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

[00:00:00] Hello and welcome to Beyond The Paper Gown where we focus on the issues and factors that

[00:00:13] impact women's health. Our goal is to provide the most credible information, from scientists,

[00:00:19] clinicians to innovators, to help you live your healthiest life. And I'm Dr. Mitzi Krockover.

[00:00:26] Do you know what the number one cause of death is in women? If you said heart disease,

[00:00:30] you'd be correct. While we tend to think that the typical person with heart disease

[00:00:35] as a man, usually a white obese older man who comes to the doctor clutching his chest,

[00:00:41] women experience heart disease just as commonly but differently and therefore their diagnosis

[00:00:47] may be missed or delayed. What we're going to do today is talk about who's at risk,

[00:00:52] the symptoms of heart disease in women, as well as how to prevent it and how to get

[00:00:57] the medical care you need. To clarify we're primarily going to talk about

[00:01:01] ischemic heart disease or heart disease that occurs when there's a blockage of an artery

[00:01:06] bringing blood and therefore oxygen to the heart, as well as its relationship to stroke

[00:01:11] and other blood vessel diseases. Joining us today is a leader in the field of cardiology

[00:01:17] Dr. Rachel Bond. She's a board certified adult cardiologist with a practice in preventative

[00:01:23] cardiology and serves as system director for the Women's Heart Health program at Dignity

[00:01:28] Health in Arizona. She also holds leadership roles in the American College of Cardiology,

[00:01:34] the American Heart Association and the Association of Black Cardiologist and drives initiatives

[00:01:40] that emphasize diversity in medicine and bolster the representation of women, particularly

[00:01:46] women of color in the field of cardiology. Just a reminder, this podcast is for educational

[00:01:53] and informational purposes only and should not be taken as medical advice. What we hope

[00:01:59] you'll do is to share what you've heard today with your healthcare provider and consult

[00:02:03] him or her for any specific questions you have about your personal health.

[00:02:16] Hi, I'm Dr. Mitzi Krock over and this is Beyond the Paper Gown. Welcome and I also want

[00:02:27] to welcome our guest today who is extraordinarily accomplished has such great expertise that

[00:02:33] I'm just really excited to dig in and talk about heart health today. So Dr. Rachel Bond,

[00:02:42] welcome. Yes, thank you so much for having me. I'm looking forward to this. Talk a little

[00:02:48] bit about kind of how you got into cardiology and your focus on women's health. I will say

[00:02:56] that I wanted to be a doctor my entire life. I'm the first medical doctor in my family.

[00:03:02] It was a great accomplishment for me when I did finally match into medical school and then

[00:03:07] eventually residency and I knew at a pretty early age that I wanted to do cardiology.

[00:03:12] I just didn't know quite what in cardiology. And as I journeyed through school and understood

[00:03:18] that heart disease is our greatest threat, but it's so largely preventable. I wanted to

[00:03:24] really hone in and focus my energy on the prevention piece of it because many people don't

[00:03:29] realize, but it is 80% preventable and a lot of times that's through conventional risk factors

[00:03:36] and making sure that those risk factors are under control. And I understanding that the

[00:03:43] prevention piece was such a key factor then decided to journey into the different sex and gender

[00:03:49] disparities because glaringly we see especially in the field of cardiology that oftentimes women

[00:03:57] are under diagnosed. They have delayed diagnoses and even when they're diagnosed, they have delayed

[00:04:02] treatment. And I really wanted to be the voice to help improve that but also help to educate

[00:04:08] the next generation so we weren't having the same replication of how we're treating patients.

