What You Need to Know About Heart Disease in Women: Part 2

[00:00:00] Hi, welcome to Beyond The Paper Gown I'm Dr. Mitzi Krockover. In our last episode, I set

[00:00:14] down with Dr. Rachel Bond a board certified adult cardiologist with a practice in preventive

[00:00:21] cardiology and we talked about women and our number one cause of death, cardiovascular disease.

[00:00:27] Specifically, we talked about ischemic heart disease which involves blocked arteries.

[00:00:33] If you haven't had a chance to listen, I highly recommend checking out that episode.

[00:00:38] It's full of information about symptoms, risk factors and also how to prevent heart disease.

[00:00:44] In today's discussion, we're diving deeper into what makes women's heart health so unique

[00:00:50] and we're specifically talking about arrhythmias or abnormal heart rhythms and heart failure,

[00:00:56] especially the kind that affects women more but may remain unrecognized. Dr. Bond will also tell

[00:01:03] us what needs to change in research and treatment to improve outcomes in heart disease that affects

[00:01:09] women and we'll also talk about a number of other issues including heart disease and transgender

[00:01:15] women, advocating for more inclusivity and healthcare for everyone and how technology can help doctors

[00:01:22] and patients become a team to work together to improve personal health.

[00:01:27] Here's a little more about Dr. Rachel Bond. She serves as a system director for the Women's

[00:01:32] Heart Health program at Dignity Health in Arizona. She also holds leadership roles in the American

[00:01:38] College of Cardiology, the American Heart Association and the Association of Black Cardiologists

[00:01:44] and drives initiatives that emphasize diversity in medicine as well as an increase in the numbers

[00:01:49] of women, particularly women of color in the field of cardiology. In just a reminder, this podcast

[00:01:56] is for educational and informational purposes only and should not be taken as medical advice.

[00:02:02] What we hope you'll do is to share what you've heard today with your healthcare provider

[00:02:07] and consult him or her for any specific questions you have about your own personal health.

[00:02:13] Now let's join the second part of our conversation with Dr. Rachel Bond.

[00:02:30] We've talked about heart conditions and pregnancy. We're now talking about cardiovascular disease.

[00:02:37] What are some of the other heart issues that affect women?

[00:02:44] So women have the same, I would say, if not more, symptoms, not symptoms but conditions.

[00:02:52] That could affect them when it comes to their cardiovascular system. So oftentimes we talked a lot

[00:02:58] about the blocked vessels, how the pattern of it may not be as discrete where you have one single

[00:03:05] vessel that's blocked but more of like a sort of lining and lumpy, bumpy plaque that's going

[00:03:11] through the big vessels or maybe the microvascular has disease. But then we know that cardiovascular

[00:03:18] disease encompasses a larger array of conditions. As an example, we have arrhythmias. So arrhythmias are

[00:03:24] in the form of abnormal heart beats. The most common arrhythmia in the United States is a condition

[00:03:30] called atrial fibrillation. That is when the top chamber of the heart beats erratically and as

[00:03:37] a result of that, if you're not protected depending on your risk in the form of being on a blood thinning

[00:03:43] medicine, it can increase your risk of having a stroke. I bring this up for us as women because

[00:03:49] we know that data supports the fact that even though women do better by coming out of A-5 and having

[00:03:57] procedures that remove them from A-5, they are less likely to be referred to have such procedures.

[00:04:05] And again, this is where that unconscious bias comes into the mix. The other condition that I think

[00:04:11] is really important is heart failure and there's different types of heart failure. So what is heart

[00:04:16] failure? Heart failure is when there could be an inability of the heart which is a muscle to either

[00:04:23] pump blood or relax the heart to allow that blood to be pumped to the rest of the body. When the

[00:04:29] heart is unable to pump the blood, you have a weakened heart muscle and oftentimes women can have

[00:04:35] that but more commonly they don't have a weakened heart muscle. We as women more commonly if we're

[00:04:40] having heart failure have the inability to relax the heart. It's a condition called diastolic

[00:04:46] heart failure and because it's often more common in women than men, it hasn't been as studied

[00:04:53] and you will notice that when it comes to cardiovascular disease and they're focusing in on research,

[00:04:59] the research is always usually for the conditions that impact men. The reason behind that is that

[00:05:05] when we first did our cardiovascular research studies, they used men often men from the VA. At the time

[00:05:11] it was majority men in the Veterans Affairs Hospital. Now that we are seeing that there are other

