“You Will Feel Better”
For preventing heart disease, the best medicine doesn't come from a pharmacy.
Cardiologist Franck H. Azobou Tonleu has a simple but powerful message for patients worried about high cholesterol and heart disease: the changes you make in your daily life are worth “a hundred times” any medication he can prescribe. As an expert in advanced cholesterol disorders and preventive cardiology, his first focus is helping people feel and function better, not just lowering a number on a lab report.
Dr. Franck H. Azobou Tonleu
We spoke with Dr. Tonleu about how he partners with patients to bridge the gap between clinical guidelines and real life.
Q: Why does lifestyle come first in cholesterol care for most patients?
A. High cholesterol is a major contributor to heart disease, which can lead to heart attacks, strokes and other life-threatening conditions. We need to do more than just write a prescription to tackle these serious health risks. When I meet new patients, I often see that they were started on cholesterol medications very quickly, despite being at low risk and without having given a chance to try lifestyle changes first. It is, in my experience, too easy to start medications and not nearly as easy to take them off, and if we rely only on pills, we can turn people into pill boxes instead of partners in their own health.
Q: What is the balance between managing cholesterol with medicines and addressing lifestyle factors?
A. Medication matters – but it’s not the whole story.
- Cholesterol medicines such as statins absolutely do reduce heart risk and save lives, both in people with heart disease and stroke, as well as those who are at higher risk based on risk factors.
- At the same time, those medicines usually don’t make you feel better day to day. The things that reliably improve how you feel – your energy, your mood, your sleep – are lifestyle changes: what you eat, how much you move, how you rest and manage stress.
- My goal is to use medicines when we need them, but always to work with my patients toward lifestyle changes that may allow us to reduce or even discontinue certain drugs when it is safe to do so.
Q: How do you help your patients see risk before something serious happens?
A: One of the hardest parts of proactive health care is that, as human beings, we have a very hard time imagining what a heart attack or stroke would mean before it happens. I can explain risk percentages and future possibilities, but it’s hard for people to really understand it unless they or a loved one has experienced it.
So, I find it more effective to focus on how you will feel once you make changes. I’m very honest that when I go through weeks where I don’t exercise or I eat poorly, I don’t feel good myself. When I eat better and move regularly, my sleep is better, my mood is better, and frankly I am kinder and easier to be around for my family and colleagues. I ask my patients to imagine that difference for themselves. My message is: you will feel better. Sometimes you don’t know what “better” is because you’ve never been there, but once you get there you look back and think, “Where has this been my whole life?”
Q: What does lifestyle change actually look like?
A: I always emphasize that lifestyle change is not about perfection; it’s about ownership. Many of my patients feel better partly because they took ownership – they made intentional choices, not just took a new prescription. I often see couples or friends keeping each other accountable for eating well and staying active, and that turns prevention into something you do together, not a solo struggle.
Q: What practical steps do you recommend?
A: I encourage people to shift away from highly processed foods and move toward more home-prepared meals with fruits, vegetables, lean proteins and whole grains. I recommend regular walking. Ideally, I like the idea of walking in a park or just outside in general because being in nature adds something that’s harder to measure but very meaningful. But if your neighborhood doesn’t offer safe or convenient places to walk, we talk about treadmills and gyms. Other options for people who cannot work due to joint issues or who just don’t enjoy walking are swimming, biking, or various gym classes. The best exercise ultimately is the one you enjoy and stick with. The key is movement.
In my experience, when people focus on the right behaviors for a few months, their bodies often “reset.” We start to see changes in weight, cholesterol and blood pressure as natural consequences of those habits, not as the only target.
Q: What roles do dietitians and other professionals play?
A: For many of my patients, I recommend talking with a dietitian. This can be an amazing resource because the dietician can go into a lot more details about meals throughout the week and identify areas to improve, as well as provide recommendations. I think we all, including doctors, would benefit from more education regarding diet. This would allow us to better counsel our patients regarding healthy eating.
Q: How do you approach smoking when life is complicated?
A: Every time I see a patient who smokes, I bring it up and I check how they’re doing. I absolutely encourage quitting, but I recognize that there are times when life is incredibly complex – stress at home, financial pressure, grief. You have to pick your battles and know when the time is right for change. Sometimes I’ll say, ‘We’re going to talk about this again next time.’ I remind myself that this is an ongoing conversation. I’ve had people who smoked for 46 years quit. Even if it is one out of twenty, you really save a life, and that makes every conversation worth it.
Q: How do you talk about change when it feels overwhelming?
A: I think humility becomes very important here. I don’t like to pretend that I am somehow going to help someone completely change their lifestyle in one visit. I must be honest about what we can do. I can help you change your cholesterol, your blood pressure; I can prescribe medicines. But I always try to add education. We talk about what you eat and how much you move. We know that only about a 20 percent of health comes directly from medical care. The rest is everything else in someone’s life. I’m very upfront that this is hard, but change starts with making the choice.
Q: How do you help patients overcome real-life barriers to change?
A: Effective prevention starts with understanding the context you live in. Where you live matters – whether it’s easy or safe to walk, whether there is a park nearby or you are close to a highway with no sidewalks. Your family and social networks also matter; they can support your decisions or make them harder.
I have seen patients whose families discourage medications, even when their cholesterol is high and we can see plaque in the arteries. Experiences like that remind me that medical decision-making must go well beyond what the guidelines say or what the bloodwork shows. It should be teamwork between you and me, taking into account your reality, not just numbers on a page.
About Franck H. Azobou Tonleu, MD
Inspired by his mother, a nurse serving an underserved community, Dr. Azobou Tonleu is dedicated to connecting care with the everyday realities of his patients’ lives. He believes cardiology should help people live better – not just treat heart attacks after they happen.
How to refer or schedule
- Cone Health Heart & Vascular at Drawbridge Parkway, 3518 Drawbridge Pkwy, Suite 220, Greensboro, NC 27410 – 336-938-0800
- Cone Health HeartCare at Magnolia Street, 1220 Magnolia Street, 5th Floor, Greensboro, NC 27401 – 336-938-0800