[00:04:14] You brought up two topics that I really wanted to dig into, number one or the gender and other

[00:04:21] disparities in inequities as well as the preventive part. So let's take the gender and other

[00:04:27] disparities first especially when it comes to men and women. What are those differences? And why

[00:04:35] are those women getting their diagnoses later or perhaps not even at all? That's a wonderful

[00:04:43] question and I would say that it's multifaceted so when we think about first of all the differences

[00:04:49] biologically, the XX chromosome versus the XY chromosome, we know that as women we do have more

[00:04:56] unique risk factors compared to men. So what are those? So a lot of the risk factors that could

[00:05:01] increase your risk for heart disease could occur during one's pregnancy if they decide to have

[00:05:06] a pregnancy. So risk factors such as gestational diabetes, high blood pressure during pregnancy,

[00:05:13] a condition called preoclampsia where you have an elevated blood pressure and it can actually

[00:05:18] sometimes affect your other organs like your kidneys, your brain, your heart. Those are actual risk

[00:05:24] factors for heart disease which many women don't realize and I will say that our obstetricians

[00:05:29] are doing a much better job now in providing that education but then there are other risk factors

[00:05:35] that are more predominant in women stress, anxiety, depression. Yes everyone experiences it

[00:05:42] but women often have a greater impact from it than their male counterparts and as a result of that

[00:05:49] the release of adrenaline that often can occur just being a woman living in the United States

[00:05:55] going through the sort of patriarchy of the United States can often release those extra stress

[00:06:04] hormones and that in of itself can predispose them to cardiovascular disease. And then when we look

[00:06:10] at the more traditional risk factors like high blood pressure, high cholesterol, diabetes even a

[00:06:16] history of smoking. We know that women often have actually higher likelihood of heart complications

[00:06:24] if they have those risk factors as compared to their male counterparts and that's the XX versus

[00:06:30] the XY so the biological means behind that. As an example I always say this to my patients if you

[00:06:37] smoke the same number of cigarettes for the same duration as your male counterpart, you're at a

[00:06:42] 25% greater risk of having a stroke and heart attack. And of course we suggest smoking is bad for all

[00:06:50] regardless of sex, gender, race, ethnicity but there is disproportionately a higher burden on us

[00:06:57] as women versus our male counterparts. The other factor that we have to think about when we

[00:07:02] think about the differences is also the symptoms so oftentimes women present with more vague symptoms.

[00:07:10] So what do I mean by that? When we think about a heart attack, we always think in the movies

[00:07:15] someone clutching their chest they describe it as an elephant is sitting on their chest and maybe

[00:07:20] it radiates to their jaw. It goes to their arm maybe they feel a little sweaty, they feel a little

[00:07:26] dizzy and short of breath. Women may not have those symptoms, they may have more subtle symptoms where

[00:07:32] they have shoulder pain, back pain perhaps they feel a little indigestion or nausea or even tired

[00:07:40] or fatigue is the best word to use. Fatigue and tiredness is a common common

[00:07:46] risk, a common common sign that there may be something going on from a cardiovascular perspective

[00:07:52] and oftentimes I tell my patients particularly those who have risk factors for heart disease

[00:07:58] if you're getting enough sleep if you are ruling out other things that can cause fatigue and tiredness.

[00:08:04] It's really important that you talk to your primary care doctor about getting your heart

[00:08:09] checked because that could be an early sign that there is something going on with your heart.

[00:08:15] In my mind I'm hearing the voice saying yeah I'm gonna go to my doctor,

[00:08:19] I'm gonna tell him I'm tired or I'm tired and they're not going to really take me seriously.

[00:08:26] So you know it is hard you know as a clinician you know fatigue can be a sign

[00:08:33] under symptom of so many things. So what do you advise your patients or others you know just

[00:08:42] the folks that you're educating about how to communicate with a physician whether it be in

[00:08:49] the doctor, you know the outpatient doctor's office or the emergency room?

[00:08:55] Yes and it's very different in the outpatient doctor office versus the emergency room.

[00:09:00] So if we're in the emergency room I always encourage my patients particularly my female patients

[00:09:05] if they believe they're having a cardiac event to express that. When you tell someone you believe

[00:09:11] you're having a heart attack, they can't ignore you, they have to rule it in or out preferably.