[00:05:17] conditions, one of this being diastolic heart failure, we now in the year 2024 are realizing we

[00:05:24] have to do more research to figure out how do we best treat it? Why does it disproportionately affect

[00:05:30] more women than men and if we're not treating it appropriately, how are we doing a good service

[00:05:37] to our patients? The answer is we're not and as a result of that, we really have to hone in on what

[00:05:42] is the best way to treat these patients. So when women present with signs of heart failure, which a

[00:05:48] lot of times could be shortness of breath, weight gain, swelling in their legs, a pressure in their

[00:05:55] chest, usually the first thing that they do is an ultrasound of the heart and oftentimes what I

[00:06:01] notice is that if the heart demonstrates that it's doing its job by pushing blood out, the doctors

[00:06:08] just end there. And that's a challenge because again, it's not just the fact that the heart is able

[00:06:13] to push the blood out, is the heart able to relax and oftentimes it's not able to win women

[00:06:19] and we have to do a better job in diagnosing that. That way we can figure out how best to treat these

[00:06:24] women and improve their quality of life but also their longevity of life. So those are probably the

[00:06:30] differences when it comes to men and women with heart disease. You know, as you will know, just

[00:06:38] it's a recurrent theme that we don't have enough research and therefore it hasn't been translated

[00:06:44] to the bedside so I'll just leave it at that. At the very beginning we talked about gender versus

[00:06:52] sex and I don't want to get too much in the weeds but I feel like I want to ask the question about

[00:06:58] how if you're a transgender woman, where does your risk lie and are there any other considerations

[00:07:07] that you might have with respect to cardiovascular disease? Absolutely. So somebody who is a transgender

[00:07:16] female often meaning that biologically they were born male and have since transitioned to a female

[00:07:26] and based on their gender identify as female, have sometimes a plethora of risk factors and

[00:07:34] a large portion of that could occur in that transition. So when you are taking sometimes those

[00:07:40] supplemental hormones it could as noted depending on when's risk impact the other risk factors we

[00:07:46] talked about, the cholesterol, the blood sugar and also the blood pressure. As a result of that,

[00:07:53] we are very much recommending that the primary care clinicians or the clinicians who are prescribing

[00:07:59] the hormone therapy before providing these hormones are checking those basic labs but also periodically

[00:08:07] continuing to check them. I would say the greatest driver though that we're seeing in the LGBTQIA

[00:08:13] plus community, not just specific to transgender, but the entire community as a whole is the impact

[00:08:21] that stress plays on their cardiovascular system. The community itself is a marginalized community,

[00:08:28] there's lots of biases often not unconscious, lots of conscious biases that are directed towards

[00:08:35] that community and the strain and stress of that absolutely impacts their cardiovascular health

[00:08:42] and it's absolutely for that reason that we are encouraging and not only are we helping them in

[00:08:48] their transition but we're screening for depression, anxiety. We're screening for sometimes other more

[00:08:55] riskier conditions that could not only affect their mental health but also their physical health

[00:09:00] and their physical health in the form of cardiovascular disease. And I know I alluded to the fact

[00:09:06] that stress in of itself is a risk factor. Yes one that disproportionately affects women

[00:09:12] it affects all marginalized groups because of the lived experiences that they're encountering

[00:09:19] and just imagine the amount of stress that one may encounter even in a transition where that

[00:09:25] stress is consistently leading to the release of adrenaline. It's affecting their inflammatory

[00:09:31] systems and oftentimes it could lead to premature heart disease as well as cognitive impairment.

[00:09:37] So I would say the greatest, greatest risk for the entire LGBTQIA plus community oftentimes has

[00:09:44] to do with the mental health that has to do with the societal view of them as an individual and we

[00:09:51] do it's a society need to do better to prevent that and more importantly treat these patients equally.

[00:09:59] I couldn't agree more and as you know policy politics all impact on not only that issue but so much

[00:10:10] more. Are you working in any way in terms of advocacy for certain policies and if so what do you

[00:10:18] feel is important? Absolutely and you know I will say from an advocacy perspective we have to have

[00:10:26] better access to mental health screening also making sure that there's access to affordable

[00:10:33] healthcare which I think at the minimum is where it should start. The American College of Cardiology

[00:10:39] as an example, I am I sit on the National Leadership Committee for Diversity, Equity and Inclusion

[00:10:46] and we have a subcommittee that's specifically dedicated to the LGBTQIA plus community where

[00:10:54] we provide a series of educational materials out to the community but we also provide our clinicians

