Scott Webb (Host): This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Today, we're going to do a little myth-busting about preventative cardiology for women with Dr. Brianna French. She's a cardiovascular disease specialist with Summa Health. Dr. French, nice to have you here today. We're going to talk preventative cardiology for women. And what does that mean? You're going to tell us, of course.

And we're going to do a little myth-busting along the way. And, you know, when I think of preventative cardiology in quotes, like saying that out loud, or when you do, what are the biggest levers that make the most difference for patients?

Dr. Brianna French: You know, the thing that excites me most about cardiology and the reason why I went into the field is prevention. And kind of depending on what study you look at, we think that about 80% of premature heart disease and strokes can actually be prevented by kind of, as you said, pulling some different levers.

People think that prevention is some complicated medical mystery. But honestly, the American Heart Association kind of already gave us the playbook. They talk about their Life's Essential 8, and I talk about that with a lot of my patients, that those are kind of really the things to hone in on.

And that's, you know, eating better, moving more, getting good sleep, avoiding nicotine, maintaining a healthy weight, and really knowing your numbers. So, things like blood pressure, cholesterol, and blood sugar. What's nice about those is none of those things require a prescription from me, so...

Host: Right.

Dr. Brianna French: I, you know, absolutely use medications when needed, but the greatest impact can often come from the choices that you and I make every day before we may need a procedure or a pill.

Host: Right. Yeah. As you say, family history, of course, we can't outrun, but knowing our family history would be good. But behavior, lifestyle, those levers that we can control, like we're in charge here, and we can do things like that. As you say, eat better, exercise more, quit smoking, all of that. And, Doctor, I know there's this, like, persistent myth that heart disease isn't the number one killer of women. What do you want women to understand about their risk and that myth, if you will?

Dr. Brianna French: Yes. Oh my gosh. This is one of the biggest misconceptions, I think, in women's health.

Host: I'm sure.

Dr. Brianna French: Yeah. As you probably know, many women fear breast cancer. And you know, breast cancer awareness is incredibly important, but heart disease remains the number one killer of women. And in fact, it actually claims more women's lives than all forms of cancer combined.

And I think that's the real challenge that, as you were kind of saying, most women don't see themselves as being at risk. They kind of think of heart disease as something that happens to older men. I take care of tons of women in their 30s, 40s, 50s who are dealing with high blood pressure, elevated cholesterol, pregnancy-related complications, have had a heart attack or stroke themselves, or have a really strong family history that increases their future risk. That's not meant to scare people. The good news is kind of as we were just talking, you know, a lot of this is preventable. And I think identifying that we're at risk early and starting to make those changes can have a big impact. You know, sometimes I joke with my patients that, you know, us as women, we spend years scheduling mammograms, OB appointments, coordinating, you know, all the pediatric visits for the kids. But, I guess, my message would be just put your own heart health on that list too.

Host: Yeah. Make some time, know your risk factors, address them as best you can. As you say, prevention. And, Doctor, this is anecdotal at best, but I've spoken with many, many heart experts, if you will, over the years, and some have told me that women tend to have symptoms or warning signs that are atypical, and others say, "No, it's exactly like men." You're the expert on this call today. Like, what are the symptoms and warning signs that maybe women overlook, maybe their doctors overlook? And then, maybe, you know, in light of some of the more severe ones, serious ones, when should women seek urgent care?

Dr. Brianna French: Yeah. So just as you kind of said, Scott, you know, women can have atypical symptoms, but they can also have the classic crushing chest pain like we see in the movies.

Host: Having the big one, right? Like Fred Sanford on The Sanford and Son. You're not probably old enough to remember that, but I am. And maybe some listeners are. The clutching the chest, "I'm having the big one." That can happen too, right?

Dr. Brianna French: Yes. Yes. That can happen to women just as much as it could happen to men. You know, everyone's different. But women are more likely to experience some other symptoms like shortness of breath, nausea, unusual fatigue, maybe more upper back discomfort, jaw pain or, you know, kind of just a general feeling that something is not right.

Host: Yeah.

Dr. Brianna French: You know, in fact, this actually hits really close to home for me. Just this past year, my mom started experiencing shortness of breath, and because she has a history of asthma, she assumed it was her asthma acting up. And I'm not going to lie, even I initially thought, "Oh, yeah."

Host: "Oh, it's your asthma. You're fine."