[00:09:18] With that being said even sometimes when women do that there are still challenges because of those

[00:09:24] implicit or unconscious biases that people have and I will say that we in the medical field are

[00:09:31] really trying our best to improve education at the level of medical school and nursing school.

[00:09:37] That way these unconscious biases don't exist, that way if someone does present the emergency room

[00:09:43] perhaps not with the typical symptoms but maybe more atypical subtle symptoms especially if they

[00:09:49] have risk factors or thinking about cardiovascular disease. But for the patients and the outpatient

[00:09:55] setting, the first and most important thing that I tell them is that you have to be with a clinician

[00:10:00] you trust someone who is willing to listen to you, someone who is willing to express to you what

[00:10:06] your risk factors are but more importantly explain to you what those risk factors are and what we can do

[00:10:12] to improve them. You talked about the risk factors, what is your advice in terms of screening

[00:10:21] for those risk factors so that you know if you're at risk or at increased risk and also

[00:10:29] talk a little bit about the effect of age in women and menopausal status with respect to risk.

[00:10:36] Absolutely so all adults, men as well as women need to go at least once a year for what we call

[00:10:45] well check up and that well check up looks at all of those standard risk factors through blood work.

[00:10:51] They check your blood pressure, they check your weight, they discuss with you if your weight is

[00:10:55] appropriate for your height, they counsel you on your nutrition and your physical activity level

[00:11:00] and when they're looking at your labs, they're specifically looking at key things,

[00:11:04] your blood sugar, your cholesterol, your kidney function, your thyroid function all things that

[00:11:10] absolutely can affect your cardiovascular health. If you have a family history it's most pertinent

[00:11:17] that you start this conversation as early as possible and when we think about a family history

[00:11:23] we know that if you have a first degree relative which includes mom, dad or siblings

[00:11:28] in a woman before the age of 65 or in a male before the age of 55 then you actually could be at

[00:11:35] a higher risk or a height and risk of having a cardiac event. Therefore that screening may occur

[00:11:41] a little bit earlier or it could actually occur more frequently but the basic basic basic basic things

[00:11:48] that we always do includes that well check up or we're examining you, we're reviewing your blood

[00:11:54] work and always, always, always also doing what's called an electrocardiogram where we're able to

[00:11:59] actually look at the heart and see if the heart has any abnormalities even without symptoms. So

[00:12:05] it's a great screening tool to help dictate if additional testing should occur. For women that

[00:12:11] reach menopause, even parry menopause I would say that that is probably the second chapter in our

[00:12:19] life that is of most importance, the reproductive years 100% are important but once we reach the

[00:12:25] years of menopause it's important because we always see that with a depletion of the hormones

[00:12:32] that our body is naturally producing it affects our arteries. It makes the arteries differ so

[00:12:38] oftentimes we can see a rise in our blood pressure. It also makes it a little bit harder for us to

[00:12:44] release cholesterol. As a result it's not uncommon that when women are going through either

[00:12:49] parry menopause which is right before a menopause or have fully gone through menopause they may have

[00:12:54] elevations in their cholesterol. We also notice that menopause could affect our ability to keep stable

[00:13:01] weight so oftentimes it's not uncommon that we may notice some weight gain and with weight gain

[00:13:07] that could affect cholesterol, it could affect blood pressure, it could put us at risk of insulin

[00:13:12] resistance or diabetes. There's a lot that menopause can do in terms of our risk for cardiac disease

[00:13:19] because of those risk factors that it can sometimes lead to. With respect to that

[00:13:29] I think back about when I was practicing on a regular basis and we were giving estrogen for

[00:13:37] not only symptoms of parry menopause but also reducing the risk of heart disease, osteoporosis

[00:13:44] and cognition. Then the Women's Health Initiative came out and suggested that by giving estrogen

[00:13:53] you might increase cardiovascular risk. Then once the data was analyzed to say that no that was

[00:14:01] only for women that are older, 65 and up. Yet there's still not recommendations for using

[00:14:09] estrogen as a cardiovascular protector. Is that correct? Do you have thoughts about that?

