Selected Podcast
Women's Heart Health: What You Need to Know
Heart disease is the leading cause of death for women. Dr. Nelly Kazzaz, cardiologist, discusses what you need to know about heart health for women.
Featuring:
Nelly Kazzaz, MD
Dr. Nelly Kazzaz received her medical degree from University of Jordan Faculty of Medicine and has been in practice for more than 20 years. Specialty / Subspecialties: Cardiology / Adult Congenital Heart Disease, General Cardiology, Interventional Cardiology, Nuclear Cardiology. Transcription:
Michael Carrese (Host): Although heart disease is sometime though of as a man’s disease; almost as many women as men die each year of heart disease in the United States. And it’s the leading cause of death in women. We’ll be hearing all about what women need to know about heart health today from Dr. Nelly Kazzaz a Cardiologist with St. Joseph’s Health. Dr. Kazzaz thanks very much for joining us. Do you think most women are aware how much of a risk heart disease is for them?
Nelly Kazzaz, MD (Guest): Thank you for having me. I think you used a magic word, awareness which I always talk in public and in my office and the hospital about. The awareness of the importance of heart disease in women is the key factor. Unfortunately there were a lot of misconceptions and myths surrounding heart disease in women including that it’s a man’s disease or I’m too young or I’m too fit or I’m too healthy to have heart disease.
But heart disease looks like all of us. We can be at any age or any size or shape particularly if we have a predisposition including a family history. While most women live to fear breast cancer, one in three American women will die from cardiovascular related illnesses. And it continues to be the leading cause of death in the United States. There are more women dying from heart disease than all cancers, respiratory diseases and Alzheimer’s combined. But I always say enough of the bad news, the best new is that 80% of heart disease is preventable and there are modifiable factors that we can do to adjust our risk.
The things we can’t change is we will age and as we age; our risk of heart disease will increase. And our family history. We can’t change who our parents are and what we inherit but all the other factors including our blood pressure, our cholesterol, our lifestyle, our weight, our habits including smoking, drinking can all be modified.
Host: So, those are all the main risk factors it sounds like to me that you just ticked off there. Quitting smoking obviously is hugely important. If you have high blood pressure, what’s the way to manage that?
Dr. Kazzaz: So, most important thing that I recommend is to know your numbers. Because a lot of the patients that I talk to would not be able to provide me with what their blood pressure normally is or their cholesterol is so, first of all, knowing your numbers. Second of all, starting risk factor modification with lifestyle including losing weight, lowering your salt intake, increase exercise, lowering the level of stress in life including meditation, or yoga are very helpful in lowering blood pressure. A lot of times, we’re not successful just by modifying the lifestyle then we will consider medications because that’s the only available option for treating hypertension.
Host: I want to touch a second on the exercise piece that you mentioned because I think it’s surprising to people that even just a little bit can make a difference. Sometimes I think people figure well I have to become a runner for it to make an impact but really, just walking several times a week can help, right?
Dr. Kazzaz: Absolutely and I always mention to patients, it’s great that you run, or you carry heavy weights but for your heart health, all that you need is to walk or increase your heart rate thirty minutes preferably up to five times a week. And everything matters including parking your car a couple of spots away. I use the standing desk in my office to be able to stand instead of sit while I’m reading or answering emails and triages. And I try to move my legs at the time and all of these things will count absolutely.
Host: For women who are listening to all these lifestyle changes, like exercise, but also diet and you talked about smoking and some other things who may feel a little bit overwhelmed by it. what do you tell your patients to do in terms of just getting started?
Dr. Kazzaz: Sure. First of all, it’s not about our size or our weight, it’s really about our health. And that should be your goal. And every small change in your lifestyle habits will matter. Any major diet will work but unfortunately, we gain the weight back. So, I always talk to them about minor changes that they can live by. I recommend to lose about a half a pound a week which sounds very easy to do but it will add up to twenty six pounds a year if we make minor changes that we can stick to. I always recommend to follow a healthy lifestyle change meaning making a small change at a time and not major changes that we can’t live by.
