Arash Bereliani Podcast Transcript
Arash Bereliani joins host Brian Thomas on The Digital Executive Podcast.
Brian Thomas: Welcome to The Digital Executive. Today’s guest is Dr. Arash Bereliani. Dr. Arash Bereliani is a board-certified cardiologist on a mission to change how medicine sees women’s hearts. Board certified in cardiovascular disease and internal medicine, Dr. Bariliyani serves as a clinical associate professor of medicine and cardiology at the David Geffen School of Medicine at UCLA, and is on staff at Cedars-Sinai Medical Center.
He is the medical director of the Beverly Hills Institute for Cardiology and Preventative Medicine, where he spent more than 20 years focused on preventative cardiology, early detection, and highly individualized care. Well, good afternoon, Dr. Bariliyani. Welcome to the show.
Dr Arash Bereliani: Thank you. It’s a pleasure to be here.
Brian Thomas: Thank you so much. I appreciate it, making the time. You’re hailing out of Beverly Hills, California, southern California. Beautiful place. I was… used to live in Orange County, but I appreciate it. I’m in Kansas City. You traversed a couple time zones to get here, and that makes me so happy ’cause it’s, it’s hard to do that sometimes.
So Dr. Bereliani, let’s just jump right into this if you don’t mind. You graduated first in your class, trained at UCLA, and have spent more than 20 years in preventative cardiology in Beverly Hills. But you’ve said this work became deeply personal when your wife, your wife’s mother, actually collapsed and died suddenly at age 67 with no recognized warning signs, alongside heart disease in your own family.
How did those losses reshape your practice and lay- lead you to make women’s heart health your mission?
Dr Arash Bereliani: Well, Brian heart disease is very personal to me from a very young age. I was eight years old when I used to come home from school and I used to see my dad grabbing his chest and, and in pain.
He ended up getting five-vessel open heart surgery when I was young. It was traumatic. Two years later, my brother, who’s two years younger than me, developed rheumatic heart di- fever which is an infection that affects the heart. And I saw him, I saw how s- he’s, how sick he became, how you know, he was b- he was my best friend. We used to play together, and seeing him so sick really affected me. I felt very helpless. I felt like, I wanted to do something to help my brother, to help my dad, and I felt like there was nothing anybody could do. So from very, this changes you in two ways.
Some people, when they go through that helplessness, they, they, they become, they become even more helpless. They, they give up. For me, it was the opposite. I wanted to really do something about it. So ever since I can remember, I wanted to be a doctor. Then when I went to medical school and I end up loving cardiology, obviously, I, I…
not only because it was personal, but also I loved the whole I loved the heart, I loved the physiology of the heart. I loved everything about it. And I end up, I studied cardiology. I became certified in cardiovascular diseases. But then when I was dating my wife when we were dating, at that time, my wife’s mother was 67.
She was active she was loved and she had no recognized warning signs. And one day she collapsed, and she was gone You know, as a cardiologist, that’s a very particular kind of grief. You keep replaying it. You ask yourself what the signs were, who missed them, and whether I missed them. And at that time, that’s when I became interested in women and heart disease.
What I, what I came to understand was that her story wasn’t unusual. It was typical. Women’s symptoms are often quieter. They’re more scattered. You know, fatigue, shortness of breath, a vague discomfort in the jaw or back. So just a sense that something is off. That’s how usually women present with, and these symptoms get missed by doctors, even by women themselves, because they don’t match the textbook. They don’t match the textbook of heart disease, ever since the field of cardiology has been around everything we know about heart revolves around men. All the trials, all the clinical data that we have is designed for men.
Women were actually intentionally kept off initially on these studies, and it wasn’t a conspiracy. It, it was– The reason the women were off were not studied was because, the study investigators did not wanna include women because of pregnancy, because of their hormones. They didn’t want that to affect the study.
So then they assumed that everything that applies to men automatically apply, applies to women. So they took everything we know about men, and then they basically transla- transferred them to women. But that was wrong because women heart are different than men’s. And obviously, we, we’re gonna get more into it.