[00:14:19] Yeah so you're 100% correct so the data confuses us. It's still this day confuses us.

[00:14:26] We stopped. The WHO came out, we dropped estrogen and then all these women suffered for that.

[00:14:36] They suffer from it and I see so many women who are desperate to be on hormone therapy but they

[00:14:43] don't know if it's right for them. What is their risk? Is it safe? Oftentimes I actually

[00:14:48] have referred patients to help answer that question. What I can say is that to date there is no

[00:14:55] recommendation that we should be using hormone replacement therapy for the prevention of cardiovascular

[00:15:01] disease. There are several other things that we can do that would be preferable before we go to

[00:15:07] hormone therapy such as focusing on nutrition, physical activity, making sure that those risk factors

[00:15:14] are under better control so that is what the guidelines suggest. With that being said if we have a

[00:15:20] patient who has what are called vasomotor symptoms so those hot flashes, the night sweats,

[00:15:26] the fatigue, those symptoms that really really impair their quality of life. The use of hormone

[00:15:33] therapies as early on as possible can be safe when we have those other risk factors under control

[00:15:41] and oftentimes for my patients because there are women out there who have cardiovascular disease

[00:15:48] and also are going through menopause we have to have that sort of shared decision making and

[00:15:54] that discussion where we talk about well what are the risks, what are the benefits and if the

[00:16:00] benefits of the hormone therapies because it's going to improve their quality of life

[00:16:06] over seed the potential risks we have that conversation as well. That may mean for me as a

[00:16:12] cardiologist I'm monitoring them most closely but I'm also giving them guidance on what the

[00:16:18] right thing to do is and the right path to go. I would say I'm very excited because in the world

[00:16:25] right now we're actually talking about menopause it was very taboo before no one ever even discussed

[00:16:31] it but now we're having conversations about it and as a result of that even back a few months ago

[00:16:38] there was a non-hormonal medication that helps with menopause symptoms so now we're actually going

[00:16:44] down a path of the use of non-hormone medications to help with these symptoms for those patients

[00:16:51] that may be deemed at higher risk. What I will say to patients out there is that it would be best

[00:16:57] to speak with your clinician before starting hormone therapy because there are several things

[00:17:02] that the clinicians can do to determine what your risk is. If your risk is low absolutely you can

[00:17:08] proceed if your risk is high this is again where that shared decision-making is so important.

[00:17:14] Absolutely one of the questions that I often get is what's a good cholesterol? What should my

[00:17:20] cholesterol be? What's the good cholesterol? What's the bad cholesterol? So help us make some

[00:17:25] sense of that. Yes and another comment that I often hear is well my good cholesterol's good so

[00:17:32] it's okay that my bad cholesterol is a little bit high. The answer is it's not so when we think about

[00:17:38] when we think about what is actually causing the plaque to build up in the arteries of the heart

[00:17:44] it's that LDL which is that bad cholesterol and as a result of that we want that LDL for the general

[00:17:50] population to be less than a hundred. Those are our basic goals of course if someone has

[00:17:56] underlining heart disease or if someone has evidence of several risk factors that may predispose

[00:18:02] them to heart disease our recommendation may be a little bit lower so every patient is individual

[00:18:09] but the rule of thumb is that the lower your bad cholesterol and the higher your good cholesterol

[00:18:15] the better your overall cardiovascular health and there are several factors that we can look into

[00:18:21] when it comes to cholesterol. 25% of our cholesterol comes from what we eat so nutrition is such an

[00:18:28] important aspect. Another percentage comes from our physical activity and the American Heart Association

[00:18:34] as an example recommends at least 150 minutes per week of moderate physical activity. That could be

[00:18:41] in the form of walking but we would want to walk at a brisk pace and that's what I always tell my

[00:18:47] patients that if you don't have access to a gym or exercise equipment going out in the environment

[00:18:53] going out in your community going for a walk is going to make a significant difference. The rest

