Heart Care
Q & A with Dr. Anthony Bashall
This month, we sat down with Anthony Bashall, MD, FACC, board-certified cardiologist with Franciscan Health who specializes in cardiometabolic care, heart failure, and preventive cardiovascular medicine. With a focus on early detection and whole-body health, Dr. Bashall helps patients understand the complex connections between metabolism, inflammation, weight and long-term heart health, shifting the conversation from treatment to prevention.
Q: Why should people be paying attention to their cardiac health before they experience symptoms?
A: Cardiac health is about balance—how well the heart and body function together to keep us healthy. Heart disease often develops slowly over many years, and symptoms can become so subtle that people dismiss them as normal aging or weight gain. When testing shows normal results, the goal is to keep it that way through prevention. If disease is discovered early, treatments can slow or stop progression. Prevention is far more rewarding for patients and can be easy to manage with lifestyle and medical changes to help avoid surgeries, hospitalizations and invasive procedures. It also typically requires fewer medications and medical visits than treating heart attack, heart failure or atrial fibrillation after they occur. Q: Many people still associate heart disease primarily with cholesterol. What are some of the less obvious markers that play a major role in heart health? A: Cholesterol remains a major contributor to arterial blockage, which can cause heart attacks, strokes or peripheral arterial disease. Knowing your cholesterol (and whether it’s at a safe level) is critical. In recent years, LDL (“bad” cholesterol) targets have dropped significantly, with levels below 55 now recommended for many high-risk patients. At these levels, plaque can actually shrink, reducing future risk. Inflammation is another critical factor. High-sensitivity C-reactive protein (hs-CRP) has emerged as an important predictor of premature heart disease and, in some studies, is even more predictive than cholesterol—especially in women. Protein in the urine is another overlooked marker. When the kidneys leak protein, the same cardiometabolic process harming the kidneys is often harming the heart. This can more than double heart disease risk in men and nearly triple it in women. Lipoprotein(a) is a genetically determined cholesterol that increases risk for heart and valve disease. While direct treatments are still being studied, measuring it can help guide cholesterol and blood pressure management. Finally, fatty liver disease is closely linked to heart disease. In middle-aged adults, those with fatty liver are more likely to die from heart disease than liver disease, making cardiometabolic evaluation essential. |
Q: GLP-1 medications are often discussed in the context of weight loss. From a cardiologist’s perspective, how do they impact heart health?
A: GLP-1 medications provide significant cardiometabolic benefits that begin well before any weight loss occurs, and these benefits apply whether a patient has diabetes or not. They reduce inflammation by lowering markers such as high-sensitivity C-reactive protein, which in turn lowers the risk of heart attack, stroke, peripheral arterial disease and atrial fibrillation. Weight loss is a meaningful and welcome additional benefit, but it is not the primary reason these medications improve heart health. GLP-1 medications mimic a natural hormone produced in the gut after eating and help regulate blood sugar, appetite and inflammation. They can stabilize and, in some cases, reverse fatty liver disease, improve kidney function, and reduce sleep apnea. Many patients experience better diabetes control without episodes of low blood sugar, and some are able to put diabetes into remission without the need for insulin. These medications also work particularly well when combined with SGLT2 inhibitors, offering added cardiometabolic protection. Beyond the heart, many patients report improvements in joint pain, and there is growing research into the role of GLP-1 medications in addiction management, autoimmune disease and cancer prevention. While research is ongoing, it is increasingly clear that these medications are powerful metabolic and anti-inflammatory tools, not simply weight-loss drugs. Q: How does excess weight contribute to inflammation? And why does that matter for long-term heart health? A: Excess visceral fat (fat surrounding the organs) loses adequate blood supply and begins releasing inflammatory signaling molecules called adipokines. Inflammation is designed to fight infection and heal wounds, but when it targets organs like the heart, it causes damage. This inflammation directly affects the heart, kidneys and liver, leading to heart failure, kidney disease and fatty liver. Excess weight places inflammatory tissue directly on vital organs, accelerating long-term cardiometabolic damage. Q: What screenings or conversations should generally healthy adults be having with their doctor? A: Testing should begin before symptoms, often in the 30s. Heart scans are a quick, affordable way to assess arterial blockage, and everyone over 40 should consider one. A zero score is reassuring and helps guide prevention; a higher score may prompt further testing such as stress tests or advanced imaging. As weight increases, conditions like sleep apnea and atrial fibrillation become more common. Both contribute to heart disease and stroke risk, and both can be treated, often in part with GLP-1 and SGLT2 inhibitor therapies. While testing and medications are important, diet and exercise remain essential, especially preventing weight gain in the first place, starting in childhood. Even people who appear healthy can have significant cardiometabolic disease, so proactive screening is key. |
Take the first step toward better heart health today. Schedule a cardiology appointment at Franciscan Physician Network Indiana Heart Physicians at 317-893-1900 or visit FranciscanHealth.org/HeartCare for more information.