But I realized that at the very beginning of my career that this is the problem. That’s why heart disease is the number one killer of women. That could be one of the reasons my mother-in-law passed away because her symptoms were unusual. Probably her doctor didn’t re- notice it. So this became the mission.
It was… initially it was an interest and passion, and then it become a, it became a mission. I didn’t want another family to get that phone call, and that’s why I got on this mission to sha- to inform everybody, to make, to raise awareness about women and heart disease and how it is, how it could be different than men. And here we are.
Brian Thomas: Thank you very much. I appreciate you sharing that backstory. We typically start the podcast off with the story of, where you were and where you are today and, and what kind of was the why behind where you are. And obviously it was sad and traumatic. You’ve obviously had a brother that suffered from heart disease, but also the fact that your mother-in-law passed away from it suddenly, and you learned so much from it.
But that drove you to be where you are today. It drove your curiosity, and of course, now you’re a well-respected cardiologist in your field, and you’re doing very well. So thank you. Dr. Bereliani, your book’s subtitle is pointed: How a Male Model Medical System is Putting Women’s Health at Risk. Heart disease is the number one killer of women, which you did mention, yet most research and diagnostic standards were built around men.
How did cardiology end up being so male-centered, and what are the real-world consequences for women sitting in exam rooms today?
Dr Arash Bereliani: Yes, and that’s what my b- that’s the gist of my book, and that’s the gist of my, my message is that, initially, as I mentioned earlier, for decades, the standard patient in research was a middle-aged man.
All the classical symptoms of a heart attack that we know of, like left-sided chest pressure with radiation to the left arm, sweating and all that, it was based on a middle-aged man, not women. Women were often left out of clinical trials, partly out of caution about pregnancy and hormonal variability. So because of that, all the studies were calculate…
All the risk calculators, diagnostic testing, even treatments, were designed and buil- were built on male data. And they assume that because of that, because the, the… Basically, they took that and they expanded it to women, assuming that women were, were gonna be the same. It turns out that women are very different than men, and many of the things that apply to men does not apply to women.
Even today, women are underrepresented in cardiovascular trials relative to how many of them actually have the disease. So, so what does it mean? So it means that, the symptoms get misread. So a woman with fatigue, nausea, or shortness of breath is told it’s anxiety, it’s reflux, it’s stress, but, but, but it could easily be his, her heart.
The second thing is, doctors that, do some testing on women, the tests come back, quote unquote, “normal” when she’s in normal. Many women have disease in the small vessels of the heart, not the big blockages that men get, and a standard angiogram can miss it entirely. They tell her after an angiogram, “Oh, your angiogram was normal.
Your big arteries are normal. Your pain is not your heart.” But they don’t check the little blood vessels of the heart, and that’s where the disease is in majority of women. The third thing is that the female-specific risks get ignored. For example there’s a condition called preeclampsia, where women during their pregnancy develop very high blood pressure.
There is another complication during di- during pregnancy called gestational diabetes, where healthy women all of a sudden become diabetic. Early menopause, polycystic kidney disease, or polycystic ovarian disease, autoimmune diseases, these are risk factors that significantly increase a woman’s risk of heart disease.
But most cardiologists never ask about them, never talk about them, never realize that they are major risk factors. And then the last thing is that even if a patient, a woman is diagnosed with heart disease, the, the treatment is less aggressive. So women tend to be treated less aggressively with less medication or treatments and that they’re less likely to go under preventive therapy as men are.
So these four things are the causes the reason why heart disease is the number one killer of women worldwide, not in the US, not just in the US, worldwide. So to put it in perspective, heart disease kills more women than all cancers combined. So if you get breast cancer, ovarian cancer, colon cancer, you add all of them, heart disease still kills more women in one year.
But we do not, most of us don’t know about it, because, unfortunately, the publicity is not there. We know more about cancer and women than heart and women.
Brian Thomas: That, that is amazing. I, and I didn’t know that statistic, and I’m glad you’re sharing that with our audience. And more importantly, obviously, your book, and again, your book, How a Male-Modeled Medical System Is Putting Women’s Hearts At Risk I love that you’re getting the message out there.