[00:18:59] of the percentage is family history when it comes to your cholesterol and this is why it's so

[00:19:04] important to know what your family history is because again it will help to pre at least for us

[00:19:11] predict what your risk may be of requiring additional therapies or additional management for yourself

[00:19:17] in the future. So say you are someone at high risk you start having some symptoms,

[00:19:26] you go to your physician, what is there a difference in how you diagnose or the kinds of

[00:19:32] diagnostics you use for women rather than men? So that's a wonderful question. So women because

[00:19:42] we are such a unique entity often have heart disease that's a little different than male pattern

[00:19:48] heart disease. So when we think about male pattern heart disease it's usually where there could be

[00:19:53] a single vessel where there's a severe blocked vessel. Sometimes yes women can encounter that and

[00:20:00] it's usually women in the postmenopausal period. Before our women of reproductive age who are

[00:20:05] presenting with signs or symptoms concerning a heart disease, if we do additional testing

[00:20:11] it's not uncommon that we may see a little bit of plaque spread across the vessels and many people

[00:20:18] would say well if that plaque is not causing a blockage how is it possible that that plaque could

[00:20:23] be causing symptoms? It could and we're now actually exploring that because it's not just the big

[00:20:28] vessels that have that plaque probably. It's probably the little tiny vessels that come off of

[00:20:34] those little vessels a condition called micro vascular disease and oftentimes that predisposes women to

[00:20:41] have issues with their heart in the future but that condition actually predominantly is in women

[00:20:47] more than men. The treatment right now we are still in the early phases of what would be best

[00:20:53] in terms of treatment but what we do know at a minimum is that we want to control their risk factors.

[00:20:59] So if their cholesterol is high we make sure that we talk to them about lifestyle management,

[00:21:04] a lot of times we recommend medications as well if their blood pressure is high we would do the same

[00:21:10] but as a result of that women often have more of those unique presentations and this is why again

[00:21:17] anytime you're coming in with symptoms you want to make sure that you're not only trusting your

[00:21:22] clinician but that your clinician is aware of the differences that women may present with because

[00:21:28] there are several women that have presented to my clinic who have gone through two or three different

[00:21:34] cardiologists before we diagnose them with their heart condition because they weren't thinking

[00:21:40] about the more specific conditions that could affect women and they were thinking more about the

[00:21:45] conditions that often affect men. Are there any other things that we need to do or that a woman

[00:21:51] should expect to have been done to see some of those kinds of things that you just talked about in

[00:21:56] terms of microbascular changes? So I would say that the key is first figuring out if your symptoms are

[00:22:06] due to a cardiac cause or not so traditionally in the past often we start with the basics which

[00:22:13] is an electrocardiogram which is an EKG of the of the chest and what the EKG will help to dictate

[00:22:19] is the next test. If the EKG shows that there are changes that if we changes in the sense that

[00:22:27] if we compare it to your prior that may make your symptoms more alarming at which point we would

[00:22:33] determine do we want to go straight to what's called anatomical evaluation meaning looking at

[00:22:39] the vessels so the first thing we would want to do is make sure that the big vessels don't have

[00:22:45] blocked vessels or blockages and the only way to do that would be to look at them so that would be

[00:22:50] through the use of a CAT scan where they place an IV in your arm, they give you contrast which is

[00:22:56] die and they're able to light up the arteries in your heart. That also alternatively could be through

[00:23:01] a coronary angiogram or catheterization where similarly they instead of going through the vein go

[00:23:07] through the artery either in the wrist or the groin and they're able to access the heart through

[00:23:12] contrast by again looking for a blocked vessel. If that doesn't demonstrate a severe blockage but

[00:23:19] our suspicion is still high that the symptoms are due to cardiac disease then we would go down

[00:23:26] the route of doing more of different types of stress tests and also even tests that are called

[00:23:34] MRIs to help us explore if there's a possibility of it being the microvascular.

