According to the NIH, in the United States, 1 in 4 women dies from heart disease. In fact, coronary heart disease (CHD)—the most common type of heart disease—is the #1 killer of both men and women in the United States.
You can find out if you are at risk for heart disease with HeartAware. It's quick, free and confidential. If you are at risk, you can meet with a nurse about your health.
In this segment, Dr. Ryan Shelstad, cardiothoracic surgeon at Bryan Heart, discusses risk factors and what women can control vs. what they can't control when it comes to heart disease.
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Heart Disease: Are You at Risk?
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Learn more about Ryan Shelstad, MD
Ryan Shelstad, MD, Bryan Heart
Dr. Ryan Shelstad is a cardiothoracic surgeon at Bryan Heart.Learn more about Ryan Shelstad, MD
Transcription:
Heart Disease: Are You at Risk?
Melanie Cole (Host): According to the National Institutes of Health, in the United States, 1 in 4 women dies from heart disease. In fact, coronary heart disease, the most common type of heart disease, is the number one killer of both men and women in the United States. My guest today is Dr. Ryan Shelstad. He’s a cardiothoracic surgeon at Bryan Heart. Welcome to the show, Dr. Shelstad. First, we’re talking specifically today about women, how does heart disease affect women differently than men?
Dr. Ryan Shelstad (Guest): That’s a great question. The population as a whole certainly shares risk factors for heart disease, but the ways those present is different. In women, it is different, mostly because of hormones. Men are traditionally thought of as at risk for heart disease, and that is true, but women have hormones obviously, and those are somewhat protective for heart disease. But as we know, as women age, their hormone balances change and those risk factors can start to equalize with men as they get older in age.
Melanie: Back in the day, Dr. Shelstad, studies about heart disease and heart attack risk factors were done mostly on men. Do you see that these are starting – the tide is turning, and you’re starting to see more about women and what we’re at risk for?
Dr. Shelstad: We are. Even though heart disease remains the number one killer of men and women, people are still living longer, so we’re starting to see these changes in who gets heart disease and when bear out.
Melanie: Let’s talk about risk factors. First, the risk factors that we cannot control, as women, what age group, what kinds of ethnicities – who’s most at risk?
Dr. Shelstad: Certainly. The things we cannot control – our age, our gender, our race, our family history, and our genes. Heart disease is something that develops over time, and anytime you get on in age – beyond the age of 50 or 55, we start to see those risk factors.
Melanie: So, 50, 55-years-old is when we start to increase our risk factors, what ethnicities are more at risk than others?
Dr. Shelstad: Statistically, we see the most heart disease in Caucasians by numbers, but minority populations have – not as prevalent, but their outcomes are not as good when it comes to heart disease. Not that it’s more common in other races, but when you look at health outcomes and death from heart disease it’s a higher percentage in some minorities.
Melanie: And what role does menopause and family history play?
Dr. Shelstad: Right, family history is, unfortunately, something we cannot control and probably the biggest risk factor when it comes to heart disease. That just has to do with how we metabolize our lipids and how we process them and how it leads to atherosclerosis in the blood vessels. As far as menopause goes, estrogen is protective for heart disease in that it increases our high-density lipids of our cholesterol, which is thought to be protective, and it decreases low-density lipids, which are associated with heart disease. After menopause, estrogen levels go down, and those protective effects then go away.
Melanie: Let’s talk about some risk factors that we can control. List some of them out for us, Dr. Shelstad, and speak about the importance of things such as cholesterol, blood pressure, smoking, obesity, diabetes, any of these things as they relate to women and heart disease.
Dr. Shelstad: Yeah, so things we can control include our weight and it’s probably the easiest – although easier said than done, obesity associated with it, differences in lipid profile, as well as elevations in blood pressure and the presence of diabetes. Another thing we can control is exercise, and that’s related to weight. Simply exercising 30 minutes a day a few times a week has a profound protective effect when it comes to rates of heart attack and death from heart disease. Another one that’s very easy to control is smoking – well, again, easier said than done – but smoking is a very strong risk factor for heart disease and quitting smoking has a profound effect on that risk profile. Diabetes is another one. We can’t always control whether or not we have diabetes, but we can control how well it’s managed. Keeping blood sugars under control is very important for preventing heart disease. In fact, about 80% of people with diabetes end up having heart disease and dying from some complication from heart disease. Another risk factor is blood pressure, and like I mentioned, some people have blood pressure that is high, but being obese, or smoking, or not exercising contributes to that high blood pressure, and lastly is cholesterol. I mentioned earlier in the segment that family history dictates our genes in how we process lipids, but outside of that, we do have the ability to control our cholesterol. Again, exercise is important in maintaining that balance, but also there are medicines that we now have for patients who we know are prone to higher cholesterol to lower it.