There is so much knowledge to be shared from you and, and from other peers in your profession. We need to get, certainly get the, the message out that the symptoms are very much different, so I appreciate that. Dr. Bereliani, your practice, integrative preventative cardiology, asking patients about sleep, nutrition, stress, and nutrients, not just cholesterol and blood pressure.
Many of our listeners here in our audience are tech and business leaders running on long hours, constant pressure, and not enough sleep. What does chronic stress actually do to the heart over time, and what warning signs do high performers tend to brush off until it’s too late?
Dr Arash Bereliani: So this one is for your listeners because I see them in my office every week, and frankly, they’re often the hardest patients to reach.
They treat their bodies like a server that’s never allowed to go down. They work so hard all the time. So here’s what chronic stress does. Your body is built for short bursts of adrenaline and cortisol, the, the so-called fight and flight response, right? When that switch never turns off, meaning that, your bodies– our bodies are designed to have this burst of stress hormones released to help you with stress, but they’re meant to go on and off during, only du-during stressful situations.
But when the body continues to produce stress hormones because you’re constantly stressed, in other words, when that switch never turns off, blood, blood pressure stays elevated, heart rate stays high, blood sugar rises, inflammation quietly damages the lining of your arteries. And on top of that, short sleep, risk of makes it worse.
So putting all that together, lack of sleep and chronic stress puts a lot of stress on your body by increasing your stress hormones. And the stress hormones long term damage your heart. That’s the easiest way to put it stress can even affect the heart directly. We even had a condition literally called broken heart syndrome.
It’s, it’s a real true condition where extreme stress causes the heart to become paralyzed. The, the heart actually enlarges and stops working. And it’s a, it’s a known fact. I’ve had, like, two or three patients over the past year with this condition. So it’s really, really important to deal with stress.
Stress is turning to be one of the most important risk factors for cardiovascular disease. Now, some of the the warning signs that, your listeners should be aware of, and, especially because they’re, they’re during such a high-stress environment, things like unusual fatigue.
Like, “I’m just busy, that’s why I’m so, tired.” A kind of fatigue that doesn’t go away with rest. So, if somebody just has this chronic fatigue that just no matter how much str- rest you get, you still have it, you, you have to see your doctor. Shortness of breath climbing up stairs shortness of breath on walking when you didn’t have it before, racing of the heart, chest pressure.
One of the things that’s really important, one of the risk factors for heart disease is sleep apnea. That’s manifested a lot of times with snoring. If any of your listeners are, snore a lot, or if they’re tired during the day, they need to be checked for a condition called sleep apnea that significantly affects the heart And then, the last one is the blood pressure.
A lot of people say, “Oh, my blood pressure is high because I have stress.” But then the problem is that your stress is there all the time. You always have stress, and blood pressure doesn’t care that is stress. It still affects your heart. So even if your blood pressure is slightly elevated, you need to work on it.
You need to treat it. Now, I don’t mean you need medication, but there are ways to lower the blood pressure without medication. So my message to your executives is simple. Think about a company. You’d never run your company without a dashboard. You need to know your numbers. You need… So before you do anything, you need to u- know your numbers, right?
We want– we know our finances, we know our financials for our company. Same thing with our body. There are five numbers that everyone should know, both men and women. They need to know their blood pressure, they need to know their blood sugar, they need to know their blood cholesterol level, they need to know their there’s a test called lipoprotein A, a blood test that significantly raises the risk of heart disease, and the fifth one is the waist size.
So knowing your waist, abdominal obesity or basically obesity has a, is a major risk factor. So, your heart is one piece of infrastructure that you can’t replace, so you have to really be active and work to make sure that stays healthy.
Brian Thomas: Thank you.
Dr Arash Bereliani: I- And one last thing that I wanna mention is that, prevention is the key.