I highly recommend Mediterranean diet. I always inform them of the importance of increasing the food that is known to lower our bad cholesterol including olive oil, avocadoes. There were studies made on avocadoes that if they are eaten regularly, they can lower our bad cholesterol up to 13 points which is better than some medications. Also, avoiding excessive red meat, dairy products and obviously fried food.
Host: You’re listening to Dr. Nelly Kazzaz, she’s a Cardiologist with St. Joseph’s Health. We’re talking about women’s heart health today. And let’s talk about symptoms because I think a lot of people probably are aware that obviously chest pain is a big symptom, they hear about arm pain, maybe dizziness. But there are other things to watch out for and the symptoms can be different for women right than men?
Dr. Kazzaz: Absolutely. Although as with men, women’s most common symptom is chest pain or discomfort. But we are more likely than men to experience atypical symptoms. It can be as simple as fatigue which is unexpected or sudden. We can have nausea. We are more likely to have jaw pain caused by heart disease or upper back pain between the shoulder blades. Occasionally I see patients complaining of dizziness particularly with activity. So, the atypical presentation of women will definitely make it harder to first of all seek medical help and then the bias and actual work up and diagnosis which will delay the treatment and most likely that’s what leads to the worse outcome in women with heart disease even if they present with such symptoms.
Host: So, do you mean like some medical professionals might not even pick up on the fact that it could be a heart problem?
Dr. Kazzaz: First of all yes, because of the atypical presentation like if we present to emergency rooms once you say you are having chest pain, the triage nurse will place you on the highest emergency level but if you present with fatigue or nausea, that will create the delay in the treatment and unfortunately, up to 26% of women will die within the first year after they present with a heart attack compared to only 19% of men will die in that first year. And there are a lot of things we are not certain of the reason but definitely the delay in initiation of treatment or getting the help or getting the appropriate management including blood pressure medications, cholesterol medications, aggressive lifestyle modification, referral to cardiac rehabilitation. We tend to see that women are less likely to receive all of that than men.
Host: So, for women listening to this, and they are thinking about the symptoms and how they can be different; would you say that okay you’ve got chest pain, if you have one of those you should call 9-1-1 or what guidance would you give folks about that?
Dr. Kazzaz: Sure, of course 9-1-1 is always an option but that’s in acute cases. All that I tell my patients and my friends, and my community is that let the professional decide. If it is a false alarm you think you are just tired because, let the professional decide and we don’t mind you coming with a symptom that turns out to be a false alarm and your heart is healthy. But at least give us the chance to evaluate you and give you the appropriate advice. The second thing I would say you have to know your numbers. If I don’t know what my blood pressure is, or what my cholesterol is or what my blood sugar is; how do I really know that I’m healthy or am I at higher risk for heart disease than the average person or not.
Host: So, that speaks to getting regular checkups I would think.
Dr. Kazzaz: Absolutely and that’s where is starts with primary care physicians getting at least an annual physical, knowing your baseline numbers and of course whenever you develop any new symptoms, you can start with your primary care physician and then they can refer you to the appropriate subspecialist if needed.
Host: Dr. Kazzaz, you mentioned before that getting older itself is a risk factor. How much should people maybe worry about getting checked more regularly as they get into their 50s or 60s or at what point should you pay more attention do you think?
Dr. Kazzaz: As we get older, we obviously are at higher risk of a lot of diseases and that’s what we concentrate on. People will say I never had hypertension. Unfortunately, hypertension is one of the diseases that will happen as we age because of the hardening of our arteries. So, even if we never had hypertension, our risk of blood pressure increases with age. For women in particular, after menopause, there is a change in our cholesterol levels that happens secondary to the hormonal changes that we can’t control. So, even if we were healthy in our 40s or even early 50s; as we get older, we definitely need more attention to details, more routine follow ups, more preventive care because there are changes that happen to our bodies that we cannot modify but we definitely can modify the outcome.
Host: Very good advice for people listening to this to take heed of. You’ve been listening to Dr. Nelly Kazzaz. She’s a Cardiologist with St. Joseph’s Health. And to learn more about cardiovascular services at St. Joseph’s you can visit www.evrybeatmatterssjh.org. Dr. Kazzaz, thanks very much for joining us.