Melanie: Dr. Shelstad, what role does stress play, especially for women, as we’re the caregivers of society, and sometimes we’re taking care of everybody else besides ourselves. Sometimes even stress can mimic symptoms of a heart attack or heart disease. Speak about stress and reducing it so that we can reduce our risk for heart disease.
Dr. Shelstad: That’s a very important point. That is true to a strong degree in almost every household that I can think of. It’s harder to quantify stress as it is the risk factors that I mentioned earlier. We know that stress, and how people manage stress – or don’t manage stress, is a risk factor for having a heart attack as well as an event. It’s not so much that stress is a risk factor for having atherosclerosis or heart disease by itself, but it is a risk factor for having a complication from heart disease.
Melanie: And what about nutrition? Because we hear so much – and you’ve spoken about diabetes and obesity and even blood pressure, but nutrition plays such a large role, and we’re learning more and more about the role of what we eat as it contributes to many disease states. What do you tell your patients about an unhealthy diet as it contributes to heart disease?
Dr. Shelstad: Diet recommendations are ever-changing, and there’s always new, popular approaches to diet. I think all of them have some merit. We know that having a diet that’s high in processed foods or high in fats and simple sugars that are processed all contribute to diabetes and heart disease. The recommendations are diverse, but I think that a simple rule is to eat a balanced diet – a lot of whole grains, vegetables and lean meats. We need all of the different food groups, but less of the bad foods and the more balanced diet we eat result in the best risk modifications.
Melanie: And one more thing we’re learning about, Dr. Shelstad, is sleep. Sleep apnea, and its contribution to things like obesity and diabetes, what do you tell women about that good, quality night’s sleep and their risk of sleep apnea?
Dr. Shelstad: Yeah, obesity is the largest risk factor for sleep apnea. As patients become obese, the pressure in their abdomens increases and it pushes up on the airway mechanism and cause us to obstruct that airway when we sleep. When we do that, we actually stop breathing, and that can cause changes in heart rhythm. It also causes the night of sleep to be not restful because you’re waking up several times in the night. Even if you don’t awaken you stop sleeping and you’re not in the deepest sleep, so it’s not a restful sleep.
Melanie: Would a woman know if she has heart disease? Are there some symptoms or signs, not necessarily of a heart attack, but heart disease? Would we check for it at our annual physicals? How would we know?
Dr. Shelstad: That’s the one thing about heart disease is we call it the silent killer because there are often times not many symptoms in its early phases. It starts as a simple plaque or narrowing of a blood vessel in the coronary arteries that supply the blood to the heart and until that narrowing becomes critical, we oftentimes don’t have a lot of symptoms. That’s why we talk about risk factors so much in terms of education and awareness so that people know what the risk factors are and they can pay attention to the small symptoms, such as a little less exercise tolerance, some chest discomfort or palpitations with activity. Those are not very specific to heart disease, but they’re the kinds of things that someone may have – a sign that they have heart disease.
Melanie: And in our blood tests sometimes they take the c-reactive protein. Is this an indicator or a marker of an inflammatory situation that could signal heart disease to you doctors?
Dr. Shelstad: It does. Now, a lot of things can cause that to be elevated, but we find that patients who have it elevated are at higher risk for an event related to heart disease. It’s similar to stress. For the same reasons, it can unmask underlying heart disease. But it is a marker for general inflammation, and we find that patients with inflamed vessels with narrowing in them are at higher risk of having an acute blockage of that.
Melanie: Wrap it up for us, Dr. Shelstad, with your best advice for women listening and for their partners that love them, what you want us to know about heart disease, our risks, our controllable factors and even possibly prevention.
Dr. Shelstad: Certainly. The risk factors that we mentioned are all intertwined, and they have other benefits as well. If you’re eating sensibly, watching your weight, exercising, not smoking, managing your diabetes and your blood pressure, and you’re keeping your cholesterol at the appropriate levels, not only does it decrease your risk of having heart disease or a complication of heart disease, but there are lots of other benefits as well. State of mind, positive effects of exercise, getting a better night’s sleep, all of those things come into overall having a better well-being, in addition to decreasing your risk of having heart disease or a heart attack.
