Vivian A. Kominos, MD, FACC
732 395-3059
Welcome to Integrative Cardiology July, 2018

At a recent cardiology conference I introduced myself to one of the speakers who I had admired from afar for many years. “Hi, I am Vivian Kominos, an integrative cardiologist!” He looked quizzically at me and asked “but are you a real cardiologist?” I enthusiastically responded “For fifteen years I was an invasive cardiologist. I still send people for cardiac catheterization and bypass surgery when they need it.” But he was not impressed and still seemed a bit baffled.  I continued “I am a real cardiologist…I prescribe aspirin and statins….” He walked away as I was still speaking.

The correct answer, one that did not come to me until later, is “I am the real cardiologist! I look at the whole person, not just several centimeters in a blood vessel.” 

When people learn that I am an integrative cardiologist they often ask “what do you do?” This is easy to answer but difficult to understand. We all know what conventional cardiologists do. They are very good at testing hearts and blood vessels with various imaging techniques, inserting catheters and balloons to relieve blockage, burning tissue to stop rhythm disturbances. They are there to save us during life-threatening illnesses such as heart attacks and heart failure and I applaud them.

I loved practicing this acute care cardiology for over 20 years. But when heart disease hit home, I realized that I was doing very little to prevent or heal heart disease. I was plugging a leak without turning off the faucet!

A two year fellowship with the Arizona Center for Integrative Medicine taught me that conventional cardiology, when coupled with lifestyle and alternative and complementary medicine, was far superior than the way I was practicing. I learned the power of the mind in pain management, stress reduction and blood pressure control. I learned that acupuncture is sometimes as effective as anti-arrhythmic drugs for certain heart rhythm problems and that a healthy diet can reduce depression. I learned that physical activity can reduce the risk of cardiovascular death and that drugs are often over prescribed. I learned much more, including how to be a better person and physician. Integrative medicine looks at the entire person, their lifestyle and their emotional, physical and spiritual environment to determine the root cause of their health issues. 

Over the last five and a half years I have worked in integrative medicine practices with luminaries in the field, with practitioners of functional medicine, acupuncture, psychology, massage therapy, nutrition and exercise physiology. I learn continuously as I am now on the faculty for the Arizona Center for Integrative Medicine. I feel truly blessed that I can practice the cardiology of my dreams. And YES I am the REAL cardiologist! Join me monthly as I post a new topic. Coming up: Yoga and the Heart, The Best Way to Prevent Heart Disease, The Healthiest Diet and many more.  

Yours in Health,

Vivian A. Kominos, MD, FACC



I started practicing yoga over 20 years ago while training for my first long distance race, a half marathon. I noticed that I was becoming stiff after my runs and thought that yoga would help me regain flexibility. I quickly realized that yoga made me stronger both physically and mentally. My muscles didn’t ache and I was more flexible. More importantly, yoga made me calmer and less anxious. Soon I was craving my yoga practice as much as my runs. 

Yoga originated in ancient India for physical and spiritual fitness. Yoga incorporates movement poses known as asanas, breathing exercises or pranayama and meditation or dhyana. Recent studies found that yoga reduces many of the risk factors for heart disease: it improves glucose, reduces blood pressure, decreases weight while improving body composition and even increases lung capacity. Even more important may be the relaxation that results. Yoga reduces stress, anxiety and depression, some of the most potent risk factors for heart disease. 

Yoga has become very popular in the United States and the number and types of classes available can be confusing. The important thing to remember is that yoga is not a competition! You do not have to twist like a pretzel for it to be effective but need to honor your body. Anyone can practice yoga regardless of fitness or flexibility. Look for a class suited to you. This may be a therapeutic class where you may be sitting on a chair or it may be an energetic power flow with advanced poses. All good yoga classes begin with the teacher asking if there are any injuries or problems. The classes start with breath work and meditation followed by poses and movements that gently stretch and strengthen the muscles. The ending incorporates a closing meditation called savasana. 

The National Center for Complementary and Integrative Health is a good resource to learn more about the benefits of yoga: https://nccih.nih.gov/health/yoga/introduction.htm. And remember, anything that is good for the heart is good for the entire body, mind and spirit. 

Yours in health,

Vivian A. Kominos, MD, FACC



A study recently published in the prestigious medical journal, The Lancet, found that the Tsimane, an indigenous population who live in a remote corner of the Bolivian Jungle, have the healthiest arteries. The Tsimane farm and forage for food. Anthropologists report that they have very few risk factors for cardiovascular disease. In a research project, over 700 Tsimane traveled for days to get CT scans of their hearts. These scans showed that most had no calcium in their arteries. Calcium is a marker for blockages in the arteries: the more calcium, the greater the risk for heart disease. The researchers found that the average 80 year old Tsimane had the arteries of a 50 year old American!

Scientists asked the question, why are they the healthiest people on earth? Is it possible that the answer can be found by looking at their lifestyle? While processed foods make up more than half of the standard American diet, the Tsimane eat mainly wild game, fish, maize, fruits and nuts. Their diet is very low in saturated fat and most of their calories are from plants. And while the typical American walks 6,000 steps, the Tsimane walk 17,000 steps. They have to walk for their survival: they hunt, fish, and farm. They live in a connected culture with large families and strong community connections.

Cardiologists agree that up to 80% of premature heart attacks and strokes can be prevented with a healthy lifestyle. Maybe we can take lessons from the Tsimane. Besides diet and social connectedness, the amount of physical activity differs greatly from Americans. The Tsimane walk 8 miles a day just to live their normal every day existence while the average American walks 2.8 miles. We live in a sedentary culture where food is delivered to our doors, meetings take place over the computer, and social media connects us to our family and friends. More and more evidence reveals that sitting time is dangerous.

I am not advocating that we give up our modern conveniences. But it is obvious that we need to move more. The current recommendations from the American College of Sports Medicine recommend that we get at least 150 minutes of moderate physical activity and 2 sessions of resistance training of major muscle groups each week. Examples of moderate physical activity include walking 30 minutes, five times a week at a brisk 3-4 minute mile pace, riding a bike at 5-9 miles per hour, ballroom dancing, or playing doubles tennis. But suppose you cannot exercise this much? I tell all my patients that ANY exercise is better than no exercise and simply to become more active.

There are many ways to build activity into your day. Park at the farthest space in the lot rather than the closest to the store. Stand when you are on the phone. Walk to colleagues’ offices when you need to talk to them instead of texting or emailing. Create multiple work stations at work and at home so that you do not sit in the same position for extended periods. And if you do have a sedentary job, see if you can get a standing desk. And if you have to sit for long periods, get up every 20 minutes and walk for a couple minutes. When you go to concerts or games, don’t bring a chair but stand and pace. Cook your own food and go for a brief walk after eating.

I have been physically active my entire life. I started running at the age of 38 and completed 5 marathons. I no longer run long distances but run for fun, health and fitness, 15 to 20 miles a week. I hike and kayak. I practice yoga for resistance training and for the peace it creates. I would love to help you create a more active life. To find out more, call my office at 732 395-3059!

Yours in health,
Vivian A. Kominos, MD, FACC