I always tell my patients, if somebody comes to me with chest pain, it’s not that’s too late. You don’t wanna go and see a cardiologist when it’s too late. You wanna see them right before. And Brian, you know what’s really interesting is every time I go to a, to an event, I go to a wedding, I go to an event, and I get introduced to people, and they find out I’m a cardiologist, the first thing they tell me is, “Oh, you’re a cardiologist.
I hope I never have to see you.” And my answer is, “No, it’s the other way around. You have to see me to prevent heart disease.” Because unfortunately, the mentality still is that, okay, you don’t need to see a heart doctor unt- unless you have heart disease. But I’m hoping to change that by ma- raising awareness that prevention is extremely important.
And I believe that no one should develop heart disease or die of heart disease before the age of 100, and I’ve proven that in my practice. We have the technology, we have the, we have the technology, we have the knowledge, we know how to prevent and treat heart disease.
Brian Thomas: Thank you. I appreciate you sharing that.
You highlighted some things as far as preventative that are so, so important. Talk, talked about your blood pressure, blood sugar your abdominal, your waistline, obesity, that sort of thing. But the big message I took away is be sure you’re seeing your cardiologist before you have an event or before you feel bad, or you feel like you’re overworked and overstressed and tired.
So thank you. And Dr. Bereliani, last question of the day, if you could just briefly share, between your book, your 90-day heart reset, and growing awareness of these gaps, the field seems to be at a turning point. As we look five, maybe even 10 years out, how do you see the diagnosis and treatment of women’s heart disease changing, and what has to happen in research testing and medical training, and what gives you hope that the next generation of women will be better protected?
Dr Arash Bereliani: That’s a great question. So, I believe that three things have to happen. Number one, research has to include women by design, with results analyzed by sex, not as an afterthought. Number two, testing has to get sex specific. So, it’s really important to treat women to do the right testing for women, not just do a standard test for everyone, because testing for women can differ for men in men than in women.
So it’s really important to personalize the, the testing for women. And the third thing is that medical training has to change. Every physician from the ER doctor to primary care to OBGYN needs to learn that a woman’s pregnancy history is part of her cardiac history. Menopause is part of her cardiac history.
Those are inflection point in a woman’s health history. So, so they have to understand. And the last thing is that do- we need to raise awareness so both doctors and patients take patients’ symptoms women’s symptoms seriously. Now, my hope is that the next generation won’t have to fight to be believed.
Next generation of women doesn’t have to fight to be believed that they have heart disease. Now, what gives me hope? Two things give me hope. One is women themself. Women these days are now asking better questions. They are they are they’re becoming more educated, and they’re asking the right questions from their doctors.
They demand answers. And that gives me hope that things are gonna change, because now women are becoming advocates for their own health. And the second thing is the technology. The way the technology is going, the, the way AI and all the, newest technology that we have in medical imaging I think it’s gonna take this field to a completely different level in about 5 to 10 years.
A lot of diseases are gonna be prevented from the very, very beginning or easily treated. So I’m very hopeful. I’m very hopeful that, future is gonna be great, and I really believe that hopefully in about 10 years maybe even sooner, heart disease will end up being at the bottom of the list of the deadliest diseases.
And that’s my hope.
Brian Thomas: Thank you. I, I appreciate that, really do. And the big thing is the message I, I took away is make sure that in these trials and these tests, that we are including women at those numbers so that we, we can truly make heart health important for women just as we do for men.
That, that’s very important. And again, you’re doing so much to get the awareness and knowledge out there, but the last thing we always talk about here on is the emerging technology, and we know with wearables and imaging, et cetera AI, in the next several years we’re gonna see s- a lot of breakthroughs and innovation in preventative medicine.
So I appreciate that.
Dr Arash Bereliani: Absolutely.
Brian Thomas: And Dr. Bereliani, I really appreciate you having you here today on the show, and I really look forward to speaking with you again soon.
Dr Arash Bereliani: Thank you again for having me. This was a pleasure. I’m looking forward to seeing you again.
Brian Thomas: Bye for now.
Arash Bereliani Podcast Transcript. Listen to the audio on the guest’s Podcast Page.
