Cardiovascular Health in Women
Occasionally, I will feature articles written by trusted colleagues who offer other expertise and perspectives. As part of my style of care with my patients and their whole care team, I really enjoy talking to — and collaborating with — other providers to provide the best care possible. This post is by Dr. Stephanie White (she/her), a cardiologist I refer to at SSM Health Heart & Vascular Care in St. Louis, MO.
— Dr. Jay
We’ve all had it drilled into our heads that heart disease is a number one cause of death, both around the world and here in the U.S. In the U.S., it accounts for 1 in 5 deaths. And while we often hear talk about the symptoms in men, the message in the media around cardiovascular symptoms in women typically boils down to: “Well, the symptoms are different in women and so it is hard to get them appropriately diagnosed or treated because ERs work off of the symptoms that men exhibit. Good luck…”
While there is clearly work to do with acute identification and management procedures for heart attacks in women and those assigned female at birth (unless they have taken testosterone), what we don't hear is people talking about all the diagnostic tests we can use to help identify cardiovascular issues and risk factors before they have a chance to turn into a heart attack/coronary event.
Risk factors
We need to think about risk really carefully. We are thinking about risk as an increase over what’s expected. We know that any woman is at risk for heart disease. Even women in perfect health sometimes have heart problems. But there are things that make our risk level higher than it should that we can identify — and work to change. Let’s talk about a few of those:
History of hypertension (high blood pressure)
Every time you go to the doctor, they probably check your blood pressure. When we measure blood pressure, we look at two numbers. The first number is your systolic blood pressure, which is just a fancy way of saying the pressure that’s measured when the heart is actively pumping. The second number is your diastolic blood pressure, which is the pressure that’s measured when the heart is between pumps.
Your systolic blood pressure should normally be less than 140, and your diastolic blood pressure should be less than 90. It’s normal and common for blood pressure to be increased sometimes, like when you are stressed out or exercising. But if either the systolic or diastolic blood pressures are usually increased, your risk for heart disease goes up.
History of smoking
A history of smoking is a risk factor. For every death from cardiac disease, 1 in 4 is due to smoking. If you quit, there is a sharp decrease in your risk for heart disease 1-2 years after quitting, and then a steady further decrease in risk the longer it has been since quitting.
Source: CDC
Cholesterol levels
Cholesterol is a substance in our body that serves a useful purpose. It’s used as a building block of the cell, and so it’s essential to life.
The trouble with cholesterol comes with how it’s transported through the blood. We measure globs (now there’s a fancy medical term) of cholesterol based on how large they are, and what proteins are associated with them. This is where we get the concept of “good cholesterol” and “bad cholesterol.” It’s not the cholesterol itself that’s good or bad. It’s the size of the cholesterol globs that are traveling through our blood.
The smaller globs are called High Density Lipoproteins, or HDL. The larger ones are called Low Density Lipoproteins, or LDL. When you have too many LDLs in your blood, your risk of heart disease increases. These can be easily measured with a blood test.
Other types of cholesterol globs
We are learning more and more about the risk that cholesterol levels pose for the body. Some doctors have begun to measure two other types of cholesterol. One is called Apolipoprotein B (or apoB for short, pronounced “ape-oh-bee”). The other is Lipoprotein (a) (we say “ell-pee little a” for short).
It’s unclear precisely what role these substances have for long-term risk or how treating them might help. But at the least, having higher than expected levels of these increase cardiac risk, and might make us pay closer attention to other risk factors.
Blood sugar and hemoglobin A1C
Your sugar level definitely increases your risk of heart disease. If you are a diabetic, you have at least twice as much risk for heart disease, so we need to manage your other risk factors more carefully.
Many women do not have diabetes, but do have higher than normal blood sugar. These women will show up with a moderately elevated blood sugar. We can also measure something called hemoglobin A1c to look for this risk.
Coronary calcium scan
This test is non-invasive and done by getting a CT scan of the heart and looking for calcium deposits in the arteries that reduce blood flow to the heart. It’s a good way to detect cardiovascular issues early, before there are symptoms.
I use the coronary calcium scan to help me put everything above together. This is an easy test to get and although insurance doesn’t always pay for it, you can generally get it for $125 or less. It is one additional piece of evidence that helps me put an overall plan together for each patient. I talk about this test as a possibility for anyone over the age of 45, or those who are younger who have a significant family history or have abnormal cholesterol numbers.
If you know your risk profile, you are able to:
Implement positive changes to impact your heart health going forward, and
Better advocate for yourself if you do have acute symptoms and need emergency care
Making positive changes
All of the factors above have interventions we can use to change them.
Blood pressure can be reduced by eating differently (mainly by reducing your salt intake) and by using medications.
Cholesterol levels can be managed with diet and exercise (watching the amount of fat you take in, and doing moderately strenuous exercise a few times a week). There are also a multitude of safe and effective drugs that can help lower cholesterol levels.
Smoking is a habit that can be very hard to break. But there are therapeutic interventions that can help, and medicines that can manage cravings and increase your odds of being successful with stopping smoking.
High blood sugars are managed with diet and exercise, as well as medications. A variety of oral medicines and even insulin can be used to take care of these problems.
When women know what to manage, they can lower risk. And that’s a good thing, because heart disease remains the leading cause of death of adult women. I hope you’ll take a few minutes to think about your own risk factors and consider how you might lower them. If you need help, I’m happy to assist! Just give our office, SSM Health Heart & Vascular Care, a call at (314) 645-6450. I’d love to meet you.
