Ashlee Williams, MD (Host): Heart disease is the leading cause of death for women, yet many women don't realize they're at risk or don't know when their heart is asking for help. From subtle symptoms to risk factors that show up long before a heart attack, women's heart health is often misunderstood and overlooked.

Welcome to The Healthier You Podcast. I'm Dr. Ashlee Williams. And today, I'm talking with Dr. Sneha Gadi, a board-certified cardiologist here at Kaiser Permanente about what every woman should know about her heart. We'll cover how heart disease can show up differently in women, what warning signs shouldn't be ignored, and simple evidence-based steps that can help protect your heart at any age. Dr. Gadi, thank you so much for being here.

Sneha Gadi, MD: Dr. Williams, it's such a pleasure to be here. I'm super excited and very passionate about this topic, so I'm very happy to be here today.

Host: Yes. We're so excited to have a cardiologist here to talk about this important topic. So, we always like to start with the basics. Why is heart disease often overlooked in women?

Sneha Gadi, MD: So, I think it comes down to the lack of understanding, both from a patient and sometimes the provider on what heart disease can look like in women. So, we often hear that heart disease or heart attacks can present differently in women when compared to men, but we often don't talk about what that means, what patients should be looking out for, and what providers need to ask to be able to get that good history that helps us identify patients that are at risk.

Another key important part of patients health that we often overlook is taking into account gender-specific risk factors that put women at a higher risk of heart disease that we often overlook.

Host: do women really experience heart disease differently than men?

Sneha Gadi, MD: Yes, this is a great question. And thankfully, we're actually doing more research over the past 10, 20 years, understanding the pathophysiology or how plaque and heart disease forms and affects women. Heart disease absolutely looks different in women. It can have different symptoms. So, women are more likely to not necessarily experience that classic chest pressure, chest burning, elephant sitting on the chest symptom. More often than not, women can have breathing difficulties. Women can have nausea, vomiting. People can have fatigue, unexplained fatigue, weakness. Sometimes women can have palpitations, headaches as well as whole body symptoms.

And what I would say is in addition to evaluating these specific symptoms, also ask patients how are these symptoms related to exertion or exercise? So, women can have exertional nausea, exertional vomiting, and that piece is very important to tease out. If you have a patient in front of you and they're complaining of nausea or band-like sensation around the chest and you don't ask, "Is that worse when you move around, when you walk around, when you try to do exercise?", you might miss a really key factor in their story that would heighten your response and make you want to evaluate further for heart disease.

It can also look different in women because we experience worse outcomes with the same level of heart disease burden. So, there's a lot of data out there looking at women that have heart attacks, but normal coronary arteries. Their arteries in their heart can have minimal plaque, even no plaque. And yet, they can still experience heart attacks and all the associated bad outcomes we see in patients with heart attacks. So, we cannot ignore these symptoms And we cannot take it lightly just because they have potentially normal coronary arteries. And we have to investigate further and do the testing and make sure we can fully understand and evaluate these symptom.

Host: I agree. Making sure that we're asking the right questions is so important. And I love that we're doing so much more research in menopause. Can you talk a little bit about how menopause can affect a woman's heart?

Sneha Gadi, MD: Yes. Thank you for asking that question too, and really paying attention to that piece of it. This goes back to these gender-specific risk factors that I think all of us can do a little bit of a better job in asking our patients. So, menopause is a key moment in a woman's life. When we start losing the cardioprotective aspect of estrogen and really instead of menopause, we can even start talking about perimenopause, which often comes to light, even 10 years before actual menopause, and that can be the time to really intervene on patients and their risk factors.

So, estrogen is a very cardioprotective hormone that women have. It helps increase HDL levels. It helps decrease LDL cholesterol levels and helps keep our body mass index, body fat percentage, and as well as kind of our stress response and sleep all balanced. So once we start hitting that perimenopause age, which can be as early as 35, 40 years old in some women, we start seeing a decline in estrogen levels and we start seeing increases in affecting sleep quality, we have a decrease in HDL cholesterol, increase in LDL cholesterol, as well as other cholesterol-like particles that are known to increase cardiovascular risk, and all of these along with increasing central adiposity-- this means fat buildup around the central part of our body, which is highly associated with cardiovascular disease-- loss in muscle and increased insulin resistance. All of these contribute together to increase our cardiovascular risk. But the good thing is that because it takes a long time to develop heart disease, understanding that this is a critical age for women, we can start intervening on all of these risk factors early and hopefully preventing cardiovascular disease, which is the main goal for both of us.

