Intro: It's Your Health Radio, a special podcast series presented by Henry Mayo New Hall Hospital. Here's Melanie Cole.

Melanie Cole (Host): Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. And joining me today is Dr. Marwah Shahid. She's a cardiologist starting the Women's Heart Disease Program at Henry Mayo Newhall Hospital in the summer of 2023. And she's here to tell us about women's heart health.

Dr. Shahid, it's a pleasure to have you with us. This is a really great topic. I'd like you to start by telling us a little bit about how common heart disease is in women and how you feel awareness of heart health has changed over the years.

Dr. Marwah Shahid: Hi, Melanie. Thank you so much for having me. Cardiovascular disease is actually the number one killer of women. It causes one in three deaths each year. Cardiovascular disease actually kills more women than all forms of cancer combined, yet only 44% of women recognize that cardiovascular disease is their greatest health threat.

When we generally think about women's heart disease, we think about breast cancer. However, cardiovascular disease, as I mentioned, kills more women than breast cancer. The good news is that most cardiovascular diseases can still be prevented with healthy lifestyle changes. I hope that by creating the Women's Cardiovascular Disease Center at Henry Mayo, we can improve the awareness of cardiovascular disease in women because this is definitely still something that is under-recognized and under-treated.

Host: I certainly agree with you. And back when I was in grad school and we were working with post-heart attack patients, and boy, it was mostly men then. And of course, all the studies on heart disease have always been done on men until recently. So Dr. Shahid, let's talk about some of the risk factors for cardiovascular disease. Some we can control, some we cannot control, and some are ones that we didn't used to really recognize: stress, obesity, things that we didn't look at before and we certainly do now.

Dr. Marwah Shahid: Yes, absolutely. So, there are traditional risk factors for heart disease, like you mentioned, and a lot of emerging non-traditional risk factors that we've been learning about through all of our robust research over the past decade.

Some of the traditional risk factors that we think of that contribute to heart disease include having diabetes, smoking cigarettes, being obese or overweight as you mentioned, being physically inactive, having high blood pressure and having high cholesterol. Some things that are really important for women specifically is that what we're now learning is that there are a lot of emerging risk factors for women. Having a preterm delivery, hypertensive heart disease of pregnancy, having diabetes when you're pregnant, having certain autoimmune conditions, being treated for breast cancer, and depression and stress, all contribute to women's heart disease in ways that we had not known about before.

Host: They sure do. We're recognizing more and more of those things. Now, let's talk about early detection. Because I think one of the things as we learn more, Dr. Shahid, about the difference between the symptoms, the old-fashioned men's symptoms, the clutching of the chest, you know, the movie stuff and the pressure, the elephant on your chest. But we've learned that for women, this is different. We can have pain in our arm or our jaw or our back. But Dr. Shahid, we get these pains anyway. We get them from stress. We get them from sitting in front of a computer or a bad pillow or lack of sleep, things that we do. How do we know the difference?

Dr. Marwah Shahid: Absolutely. So, I know it's really hard to distinguish between some of those pains. But my first recommendation to my patients is that if they're having any kind of pain, they know their body better than anyone else. So if it doesn't feel right, that's when you should get checked out. It's way better to be wrong and be nothing at all then to miss something deadly like a heart attack.

The good news is that we have a lot of tests now that can help understand your risk of heart disease. What we generally do for our healthy patients, we determine what their risk factors are. So based on the risk factors I mentioned earlier, both the traditional and emerging risk factors, we develop a type of risk profile for patients. After this, we can do several lab tests, including checking the levels of cholesterol in the body and checking certain hormones and inflammatory markers to help modify that risk. If needed, we can also do further testing, including a test called a heart scan, which is assessing the amount of calcium in the coronary arteries. Based on these risks, we determine what the risk profile for every patient is individually and refer the patient for further testing if needed based on these tests.

Host: So if a woman is feeling like something's not right, we get the occasional chest pain, or we're feeling just a little bit different, those kinds of scans, the heart scan, those would be your first options, correct? When does things like a stress test, a stress echo, when do these kinds of tests come into your picture, Dr. Shahid?

Dr. Marwah Shahid: Definitely. So, we have a lot of different types of stress tests. We can have the patient run out on a treadmill to do a stress test, or we can give them a special medication that stresses their heart. We can also look at the coronary blood flow through special tests. And on the more invasive side, we can actually look at how blood travels through the arteries of the heart with a cath.

I generally recommend these procedures once I've determined one of my patient's risk profiles. And if the risk is high, the patient has symptoms that I'm concerned about, the patient feels like they're not able to do what they generally do in terms of exercise capacity or household chores, that's when we start talking about doing a stress test, either invasively or non-invasively.

Host: And then what? So if you do determine that somebody has some blockages or that they've got plaque buildup, maybe even in their periphery, in their arms and legs, maybe they're getting leg pain and it's more peripheral vascular, what do you do then? I mean, tell us a little bit about interventions. You're starting this program at Henry Mayo Newhall Hospital. What are you going to be doing for women? Is it lifestyle, medication, all of these things together and certainly stress reduction?

