Deborah Howell (Host): As women, we know how important it is to take care of ourselves so we can take care of others. But what about taking care of our own hearts? Welcome. I'm Deborah Howell, and today we'll talk about the importance of heart health for women. Our guest is Dr. Nissi Suppogu, Medical Director of the Women's Heart Center at Memorial Care Heart and Vascular institute.

Deborah Howell (Host): Welcome, Dr. Suppogu.

Nissi Suppogu, MD: Thank you, Deborah. Thank you for having me over on this podcast today.

Host: Thrilled to have you. Let's dive right in if we can. First off, why is heart health in women so important?

Nissi Suppogu, MD: Well, heart health is always important, I think, but more so in the last two decades, we have seen that cardiovascular disease is the number one killer in women and it surpasses all the deaths caused by all sorts of cancers or, lung diseases, COPD, and so on. But it's amazing that heart disease is the number one killer amongst women, and in the most recent survey done by the American Heart Association, it shows that only a little over 50 percent of women actually know this truth, that heart disease is still the number one killer among women, and most of them still think that breast cancer is the leading cause.

Host: Sure. So, I'm curious, do men and women show the same symptoms for heart disease, or are they different?

Nissi Suppogu, MD: Very important question and very important for women in the audience to hear this, that men and women definitely show the same symptom of chest pain, yes, but women also show additional symptoms in addition to chest pain, like chest discomfort, like a heaviness, like pressure, dizziness, fatigue, weakness, decrease in exercise capacity.

So when women present with chest pain, they also talk about three other symptoms. And that's when we get lost in recognizing chest pain as a presentation and give them the importance that is needed at that time. Or it's the other way around where women get lost in all the other symptoms and dilute the importance of actually taking care of this cluster of symptoms that come together with chest pain.

Host: Now, why do women tend to have additional risk factors for heart disease?

Nissi Suppogu, MD: Because we are women, we're special. We come with a lot of things.

Host: That is the truth.

Nissi Suppogu, MD: Well, women are special because, you know, we are made special. We have a different hormonal cycle in our lifetime that we go through, like menarche and menopause and whatnot, and pregnancy as well. And over the years, studies are starting to show how these hormones can have a different effect on the outcomes of heart health.

That's why women tend to have additional risk factors which are related to just the hormonal changes, but also now we have enough evidence to show that pregnancy related conditions like preeclampsia, preterm labor, gestational diabetes, also tend to lay a foundation for future development of heart disease in women.

And also, there's other general diseases like inflammatory diseases, rheumatoid arthritis, lupus, which are all inflammatory diseases. And when you look at the population in general, women tend to have these diseases more often than men do. And then when we look at depression or anxiety alone, we see that more women than men tend to be affected by this.

And this itself, like stress, depression, anxiety can themselves have an adverse outcome for heart health outcomes in women. So yes, it is very important to understand that women have additional risk factors apart from the common ones like hypertension, diabetes, obesity, smoking. Apart from these, women tend to have these additional risk factors as well.

Host: Okay, that makes sense. And why do you think it is that women tend to overlook their own heart health?

Nissi Suppogu, MD: Well, I think when we were created, we are created with a lot of duties that we take care of, because I think we're so brilliant in managing multiple things at the same time. We

help run families, we play big roles in our community, whether we are women of career or not, we are handling multiple things at any day and given time.

And I feel like women tend to A, because women are not aware of all these other symptoms that we spoke about, right? If it's just pain or three other things and they think, oh, maybe it's gas or acid reflux or whatnot. Or maybe they do make an appointment but tend to not keep up the appointment because, oh, they have to take their child to the dance class or to do a football game or, oh, they'll move it to the next month because they have something else to do.

So I feel like women don't understand the importance of getting themselves checked. And also they tend to kind of put themselves last, maybe not truly intentionally, but because of how the society is structured that they can't take time out of their busy life of a homemaker or a career woman to go and get themselves checked, to see if they have anything concerning with them.

And also because when they do go, they tend to be disregarded, saying that, oh, it's just stress, you need to take care of yourself, or oh, it's just acid reflux. So I think that's what, just the role that we play in the society hasn't taught us how important it is for us to speak up for ourselves and get helped, and not to wait until it's too late.

Host: Thank you so much for that. It's a message we all need to hear. How does the Women's Heart Center at Memorial Care Heart and Vascular institute help diagnose women with heart issues before a major cardiac incident occurs?

Nissi Suppogu, MD: Yes, because I'm here, first of all, because I'm trained in women's heart health specialization and I'm actually looking for and always talking about it to my colleagues. We know and are very aware of the various symptoms and conditions that are more prominent among women and how women tend to present, and we don't wait for a fifth encounter or a sixth clinic visit to start looking into heart disease.

But knowing that heart disease is the number one killer in women, we definitely look for the traditional testing to rule out obstructive disease. But also women tend to most often present without obstructive disease, without the blockages in their heart vessels, but the smaller blood vessels causing abnormalities and presenting with all the symptoms that they present.

And we have specialized testing to offer to them. When we go looking for the obstructive disease and there's not obstructive disease; in the same testing, we can add additional procedures to find out if they have the smaller blood vessel disease or the microvascular dysfunction. So there's no delay in getting the testing to them and finding out if there's other things wrong with the heart.

Host: So this all starts with just going to your normal doctor and maybe getting a referral.

Nissi Suppogu, MD: We're working really hard at Memorial Care here to create awareness about women's heart health symptoms presentations so that physicians will be able to recognize when a female patient presents with such symptoms and they can refer such patients to me, hopefully, being the women's heart health specialist, so I can cater to the needs of these women and get them on the track to change the trajectory of heart health outcomes in these women.

Host: And Dr. Suppogu, can you tell me how the Women's Heart Center at Memorial Care Heart and Vascular Institute differentiates itself from other programs?

Nissi Suppogu, MD: Well, having a women's heart center in itself is a unique specialization or a specialty that we are providing to our population that we cater to, because not many hospitals have this. And even if they do, some of them don't really have an expert that's trained in women's heart health to take care and address these issues. And even if they do, they don't have the expertise to provide the testing that's available that we have created here to these patients. And they're often referred to other specialized centers.

So I think having the ability to test these patients and provide them with the right care at the right time is what sets us apart at Memorial Care Heart and Vascular Institute.

Host: What a wonderful resource for the community. Is there anything else you'd want to add to our conversation?

Nissi Suppogu, MD: Yes, I want to encourage all women to be aware of their symptoms, to advocate for themselves, and like I always tell my patients, it's like the low pressure situation in an airplane. Unless you put the mask on yourself and you have taken care of yourself, it'll be hard to provide care for everybody else around you. So recognize your symptoms and advocate for yourself and get checked.

Host: Yeah. It goes against everything in our being, but we must do it, right? Well, thank you so much, Dr. Suppogu, for your time and your expertise today. We really enjoyed having you on the podcast.

Nissi Suppogu, MD: Thank you, Deborah. I appreciate this opportunity to share the message.

Host: And for more info or to listen to a podcast of this show, call 562-933-3370 or visit memorialcare.org/womensheart. That's all for this time. I'm Deborah Howell. Have yourself a terrific day.