Jamie Lewis (Host): Heart disease is the number one cause of death worldwide for both men and women. But according to the American Heart Association, it claims a higher percentage of women than it does of men. Why is that? Well, today we're speaking with Dr. Katherine Shreyder, a board-certified cardiologist with a special interest in women's heart health at St. Clair Health.

On this episode of Curating Care, Dr. Shreyder shares insights into the unique aspects of women's heart health and who might be at a higher risk for heart disease. This is Curating Care, a podcast from St. Clair Health. I'm Jamie Lewis. Dr. Shreyder, we're so glad you're joining us today.

Dr. Katherine Shreyder: Thanks for inviting, Jamie. I'm really honored to be here today.

Host: Well, will you start a little by sharing your journey in Cardiology? What inspired you to specialize in this field?

Dr. Katherine Shreyder: I went to medical school with the thought of being a heart doctor, and I think that was a really childish thought at that point. But during the training, it appeared that Cardiology was so fascinating, so interesting, and so appealing, that I joined Cardiology training back in 2002. And until now, I'm really excited every single day I'm at work. So, I am very happy with my choice back then.

Host: What do you find most rewarding about this career?

Dr. Katherine Shreyder: I think what is interesting about Cardiology is that it is very meaningful on all stages of a patient's life and anything that a physician does. It's meaningful in the office when you try to talk about risk factors with a patient, and helps to quit smoking or adjust blood pressure medicines. It is meaningful in the hospital when you treat heart failure on the floor. It is of course important to treat patients in the CCU where they are most critically ill. And on all these steps, you make so much impact in a patient's life that, of course, brings a lot of reward to our everyday tasks.

Host: Let's talk a little bit about women's heart health in general. Can you please share some insights into the unique aspects of a woman's heart health that are different from a man's symptoms and lifestyle or risk factors?

Dr. Katherine Shreyder: I think that the most important thing is that we have to know that in females there are some unique risk factors of heart disease that unfortunately are not paid attention to. Of course, for both genders, smoking excessive weight, high blood pressure, diabetes, and high cholesterol are the most important risk factors of artery disease and stroke.

But in women, problems during pregnancy such as gestational diabetes, gestational high blood pressure, preeclampsia or a baby that is born prematurely with a low body mass can significantly increase the chances of getting a cardiovascular problem in the future. Besides, females who underwent treatment for breast cancer are at additional risk. So, there are a lot of patients that are missing efforts in reducing risk factors of cardiovascular disease.

Host: What are some common misconceptions or myths around women's heart health that you often encounter?

Dr. Katherine Shreyder: I think that the most often one and the first one is that it happens more rare compared to men. That's not true. Heart disease happens pretty equally in both genders. In women, it does happen usually a little bit later in life. However, lately, there has been an increase in cardiovascular disease in especially young females. That's the first thing.

And the second, I think the symptoms, the symptoms of heart disease differ greatly between genders. The majority of symptoms in females would be pretty much similar. Chest pain, shortness of breath, palpitations, but it feels that females at times describe their symptoms differently from men and that misleads physicians when they make a differential diagnosis.

Host: It's actually very interesting. You focused on female-specific risk factors across a woman's lifespan, particularly those who have experienced complications during pregnancy, like you mentioned, preeclampsia, gestational diabetes, or preterm labor. Why are these women potentially more at risk for cardiovascular disease?

Dr. Katherine Shreyder: So, this is a good question, but unfortunately I don't have a good answer. At this time, we don't know yet a lot about the specifics of women's cardiovascular problems, and we are yet to investigate a lot in this area. At this time, we only know how to identify these patients who are at more risk than others, and we need to implement risk factor modifications as soon as possible.

Host: Are there specific warning signs or symptoms they should watch for?

Dr. Katherine Shreyder: The symptoms of heart disease in both genders are usually chest pain, shortness of breath, inability to exercise, fatigue, sometimes leg swelling, elevated blood pressure or palpitations.

Host: Are there key preventative strategies you recommend for women following pregnancy to support their heart health?

Dr. Katherine Shreyder: First of all, for all women, it is very important to lose pregnancy weight to control the blood pressure, not only during pregnancy, but the first weeks after pregnancy. It is, of course, important to maintain good Mediterranean style diet and regular exercise.

Host: I'm thinking of the stages of a woman's life. And I'm curious, how do hormonal changes throughout a woman's life like puberty, pregnancy, and menopause, how do those impact her cardiovascular health?

Dr. Katherine Shreyder: Yes. You're right, straight to the point. Of course, hormonal fluctuations do affect basically every system of a female's body and, of course, cardiovascular system. For example, in menstruating females, irregular heartbeats or palpitations are more often in the second phase of the menstrual cycle. The premature menopause or menstrual irregularity like in patients with a polycystic ovarian syndrome significantly increases chances of cardiovascular problems in the future. Those increase the probability of cholesterol and other lipid disorders as well as high glucose, and this way, promote the plaque buildup in the arteries of the heart and brain. Menopause is usually a stage after which females are more prone to get cardiovascular problems. And this is, of course, the time when more often patients develop elevated blood pressure or glucose abnormalities, as well as weight gain.

Host: As for the future of women's cardiology, are there any advancements or research findings in the field that are particularly relevant to women's heart health?

Dr. Katherine Shreyder: Since we now know more about the frequency of cardiovascular problems in females with specific risk factors, researchers are starting to look for early signs of cardiovascular problems in those patients. Like for example, proceeding with CT to analyze the initial plaque buildup is very important in patients who had preeclampsia. Looking for thorough lipid markers in patients with polycystic ovarian syndrome early enough is a second important step. So, I think at this point we're learning more and more every year about these problems and implement these things, you know, in daily practice.

Host: Thanks so much, Dr. Shreyder, for shedding light on this important subject.

Dr. Katherine Shreyder: Thank you, Jamie, for inviting me.

Host: I'm Jamie Lewis, and this has been an episode of Curating Care from St. Clair Health. If you're interested in learning more about women's heart health, schedule an appointment with Dr. Shreyder by calling 412-942-7900.