Women and Heart Disease

Dr. Evyan Jawad discusses heart disease and how it affects women differently than men, as well as healthy habits to promote your heart healthy.
Women and Heart Disease
Featuring:
Evyan Jawad, MD
Dr. Evyan Jawad is board certified in cardiovascular disease and interventional cardiology. She attended medical school at the Al Mustansiriya (mus-STAN-si-ree-yah) University in Baghdad and completed her residency and fellowship program with Rosalind Franklin University, at Mount Sinai Hospital in Chicago. Her office is at the Franciscan Physician Network Specialty Clinic near Franciscan Health Lafayette East hospital.
Transcription:

Scott Webb: Many women believe that the greatest threat to their health is breast cancer or other kinds of cancer. But the truth is that heart disease in the form of heart attack, heart failure and stroke is the leading cause of death in both women and men. The American Heart Association has made great strides in the past two years to raise women's awareness of the risk for heart disease, but there's still work to be done in this area.

And today, cardiologist, Dr. Evyan Jawad, from the Franciscan Physician Network Specialty Clinic, will walk us through the important points of women and heart disease. This is the Franciscan Health Doc Pod. I'm Scott Webb. So doctor, thanks so much for your time. You know, I know men and women have the same risk factors for heart disease, so let's just go through them. What are the risk factors for heart disease?

Dr. Evyan Jawad: Heart disease is the leading cause of death in women nowadays. And in the past 40 years, it had really declined, but in younger woman, it had plateaued. So heart disease, the risk factors the most common are a family history of heart disease, smoking, obesity, diabetes mellitus. Early menarche actually in woman can cause a higher incidence of heart disease and risk factors of high cholesterol is another one.

Metabolic syndrome is a recent concept that we came to know about in medicine where patients have truncal obesity, high bad cholesterol, low good cholesterol and insulin intolerance. Glucose intolerance and increased insulin productivity in the body puts the vascular system into a higher inflammatory process and that predisposes to accelerating heart disease. Heart disease is part of cardiovascular disease overall. Cardiovascular disease affects the heart vessels, peripheral vessels, causes stroke, abdominal aortic aneurysm, peripheral vascular disease where the endpoint for it would be lower extremities amputation or presents with a heart attack, like ST-elevation myocardial infarction or unstable angina.

Scott Webb: Yeah, so early diagnosis and treatment, those would all be important factors in this in managing this for women. And, speaking of women, you know, I know they wear many hats, right? A mother, daughter, wife, employee, and so many others and a lot of demands on their time, but they do need to remember to take care of themselves. We all do, but especially women because heart disease is so prevalent in women. So that means taking a good look at their heart health. So maybe I can just have you take us through that. What does that look like? How can women best take care of their hearts?

Dr. Evyan Jawad: So nowadays, women are in the workforce, just like men. So stressful life is the leading cause of heart problems. And that's why women are catching up with men, especially like younger woman usually, it's less incidents than men, but post-menopause, they catch up with men. The most important thing is lifestyle changes and risk modification and early detection of coronary artery disease as young as women in their 20s.

So certain heart problems can happen for women who have polycystic ovaries or are born with congenital heart disease, or when they go through pregnancies, especially multiparous pregnancy or pregnancy that is complicated with gestational diabetes and gestational hypertension are very high risk for complications compared to women who don't have those conditions.

And it's modifiable. The risk factors that we can modify is smoking. If we cut back on smoking, it decreases the incidence of heart problems by 16%. Diet changes can lower the incidence of heart problems by 13% by cutting back on saturated fat and increase unsaturated fat. And physical activities are very important. At least 30 minutes a day of physical activity is highly recommended.

The other thing that really cuts back on the incidence of coronary artery disease is obesity. If they become the normal BMI, that cuts back on the incidence of coronary heart disease by 8%. So if you combine all together, almost you can cut back by 50% if you lead a healthy active life.

Scott Webb: That's good to know that there are so many modifiable factors. And I think one of the things, maybe it seems obvious, but maybe it's not to everybody, is women just need to have a primary care physician, right? Like they need to have a first point of contact, right?

Dr. Evyan Jawad: Primary care doctors are essential in patient's care and everyone's care actually. Before becoming a patient, is preventing problems. But the main role for primary care to prevent coronary artery disease and cardiovascular disease in general overall is by checking patient's cholesterol. There is a certain percentage of population that are born with a family tendency of having abnormal cholesterol and abnormal triglycerides. They are at higher risk of premature coronary artery disease. So primary care doctors can detect this early and treat it appropriately.

