Ask The Heart Doctor: Women's Heart Health-Part 3 - Weight Loss & Hormone Replacement Therapy

Podcast Transcript

Announcer:

Welcome to Love Your Heart, brought to you by Cleveland Clinic's Sydell and Arnold Miller Family Heart, Vascular &Thoracic Institute. These podcasts will help you learn more about your heart, thoracic and vascular systems, ways to stay healthy and information about diseases and treatment options. Enjoy.

Leslie Cho, MD:

Welcome, everyone to a session on Ask Your Heart Doctor. Today our focus is on women and heart disease, and we're joined by our surgeon as well as our cardiologist colleagues. And we're going to go around and introduce ourselves first. My name is Leslie Cho. I'm the Director of Women's Cardiovascular Center at the Cleveland Clinic.

Donna Kimmaliardjuk, MD, FRCSC:

I'm Dr. Donna Kimmaliardjuk, and I'm a Cardiac Surgeon with a special interest and focus on coronary artery disease and bypass grafting.

Christine Jellis, MD, PhD, MBA:

I'm Christine Jellis. I'm an Imaging Cardiologist with a special interest in advanced imaging. I'm one of the detectives, and we use this imaging to figure out how bad heart disease is.

Leslie Cho, MD:

I'm going to talk about prevention, so I'm going to lead off with a couple of questions from the patient groups about prevention. So one of the many questions about Ozempic and Wegovy and terzepatide and every other GLP-1 receptor agonist that are out there. And the question is, does losing weight help with heart disease? And the interesting analysis, actually there was a big trial that was done by one of our colleagues, Dr. Mike Lincoff, and it's called SELECT. It is Ozempic in patients with cardiovascular disease without diabetes. And people actually had less heart attack, less need for hospitalization. They had improvement in major adverse cardiac events while losing weight.

Now, there is a huge interest, especially among our female patients and these new compounds. And the question is, can you ever get off of these medications? And I will say that looking at a lot of the trials that's been done, 80% of people unfortunately gain weight back, but 20% are able to come off the medicine without gaining weight back.

And I think what that tells us is that people who have embraced sort of the notion of diet and exercise and really change their lifestyle can use these medicines to jumpstart their diet and are able to maintain weight loss off of these medications. We try to get people off, always. We max out on therapy and then we try to wean them off, because these medicines unfortunately have been associated with some rare but life-threatening complications. So we do want to try to get you off these medicines.

Okay. Hormone replacement therapy, Christine, question is for patients with valve disease, especially patients with atrial fibrillation and valve disease, taking hormone replacement therapy, what do you normally tell them?

Christine Jellis, MD, PhD, MBA:

I think it's always a consultation with the patient and their preferences, but also everyone else who's looking after their care: their primary care doc, endocrinologist, and other people. It obviously depends on a lot of factors, symptoms being one. And we know some women have worse menopausal symptoms than others. The other factors that are important are other things like history of blood clots, malignancies, family history. All of those things have to come into it. So I think ideally, we never want to put people on medication necessarily and not review the individual factors or review the longevity of someone being on hormone replacement therapy. So I always tell my patients, "It's a discussion, it's an individualized discussion. If you need it for your symptoms and to be able to function, we'll make sure it's safe for you. And then we need to continue reviewing that as you get older and maybe circumstances change." I'd probably also find you in the corridor, Leslie, and ask you, "Hey, what would you do in this scenario?" So I'd be interested in your thoughts.

Leslie Cho, MD:

Yeah. I think hormone replacement therapy, if you don't have coronary artery disease, if you don't have risk factors, is relatively safe. The problem with hormone replacement therapy comes in people who have had stroke. We definitely do not recommend you to be on hormone replacement therapy if you've ever had a stroke or any type of blood clot or coronary artery dissection because there's a hormonal component. So you really have to have a discussion.

I am not a fan of the bioidentical hormone replacement unless it is the FDA approved bioidentical hormone replacement therapy. I am not a fan of compound therapies that you can get at a compound pharmacy. I think it's very important if you're going to take something inside your body that they be sterile, that they have gone through the FDA. I think all of those things are really important. I know you want to take drugs to lower your risk or you want to have a little edge to lower your risk. I totally get that. I'm a hundred percent with you on that. Unfortunately, hormone replacement therapy has never been shown to reduce the risk for cardiovascular disease.

Announcer:

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