[00:23:40] For us in cardiology we have so many different imaging modalities that it can want to be overwhelming

[00:23:47] not just for patients but also for us as providers but again you want to make sure that you are

[00:23:54] at the in the hands of a provider who knows which tests to look for because it's not uncommon

[00:24:01] that I'm ordering one test and then going down the path of ordering another for me to make that diagnosis.

[00:24:08] Sure and with respect to treatment are there differences in treatment options or if efficacy if you

[00:24:18] will between the genders or the sexes? What I can say when it comes to treatment and I will use a heart

[00:24:25] attack as an example is that oftentimes when women present with heart attacks even after we diagnose

[00:24:32] them with a heart attack they are less likely to be treated with the guideline suggested medication.

[00:24:37] This includes aspirin this includes cholesterol medications sometimes medications to relax

[00:24:43] the heart which could be in the form of blood pressure medication and this is again even when

[00:24:49] we diagnose them with a heart attack. The other thing that we've noticed and there's a lot of

[00:24:54] data to suggest that patients after they present with a heart attack do amazing when they're referred

[00:25:00] to something called cardiac rehab. Cardiac rehab is an exercise program where it supervises so

[00:25:08] there's a nurse who monitors you after the event you go three days out of the week for a total

[00:25:14] of 12 weeks for a total of 36 sessions and it leads to better outcomes. It leads to decreased

[00:25:20] hospitalizations, it improves longevity, it improves a reduction in having another event.

[00:25:27] Women on average are less likely to be referred to cardiac rehab than men

[00:25:33] and then when women are referred they're less likely to complete it so to date we are working now with

[00:25:40] again these cardiovascular societies to try to see if we could have more flexibility in the time

[00:25:46] of the cardiac rehab perhaps they should be outside of the work hours perhaps they should be maybe

[00:25:53] on weekends because right now it's more of a Monday through Friday 9 to 5 but we have to get back

[00:25:58] to the core of why our women less likely to receive these treatments versus men even when data

[00:26:06] supports that they're helping them just as much as they are their male counterparts and it goes

[00:26:11] back to that unconscious bias that we still have in the medical field. Talk also a little bit about

[00:26:18] you alluded to not only sex or gender differences but other inequities and differences.

[00:26:27] Absolutely so another passion of mine is not just speaking about women's health but also

[00:26:33] health inequities and health disparities as it pertains to one socioeconomic status race and

[00:26:39] ethnicity and when it comes to cardiovascular disease there's a plethora of that. When we actually

[00:26:45] look at the statistics we see that the greatest culprit often of our health is the social

[00:26:52] determinants of health so access to you know is there access to medical care? Is there access to

[00:26:58] equitable medical care? What environment are you growing up in? Do you have a safe neighborhood

[00:27:05] where you could actually exercise? You have the nutrients that you need in that neighborhood and

[00:27:10] oftentimes if the answers no it's going to predispose you to many of those risk factors and

[00:27:15] those risk factors are going to lead to heart disease. So it should come as no surprise that the

[00:27:20] black and brown community have the highest rates when it comes to cardiovascular conditions

[00:27:26] specifically I would say the black community especially black women. They are probably the

[00:27:32] largest group when it comes to the highest risk because of the fact when we look at a black female

[00:27:38] and myself and the black females I'm very aware of this we see that black women above the age of 20

[00:27:46] nearly 60 percent of them have some form of heart disease and oftentimes that's because of

[00:27:53] the greatest risk factor which is high blood pressure. It's a commonality in the community

[00:27:58] and when it is diagnosed another issue is that it's very much under treated so even though patients

[00:28:06] are being told that their blood pressure is elevated we as clinicians are not aggressively

[00:28:11] managing that blood pressure we're not educating them on the nutrition or aspect, the physical

[00:28:17] activity aspect and we're often sometimes not even prescribing them the right medications and as a

[00:28:22] result of that they're not getting the adequate blood pressure management and in the long run this

[00:28:28] is why we're seeing these heightened rates of stroke and heart attack which are largely preventable.