Dr. Kazzaz: Thank you very much for having me.
Host: This has been St. Joseph’s MedCast from St. Joseph’s Health. I’m Michael Carrese. Thanks for listening.
Michael Carrese (Host): Although heart disease is sometime though of as a man’s disease; almost as many women as men die each year of heart disease in the United States. And it’s the leading cause of death in women. We’ll be hearing all about what women need to know about heart health today from Dr. Nelly Kazzaz a Cardiologist with St. Joseph’s Health. Dr. Kazzaz thanks very much for joining us. Do you think most women are aware how much of a risk heart disease is for them?
Nelly Kazzaz, MD (Guest): Thank you for having me. I think you used a magic word, awareness which I always talk in public and in my office and the hospital about. The awareness of the importance of heart disease in women is the key factor. Unfortunately there were a lot of misconceptions and myths surrounding heart disease in women including that it’s a man’s disease or I’m too young or I’m too fit or I’m too healthy to have heart disease.
But heart disease looks like all of us. We can be at any age or any size or shape particularly if we have a predisposition including a family history. While most women live to fear breast cancer, one in three American women will die from cardiovascular related illnesses. And it continues to be the leading cause of death in the United States. There are more women dying from heart disease than all cancers, respiratory diseases and Alzheimer’s combined. But I always say enough of the bad news, the best new is that 80% of heart disease is preventable and there are modifiable factors that we can do to adjust our risk.
The things we can’t change is we will age and as we age; our risk of heart disease will increase. And our family history. We can’t change who our parents are and what we inherit but all the other factors including our blood pressure, our cholesterol, our lifestyle, our weight, our habits including smoking, drinking can all be modified.
Host: So, those are all the main risk factors it sounds like to me that you just ticked off there. Quitting smoking obviously is hugely important. If you have high blood pressure, what’s the way to manage that?
Dr. Kazzaz: So, most important thing that I recommend is to know your numbers. Because a lot of the patients that I talk to would not be able to provide me with what their blood pressure normally is or their cholesterol is so, first of all, knowing your numbers. Second of all, starting risk factor modification with lifestyle including losing weight, lowering your salt intake, increase exercise, lowering the level of stress in life including meditation, or yoga are very helpful in lowering blood pressure. A lot of times, we’re not successful just by modifying the lifestyle then we will consider medications because that’s the only available option for treating hypertension.
Host: I want to touch a second on the exercise piece that you mentioned because I think it’s surprising to people that even just a little bit can make a difference. Sometimes I think people figure well I have to become a runner for it to make an impact but really, just walking several times a week can help, right?
Dr. Kazzaz: Absolutely and I always mention to patients, it’s great that you run, or you carry heavy weights but for your heart health, all that you need is to walk or increase your heart rate thirty minutes preferably up to five times a week. And everything matters including parking your car a couple of spots away. I use the standing desk in my office to be able to stand instead of sit while I’m reading or answering emails and triages. And I try to move my legs at the time and all of these things will count absolutely.
Host: For women who are listening to all these lifestyle changes, like exercise, but also diet and you talked about smoking and some other things who may feel a little bit overwhelmed by it. what do you tell your patients to do in terms of just getting started?
Dr. Kazzaz: Sure. First of all, it’s not about our size or our weight, it’s really about our health. And that should be your goal. And every small change in your lifestyle habits will matter. Any major diet will work but unfortunately, we gain the weight back. So, I always talk to them about minor changes that they can live by. I recommend to lose about a half a pound a week which sounds very easy to do but it will add up to twenty six pounds a year if we make minor changes that we can stick to. I always recommend to follow a healthy lifestyle change meaning making a small change at a time and not major changes that we can’t live by.
I highly recommend Mediterranean diet. I always inform them of the importance of increasing the food that is known to lower our bad cholesterol including olive oil, avocadoes. There were studies made on avocadoes that if they are eaten regularly, they can lower our bad cholesterol up to 13 points which is better than some medications. Also, avoiding excessive red meat, dairy products and obviously fried food.
