is they have
a lot of anti inflammatory you know, nutrients in them. Yeah,
(07:32):
you know what the Mediterranean diet extra virgin olive oil.
Speaker 4 (07:36):
Very right, important?
Speaker 2 (07:37):
Yeah, very important. And yeah, it's true DASH diet and
Mediterranean diet overlap I think more than they don't, so
some nuances. But yeah, okay, so let's take a slightly
different look at this. Are there cardiovascular conditions or issues
that themselves are associated with an increased risk of cancer?
Speaker 4 (07:58):
Absolutely?
Speaker 3 (08:00):
I think I should talk about the most common cardiovascular
disease risk, hypertension, because almost fifty percent of our population
in the US and even globally has hypertension. Some people
don't even know that they have it, and studies have
shown that there's a significant association between hypertension and kidney cancer.
Speaker 4 (08:23):
We've known that for a long time.
Speaker 3 (08:25):
In fact, in a recent meta analysis, a study that
looked at many many different studies and put them together,
people with hypertension have approximately forty percent increased risk of
kidney cancer compared to people that don't have hypertension. But
besides kidney cancer, hypertension has been linked to an increased
(08:47):
risk for other cancers. If you have hypertension, you have
a higher risk for esophageal cancer, coorectal cancer, and hypertension
is associated with worse outcomes and people that have cancer.
So you know the question, what is it about hypertension
that is increasing the risk for cancer? And there's several mechanisms.
(09:12):
Because hypertension itself does what It increases inflammation, It increases
growth factors for cells that make them abnormally. There's insulin
growth factor, there's certain proteins called matrix metalloproteinases, and this
may promote cell growth and cause cancer. So if you
(09:35):
have cancer, you need to make sure that your blood
pressure is well controlled. And if you have high blood pressure,
you need to make sure that you bring your blood
pressure down.
Speaker 4 (09:45):
And there's one other risk. I want to talk about
type two diabetes because.
Speaker 3 (09:50):
That's also very very common in our heart disease patients,
and about twelve percent of the US population has full
blown type two diabetes. And diabetes has been linked to
increased risk for quite a few cancers, with the highest
risk for colorectal, pancreatic, goldbladder, liver cancer, and people with
(10:11):
cancer who have diabetes have worse outcomes. So there's many
risks that these two conditions share. You know, there's there
could be genetics obesity, but like hypertension, diabetes causes what
it causes increased inflammation, stress, oxidative stress, and you form
(10:33):
these if you have a lot of uncontrolled blood sugar,
you form these advanced glycation and products and they interact
with specific receptors that activate some of the inflammation that
we're seeing in people with diabetes and with cancer. So again,
if you if you have cancer or you have diabetes.
(10:57):
We have to control the diabetes to help to reduce
the chance that the cancer will come back or that
it won't be treated.
Speaker 2 (11:06):
Well, yeah, I'm glad you mentioned that because I want
to go back to hypertension and or high blood pressure
and various cancers, including kidney cancer.
Speaker 4 (11:16):
Strong association.
Speaker 2 (11:17):
But would you say that it's the high blood pressure
that itself is causing the increased risk, or that things
that lead to high blood pressure also lead to kidney cancer,
So it's almost serving as a marker of those olders.
Speaker 3 (11:35):
I think it's possibly, you know, both, But as I mentioned,
hypertension itself actually causes changes you know that increase inflammation,
You have higher insulin growth factors, higher of these dangerous
proteins that actually can promote cell growth. So, you know,
(11:57):
hypertension is interesting because even though it's so common, when
we can treat it and reduce the risk for hypertension.
So is it just a marker. I don't think it's
just a marker. It's certainly, you know, a risk factor,
but I think that it is somewhat if I can
(12:18):
say it causing neoplastic changes in some people, there could
be a genetic predisposition there could be other risk factors,
like if you have hypertension and obesity, or hypertension and
you smoke, or hypertension and diabetes.
Speaker 4 (12:33):
Yeah, okay, just learning more and more about this.
Speaker 2 (12:37):
Yeah, So, I mean, I think the takeaway here is
that if somebody has high blood pressure, it is important
to control that high blood pressure through whatever means that
person decides to utilize. And at the same time, I
would say, also maybe seek an integrative consult so that
the underlying factors that contributed to that high blood pressure
(12:59):
are addressed as well. So I think that would be
kind of the most comprehensive way to reduce the risk
both of the high blood pressure and the cancer, and
the same for diabetes. You mentioned, you know, the mechanisms
underlying those, So I guess I'm wondering, you know, given
this research that you've done into these connections, how important
is optimizing cardiovascular health to cancer prevention.
