Heart disease is the number one killer of women. UPMC cardiologist, Malamo Countouris, MD, explains some of the reasons unique to women that make them high risk and what women can do to get and stay healthy.
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– This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgments when advising their patients. Patients in need of medical care should consult their personal care provider. Heart disease is the leading cause of death for women in the United States. And if you are a woman of color, you are at a higher risk for the disease. Hi, I’m Tonia Caruso. Welcome to this UPMC HealthBeat Podcast. And joining us right now is Dr. Malamo Countouris. She’s a cardiologist at UPMC, specializing in women’s cardiovascular disease. Thank you so much for joining us.
– Thank you, it’s a pleasure to be here.
– So let’s really start with, typically, you think of heart attacks, you might often think of men, but this is really an issue that affects women.
– Such an important point. Heart disease is the No. 1 killer of women. One in three women will die from a heart disease cause, so this is something that we really need to focus on when we’re talking about women and optimizing their health.
– And so, why is this? What are the risk factors for women?
– Women have traditional risk factors that we would think about for men and women: hypertension, diabetes, high cholesterol. The thing is that even those traditional risk factors have a higher association with cardiovascular disease for women. In addition, we, nationally, are particularly bad at controlling risk factors for women and need to focus a little bit more for women in the traditional risk factors. Women also have nontraditional risk factors for heart disease that we might not think about as typically because we don’t see them in men, but there are pregnancy complications like preeclampsia, gestational hypertension, gestational diabetes, that are also associated with heart disease in later life. So, there are some things that we think about unique to women in terms of risk factors. There are some barriers for women, in particular, there are a lot of competing priorities, and sometimes it’s hard for people to recognize that they could have something wrong. We don’t want people to ignore symptoms, in particular, and we want people to really be getting the best preventive care that they can, and this involves women coming to their doctors and telling us what’s going on, telling us about their symptoms, and making sure that they’re bringing that to the table when they talk with their physician so that we can find a treatment approach to prevent heart disease or to treat heart disease.
– So, in some ways, the deck is stacked, but if you’re a woman of color, it can be stacked even more. Talk about the issues with disparities and why it is that we know that African-American women and other minorities have a greater chance of developing heart disease. Is it genetic? Talk about those risk factors.
– For sure, there’s a genetic component to heart disease, and that’s why we really ask people, especially in first-degree relatives, if you have someone, a sibling, if you have a parent, or even a child that has had heart disease. Those are the genetic risk factors that we think about from a family history perspective. For Black women, in particular, they’re at very high risk of heart disease, and it’s being under-recognized, partially by physicians, and partially, I think, by patients. Women of color who have lower socioeconomic status may have barriers to accessing care. We think about transportation, we think about access to appointments, and sort of proximity to medical care. These are issues that may affect Black women sort of disproportionately when we compare to their white counterparts. So, we at UPMC have really focused on optimizing care for women who may be at risk for heart disease, or who have heart disease, that this is a vulnerable population that we really need to take extra steps to ensure that they have the best care. We take care of a lot of pregnant women at Magee, and women who have pregnancy complications, but we’ve actually shown that some of the risk factors for pregnancy complications exist before pregnancy. So, even as early as women in their 20s or 30s, especially if you might already have some risk factors for heart disease, like high blood pressure or diabetes, these are times when we want to see women. Prevention starts early. The earlier we start it, the better sort of longitudinally we’re going to see prevention of heart disease for the future.
– The symptoms for women when it comes to a heart attack. Are they the same as the symptoms for men? What does that look like?
– For women, symptoms of a heart attack most commonly are still going to be chest pain above other symptoms. That being said, it may look a little atypical for women as well. So, it could be more of a chest pressure, a chest tightness. It could be actually shortness of breath, or nausea, or even vomiting with exercise, in particular. So, we look to see are symptoms happening with exertion, when the heart is under more strain, and look for some of these more atypical symptoms for women that we are less likely to see in men.
– Let’s talk about what we all should be thinking about when it comes to our heart health. We always hear “know your numbers,” when they talk about Heart Month. We should know our numbers all year round, but what are those numbers? What should we be thinking about?