And the other thing is they would pick up as patients is leading unhealthy life. If they are smokers, they would encourage patients to stop smoking. And if patients are obese, encourage patients to lose weight. Put them in exercise programs to lose weight and become more healthy. Daily changes of patient's daily activities, just by doing simple things, they can improve their overall health. I'll give you a simple example, parking the car far away from the entrance, just by walking to get from a parking lot to get to a building, that by itself is an activity. Using stairs instead of elevators, just simple things that you can modify to improve the overall physical well-being.

Scott Webb: Yeah, that active lifestyle is so key. Not just running after the kids or doing errands, making that walk a little longer and maybe taking the long way around Costco, things like that, right?

Dr. Evyan Jawad: Absolutely, yes.

Scott Webb: Yeah. So it's good to know that the primary care physicians really are all about helping women to take those preventative measures, checking cholesterol, blood pressure, and so on. And women certainly need to address the stressors that they know can impact, we know can impact their heart health. According to the American College of Cardiology, when not managed well, these stressors seem to impact women's heart health, even more than men. So let's go through them. What are the stressors and why do they affect women more than men?

Dr. Evyan Jawad: Well, it’s really unknown why women gets affected more than men with stressful life. But one of the things is pre-menstrual women go through hormonal changes and that may be the cause. Post-menopausal women, as I mentioned to you earlier, have higher incidence of coronary artery disease to the point they catch up with men.

And the reason for that is really because of hormonal changes, but the treatment for it and the management for it is not very clear. We're still not sure if hormone replacement would halt the incidence of increased coronary artery disease in women. So it's still in study process. We're still having to gather more information about it. And so far, to lower the incidence of coronary artery disease, we cannot recommend hormone replacement therapy at this point.

Scott Webb: Yeah, interesting. This is such a prevalent issue for women, but, as much as you know, there's still some unknowns and still more research and data to be collected in order to make the best recommendations, treatment options, you know, treatment recommendations for women. So let's talk about habits, good habits. What are some of the good habits that women can adopt to decrease their risk of heart disease?

Dr. Evyan Jawad: First of all, they have to learn how to de-stress themselves either by prayers, meditation, taking long walks, regular exercises, all these things really lowers the effect of nowaday's stressful life. And managing their time appropriately is also another thing that women should learn how to manage their life and de-stress themselves and not to burden themselves by too many responsibilities.

As I mentioned, nowadays, women are more out in the workforce compared to like last century, a hundred years ago, where women were mostly at home. The incidence of coronary artery disease at that time were way lower than nowadays where women are in the task force competing with men and having to deal with managing their family lives.

Now, the important other problem is nowadays women smoke as much as men smoke and that's a major risk factor that's affecting women. So those are the things that women in general need to tackle to decrease the risk of coronary artery disease, especially if they have family history of early coronary artery disease, which is women younger than age 60 or men younger than age 50 with incidence of coronary artery disease in their family.

Scott Webb: Yeah, it's so important to know your family history, genetic predisposition, to see your primary care, to do all the things that you've discussed here today. And maybe you could talk just a little bit about the advantage of aerobic activity. Why is that so key? Why do women need to get their heart rates up?

Dr. Evyan Jawad: Aerobic activity because it improves the cardiovascular system and it actually adapts the cardiovascular system to take more stress. The more fit person, their baseline heart rate would be lower than unfit person. Aerobic activity also gets rid of the extra poisons in the body, which is serum glucose. High serum glucose is has a major inflammatory response on the vascular system. And the body, if you're not exercising, utilizes it by secreting more insulin. And the insulin by itself is a pro-inflammatory hormone. So exercising makes the body get rid of the extra sugar, the triglyceride that's in the system. It makes the body utilize it and, at the same time, it adopts the heart to go faster heart rate and that, with time, will decrease the baseline heart rate and improve the cardiovascular system overall.

Scott Webb: When would a woman be referred to a cardiologist? Is that irregular heartbeat? A heart murmur? Angina? All the above? Maybe you can just take women through that process of, you know, they have a primary, there may be an issue. When would they be referred?

Dr. Evyan Jawad: The most common cardiovascular morbidities are hypertension and hypercholesterolemia. So if the primary care doctor is able to control systolic and diastolic blood pressure appropriately according to the AHA guidelines, then there's no need to see a cardiologist. But when patients have accelerating high blood pressure or uncontrolled hypertension or signs of coronary artery disease-- and women really have kind of different symptoms than men. They don't present with chest pain as much as men too. They present with excessive fatigue or shortness of breath or feeling unwell or just nausea and vomiting. And they turn to be going through an acute heart attack.

So, early detection is very important. So that's why the primary care are very essential in caring for overall population health, whether women or men, because seeing their primary care on a regular basis and having the health problems under control and managing them properly decreases the incidence of coming to the hospital with an acute heart attack, which is a major health problem that has like a significant percentage of mortality, depends on what they present with.

