Maggie McKay (Host): If you're a woman and you notice something unusual going on with your heart, don't ignore it. Rather, listen to your heart. Today, Chief of Cardiology, Dr. Irfan Admani, will tell us what women need to know for cardiac health. Welcome to Wellness Waves, a podcast from Bergen New Bridge Medical Center. I'm Maggie McKay.

Dr. Admani, it's so great to have you here. Would you please introduce yourself?

Irfan Admani, MD: Hi, my name is Dr. Irfan Admani. I'm the Chief of Cardiology at Bergen New Bridge Medical Center. It's a pleasure to join you and join Maggie in this discussion.

Host: So, why is there often delayed recognition or diagnosis of cardiac issues when it comes to women?

Irfan Admani, MD: This has been a issue with women for a while now. Women's presentation has been somewhat atypical. Diagnosis of coronary artery disease and other manifestations of heart disease have been challenging for women, but I think we have made some progress over the past few years and we have come to realize that women were underdiagnosed when it comes to heart disease and other structural issues of the heart. So we are more aware of it and we do make an effort to be a little bit aggressive in the diagnosis and treatment of heart disease in women.

Host: And, Dr. Admani, why do women often experience delays in treatment for cardiac events like a heart attack?

Irfan Admani, MD: So once again, it goes back to their presentation. Men tendencies to typically present in typical fashion. They have the chest pains, the jaw pains, the left arm pain, the shoulder pain. So men do have a typical presentation and makes it much more easier to make the diagnosis of heart disease in men as opposed to women.

Women do not have typical symptoms, generally speaking. Their symptoms are more atypical, so symptoms such as fatigue, shortness of breath, just tiredness, unable to do daily household activities, and just a lack of energy or fatigue and lack of tolerance to exercise makes us think about heart disease in women.

Host: Doctor, I rarely take naps, but when I'm that tired to take one, I think, uh oh, is this the beginning of a heart attack? I mean, I know that sounds dramatic, but you often hear of someone saying, oh, I don't feel well. I'm just going to lay down. And then before you know it. So, how do race, ethnicity, and other social factors impact heart health disparities for women?

Irfan Admani, MD: The race and social, ethnical differences also are playing an important role now. We have had landmark studies telling us that people of the Latino descent, Southeast Asian Americans, tendencies to have heart disease at a higher incidence is higher as opposed to the other populations that we deal with.

 This also has been recognized now that some of the different ethnic backgrounds predispose you to increased risk of heart disease. We are being aware of that and being much more aggressive when it comes to women. We're looking to diagnose heart disease early in women. We're educating women to present to your doctor at an earlier stage as opposed to at a later stage. And prevention has always been better than cure. So early diagnosis or early presentation to your cardiologist, all these factors help us make the diagnosis early.

Host: And what signs or symptoms should women be looking out for, should we be aware of and share with our provider?

Irfan Admani, MD: Yes, I mean, for women, menopause is a time where things begin to change metabolically. Since the symptoms are atypical in women, we are advising women, if you are feeling tired, if you are feeling shortness of breath, if you are feeling palpitations, nausea, vomiting, some sort of anything that is not yourself. You're not feeling yourself while you're in your mid forties or late forties, especially if you have risk factors such as hypertension, diabetes, cholesterol, as well as smoking, and family history, then these women should really seek medical attention or cardiac attention at a much earlier stage than traditionally they would.

Host: That was my next question, risk factors for cardiac issues and disease. Any others you want to add to that list?

Irfan Admani, MD: In addition to hypertension, which is a big one, diabetes is, the incidence of diabetes is increasing, so diabetes is a big risk factor for us. Diabetes is as risk factor is the most important one. It is as good as having had a heart attack if you have diabetes. So these patients are treated much more aggressively, much more, we are much more proactive in them.

 Cholesterol issues, your lipids need to be checked once you are in your mid 40s, because that gives us an idea as to what your cholesterol profile is. Activity level, are you leading a sedentary lifestyle as opposed to an active lifestyle? So that also helps. Smoking is definitely has been a risk factor.

And the other issue that we are beginning to realize is that, obesity has become also a major risk factor here. When it comes to obesity, we are beginning to realize that the BMIs do have some limitations. So we're looking at more of a distribution of your excess weight as opposed to BMI itself.

The other risk factors that have been important over the last few, years have been, sleep apnea is a risk factor for heart disease, which we have kind of not really taken it seriously, so that's important to know. Stress has always been a risk factor when it comes to heart disease or even other disease processes.

Unfortunately, there's no real way to measure stress, so we are advocating that if you are in a stressful situation, identify, recognize that the stress is playing an important role and institute therapies such as meditation, yoga to reduce the amount of stress. So, those are the major risk factors that we look for when somebody comes to our office looking to, uh, heart health issues and early diagnosis.

