Scott Webb (Host): Today, we're discussing ways in which women can keep their hearts healthy and the value of a calcium score in predicting risk for future heart attacks. And joining me today is Dr. Lewis Janeira. He's a board-certified cardiologist, subspecializing in non-invasive cardiology at Franciscan Health.

 This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, it's a pleasure to have you here today. We're going to talk about preventing heart attacks, but specifically for women, how can they stay heart healthy, prevent heart attacks, all that good stuff. So, I guess, I just want to start with maybe the most obvious one. Like, do men and women present differently? And if so, is that one of the reasons maybe why there's a disparity in diagnosis and treatment for women? Take us through that.

Dr. Louis F. Janeira: The typical thing you see in the movies or read about in books about heart attacks, basically is related to men. What we learned back in the '60s and '70s when we began to explore heart disease. Most of it was done in VA hospitals; therefore, men. And of course, we assume that women presented in the same way, at the same type of scenarios, the same type of presentation. What was learned over the many years is that that's not always the case.

The typical scenario, if you will, that say man would more often have would be a very heavy pressure sensation or squeezing in the middle of the chest, that's sometimes associated with shortness of breath, breaking out in a cold sweat. Those would be the so-called typical symptoms. And certainly, women do have those at times as well. But more often women will present with atypical features. Women, for instance, will often present without any chest pains at all. A lot of times, women will present with just a feeling of profound fatigue and weakness. Sometimes just being short of breath with activities that they could previously do just fine. Some of them will present with back pain, which would be unusual. Quite unusual for men, but can occur as well.

So, that sort of thing sometimes, of course, makes it difficult for women to recognize their symptoms as being heart disease, because it's so easy to say, "It's something I ate" or I slept wrong," or come up with some excuse for those symptoms they are experiencing. And by the same token, in the emergency room setting, for instance, it can also be missed. Women can come in with, say, for instance, back pain and people are thinking muscles or bones or kidney stones or something different, and perhaps be more apt to miss the heart being the problem.

Host: Yeah. You get a little sidetracked.

Dr. Louis F. Janeira: Right. So, I think there's a big value to a marketing type of scheme whereby we let people in general, but certainly women, know that the typical symptoms aren't always expected when people are in the throes of a heart attack.

Host: I guess, I'm just wondering, You know, knowing the women in my life, Doctor, and knowing, you know, how tough they are, generally speaking, when we think about the diagnosis treatment, the disparities, is it that maybe men tend to go to the doctor more about these things, they tend to complain more about these things, and women sort of suffer in silence? Is that maybe part of this?

Dr. Louis F. Janeira: Yeah. That's is true. Women tend to be caregivers. They're taking care of the family, they're making sure they're fed, they're making sure everything's going their way, and their work, their lives. So, perhaps they tend to be less concerned about their own health and not think so much about themselves.

They are tougher, that's for sure. I say that as a man. They are tougher, so perhaps they just think, "Oh, you know, I'm just going to toughen out because it's just my muscles aching" or something of that nature. So, it is important for them to think that, yes, women do have heart disease, and that the symptoms aren't always like the episode of some of these shows that you were mentioning.

Host: Yeah. I mean, it's the number one killer, of course, and there's just as many women as there are men, and we need them to go to their docs and see specialists like yourself. And I guess it just makes you wonder, Doctor, like how can specifically women stay more heart healthy? I hear a lot of the same things from all the experts. You know, we need to eat better, we need to get more exercise. Are there some things specifically though that you recommend for women?

Dr. Louis F. Janeira: Yes, for sure. You know, the usual that you just mentioned are very important. But also, things like not smoking. Smoking had been a huge problem years ago. We have done a pretty good job as a society to lower the incidences of people smoking, which is so wonderful.

But the thing that we're seeing now, which is just as bad, if not worse, is actually obesity, which of course come about from not enough exercise, from not eating properly. But I used to say, and I often say to my patients, 80% of what I used to do, it used to be from smoking and now it certainly is from obesity. So, keeping the weight down with diet and exercise is certainly important. And not smoking, also very important. Blood pressure, it's very easy to buy a blood pressure machine to take the blood pressure at home. And there's different theories on this, different doctors will approach it differently. I, myself, like my patients to take their blood pressure first thing in the morning at rest, because if they're walking around, showering, going to the bathroom, getting dressed, getting their coffee ready, well ,they're now not at rest. They're exercising. So when they take their blood pressure, the numbers may be expected to be a little bit higher because of that. So, I tell my patients, wake up, sit up, and take it before you do much. We'd like the blood pressure, ideally less than 120/80. We start to get concerned and want to do something about it if it's repeatedly over 130/80. So for blood pressure, we recommend low-sodium diet, more exercise, again, weight loss.