Host: So, we love early intervention and preventative care. What are some important ways that women can start protecting their hearts?

Sneha Gadi, MD: So, this is a really important topic. So, women should absolutely feel empowered to take their heart health into their own hands. Really, key things that we can all do is getting regular movement in. And this includes, of course, cardiovascular exercise, walking, jogging, swimming, but especially women moving towards their perimenopause, menopausal age, absolutely, get in the gym and lift some weights. Get that muscle. The muscle loss that we start to see in menopause, slow that down, even reverse it. It's absolutely possible. And this helps with insulin resistance and the slowing down of metabolism we often face in this age group. On top of this, having a heart-healthy eating pattern, you know, a diet that's low in saturated fats, added sugars, all of these things can help reduce inflammation in our blood vessels and help prevent cardiovascular disease.

Finally, managing stress. Women often report higher amounts of anxiety and depression when compared to men. And this matters for the heart. This can lead to accelerated plaque growth and heart disease. So, figuring out a way to manage your stress, as well as promoting quality sleep. All of this is very important to keep the heart healthy and preventing cardiovascular disease.

Host: So, you talked a little bit about some of the things that women should be looking at, like their blood pressure. Can you expand a little bit on what women should be looking at when they're looking at their overall health picture?

Sneha Gadi, MD: Absolutely. So, blood pressure is a really important risk factor for women, developing cardiovascular disease. In fact, at the same blood pressure, women tend to have higher risk of cardiovascular disease when compared to men. And I would say there should be an overall goal of trying to keep your average blood pressure less than 140 over 80.

So, this is not just one time measurement, but checking your blood pressure maybe once a week or a couple of times a month. You know, not waiting until your office visit, which may be annual, you may not get to see your blood pressure and how it's been doing for a whole year. Checking that at home maybe once a week and making sure it's really staying under that 140 top number and less than 80 bottom number.

If you do have additional risk factors, diabetes, if you already have high blood pressure, if you've ever had a stroke or heart attack, or know that you have heart disease or a strong family history of heart disease. You might even want to discuss with your doctor about getting your blood pressure lower than 130 over 80, which is one of the more strict guidelines, but that's really the goal for some of these higher risk patients, is keeping your average blood pressure less than 130 over 80. This is not a blood pressure after an exercise or heavy meal or after a couple nights of bad sleep, but rather the average blood pressure that you're checking on a routine basis.

Host: Yeah, I think that's a great point. Your blood pressure can fluctuate. So, making sure that you're checking it at the right time when you're in a restful state is great. And thank you so much for all of this great information, Dr. Gadi. We learned a lot about heart health in women and how we can keep this important muscle healthy.

Here are the top takeaways. One, heart disease is a women's health issue. Full stop. Many women underestimate their risk and delay care even though heart disease is common, serious, and often preventable. Two, knowing the symptoms can help save your life. Women often experience subtle symptoms and conditions like microvascular disease along with unique risk factors tied to pregnancy hormones, and autoimmune disease. Three, menopause is a critical turning point for heart health. Hormonal changes during menopause can accelerate heart risk, making this an especially important window for prevention and lifestyle intervention. Four, daily habits and self-advocacy make a powerful difference. Regular movement, heart healthy eating, stress management, quality, sleep, and speaking up about symptoms are some of the most. Effective ways women can protect their hearts. And five, knowing your numbers empowers prevention. Tracking blood pressure, cholesterol, blood sugar, weight, waist circumference, and family history, gives women a clear, more complete picture of their heart risk.

For more information from our experts, visit kp.org/doctor and listen to more episodes of Healthier You wherever you get your podcast. If you enjoyed this episode, be sure to subscribe and share it with others. Have questions or health topics you'd like for us to address in future episodes, let us know in the comments. Thank you. And from all of us at Kaiser Permanente, be well.