Melanie: If you’re concerned about your heart health, take our free, quick, and confidential HeartAware Online Screening at bryanHealth.org/heartaware, that’s bryanHealth.org/heartaware. Thank you, so much, Dr. Shelstad, for joining us today, and thank you to the women of Alpha Phi for funding this special heart healthy podcast. This is Melanie Cole. Thanks, so much for listening.
Heart Disease: Are You at Risk?
Melanie Cole (Host): According to the National Institutes of Health, in the United States, 1 in 4 women dies from heart disease. In fact, coronary heart disease, the most common type of heart disease, is the number one killer of both men and women in the United States. My guest today is Dr. Ryan Shelstad. He’s a cardiothoracic surgeon at Bryan Heart. Welcome to the show, Dr. Shelstad. First, we’re talking specifically today about women, how does heart disease affect women differently than men?
Dr. Ryan Shelstad (Guest): That’s a great question. The population as a whole certainly shares risk factors for heart disease, but the ways those present is different. In women, it is different, mostly because of hormones. Men are traditionally thought of as at risk for heart disease, and that is true, but women have hormones obviously, and those are somewhat protective for heart disease. But as we know, as women age, their hormone balances change and those risk factors can start to equalize with men as they get older in age.
Melanie: Back in the day, Dr. Shelstad, studies about heart disease and heart attack risk factors were done mostly on men. Do you see that these are starting – the tide is turning, and you’re starting to see more about women and what we’re at risk for?
Dr. Shelstad: We are. Even though heart disease remains the number one killer of men and women, people are still living longer, so we’re starting to see these changes in who gets heart disease and when bear out.
Melanie: Let’s talk about risk factors. First, the risk factors that we cannot control, as women, what age group, what kinds of ethnicities – who’s most at risk?
Dr. Shelstad: Certainly. The things we cannot control – our age, our gender, our race, our family history, and our genes. Heart disease is something that develops over time, and anytime you get on in age – beyond the age of 50 or 55, we start to see those risk factors.
Melanie: So, 50, 55-years-old is when we start to increase our risk factors, what ethnicities are more at risk than others?
Dr. Shelstad: Statistically, we see the most heart disease in Caucasians by numbers, but minority populations have – not as prevalent, but their outcomes are not as good when it comes to heart disease. Not that it’s more common in other races, but when you look at health outcomes and death from heart disease it’s a higher percentage in some minorities.
Melanie: And what role does menopause and family history play?
Dr. Shelstad: Right, family history is, unfortunately, something we cannot control and probably the biggest risk factor when it comes to heart disease. That just has to do with how we metabolize our lipids and how we process them and how it leads to atherosclerosis in the blood vessels. As far as menopause goes, estrogen is protective for heart disease in that it increases our high-density lipids of our cholesterol, which is thought to be protective, and it decreases low-density lipids, which are associated with heart disease. After menopause, estrogen levels go down, and those protective effects then go away.
Melanie: Let’s talk about some risk factors that we can control. List some of them out for us, Dr. Shelstad, and speak about the importance of things such as cholesterol, blood pressure, smoking, obesity, diabetes, any of these things as they relate to women and heart disease.
Dr. Shelstad: Yeah, so things we can control include our weight and it’s probably the easiest – although easier said than done, obesity associated with it, differences in lipid profile, as well as elevations in blood pressure and the presence of diabetes. Another thing we can control is exercise, and that’s related to weight. Simply exercising 30 minutes a day a few times a week has a profound protective effect when it comes to rates of heart attack and death from heart disease. Another one that’s very easy to control is smoking – well, again, easier said than done – but smoking is a very strong risk factor for heart disease and quitting smoking has a profound effect on that risk profile. Diabetes is another one. We can’t always control whether or not we have diabetes, but we can control how well it’s managed. Keeping blood sugars under control is very important for preventing heart disease. In fact, about 80% of people with diabetes end up having heart disease and dying from some complication from heart disease. Another risk factor is blood pressure, and like I mentioned, some people have blood pressure that is high, but being obese, or smoking, or not exercising contributes to that high blood pressure, and lastly is cholesterol. I mentioned earlier in the segment that family history dictates our genes in how we process lipids, but outside of that, we do have the ability to control our cholesterol. Again, exercise is important in maintaining that balance, but also there are medicines that we now have for patients who we know are prone to higher cholesterol to lower it.