[00:28:34] So if a key factor for me has really been to make sure that we are targeting those highest risk

[00:28:39] groups and as a result of that a lot of my community education has been going out to the community

[00:28:46] working with churches and faith-based organizations to try to get the education out there

[00:28:52] to go to a trusted clinician yet your numbers check but make sure you understand how best to manage

[00:28:59] your risk factors. Talk a little bit about the relationship between stroke and heart disease

[00:29:07] and what are some of the symptoms? Yeah that's a great question so when we think about heart disease

[00:29:13] stroke even a condition called peripheral arterial disease which are blocked vessels in the arteries

[00:29:19] in our in our arms or our legs typically our legs it falls under the umbrella term cardiovascular

[00:29:27] disease so often what is cardiovascular disease that is when you have disease and the arteries

[00:29:32] of any piece or any part of your body and if somebody had a stroke commonly the cause of stroke

[00:29:41] to date in the United States the most common cause is an ischemic stroke which means that you had a

[00:29:47] transient episode where you had decreased oxygen to the brain often in the form of a blockage

[00:29:53] and that blockage could either be in the neck vessels possibly even in the brain vessels

[00:29:58] and if that is the case that predisposes you to have a heart attack because the risk factors for stroke

[00:30:05] are the exact same risk factors for heart attack. The medical way we treat stroke and the lifestyle

[00:30:12] way we treat stroke are the same way we medically and lifestyle wise treat heart attacks so they're

[00:30:18] equivalent and as a result of that for all of my patients that I see who have had a stroke

[00:30:23] I'm always hypervigilant in making sure that there isn't any disease in the arteries of their heart

[00:30:29] and other vessels because the likelihood is is that they're at a much greater risk of having it

[00:30:35] as such they need to understand what their risk factors are and make sure that they're getting

[00:30:39] appropriate treatment for it. If you would review the symptoms of a stroke

[00:30:46] absolutely so when we think about the symptoms of a stroke and I do want to preface the fact

[00:30:51] that the symptoms of a stroke in women can be very different than the symptoms of a stroke in men

[00:30:56] the same way the symptoms of a heart attack is a theme there's a theme exactly so when we think

[00:31:04] about we think about the classic symptoms of a stroke we think about somebody who may have word

[00:31:09] finding difficulty they may have an inability to actually speak they may have a sudden acute

[00:31:16] onset of numbness tingling inability to move any of their foreextremities and absolutely

[00:31:23] slurred speech but also they may have visual loss those are the acute symptoms that warrant you

[00:31:30] to go immediately to the emergency room because just like the saying goes time is muscle when it comes

[00:31:37] to a heart attack time is brain when it comes to a stroke now women yes can present with those

[00:31:44] same symptoms but just like when it comes to cardiovascular disease or a heart attack they

[00:31:49] sometimes present with fatigue and that could be a sign that there is something neurologically going on

[00:31:56] they also may have more subtle symptoms where they feel dizzy or having an imbalance which again

[00:32:03] that's very non-specific are they dizzy because their blood pressure is low or are they dizzy

[00:32:07] because there's a neurological event going on so it's really really important to know these

[00:32:12] little subtle symptoms know if they're not going away but most importantly know your risk factors

[00:32:18] because if you have a family history of stroke if you have a history of high blood pressure high

[00:32:24] cholesterol diabetes these symptoms can't be ignored because we would be very very concerned that

[00:32:30] they may actually be a cardiovascular event sure well you've been so generous with your time

[00:32:38] what did I not ask you that you think is important for our listeners to understand

[00:32:45] I think what I would just be emphasized which I had stated before is that with heart disease being

[00:32:52] so largely preventable but still our greatest threat at a minimum go to your doctor every year

[00:32:58] go to your clinician every year but not just go understand what your true risk factors are

[00:33:04] ask them those questions predominantly what are my risks and what can I do to prevent these risks

[00:33:10] from happening there are several additional tests beyond blood work and beyond a physical exam

[00:33:16] that sometimes can come in favor we talked a little bit about a calcium score with a cardiac

