Transcription:

Prakash Chandran: Many women don't associate menopause with heart disease, but factors like a decline in estrogen can be a major contributor. Today we're going to learn about heart disease and the preventative steps you should be aware of as it relates to menopause. Let's talk with Dr. Ghassan Mohsen, a Cardiologist at Ridgecrest Regional Hospital. This is a podcast from Ridgecrest Regional Hospital. I'm Prakash Chandran, so first of all, Dr. Mohsen. Let's just start with the basics here. What exactly is heart disease and what causes it to occur in the first place?

Dr. Mohsen: Heart disease encompasses a wide variety of factors or diseases. Typically most commonly it's arteries known as coronary artery disease, where blockages form and can lead to things such as heart attacks. Similarly, muscle of the heart or the myocardium can be damaged and lead to conditions such as congestive heart failure. We also have valvular heart disease where valves could become damaged or deteriorate and to valvular heart disease. In addition, there is a wide range of rhythm disorders of the heart such as atrial fibrillation. I just want to mention that in terms of the topic today, we also extend to cardiovascular disease, which includes blood vessels involving the brain as well as other parts of the body such as the lower extremities.

Host: Yeah, and just kind of focusing in on that topic, we're talking about heart disease in postmenopausal women and I'm curious as to why they tend to be at higher risk than other people.

Dr. Mohsen: Yes. So as we know, age is definitely a factor and that's one of the major reasons after menopause, the human body obviously continues to function as best as it can, but with the lack of certain factors in the youth which protect us. And as you say, estrogen is likely to be one of them in women that as it declines, a woman's risk goes up. Some of the reasons why include things like high blood pressure and high cholesterol tend to get worse without the protection of estrogen. There's also some evidence that estrogen likely protects the inner lining of the arteries inside the body, providing the flexibility that is associated with healthy arteries.

Host: And just to clarify, Dr. Mohsen, what age group does this affect? I've heard that menopause starts around 50 years old. Is that correct?

Dr. Mohsen: That's correct. So, typically the age group that we're looking at, menopause will be around 50 years old. However, the risk significant goes up in the 65 years and older cohort.

Host: Okay. So if someone is listening to this and they are around 50 years old, is there things that they can do to help prevent the onset of this heart disease, knowing that their estrogen is going to be lowered and diminished when they go through it?

Dr. Mohsen: Absolutely. I think if this can be a time to make some changes, certainly is a great time. Given that 10 year, 15 year period before the risk of heart disease goes up, significantly. Basic lifestyle changes, if you're smoking, you need to quit. That's one of the most important. If you're not exercising, we strongly recommend that you start getting about 45 minutes of moderate aerobic exercise a day. In addition, if you haven't been to the doctor and checked your simple parameters like your blood pressure or your cholesterol, or to see if you have diabetes, that would be an excellent time to do so. And if you find out that you have high blood pressure, I don't think it's something that you can't fix, likely lifestyle changes can do. So if you haven't been eating healthy, this is a time to look at your diet and incorporate healthy lifestyle choices, including a high fiber diet, lots of fruits and vegetables with a healthy fats such as avocados and things such as nuts. And limiting your processes, sugars, and typically unsaturated fats that come from animal products. Fish and poultry would be good choices for healthy fats.

Host: Okay. Yeah, that's good advice. And you know, for the postmenopausal women that are listening, I have heard of hormone replacement therapy. Where, you know, you're basically taking supplements of estrogen or injections of estrogen. Does that help mitigate some risk for this heart disease? Is there anything that postmenopausal women can do to prevent the onset of it?

Dr. Mohsen: Great question. The study that looked at this specific question was a woman's health initiative and it incorporated a large cohort of women and beginning of the age of 50, and it actually was terminated early after there was findings of increased risk, especially women over the age of 65 for heart disease and blood clots. There is some concern that this may have been overestimated, but the take home message seems to be if you're over the age of 65 estrogen and it's progestin, which is it's sister hormone, do not seem to provide much benefit and in fact may cause some harm to a woman. There is a group of women who have early menopause due to things such as ovarian failure and they're in their forties. And in this group of women, hormone replacement therapy seems to be safe and actually protective for these patients. So it is an individual or a case by case look at each individual person to determine the best solution. I would caution to women who are over the age of 65 to approach hormone therapy as a solution to dealing with lowering the risk. It doesn't appear to do so.

Host: Okay. And you know, let's talk about how often women should be tested or checked. You know, I imagine that at starting at the age of 50, they should go in and check their basic parameters as you mentioned. But is that a yearly thing? Is that something they should do every couple of years? Maybe talk little bit about that.

Dr. Mohsen: Oh, great. So one thing I just wanted to mention about the previous question before we moved on. So the question is, if you hit menopause at 50 and is it safe to use the replacement therapy? Well, the evidence shows that it actually won't cause harm. So for about 10 years after you hit menopause, it seems to be relatively safe to use estrogen or progesterone for hormone replacement therapy. But that being said, you should be individual case by case basis and if you have a risk of heart disease already such as a previous heart attack, or you've had blood clots. It is not advised. So I think it's best to meet with your doctor when you're considering this, especially for symptoms relief after the year or so after out of menopause. Now going to your other question here, how often should a woman to be checked? It again depends on the person, on their health.

You know, if you have underlying medical problems such as obesity, if you have diabetes, if you have a strong family history of heart disease, I think it would be imperative to get checked out at least once a year. For those women who are healthier, who, you know, come from a very physically fit background and seem to have good awareness of their health, it may be less. But I think, what the first thing is to recognize is you have to know your body and you're not alone. If you certainly have any concerns, you should talk to friends because they're probably going through something similar like yourself. We here in cardiology, we will give you a baseline. We can help you determine what your lipids look like. And we are very concerned with preventing heart disease because we don't want to deal with problems after the heart attack happened. We would like to help you prevent it.

Host: Yeah, that absolutely makes sense. And you know, I think this is really the first time that I'm certainly hearing about it, you know, and I think women think about what menopause is and some of the things that they might expect, you know, they think about things like hot flashes. I don't think that they think about what might be potential heart disease. So, you know, you see so many women and these different cases, as a cardiologist, I'm curious as if you had one piece of advice to give them as they go into this menopausal stage, what might that be?

Dr. Mohsen: Yes. I think the first most important thing is to address any of your weaknesses. You know, so if you, going into menopause, if you're smoking, that's probably one of the first things you're going to have to do is to quit. If you have diabetes you're going to have to make an even bigger effort to get your blood sugars under control. So I think to take a look at your overall health and find the areas where you're struggling and then try to make daily efforts to improve on these areas, will go a long ways to protecting you throughout your great years, which they should be after you've now retired and you have this time on your hands, you have time to exercise. I think that is the most important thing. And as a physician, I'm glad to help you do that. And I think meeting with the team, coaches, life coaches, of doctors, of family members of community will help you kind of getting that right track.

Host: All right. Dr. Mohsen really appreciate your time today. Does Dr. Ghassan Mohsen a cardiologist at Ridgecrest Regional Hospital. Thanks for checking out this episode of Ridgecrest Regional Hospital Podcast, head to rrh.org/podcasts for more information. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks, and we'll talk next time.