Women and Heart Disease

Podcast Transcript

Announcer:

Welcome to Love Your Heart, brought to you by Cleveland Clinic's Sydell and Arnold Miller Family Heart, Vascular and 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!

Natalie Salvatore, RN:

Hello, my name is Natalie Salvatore. I'm a Registered Nurse in the Heart, Vascular and Thoracic Institute at Cleveland Clinic.

Leslie Cho, MD:

Hi, my name is Leslie Cho. I'm the Director of Women's Cardiovascular Center at Cleveland Clinic.

Natalie Salvatore, RN:

Today we're going to be talking about cardiovascular disease and specific considerations for women. So, Dr. Cho, what is cardiovascular disease?

Leslie Cho, MD:

Well, cardiovascular disease is commonly thought of as atherosclerosis, where you have hardening of the arteries, but it could also encompass peripheral arterial disease, which means arteries in the legs, or cerebrovascular disease, which is hardening of the arteries that go to your brain.

Natalie Salvatore, RN:

Are there any differences to be mindful of between the different sexes? So, between men versus women?

Leslie Cho, MD:

Well, for both sexes, it is the number one cause of death. So, both men and women, the number one cause of death is not cancer, but cardiovascular disease, heart disease. It's important to remember that even though men and women are so different, they share that one thing in common; having heart disease as the most common cause of death. The risk factors are also similar, high blood pressure, high cholesterol, diabetes, smoking, and family history. Now, women have their own unique risk factors, which we can talk about later, but really the top risk factors, high blood pressure, cholesterol, diabetes, smoking, and family history is the same for both men and women.

Natalie Salvatore, RN:

And so, for women, is there anything specific within their cardiovascular system that makes them more at risk, such as maybe anatomy or hormones?

Leslie Cho, MD:

Men have more atherosclerotic disease, but what is distinctive about women is that women have unique risk factors. Early menopause, so menopause before the age of 45, whether it's surgical or natural or chemical, if they've had hypertension during pregnancy, specifically preeclampsia, gestational diabetes, or intrauterine growth retardation, early delivery, all these things increase their risk of having heart disease later on. Women with polycystic ovary disease also have an increased risk of heart disease. Women have smaller artery size than men, but in terms of developing atherosclerosis, men develop atherosclerosis more than women. I think it's important to remember, is that in every study, ever since we've been doing studies, women are consistently undertreated, which is a shame because it's the number one cause of death for women.

Natalie Salvatore, RN:

And how would somebody know that they need to seek treatment? What are some of those symptoms that would lead a patient to schedule an appointment with their doctor and find out more about what's going on with them?

Leslie Cho, MD:

Well, usually women come and see us because they're having chest pressure, chest tightness, especially with exercise. Some women have neck or jaw pain, especially on that left side, pain radiating down their left arm, sometimes associated with sweating or nausea. Other women have unusual fatigue. They get very, very tired, excessively tired, like they were able to walk a couple of blocks last year, but this year they can barely walk a block without getting extremely fatigued. Other women come and their only complaint is shortness of breath. They can't walk as much as they used to without getting a severe shortness of breath. Usually, symptoms trigger women to seek a cardiologist. There are some women who have silent heart disease. Those women tend to be diabetics, and they come because they've had a screening EKG, and the EKG was abnormal. Everybody, whether they're a man or a woman, should be getting screened with an annual blood pressure check, annual blood sugar check, and annual cholesterol check after the age of 40.

Natalie Salvatore, RN:

So, we commonly hear that there are differences in the symptoms for heart attack for women. Are there any other heart diseases or cardiovascular diseases that might also have different symptoms for women?

Leslie Cho, MD:

So, that's one of the myths about women and heart disease. Women definitely have more atypical symptoms of heart disease, so they tend to have more shortness of breath, more nausea, more fatigue than the traditional chest pressure, chest tightness. But when you look at women overall, women still have chest pressure, chest tightness, that's 70% of women with heart disease have typical symptoms. They just have more atypical symptoms than their male counterpart. In terms of other sort of manifestation of heart disease, we don't really think of arrhythmia as heart disease, even though it is heart disease, it's not vascular disease, it's a rhythm problem. Men and women have traditionally similar symptoms. They feel palpitations, they feel fast heart rhythms. Now, women when they go through menopause, they have hormonal fluctuations. They can complain of more palpitations. Those tend to be pretty benign. But in terms of valvular heart disease, both men and women get short of breath, both men and women get fatigue, both women and men have diminished exercise capacity.

Natalie Salvatore, RN:

And are there any different testing or treatment options, or is it pretty much the same?

Leslie Cho, MD:

For cardiovascular disease, the testing is similar. We're much more mindful about exposing female breasts to radiation. So, we tend to, at the Cleveland Clinic, favor ultrasound versus a nuclear test, which has much higher radiation. Women have what we call micro vessel disease, arteries we can't see with our eyes, arteries we can't stent, arteries we can't bypass. Women tend to have more micro vessel dysfunction than men. Micro vessel dysfunction is difficult to diagnose unless you go to centers like ours that do both noninvasive and invasive testing to figure out micro vessel disease. But women with micro vessel disease, they will complain about chest pressure, chest tightness when they're exercising or under severe emotional stress. They will complain about things like shortness of breath, shorter breath when they're exercising or under emotional stress. It's rare that a micro vessel dysfunction patient will complain about having chest pressure, chest tightness when they are not doing anything.

Natalie Salvatore, RN:

Now, you mentioned our specialized center that we have here at Cleveland Clinic. What are the advantages of seeking treatment somewhere that has a specialized center?

Leslie Cho, MD:

I think it's really important for patients who have unusual disorders to seek care that's provided at places like ours. We just tend to see a lot more unusual things, so we're much more attuned to those things. But also, we have really specialized testing. For example, we have something called PET scan, which is positron emission tomography testing, which is a nuclear test, but it tests for micro vessel disease. We also do cardiac stress MRI, and we also do invasive micro vessel testing where we inject arteries with medications that can bring on micro vessel dysfunction. You want to go to centers where you have expertise in these sorts of unusual diseases if you are not getting answers to your questions and you're continuing to have symptoms. I think that's very important.

Natalie Salvatore, RN:

And I think maybe the last question would be, is there any way to prevent this?

Leslie Cho, MD:

Oh, that's the best, best, best news about heart disease. 90 percent of heart disease is preventable. 90 percent. Regardless of who your family is, regardless of your genetic makeup, you can still prevent heart disease. That's the really great news in 2023. By getting your blood pressure in line, making sure you know about your cholesterol, making sure you're not overweight, making sure you're exercising, eating right, you can prevent heart disease. The other really important thing is that most people do not go and get screened. For example, they don't get blood pressure screening, they don't get glucose screening or cholesterol screening until they're in their mid-50s. That's a real shame, because that means that you've now had over 15 years of no treatment or no real understanding of where your body is.

And so, if there's one message, whether you're a man or a woman, that I want to stress, it is that you need to be mindful. You need to know your numbers, your cholesterol, your sugar, your glucose numbers, your blood pressure numbers, your ideal body weight. You need to know all of these things. It is really important to have that as part of your annual physical checkup.

Natalie Salvatore, RN:

Great. And if you could leave our listeners with your biggest piece of advice, what would that be?

Leslie Cho, MD:

Well, I think my biggest piece is that number one, heart disease is preventable. So, the best way to never see the inside of a cardiac cath lab or the surgical suite is to prevent heart disease. And by eating right and exercising and really following the Mediterranean diet, but also getting an annual checkup where you know your numbers, you could have good cardiovascular health.

Announcer:

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