[00:33:22] cat scan we talked a little bit about an echocardiogram we talked about an electrocardiogram asking

[00:33:28] the questions would you benefit from any of those tests really helps to direct your clinicians

[00:33:34] that way we don't miss things and again knowing your risk largely can help to dictate that so

[00:33:41] for me that was really the most important messaging and for the women out there that are listening

[00:33:47] I think it's important that we as women understand that oftentimes we put everyone above our own

[00:33:55] self when it comes to our health we have to take a pause we have to go to the doctor or the clinician

[00:34:01] at least on an annual basis we also have to do things that are all more importantly going to help

[00:34:07] our mental health because our mental health equals our physical health and if our physical health

[00:34:13] needs a little bit of help oftentimes that means our mental health needs a little bit of help as well

[00:34:17] so as women out there that are listening it's really important that we take a step back

[00:34:23] focus on our self because if we don't focus on ourselves we won't be able to care for our loved ones

[00:34:29] our colleagues our friends our family that's a great way to end

[00:34:35] Dr. Rachel Bond as always I've learned so much thank you so much for being here with us today

[00:34:42] thank you so much it was a pleasure

[00:34:52] I hope you enjoyed our in-depth conversation with Dr. Bond in fact let's do a quick recap on some

[00:34:58] critical information that we discussed because it's really too important to let slip

[00:35:03] heart disease doesn't play favorites it's a leading cause of death for both men and women in

[00:35:09] the United States the common risk factors like high blood pressure diabetes high cholesterol

[00:35:15] smoking and a family history of heart issues affect everyone but for women there are extra layers

[00:35:22] to consider pregnancy complications like gestational diabetes and preeclampsia as well as stress

[00:35:29] depression and the changes that come with menopause can all influence our heart health remember

[00:35:35] those annual checkups are more than just a date on the calendar there are crucial step in

[00:35:40] monitoring and managing your health plus with 80% of heart disease being preventable lifestyle

[00:35:47] choices like a balanced diet regular exercise and stress management can be game changers heart

[00:35:55] disease in women often goes under the radar the symptoms can be chest pain shortness of breath

[00:36:01] or left arm pain but they can also be subtle and not what you or maybe even the doctor typically

[00:36:07] expect like shoulder pain indigestion nausea or even just fatigue without an obvious reason for

[00:36:14] being tired and that can lead to delays in diagnosis and treatment which in turn leads to poor

[00:36:20] outcomes in women so if something feels off speak up your voice could be the key to timely

[00:36:26] and effective care doctor bond emphasizes the importance of women being proactive about their

[00:36:32] heart health so understanding your risks recognizing the symptoms and consulting your doctor are

[00:36:39] vital steps and let's not overlook mental health it is deeply connected to your physical well-being

[00:36:46] I hope this discussion has equipped you with knowledge to safeguard yourself and your loved ones

[00:36:51] against heart disease especially a skimic heart disease in the second part of my interview with

[00:36:57] doctor bond we impact some other heart conditions experienced by women such as abnormal heart rhythms

[00:37:03] and heart failure as well as the specific concerns for the LGBTQIA plus community and other marginalized

[00:37:11] groups you'll also learn about doctor bond's passionate advocacy for policy change to better

[00:37:17] women's heart health and her insights on cutting edge innovations like wearables which promise a

[00:37:23] future where managing heart health is more personalized and proactive it's another treasure trove of

[00:37:29] information you won't want to miss I also invite you to explore beyond the paper gown for more

[00:37:35] resources articles and a community focused on wellness while you're there sign up for our newsletter

[00:37:41] to stay informed about our latest podcast events and health tips and don't forget to subscribe to

[00:37:47] our podcast on your preferred platform for the most current insights on women's health thanks for

[00:37:53] tuning in and take good care

[00:38:02] you

[00:38:09] beyond the paper gown is produced by Patrick Shambayati and me and our associate producer is Kyla

[00:38:14] Mcmillan