Dr. Marwah Shahid: Absolutely, Melanie. It includes everything you just mentioned. It includes a lot of lifestyle modifications from diet to exercise. It also includes medications that can both improve your lipid profile, which means lower your bad cholesterol and also medications if needed to prevent and improve the function of the heart. If needed, we also have the ability to do interventions on patients, which may include putting stents in the coronary arteries, or as you mentioned, if they have peripheral vascular disease, stents in the legs where there's areas of extreme blockages. It's really a holistic approach to taking care of women's cardiovascular disease, and there's no one magic bullet that will treat women, but we can do a lot to prevent disease and then manage it if it does occur.

Host: So, what about lifestyle? Now, we've mentioned obesity, we've mentioned smoking, we've touched on stress. But we're learning more and more, Dr. Shahid, about the lack of sleep, and that's relationship to various heart disease, diabetes, that sort of thing. Can you put all of that together for us as lifestyle, as we look at what we're eating, how we are treating ourselves, how much exercise we're getting, all of it together? Because I imagine your program's going to be very comprehensive and include all of those things.

Dr. Marwah Shahid: Absolutely. So, when we think about eating well and exercising, even myself, I am practicing in cardiology, I don't actually track everything I eat or how often I exercise. So, part of the program will be kind of defining metrics for what we should be doing. Everyone knows to eat well, but what does eating well actually mean?

We generally recommend either a DASH diet or a diet that's high in fish, avoiding alcohol or decreasing its use. We also have specific weight loss recommendations for patients who have elevated blood pressure, which includes decreasing their salt intake. We also work a lot with the Roberta Veloz Henry Mayo Rehab Center for Cardiovascular Disease, especially for the patients who have undergone a heart attack. And when we talk about exercise, we are actually tracking how much you're exercising and how your blood pressure is improving based on your exercise. So, it really is a holistic approach to managing stress, diet, weight loss, avoiding certain medications, et cetera.

Host: Dr. Shahid, I think a lot of women, we used to hear things about taking an aspirin a day or a glass of red wine. And you know, in these days, in this COVID, post-COVID time, we've all had so much stress. Can you speak about some of those things before we wrap up? Like red wine and its link and/or an aspirin a day, are we supposed to be doing that?

Dr. Marwah Shahid: That is a really great question because we have had a lot of new studies in the past five years that have shown that taking a baby aspirin a day, which we kind of were prescribing to everyone two decades ago, is not recommended anymore. If you don't have any risk factors for heart disease, including having a prior heart attack, prior stroke, having peripheral vascular disease, then you don't need an aspirin every day, even if your parents took it.

And then regarding alcohol, we try to decrease alcohol use as much as possible because it does have an effect on your blood pressure. And I know some people use alcohol to help with de-stressing. And as long as it's in moderate quantities, it's okay. But the American Heart Association recommends consuming no more than a moderate amount of alcohol, which is usually one serving of alcohol per day, and try to see if there's other things in your life that could help de-stress you.

Host: Dr. Shahid, this is such great information. So many women, we all really, really need to hear this. If you were to wrap it up for us with your best advice as a cardiologist, and we're talking lifestyle modifications, we are talking stress reduction and quality sleep and eating and exercise and all of these things, it could be almost overwhelming to think of all of them that could go into really keeping and maintaining that healthy heart for life, what would you want to tell us? Please give us your best advice as a summary to women's heart health.

Dr. Marwah Shahid: Melanie, that is a great question. So, I want to first off say trust yourself. You know your body better than anyone else. Don't be afraid to bring up your symptoms with your primary care doctor or cardiologist. Tell them how you feel. And in general, there are so many things that we can do to help prevent, manage and treat heart disease. So, I don't want you to feel discouraged if you feel like your risk is high, because we can help improve that. You can actually reduce your risk of having any kind of coronary event by more than 80% if you don't smoke, having a healthy body weight, consuming a healthy diet that's full of legumes and fresh vegetables and fish, and participating in moderate to vigorous exercise for 30 minutes a day.

Host: That's great advice and there are so many things that we can do. And women, you've heard me say this before, but you have to put your own mask on before you put the mask of your loved one's on. If you do not take care of yourself, if we do not take care of ourselves, we can't take care of the people that we love. We're the caregivers to society, we really are. So, I hope you heard what Dr. Shahid said today, and that you will contact your primary care provider and that you'll share this show with your friends and your family because we're learning from the experts at Henry Mayo Newhall Hospital together, and this is really great life-saving advice.

And you can visit the Roberta G. Veloz Cardiovascular Center at Henry Mayo Newhall Hospital by visiting henrymayo.com/medicalservices/heartandvascular. You can also visit our free health information library at library.henrymayo.com for so much great information you can trust. That concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. Thanks so much for joining us today.