Speaker 3 (13:21):
Oh, you know, a lot of the data is telling
us that we can certainly decrease our risk for cancer
by optimizing a heart healthy lifestyle. You know, it's important
that if you are a cancer survivor, you are at
higher risk for cardiovascular disease, and that by decreasing all
your cardiovascular risks like getting enough physical activity, reducing your stress,
(13:47):
eating healthy, having a normal blood pressure, not smoking, all
of sleeping well, all of these reduce risk for recurrence.
They improve not only cancer outcomes, but also help prevent
cardiovascular disease.
Speaker 2 (14:03):
Right, And in fact, you know, people who are treated
for cancer are understandably most concerned about doing things to
reduce their risk of recurrence. Yet heart disease is the
leading cause of death among cancer survivors.
Speaker 4 (14:18):
So let's take the reverse.
Speaker 2 (14:19):
What is it about the disease of cancer or its
treatments that specifically increase the risk of cardiovascular disease.
Speaker 3 (14:28):
So, going back to what you said the leading cause
of death, I think it has to do with heart
disease is common, but you know it has to do
with the type of cancer you have, the stage of
the cancer, so that cancer may still be the leading
cause of death, followed closely by cardiovascular disease, and for
some cancers, cardiovascular disease.
Speaker 4 (14:49):
May be the leading cause of death.
Speaker 3 (14:51):
Let's take breast cancer, right, Your chance of dying from
breast cancer, thankfully now is rare with proper treatment, and
yet women with breast cancer for eight to twenty years
after their treatment have a much higher risk for cardiovascular
disease than women who haven't had breast cancer. So both
(15:14):
the cancer itself and the treatment for cancer can increase
heart disease all cancer, you know, getting away from breast cancer.
I just use that as an example of you know,
in breast cancer survivors, cardiovascular disease is going to be
their major cause of death, not cancer. Maybe in something
(15:34):
like you know stage or pancreatic cancer, cancer is going
to be the leading cause of death. In any case cancer,
What does cancer do? Cancer? The tissue in cancer is inflammatory,
and this we know that inflammation is a common pathway
for many chronic diseases, especially for heart disease and for cancer,
(15:55):
and many of the treatments used to treat cancer it
can also cause heart disease. You know, found out that
it first became apparent that radiation to the chest caused
changes in the heart muscle in nineteen twenty nine. This
was that was the first report published that a cancer
(16:16):
treatment can also affect the heart in a bad way. So,
you know, we say that cardio oncology is a new field,
and yes, as a subspecialty, it's organized as a new field.
But we've known about this for almost for one hundred years,
and we know that radiation therapy that's used can cause
(16:39):
heart disease. We know that some of the chemotherapy that's
used can cause heart failure. Hindess inhibitors, for instance, they
cause hypertension, they can cause heart failure. Immunotherapy can cause
an inflammation around the heart muscle micarditis. So with newer
(16:59):
and better drug for cancer, it's important that we treat
patients with a multidisciplinary approach. So a patient should be
cared for by both an oncologist and a cardiooncologist. I'll
go so far to say that I don't know if
everyone increes with me on that, but you know when
(17:19):
I when you look at the data of how extensive
cancer is and how extensive heart disease is, a cardiologist
and a cardiology a cardio a cardiooncologist isn't going to
treat the cancer, right, It's not going to It's only
going to treat the heart disease. An oncologist isn't going
to treat the heart disease that develops. It's only going
(17:41):
to treat the cancer. So we need to work together.
We need to we need to have this this multidisciplinary approach,
and I'd love to say that integrated medicine should be
involved also. And you know, the other thing I want
to mention about this, sometimes the effects of the treatment
(18:02):
may not be obvious immediately. You know, the heart disease
can come up eight to twenty years after a cancer therapy,
So it's important that even if you see a specialist
during your cancer treatment, I think it's important to continue
to see the cardiooncologist or the cardiologist who knows enough
(18:24):
about the side effects of treatment because it can heart disease,
you know, can be ten twenty years after your treatment.
Speaker 2 (18:35):
Yeah, so I agree with you, and I cancel my
patients often about the cardiovascular risks, and sometimes I'm the
only person that said anything to them. So I think
that this is an important topic for people who are
going through treatment to be aware of, so they can
inquire with their own collogists, get a referral to a cardiologist.
They may not be able to find a cardiooncologist, but
(18:58):
depending on where they live, but at least a cardiologist,
if not a cardio oncologist, to just get monitoring to
make sure that if something shows up, it's seen as
early as possible, so treatments can be implemented. And of course,
from an integrative perspective, we have some strategies to reduce risks.