Host: Of all the risk factors, how do genetics factor in? Like, let's say, both my parents had heart attacks. So does that make someone even more at risk?

Irfan Admani, MD: Yes, absolutely does. I mean, if you're genetically predisposed to coronary artery disease or other risk factors associated with coronary artery disease, that increases your risk of heart disease. So those factors are important. Unfortunately, we cannot change the genetic predisposition. But we can address the other risk factors to minimize the effect of genetics on the person as far as heart disease is concerned.

Host: And what can women do to improve their heart health and prevent cardiac disease? Because you mentioned prevention earlier.

Irfan Admani, MD: So prevention is, I think, key. I think we can make a lot more changes, a lot more desired effects to our health by preventing heart disease. So when it comes to prevention, once again, diet is very important. What you eat is what you are. So dietary modifications is very important. Processed sugars are known to be harmful to your metabolism as well as to your heart health.

And other factors that do help you with prevention are exercise, controlling your weight. These days we do have very good medications that have been approved to control your weight or help you lose weight. Reducing the amount of stress in your life by utilizing techniques such as meditation and yoga and exercise.

In addition to that, regular checkups. I think it is under said that men, even though they seek cardiac attention early, women have a tendency to delay their attention to seek a doctor, because I think they feel like it's just a process of getting old is the reason that I'm not active and I'm not doing things that I used to do.

So we do recommend that women seek medical attention early. Do be aware of things that can prevent heart disease, such as a better diet. Getting rid of unhealthy habits such as smoking, alcohol consumption, increasing your activity level. AHA recommends that you stay active for 30 minutes four times a week or 40 minutes three times a week.

We're also now emphasizing that resistance type exercise should be increased as well. So, these are the factors that should be employed if you want to prevent heart disease and somewhat stay healthy from a cardiac standpoint.

Host: I think you just answered it, but what advice do you give your patients for their cardiac health, especially women? What would you say the top three key things are?

Irfan Admani, MD: Yeah, so I, I do recommend that we should be involved more in prevention. So when you are going to see your OBGYN or your GYN doctor for your checkups, which is usually in your mid 40s, you should also see your primary care doctors as well as your cardiologists. I think a good way to start is get an initial assessment done with lipids and make sure you're not an increased risk for diabetes.

Make sure your exercise level is what is recommended and make sure somebody looks through your diet and see that you're not consuming that something could be harmful to your heart as mentioned earlier, such as processed sugar, too much red meat, too many other extra recreational stuff such as cigarette smoking and other types of unhealthy habits.

But as far as risk factors are concerned, I think, one of the things that you should be worrying about is diabetes, your cholesterol, your overall weight and activity level. So those are the things I think you should pay attention to. And be on top of them and be cognizant that these are the things that are going to cause heart disease and be proactive about it.

Host: And it's never too late, right? Let's say somebody ate a lot of sugar in their life, but now they're in their 50s, 60s, starting to pay attention. And if they cut back, will that help or is it too late?

Irfan Admani, MD: it's never too late. Changes can be made at any time during your life. The outcomes are better when the changes are made earlier. Having said that, that doesn't mean at some point you just give up. I think a change made at any time of your life will help you live healthier the rest of your life.

Host: And especially with women, because like we said, the signs are not so obvious. Don't ignore pains or unusual things going on with your breathing, right?

Irfan Admani, MD: Yes, so that's something important too and that's the other reason I advocate exercise. If you're active and if you're doing activity on a regular basis and one fine day, if you feel like you're not able to do what you did the last few weeks, then that should alarm you that something's not right and something's going on.

And that's a good reason to get your heart checked out. So that way also the exercise part comes into help. Other than keeping you healthy, it also is a self check to tell you how your heart's doing, how your overall cardiac health is, and your physical health is. So that's another benefit of exercising.

And that's, if there's one thing that anybody wants to take home message today is, you know, stay active, do exercise, because not only it helps your heart health, it helps your overall health, including your mental health, your physical health, it maintains your musculoskeletal tone, and that combination of all those factors will keep you young and healthy.

Host: I like that. They're all kind of interconnected, right? You can't just do one. You have to sort of do the whole thing so.

Irfan Admani, MD: Yes, this is a holistic approach that we are looking at now. We not only try and look at the heart, we're also looking at how your overall health is. How your overall mental health is because a better mental health will give you a better physical health. So it has become somewhat of a holistic approach when it comes to heart disease as well.

Host: Thank you so much for sharing this invaluable information. Truly, we appreciate it.

Irfan Admani, MD: My pleasure. Thank you so much for having me.

Maggie McKay (Host): Absolutely. Again, that's Dr. Irfan Admani. And if you'd like to learn more, please visit newbridgehealth.org. And if you found this podcast helpful, please share it on your social channels. And check out our entire podcast library for topics of interest to you. Thanks for listening. I'm Maggie McKay. This is Wellness Waves, a podcast from Bergen New Bridge Medical Center.