Melanie: Dr. Shelstad, what role does stress play, especially for women, as we’re the caregivers of society, and sometimes we’re taking care of everybody else besides ourselves. Sometimes even stress can mimic symptoms of a heart attack or heart disease. Speak about stress and reducing it so that we can reduce our risk for heart disease.
Dr. Shelstad: That’s a very important point. That is true to a strong degree in almost every household that I can think of. It’s harder to quantify stress as it is the risk factors that I mentioned earlier. We know that stress, and how people manage stress – or don’t manage stress, is a risk factor for having a heart attack as well as an event. It’s not so much that stress is a risk factor for having atherosclerosis or heart disease by itself, but it is a risk factor for having a complication from heart disease.
Melanie: And what about nutrition? Because we hear so much – and you’ve spoken about diabetes and obesity and even blood pressure, but nutrition plays such a large role, and we’re learning more and more about the role of what we eat as it contributes to many disease states. What do you tell your patients about an unhealthy diet as it contributes to heart disease?
Dr. Shelstad: Diet recommendations are ever-changing, and there’s always new, popular approaches to diet. I think all of them have some merit. We know that having a diet that’s high in processed foods or high in fats and simple sugars that are processed all contribute to diabetes and heart disease. The recommendations are diverse, but I think that a simple rule is to eat a balanced diet – a lot of whole grains, vegetables and lean meats. We need all of the different food groups, but less of the bad foods and the more balanced diet we eat result in the best risk modifications.
Melanie: And one more thing we’re learning about, Dr. Shelstad, is sleep. Sleep apnea, and its contribution to things like obesity and diabetes, what do you tell women about that good, quality night’s sleep and their risk of sleep apnea?
Dr. Shelstad: Yeah, obesity is the largest risk factor for sleep apnea. As patients become obese, the pressure in their abdomens increases and it pushes up on the airway mechanism and cause us to obstruct that airway when we sleep. When we do that, we actually stop breathing, and that can cause changes in heart rhythm. It also causes the night of sleep to be not restful because you’re waking up several times in the night. Even if you don’t awaken you stop sleeping and you’re not in the deepest sleep, so it’s not a restful sleep.
Melanie: Would a woman know if she has heart disease? Are there some symptoms or signs, not necessarily of a heart attack, but heart disease? Would we check for it at our annual physicals? How would we know?
Dr. Shelstad: That’s the one thing about heart disease is we call it the silent killer because there are often times not many symptoms in its early phases. It starts as a simple plaque or narrowing of a blood vessel in the coronary arteries that supply the blood to the heart and until that narrowing becomes critical, we oftentimes don’t have a lot of symptoms. That’s why we talk about risk factors so much in terms of education and awareness so that people know what the risk factors are and they can pay attention to the small symptoms, such as a little less exercise tolerance, some chest discomfort or palpitations with activity. Those are not very specific to heart disease, but they’re the kinds of things that someone may have – a sign that they have heart disease.
Melanie: And in our blood tests sometimes they take the c-reactive protein. Is this an indicator or a marker of an inflammatory situation that could signal heart disease to you doctors?
Dr. Shelstad: It does. Now, a lot of things can cause that to be elevated, but we find that patients who have it elevated are at higher risk for an event related to heart disease. It’s similar to stress. For the same reasons, it can unmask underlying heart disease. But it is a marker for general inflammation, and we find that patients with inflamed vessels with narrowing in them are at higher risk of having an acute blockage of that.
Melanie: Wrap it up for us, Dr. Shelstad, with your best advice for women listening and for their partners that love them, what you want us to know about heart disease, our risks, our controllable factors and even possibly prevention.
Dr. Shelstad: Certainly. The risk factors that we mentioned are all intertwined, and they have other benefits as well. If you’re eating sensibly, watching your weight, exercising, not smoking, managing your diabetes and your blood pressure, and you’re keeping your cholesterol at the appropriate levels, not only does it decrease your risk of having heart disease or a complication of heart disease, but there are lots of other benefits as well. State of mind, positive effects of exercise, getting a better night’s sleep, all of those things come into overall having a better well-being, in addition to decreasing your risk of having heart disease or a heart attack.
Melanie: If you’re concerned about your heart health, take our free, quick, and confidential HeartAware Online Screening at bryanHealth.org/heartaware, that’s bryanHealth.org/heartaware. Thank you, so much, Dr. Shelstad, for joining us today, and thank you to the women of Alpha Phi for funding this special heart healthy podcast. This is Melanie Cole. Thanks, so much for listening.