So, primary care doctors in general, they refer patients if they cannot control their symptoms or their comorbidities. In general, it's high blood pressure, high cholesterolemia, or hearing a new murmur, or lower extremities edema, shortness of breath with minor activities, waking up at night, short of breath, gasping for air. You know, those are the major symptoms that patients present with coronary artery disease.

Now, when it comes to cardiovascular disease, it's leg pain with exercise that we call it claudication or having many transient ischemic attacks, which is a sign of vascular disease in the carotid arteries or vertebral arteries. So those are the things that, you know, primary care should pick on.

The other thing is the arrhythmic diseases. The most common is atrial fibrillation. It increases incidence with age and, actually, women with atrial fibrillation have higher incidence of having complication of atrial fibrillation, which is strokes, higher in women compared to men. So that primary care can pick this up by having regular EKGs. It depends on the age group, how frequent they can do it. If they notice an irregular heartbeat, then, you know, having an EKG and, if it's irregular, refer it to the specialist for further care.

Scott Webb: This is such good information and really just encouraging women to, you know, see their primaries regularly to work with them and all the preventative measures. And then when things maybe aren't working, whether it's cardiovascular disease or heart disease, as you say, then they could be referred to a cardiologist, to a specialist, to really dig in and get a handle on things.

And I wanted to ask you, do we know why women sort of present differently when it comes to heart attack symptoms? There's like the classic symptoms we see in TV and movies with men, you know, clutching their chest, that kind of thing. But it's not like that for women, you touched on that a little bit. It's different for women. The signs are different. The signs and symptoms are different. Why is that? Do we know why?

Dr. Evyan Jawad: We do not, but definitely they are very different in the way that you present. And women tend not to reach to doctors as much as men do. They kind of downgrade their illness. I've seen it during my career as a physician, they downgrade their illness. In public, people think heart disease is more a man disease. They don't think about it as a woman disease. Actually, as I mentioned to you, women get coronary artery disease as much as men do.

Scott Webb: And that's just so good to know, because I think you're so right. I think women are maybe conditioned or taught or whatever it might be, just something different. You know, the difference between men and women is that women tend to not reach out. They tend to minimize things. They tend to keep things to themselves and we don't want them to do that. We want them to reach out and to see their primaries and to go to specialists when they need to.

And as we wrap up here today, doctor, just some takeaways for women when it comes to cardiovascular disease, heart disease, heart health, what's your best advice to women? Because, as we've discussed here today, and we know, they suffer from heart disease as much or more than men and we don't want that. We don't want women dying of heart disease and there's ways to prevent, there's ways to treat. What's your best advice, doctor?

Dr. Evyan Jawad: So number one is that women have to know that the leading cause of death in women is heart disease. Second is risk factor modification is very important. Stop smoking if you smoke. Avoid areas where people smoke because they become a secondary smoker. And regular exercise is very important. Weight loss, if they are obese and early detection of diabetes mellitus, hyperlipidemia, and hypertension. Diabetes mellitus is becoming an epidemic nowadays, the incidence is getting so high. Obesity is epidemic, 30% of population in the United States are obese. So those are risk factors that can be modified by losing weight, eating healthy diet.

Losing weight can lower incidence of coronary artery disease by 8%. Eating healthy diet lowers it by 13%. Stopping smoking lowers it by 16%. So all those factors together can lower the incidence of coronary artery disease.

And I want women to focus on how to de-stress themselves. The best is by exercising. They can do meditation, prayers, anything that lowers stress in life. Manage their lives in a smart way because, as I mentioned, women nowadays, they will work outside the house and they have the responsibility of their homes. So it's way stressful to women nowadays compared to a hundred year ago, those are the things that I highly recommend that women pay attention to and tackle to have a better life and healthier life.

Scott Webb: Yeah. And that's the goal, right? That's what we want. We don't want people, women especially, suffering in silence. Whether it's COVID or anything else, we want them reaching out to their doctors, getting all of their tests, seeing specialists when they need to, taking care of themselves, quit smoking, lose weight, workout, all of that stuff.

Doctor, you are so compassionate and knowledgeable. I feel like I could talk to you all afternoon. You have such an easy way about you. I just want to say thank you for your time and you stay well.

Dr. Evyan Jawad: Thank you so much for your time.

Scott Webb: For more information, go to FranciscanHealth.org/heartcare. Take a free heart risk assessment or make an appointment for a screening bundle. That includes a heart and lung scan at FranciscanHealth.org/screeningbundles. You can also read articles on our blog about heart care, including special concerns individuals with heart disease should have about COVID-19.

And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well and we'll talk again next time.