Host: You’re listening to Dr. Nelly Kazzaz, she’s a Cardiologist with St. Joseph’s Health. We’re talking about women’s heart health today. And let’s talk about symptoms because I think a lot of people probably are aware that obviously chest pain is a big symptom, they hear about arm pain, maybe dizziness. But there are other things to watch out for and the symptoms can be different for women right than men?
Dr. Kazzaz: Absolutely. Although as with men, women’s most common symptom is chest pain or discomfort. But we are more likely than men to experience atypical symptoms. It can be as simple as fatigue which is unexpected or sudden. We can have nausea. We are more likely to have jaw pain caused by heart disease or upper back pain between the shoulder blades. Occasionally I see patients complaining of dizziness particularly with activity. So, the atypical presentation of women will definitely make it harder to first of all seek medical help and then the bias and actual work up and diagnosis which will delay the treatment and most likely that’s what leads to the worse outcome in women with heart disease even if they present with such symptoms.
Host: So, do you mean like some medical professionals might not even pick up on the fact that it could be a heart problem?
Dr. Kazzaz: First of all yes, because of the atypical presentation like if we present to emergency rooms once you say you are having chest pain, the triage nurse will place you on the highest emergency level but if you present with fatigue or nausea, that will create the delay in the treatment and unfortunately, up to 26% of women will die within the first year after they present with a heart attack compared to only 19% of men will die in that first year. And there are a lot of things we are not certain of the reason but definitely the delay in initiation of treatment or getting the help or getting the appropriate management including blood pressure medications, cholesterol medications, aggressive lifestyle modification, referral to cardiac rehabilitation. We tend to see that women are less likely to receive all of that than men.
Host: So, for women listening to this, and they are thinking about the symptoms and how they can be different; would you say that okay you’ve got chest pain, if you have one of those you should call 9-1-1 or what guidance would you give folks about that?
Dr. Kazzaz: Sure, of course 9-1-1 is always an option but that’s in acute cases. All that I tell my patients and my friends, and my community is that let the professional decide. If it is a false alarm you think you are just tired because, let the professional decide and we don’t mind you coming with a symptom that turns out to be a false alarm and your heart is healthy. But at least give us the chance to evaluate you and give you the appropriate advice. The second thing I would say you have to know your numbers. If I don’t know what my blood pressure is, or what my cholesterol is or what my blood sugar is; how do I really know that I’m healthy or am I at higher risk for heart disease than the average person or not.
Host: So, that speaks to getting regular checkups I would think.
Dr. Kazzaz: Absolutely and that’s where is starts with primary care physicians getting at least an annual physical, knowing your baseline numbers and of course whenever you develop any new symptoms, you can start with your primary care physician and then they can refer you to the appropriate subspecialist if needed.
Host: Dr. Kazzaz, you mentioned before that getting older itself is a risk factor. How much should people maybe worry about getting checked more regularly as they get into their 50s or 60s or at what point should you pay more attention do you think?
Dr. Kazzaz: As we get older, we obviously are at higher risk of a lot of diseases and that’s what we concentrate on. People will say I never had hypertension. Unfortunately, hypertension is one of the diseases that will happen as we age because of the hardening of our arteries. So, even if we never had hypertension, our risk of blood pressure increases with age. For women in particular, after menopause, there is a change in our cholesterol levels that happens secondary to the hormonal changes that we can’t control. So, even if we were healthy in our 40s or even early 50s; as we get older, we definitely need more attention to details, more routine follow ups, more preventive care because there are changes that happen to our bodies that we cannot modify but we definitely can modify the outcome.
Host: Very good advice for people listening to this to take heed of. You’ve been listening to Dr. Nelly Kazzaz. She’s a Cardiologist with St. Joseph’s Health. And to learn more about cardiovascular services at St. Joseph’s you can visit www.evrybeatmatterssjh.org. Dr. Kazzaz, thanks very much for joining us.
Dr. Kazzaz: Thank you very much for having me.
Host: This has been St. Joseph’s MedCast from St. Joseph’s Health. I’m Michael Carrese. Thanks for listening.