So let's talk about that, Like, what would you say,
I know this is a bit generic. You've talked about
(19:20):
a lot of different medications, and there's different cancer types,
but sort of in general, what steps would you advise
a cancer survivor or somebody undergoing treatment to take if
they've either had signs of cardiovascular disease, blood pressure's going up,
maybe they have a little tightness in their chest occasionally,
or they're just concerned about it.
Speaker 3 (19:43):
Well, I think that you're right that some oncologists may
not be sending their patients to cardiologists, but I think
that more and more now know the shared risks, and
I would say that everyone with cancer should be at
a cardiovascular disease risk assessment to determine if they're at
high risk for heart disease. You know, there's some simple
(20:05):
tools or calculators that any primary care provider can use
to just plug in a few numbers, your blood pressure,
your cholesterol, your age history to determine if you are
at risk. And if you are at risk, then you see,
you know, you should be referred to a cardiologist. But
(20:26):
you mentioned symptoms, you know, hypertension. If you're a cancer
patient with hypertension, with chest discomfort, with fatigue, with shortness
the breath, how do we know if some of these
are coming from cancer itself or the cancer treatment, or
from heart disease.
Speaker 4 (20:42):
We don't. That's why you need to be.
Speaker 3 (20:45):
Evaluated by a cardiologists who could do some testing. You know,
they may want to do some imaging or some other
diagnostic tests and then you know figure out, hey, you know,
do you have any underlying heart.
Speaker 4 (20:57):
Disease and if you do, let's treat it.
Speaker 3 (21:01):
But I think you also asked what's the evidence for
integrated if you mentioned integrated medicine.
Speaker 2 (21:08):
Yes, yeah, let's maybe break it down because that's a
big topic.
Speaker 4 (21:12):
So maybe we will.
Speaker 2 (21:13):
Go for the two for one strategy first. So, are
there any integrative medicine strategies that, from what you know,
can improve outcomes in both cardiovascular disease and cancer.
Speaker 3 (21:28):
Yeah, I think it's not rocket science. I think lifestyle
is the most important approach, you know, since stopping smoking,
eating healthy, moving more, getting enough sleep.
Speaker 4 (21:39):
All of these are.
Speaker 3 (21:42):
Decreasing risk for either recurrent heart disease or recurring cancer.
The other thing I like is mind body medicine. You know,
it's very important because we have evidence that many different modalities,
whether it's hypnosis, guided imagery, meditation, they reduce inflammation and
(22:02):
they have been studied as some of these have been
studied in populations with cancer. And acupuncture. You know, acupuncture
might be an approach, but I think the most important
approach is basically a healthy lifestyle, because that's something that's
at the crux. I think an unhealthy lifestyle is at
(22:23):
the crux of why we have a lot of these diseases.
There's also, you know, people that specialize in like yourself,
in the optimization of cancer treatment through the safe use
of botanicals and supplements.
Speaker 4 (22:37):
You know.
Speaker 3 (22:38):
And one that is pretty well known and comes to
my mind because I've used it a lot is coq ten.
You know, we could use coq ten in the treatment
or heart failure. Coq ten has been studied in some
populations with cancer to prevent heart failure. I'm not saying
that everyone should go out there and start taking coq ten.
You should talk to your physician, but there are there
(23:02):
are strategies that can improve outcomes in both cardiovascular disease
and cancer.
Speaker 4 (23:09):
Yeah, for sure.
Speaker 2 (23:10):
And I think you've highlighted the importance of lifestyle, which
really can't be understated or overstated because it's just so critical.
So what about let's get a little bit more specific.
And I think you've already identified one of your favorite
go to strategies to optimize cardiovascular health. I'm sure that's
just because you're Greek and you like olive oil, but
(23:31):
it is actually a very helpful, uh you know. Interestingly
you talk about it as a way to optimize cardiovascular health.
It also has some very unique and important anti cancer properties,
So that's a nice two for one. What are some
of your favorite go tos for cardiovascular health?
Speaker 4 (23:50):
Yeah, you mentioned it. You know, you meant nutrition. I
think I think.
Speaker 3 (23:56):
I love nutrition and movement the most. And maybe I'm
prejudiced because I am the daughter of a chef and
I am Greek, so food in my family has also
always been a way to get together and show our love,
you know, and I love to cook, right, so I
grew up with the Mediterranean diet I still needed. And
the other favorite thing that I is exercised because it
(24:17):
just makes me feel good. I mean, you need to
move in order to be healthy.
Speaker 1 (24:22):
You know.
Speaker 3 (24:22):
There was this interesting study that took healthy young people
and they divided them, they randomized them, and half of
them were told you can't and these were very active,
these young people, and half were told you can't really
move a lot, just five thousand steps a day, and
the other the other group could do all their exercise
and their hiking and their running and whatever they did.
