By Arthur Lightbourn
“Know your numbers,” Dr. Franklin Zalman strongly recommends.
“And the numbers everyone should know are basically your blood pressure, your cholesterol and your fasting blood sugar.”
Because those numbers, together with your family’s health history, are indicators of whether you may be a candidate for a heart attack.
And Zalman should know.
He has been detecting, treating and preventing cardiac and vascular diseases for almost three decades.
He’s a practicing cardiologist and, since 2002, the founding president and medical director of the non-profit Cardiovascular Disease Foundation in Carlsbad.
We interviewed the 56-year-old physician in his office in Del Mar.
Incidentally, the ideal numbers for your blood pressure are 110 to 130 over 70 to 80; total cholesterol less than 200, better yet, less than 180, with the good cholesterol (HDL) greater than 45 and the bad cholesterol (LDL) lower than 120; and your fasting blood sugar, under 100.
The numbers are usually obtained in your annual physical exam and are undoubtedly on a chart somewhere.
“But we believe the patient himself or herself should know them so then they are more likely able to make wise choices,” Zalman said. “So that when a little snack is being offered or that dessert or maybe even that extra glass of orange juice, when they know their blood sugar is borderline, maybe they don’t need those sugar calories.
“And if someone has already had a heart attack, then we need to be even stricter with those numbers … And if they can’t reach those numbers with nutrition and exercise, then we have to use medication to do so.”
Zalman was born in Yassy, Romania, a town with a dark, centuries-old history of anti-Semitism and pogroms. Zalman was 9 when he and his parents fled Jewish persecution in Communist-controlled Romania and immigrated to the United States via Italy in 1964.
“We learned our English in Italy,” he recalled.
The family lived initially in St. Paul, Minn., and moved to Los Angeles in 1966.
Zalman’s father worked in a warehouse filling orders, then “worked for a gentleman delivering milk, eggs and butter to restaurants and homes,” and then eventually opened his own business.
Zalman loved growing up in LA, he said. “It was sunny, the beach, bicycles and lots of cousins.”
In junior high, Zalman said he thought he might eventually become an architect, but while attending Fairfax High, a 9th grade biology teacher and a 10th grade chemistry teacher sparked his interest in science.
At UCLA in 1976, he earned his undergraduate degree in biochemistry, followed by a master’s degree in physiology and his M.D. from the University of California School of Medicine, San Francisco, in 1979 and 1981 respectively.
He did his internal medicine internship, residency and a cardiology fellowship at UCLA’s Department of Medicine from 1981 to 1986; and a coronary angioplasty fellowship at Baptist Medical Center, Oklahoma City in 1987.
What attracted him to cardiology?
He had considered specializing in hematology/oncology, but, at that time, he recalled “the cocktails were really hard on the patients and it didn’t seem we were making that much progress clinically;” whereas in cardiology, physicians could measure heart function and come up with treatments to affect the outcome and make heart patients better.
“That convinced me to go into cardiology,” he said.
“After my general cardiology training, I sub-specialized in doing coronary angioplasty so I can stop a heart attack with a balloon and stents; we can treat severe [artery] blockages by opening the blockages, and I’ve been doing that since 1987.”
Blockages are the result of a build-up of a fatty substance called plaque that narrows and hardens the artery and is caused by hypertension, diabetes, sedentary lifestyle, smoking, high (bad) cholesterol levels, and diets high in saturated fats.
Coronary angioplasty is a non-surgical, interventional, minimally invasive procedure that was first performed in Zurich, Switzerland, on an awake human patient in 1977. The procedure was brought to the U.S. in 1981. Ever since, it has dramatically changed the role of cardiologists in treating coronary artery disease. More than one million patients a year undergo the procedure.
After an artery blockage is located and assessed with a catheter, usually inserted through the upper thigh to a coronary artery and using a dye and x-rays (angiography), another catheter with a deflated balloon at its tip, is threaded to the blockage. The balloon, wrapped in a thin mesh tube called a stent, is then inflated, compressing the plaque against the wall of the artery, opening the blockage, reinforcing the artery wall, and improving blood flow to the heart.
“It’s done completely without opening the chest,” Zalman said, “as opposed to open-heart surgery where the chest has to be opened. So it’s much less invasive. But sometimes open-heart surgery has its place because certain blockages can’t be treated with angioplasty, so we work very closely with our surgical colleague.
“I also do general cardiology treating patients with heart failure,” Zalman added, “and preventive cardiology, which means we try to talk with patients even before they have a heart attack to modify their blood sugar, blood pressure, cholesterol, and their lifestyle in terms of their eating and exercise habits.”
In 2002, Zalman co-founded the Cardiovascular Disease Foundation in Carlsbad, dedicated to helping the public benefit from the advances made in the treatment, detection and prevention of cardiac and vascular diseases.
The foundation (www.cvdf.org) offers a number of free health programs town-hall style educational lectures, health screenings, a healthy heart nutrition program, “healthy habits/healthy kids” talks, and an access-to-health program for patients to find efficient outpatient healthcare.
“I believe that preventive cardiology can prevent up to 80 percent of heart attacks and strokes,” he said.
As a cardiologist, he wears different hats.
“When I’m on call for the emergency room [at Scripps Memorial Hospital, La Jolla] for heart attack patients, I’m there as an interventional cardiologist. In the office, I do a lot primary prevention, secondary prevention and follow-up. And, with the foundation, it is all prevention.”
Asked about the current state of cardiology in the U.S., Zalman said, “In general, we have made tremendous progress in the last 30 years.”
Treatment tools have been miniaturized, procedures have become less risky, the re-narrowing rate [of treated arteries] has decreased significantly by the use of stents, and preventive strategies have been increased by knowing how to treat blood pressure more effectively, lowering (bad) cholesterol and the use of aspirin as an effective preventive medication.
Exercise and healthy nutrition are big plus factors in combating heart disease, he said.
“Although the rate of heart disease has stayed relatively steady,” he said, the good news is that “deaths from heart disease have decreased.”
: Franklin Zalman, M.D.
: Del Mar cardiologist and coronary interventionalist Dr. Zalman is the founding president and medical director of the non-profit Cardiovascular Disease Foundation, Carlsbad, dedicated to informing the community about heart disease and stroke prevention.
: Jassy, Romania, 56 years ago
B.A. in biochemistry, UCLA, 1976; M.A in physiology, 1977-79, and M.D., 1976-81, University of California School of Medicine, San Francisco; internship and residency in internal medicine, UCLA, 1981-84; cardiology fellowship, UCLA, 1984-86; coronary angioplasty fellowship, Baptist Medical Center, Oklahoma City, 1987
Divorced. Grown daughter, Sandra
: Interventional and preventive cardiology
Hiking, walking, scuba diving, low impact exercise, travel and reading.
“The Glass Castle,” 2005 bestselling memoir by Jeannette Walls; and “Hollywood,” 1989 novel by Charles Bukowski
: Hawaii, Yellowstone, and scuba diving in the Maldives
“Independence Day” and “The King’s Speech”
“It stems my parents who were optimists...With a little bit of grace, hard work, and good will from people, a lot can be accomplished. I’m grateful. For every day we are healthy, it’s a wonderful day.”