[00:11:00] with probably best practice of what we should be doing in terms of screening and how best to manage

[00:11:07] these patients. And I assume that you apply those same principles to advocating for women

[00:11:14] and other underrepresented or marginalized populations as well? Absolutely for myself the advocacy

[00:11:23] always starts with that which is my core. A lot of the work that I've been doing in the advocacy field

[00:11:29] on women has been through maternal health. When we think about cardiac disease and maternal health

[00:11:35] there absolutely is an intersection and in the United States which is a first world country as you

[00:11:41] know you have the highest highest rates of maternal mortality and it's pretty much equivalent to

[00:11:47] that of third world countries. And when you actually separated by race as well as ethnicity we see

[00:11:54] that black women are dying at the highest rates two to three times higher than white women when it

[00:12:00] comes to largely, largely preventable conditions. Hard disease being the greatest cause of death during

[00:12:06] that pregnancy and we know at the end of the day it's not because black women inherently are at a

[00:12:12] higher risk biologically. It has to do with the social construct, the social aspects and more

[00:12:18] importantly the structure at the core racism being that that is leading to these disparities that

[00:12:26] we're seeing. Hearing women not believing them, not believing their symptoms, not believing their

[00:12:31] stories but more importantly not treating them to the same capabilities of their white female counterparts

[00:12:39] and sometimes even male counterparts. As a result of that it would be largely, largely important

[00:12:45] that when we are doing this advocacy the advocacy is really making sound change. One way that we've

[00:12:52] been trying to do that is by extending the coverage of health insurance to not just occur during

[00:12:58] pregnancy but even outside of pregnancy because a lot of these conditions can occur up to one year

[00:13:04] after delivery. So a lot of the advocacy that I've been doing with these cardiovascular societies

[00:13:09] has been to accept the fact that we need to have all states extend Medicaid coverage up to 12 months

[00:13:18] in past it would be 60 days and then they're done. Now the majority of states have extended it

[00:13:24] to one year giving them the opportunity to have a transition of care and an obstetrician

[00:13:30] preferably to a primary care clinician as well. But beyond that we have to do a lot of other policy

[00:13:37] changes where we're not only making sure that we're educating the patients but probably the clinicians

[00:13:43] as well on this intersection and most importantly probably even educating the patients on implicit

[00:13:50] bias training because I think at the core those unconscious biases are leading to these disparities

[00:13:56] that we're seeing and if they're not aware of their unconscious bias they're not going to change

[00:14:02] it and we're going to see the same outcomes in care which are I would say deplorable when it comes

[00:14:08] to the maternal mortality crisis. Let's switch a little bit to innovation and you know this is a time

[00:14:22] of technology and AI and you know hope for the future. Is there anything out there that you're seeing

[00:14:31] that you're especially excited about? I think that the future of innovation when it comes to cardiovascular

[00:14:38] disease is very robust why do I say that well two-date we are really trying to best predict who

[00:14:45] is at risk of having a cardiac event. We tried this and have been successful when it comes to

[00:14:51] something called precision medicine which is where we're able to predict based on your genetic

[00:14:57] makeup what your risk may be for cardiac disease and if your genetic makeup is high maybe we need to

[00:15:04] be more aggressive in managing your traditional risk factors. This to the same degree we're working

[00:15:10] on doing that when it comes to imaging modalities and trying to actually look at those same studies as

[00:15:17] an example and ultrasound of the heart but instead of looking at the larger muscles at the

[00:15:22] microscopic level are we able to see those subtle changes that may develop before we actually see

[00:15:29] that the muscle becomes an issue. So I'm really excited about where we are going in the world of

[00:15:35] innovation particularly as it pertains to cardiovascular disease because I think for me as a preventative

[00:15:41] cardiologist it's only going to largely focus on that prevention finding the issue before there

[00:15:48] actually is a problem. You know I know you're not a surgeon but do you see any innovation or

[00:15:56] need for innovation in even things like surgical equipment for working on women if you will?

[00:16:03] That's a great question. I will say that when it comes to surgery there actually is data to

[00:16:11] support that the outcomes of women as an example after an open heart surgery because they had to

[00:16:18] have a bypass procedure because they had blocked vessels or even more so a valvular replacement.

[00:16:25] Women usually have a much harder time recovering versus their male counterpart and we have to get

[00:16:32] to the core of why if we had an innovative way to determine that is it because the standard of

[00:16:39] care of how we're doing the procedure perhaps should be different in a woman versus a man.