Unfortunately, going back to obesity for a second, it does not only become a problem in it by itself, but also makes it more difficult to exercise, causes more high blood pressure. Sleep apnea is big with obese patients. Sleep apnea is a condition. People that have it causes a series of problems, all of which affect many things. But most importantly, the heart. So, we see a lot of, for instance, congestive heart failure. From that, we see a lot of diabetes, high cholesterol, et cetera.

Host: Right. Yeah. The greatest hits, if you will. Doctor, I've heard about these $49 scans, heart scans, calcium scores, whatever they're all called. I'm going to have you sort it out for me. But what's the value, do you believe, in some of these options for folks, relatively inexpensive options for folks, especially for women?

Dr. Louis F. Janeira: I am very big with them. Whatever the patient comes to see me for, not only do I have them get the test, but I also have whoever drove them in. Most of the time, the spouse just comes along to sit there, be moral support, and I say, "Hey, the two of you, go get this test." What it is, basically, it's a very simple CAT scan, no IV, nothing. So, it's a simple test. I tell my patients it takes longer to get on the machine than the test itself. The test itself is just a few seconds.

But what it is is a CAT scan looking to see if there's calcium in the arteries that feed the heart, which we call the coronary arteries. If there's calcium, that means the calcium is trapped inside plaque. Think of plaque as crud inside the fuel lines and think of the arteries as fuel lines. So when there's crud in there, the more the calcium, the more the plaque, the more the plaque, the closer you are to a heart attack. So, getting a calcium score, I think, is really important starting at age 40. For people especially that have a family history of premature heart attacks or heart disease; people that have high blood pressure, diabetes, certainly if they smoke, if they're obese, these things we've been talking about that increases the odds of heart attacks and heart disease, all of those patients, it would be very important to get that done.

Host: Yeah. And I love that you say, "Yeah, the two of you, you both go. Not just you, you should both go." And for less than a hundred bucks in most cases, and even if insurance won't cover it, still a great investment in our health and our future. I'll just give you a chance here doctor. Just final thoughts, takeaways. When we think about, you know, women and heart attacks and keeping those hearts healthy, what are your final thoughts?

Dr. Louis F. Janeira: Stay healthy. Again, exercise, keep your weight down. If you smoke, that's got to go. This is of course most importantly when there's a family history of people having heart attacks before age 60 or 65. Those are the patients that we also worry quite a bit, both for men and women.

Host: Yeah. As you say, like there's lifestyle, behavior, things, right? Losing some weight, eating better, getting exercise, having the calcium scores, you know, all of that. But then, there's that family history component, the genetic component that we can't outrun, but we need to be aware of and take into consideration, right? As we're making these lifestyle and behavior choices, we need to know, you know, "Dad had a heart attack in his 50s," or "Grandma died when, you know, whatever." Like, we should know that information, right, as best we can.

Dr. Louis F. Janeira: Absolutely. That's very important to know because you're like your parents genetically. There's a lot of things that get transmitted down the line, not only with cholesterol, but with other factors that then end up causing premature heart disease and, of course, we would like very much to be aware of that and to try to protect against that.

You know, the good news is we do have a lot of ways to reduce the risk. Once we identify the risk and we do those calcium score tests, we define the risk of heart attack in the next 10 years. If the risk is very, very low, well, then we don't need to do very much at all. If the risk is high, then the good news is there are a lot of therapies and things we can do to mitigate that risk. And of course, it puts you on your doctor's radar. It marks you as, you know, a high-risk patient. So of course, then, you're not just out there alone. You'll have someone that you can ask advise as the symptoms occur for them to be evaluated and managed right away.

Scott Webb: Yeah. That's perfect. Well, I appreciate your time and your expertise today. As I said, we've been on a run here of focusing on the heart, focusing on women's hearts, trying to help them keep their hearts healthy, right? And it's all good stuff. So, thank you so much.

Dr. Louis F. Janeira: Absolutely. It was my pleasure.

Host: And to learn more, visit franciscanhealth.org/heartcare. 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.