(24:45):
And in the group that wasn't allowed to exercise, their
mood and depression scores went up after one week or
two weeks, even though they knew that this inability to
exercise was temporary. So, I mean movement, physical exercise, and
physical activity have such important important uh you know, uh
(25:09):
modalities for it, so that it's it's absolutely amazing.
Speaker 4 (25:13):
Olive oil, olive oil. What I love about olive oil.
Speaker 3 (25:17):
You know, there's there's so many incredible, incredible nutrients in
olive oil. It even besides being having I think anti inflammatory,
anti carcinogenic, antiathogenic properties, it also improves your gut bacteria.
I mean, it's it's absolutely amazing. So for me, the
(25:37):
most important go to strategies for everyone would be eat
well and move, move a lot, and don't need much
and move more.
Speaker 2 (25:47):
So yes, absolutely, I know you're also a big fan
of and actually have relatively recently dived into the body
of literature on mind body medicine, And I'm wondering if
you could just talk a little bit about stress and
heart health because stress also is linked to an increased
(26:10):
risk of cancer. The data is a little hard to get,
but definitely increase risk of cancer recurrence, possibly increase risk
of cancer diagnosis.
Speaker 4 (26:22):
There's clear and you know clearly.
Speaker 2 (26:24):
People who have a lot of stress don't have this
high quality of life while they're going through the treatment.
So what would you say about stress in terms of
a strategy and how does it link in with cardiovascular health?
Speaker 3 (26:36):
Yeah, so you know what happens when you're stressed, You
have cortisol goes up, your blood pressure goes up, your
heart rate goes up.
Speaker 4 (26:44):
And it's so easy to reduce our stress.
Speaker 3 (26:48):
People don't think it is, you know, because they feel
that they can't control stress, but you know, just doing
some breath work or doing some meditation reduces it.
Speaker 4 (26:58):
We have evidence that people that meditate.
Speaker 3 (27:01):
Have lower heart disease, recurrent lower heart failure, even.
Speaker 4 (27:07):
If they've had heart attacks.
Speaker 3 (27:10):
We have evidence that people that meditate all their genes
that are associated with anti inflammation and anti viral get
you know boosted. You know, so this is epigenetics. This
is you know, these genes are are turned on, whereas
the pro inflammatory genes, the genes that are going to
(27:34):
allow you to get heart disease, cancer infections, they are
turned off. And this is just with meditation. So you know,
you don't have to meditate. There's so many different other
things you could do. You could do progressive muscle relaxation, hypnosis, movement,
you know, meditative movement like tai chiat chee goung yoga.
(27:57):
I mean, you know, we can have a whole other
session on this. It's just absolutely amazing because the data
is there for heart disease and the data is also
becoming more apparent for cancer.
Speaker 2 (28:09):
Yeah, well, yeah, good stuff. We could do a whole
other show and it maybe we will. You know, any
bundle thoughts you'd like to leave with our listeners.
Speaker 4 (28:19):
Yes, I do.
Speaker 3 (28:21):
Recently, I had I had a skin cancer and I
was treated by the worst physician in the world.
Speaker 4 (28:30):
I think and what I.
Speaker 3 (28:33):
Learned, and I mean I knew this anyway, but what
I'm going to tell everybody is take care of yourself
and get the help you need. Make sure that you're
partnered with a provider healthcare team you trust and that
listens to you and that respects you. If your physician
makes you feel bad, get another one. And I say
(28:53):
that because you know from my own personal experience. So
now I have a really.
Speaker 4 (28:58):
Great person I work with. But I think that's so important.
Speaker 2 (29:02):
M h Yeah, such good advice and from a physician,
So that kind of says something right there. Well, Doctor Communis,
thank you so much. This has been such a great show.
Where can our listeners find out more about you and
your integrated medicine services.
Speaker 3 (29:20):
So I recently closed my practice, but I am volunteering.
I'm volunteering at a clinic for the uninsured, and I
teach and you know, I'm writing, so you know I'm
on I'm on Facebook, Vivian comunos m D. But yeah,
(29:42):
so you know I'm not seeing patients privately anymore, but
I'm continuing to hopefully treat even more patients by helping
to educate the doctors of the future. The integrated medicine
doctors of the future. So you know, I love I
love working with you and with the university, and I
(30:04):
just love what I'm doing right now.
Speaker 2 (30:06):
Yeah, well, we love having you and thank you so
much for all that you contribute to the field. And
that concludes this episode of five to Thrive Live. So
again we thank our sponsors Cognizance Andticoline to enhance memory,
focus and attention, immuse of post biotic for immune support,
doctor Hir's Probiotics award winning pre and probiotic formulas and
(30:27):
pro thrivers wellness supplements designed specifically for thrivers. May you
all experience joy, laughter and love. It's time to thrive everyone,
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