– So, No. 1 would be blood pressure. So, we need to know blood pressure numbers that we divide into systolic, or the top number, and diastolic, the bottom number. So, blood pressure numbers, cholesterol numbers, LDL cholesterol, triglycerides, and HDL cholesterol, diabetes. We need to know, our hemoglobin A1C is a measure that we use to diagnose diabetes. These are sort of the top three things. The fourth I will say would be your body mass index, or BMI, so, weight in relation to your height. All of these correlate with risk factors for heart disease. If we know those numbers, we can really target treating anything that’s abnormal.
– What is a decent blood pressure range? Where should we be?
– Target blood pressure is really 120 over 80 or less. For someone who has high blood pressure, then we want to be pretty strict with blood pressure control, less than 130 over 80. It would be our kind of target for blood pressure management.
– And cholesterol, where should we be?
– Right. So, LDL cholesterol is kind of what we think about as the bad cholesterol. That we really want to see less than 100 for most folks. For people that have heart disease already, we want an even stricter goal, less than 70. And when we think about the total cholesterol, we want that to be less than 200.
– How does diabetes play into heart disease? What happens in the body?
– Diabetes is a condition where you have elevated blood glucose levels, or elevated sugar levels. And those elevated sugar levels long-term can impact your arteries, both in the heart and in the vascular system, kind of peripherally in the legs and kind of other vascular territories. So, control of diabetes can help prevent these complications that we see with diabetes long term.
– So what should we be doing besides knowing those numbers and paying attention to that? What should our lifestyle be? Any lifestyle modifications?
– Lifestyle is another really important piece, and there are some key points when we think about what is the optimal, heart-healthy lifestyle? Exercise is really important, regular exercise. The American Heart Association suggests that we should get 30 minutes of moderate-level activity five times a week. What is moderate-level activity? These are things like vigorous walking, can be swimming, elliptical, things that are going to get your heart rate up a little bit, work you up to a light sweat, and then doing that 150 minutes a week, whether that be 30 minutes five times a week, or you can do sort of longer chunks fewer times per week. Diet is another really important piece. In cardiology, we focus on low-salt, low-cholesterol diet, and eating more fruits and vegetables, lots of lean meat proteins or non-meat protein, legumes, beans, nuts. Those are all kind of healthier protein options rather than, you know, we want people to steer away from the red meat.
– Really, if you were picking one, would you prefer your patients quit smoking or lose weight? You’re probably going to say both, but talk about that as a first step as well.
– You know, it’s interesting that you mentioned smoking and sort of weight because I think both of those can lead to heart disease, they’re risk factors for heart disease, and have inflammation components that we know are bad for the heart. Smoking is sort of the No. 1. People need to quit smoking for sure. And that’s something that is not easy to quit, but is so essential for prevention of heart disease. So, I think they both need to be priorities, but if I would have to prioritize one, it has to be the quitting smoking. We actually work, at the Magee Heart Center, with nutritionists. So, if people are wanting to focus on weight loss, then that’s something also that we certainly recommend and can help prevent heart disease for the future.
– The Magee-Womens Heart Program at UPMC, this is really experts from every specialty at the table. And tell folks who all is involved there, and what was missing? What were you seeing that you all said, “We need to do this”?
– Women were coming to us and feeling like their doctors weren’t communicating. We pride ourselves at the Magee-Womens Heart Program in collaborating with a number of different specialties that also care for women and who have heart disease, or may be at risk for heart disease. In particular, when we think about pregnant women, we collaborate very closely with our obstetricians, with our maternal fetal medicine specialists. And then, beyond pregnancy, we actually collaborate very closely with our gynecology oncologists, and caring for women who have women-specific cancers.
– So, out of all the fields of medicine that you could get into, why this area? And why specifically women’s cardiology as well?
– For me, it was because I think there’s a lot of work we need to do in this space. We need really good providers, cardiologists, people who are focusing on women to really think about, how do we treat women better? How do we do better at preventing heart disease? How can we best take care of women and their unique risk factors? I think we’ve learned that women are not the same as men. They deserve a unique approach, and this is something that we can deliver at the Magee-Womens Heart program.
– We were saying early on, everybody knows February’s Heart Month, but this is really something all year round that we need to be cautious of or we need to be aware of.
– Yeah, February gives us a nice time point to touch base, but I think there’s never a wrong time to think about your heart and think about what do you need to do to best prevent heart disease for the future.
– Well, doctor, some great information. Thank you so much for coming in and spending time with us today. We certainly do appreciate it.
– Thanks, it was great to be here.
– I’m Tonia Caruso. Thank you for joining us. This is UPMC HealthBeat.
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