[00:16:45] Perhaps but I think you bring up a very valid point that because we see that these sex and gender

[00:16:51] disparities exist using innovation to figure out how can we prevent that? How can we best treat

[00:16:58] these women are going to go a long way? Surgery has been around forever. We probably do need to have

[00:17:04] some innovation are they to figure out why these disparities exist and how we could ultimately

[00:17:10] prevent them in the future? That's a great question. And along thank you and along those lines in

[00:17:17] terms of technology are you incorporating patients wearables and their data in your practice?

[00:17:26] Yes so wearables I would say are standard it has to be standard at this point in time not for

[00:17:32] every patient of course but for patients that have all often symptoms or have underlying diagnoses.

[00:17:40] And when we think about the wearables the focus that I often look at most are the abnormal heart rhythms,

[00:17:46] the arrhythmias that we're often able to capture with those wearables. We have smart watches,

[00:17:52] we have other devices that could be utilized and the value of that is that there is some accuracy.

[00:17:59] Is it equivalent to the data that we collect? Of course not but it gives us again a better idea

[00:18:06] of what is going on and that comes into I would say a huge benefit because if we have you wear data

[00:18:14] or if we have you wear devices and we're not able to capture something then and there,

[00:18:20] we're missing it. We're missing the opportunity to diagnose you sometimes with a very abnormal

[00:18:26] heart arrhythmias that could lead down the road to cardiovascular complications. If you have

[00:18:32] a wearable device perhaps we can capture it on that and it will again direct us in that right path

[00:18:39] and as a result of that I am always in favor if my patients have one access to it already or the

[00:18:46] means to afford it to use these wearable devices and to that point our cardiovascular societies

[00:18:54] right now are trying to work with Medicare and other insurancees to see if some of them will be

[00:19:00] covered because we know that there are benefits in having them as an extender often for our most

[00:19:07] symptomatic patients because it only helps us as clinicians to better diagnose them but

[00:19:13] sometimes even diagnose them a little bit earlier. Will we see success in insurance coverage?

[00:19:19] I don't know but we will continue to advocate for that because we know it's the right thing to do.

[00:19:26] Sure well you've been so generous with your time what did I not ask you that you think is important

[00:19:33] for our listeners to understand? The women out there that are listening I think it's important

[00:19:41] that we as women understand that oftentimes we put everyone above our own self when it comes to our

[00:19:48] health. We have to take a pause we have to go to the doctor or the clinician at least on an annual

[00:19:54] basis. We also have to do things that are all more importantly going to help our mental health because

[00:20:01] our mental health equals our physical health and if our physical health needs a little bit of

[00:20:06] health oftentimes that means our mental health needs a little bit of health as well so as women

[00:20:11] out there that are listening it's really important that we take a step back focus on our self

[00:20:17] because if we don't focus on our self we won't be able to care for our loved ones our colleagues

[00:20:22] our friends our family. That's a great way to end. Dr. Rachel Bond as always I've learned so much

[00:20:30] thank you so much for being here with us today. Thank you so much it was a pleasure.

[00:20:36] So as we wrap up our chat with Dr. Rachel Bond you can now see that women's

[00:20:48] heart health has many differences compared to our male counterparts whether it's disease caused

[00:20:53] by blockages and arteries or Rhythmias like atrial fibrillation or heart failure yet we need to

[00:21:00] increase the amount of research to understand not only the differences but how to diagnose and

[00:21:06] treat these conditions successfully innovations like using wearables to help monitor patients

[00:21:12] outside of the doctor's office is a great example of how technology can help us improve our heart

[00:21:17] health. Here are some action steps that we can take from our conversation keep learning about

[00:21:23] heart health so you can recognize symptoms that need to be attended to don't hesitate to speak

[00:21:29] up about your health concerns if something doesn't feel right seek medical advice consider

[00:21:36] supporting organizations that focus on women's heart health and those that advocate for inclusive

[00:21:41] health care such as women heart and the American Heart Association you can find links to these

[00:21:47] organizations in our podcast notes finally share what you've learned with friends and family awareness

[00:21:54] can save lives thanks as always for joining us today you are always welcome to our website

[00:22:00] at beyondthepapergown.com that also has articles resources a marketplace and more you can subscribe

[00:22:08] to our newsletter while you're there and speaking of subscriptions do subscribe to our podcast on

[00:22:13] your favorite platform until next time take good care

[00:22:25] you

[00:22:31] beyond the paper gown is produced by Patrick Shambayati and me and our associate producer

[00:22:36] is Kyla McMillian