Dr. Brianna French: Yeah, It's just your asthma. You know, but when her symptoms kind of really persisted and, you know, she really actually advocated for herself to have it looked into further, she ended up having a pretty significant blockage in one of her heart arteries that required a procedure to put into a stent. So, I mean, that really reinforced an important lesson for me that not every heart problem announces itself with that dramatic chest pain.

Host: Yeah. And'm glad you sort of set the record straight. As I said, we're going to do a little myth-busting here. And some people may have the classic signs and symptoms, others may not. If you are having obviously the classic, you know, crushing chest pain, call 911. Get to the ED as quickly as possible, right?

Dr. Brianna French: Yes, yes. And you know, another thing I would say is women, I mean everyone, but I feel like sometimes especially us as women, we're especially good at kind of explaining symptoms away. We'll blame stress, anxiety, menopause, I'm just out of shape, or I'm just busy taking care of everyone else.

But if you feel like you have new symptoms, they're worsening, or specifically if they're occurring with exercise when you're exerting yourself more or causing you to change something you're doing, it's worth getting evaluated. I think all of us doctors would say we'd much rather reassure someone and say everything's fine than have people ignore something serious. And yes, definitely if you're getting that crushing chest pain and you feel like it's the big one, go straight to the ER.

Host: Right. Yeah. And you kind of touched on this a little bit, but, you know, women, because they're often taking care of everybody else and they're not prioritizing their health, because of how busy their and stressful their lives may be, I think some of them, you know, in my experience with women in my life, I think that they're just afraid to cry wolf maybe is the expression. And it's okay, right? You're okay if they cry wolf, right?

Dr. Brianna French: Yeah. Just like I said, I would rather reassure someone that everything is fine and maybe do some basic testing than have people dismiss it. And a lot of times, we do end up finding significant cardiovascular disease.

Host: For sure. So, doctor, if a patient was only going to track just a couple things, right? They just can't be bothered with everything, but let's just say blood pressure, cholesterol, the biggies, the greatest hits, if you will. Like, what should they prioritize and why?

Dr. Brianna French: So, I would say, you know, blood pressure and cholesterol are big ones. I would probably start with those. They're both kind of we think of as silent killers, right? A lot of people can have high blood pressure, high cholesterol, and you're going to feel completely fine. Meanwhile, it's, you know, slowly damaging your heart, brain, kidneys, lots of organs. And, you know, cholesterol is really the big driver of plaque buildup in the heart arteries over time. So, I think knowing those numbers is important.

Another one I would say is weight, not because we would be focused on the specific number on the scale. But, you know, we've been kind of talking about different levers you can pull, and that one kind of often impacts everything else. So when you lose weight in a healthy, sustainable way, you're often seeing improvements in your blood pressure and cholesterol, your sleep quality, your energy, and kind of just overall cardiovascular risk. And then, you know, definitely know your family history. That's another big one. I know that's not something to track, but I think just trying to know it and being aware so you can identify if you're at a little higher risk than someone else.

Host: Yeah. Knowing your family history, mentioning that to your doctor, "Oh, by the way, my grandma had a heart attack when she was in her 50s." Those really relevant things, right? Those are things we not keep to ourselves. Yeah. So, let's talk about the most realistic starter plan, if you will. I hear 150 minutes a week. That one's burned into my mind. But for exercise, nutrition. For busy women who maybe feel overwhelmed, like how can they get started?

Dr. Brianna French: Oh, goodness, yes. I get this question all the time. And I think the biggest mistake I see people trying to make is going from zero to perfect. I fall into that trap myself. You know, I'll convince myself I need some elaborate workout plan that's seven days a week with a perfect schedule. And I don't know about you, Scott. But that is not sustainable for me.

Host: Definitely not, yeah.

Dr. Brianna French: You don't need a, you know, fancy workout plan, all the latest workouts, and a refrigerator full of kale. I tell people, honestly, just start moving. It's finally getting nicer outside. So, go for a walk around your neighborhood, chase your kids around the yard, take a family bike ride, play pickleball. I enjoy golf, garden, walk the dog. It doesn't matter what you do. Do something you enjoy, and just get out there and get moving. I think we underestimate how powerful just simply walking can be. So, you don't have to train for a marathon.

Host: Right. The pickeball thing, you know, is a whole other thing, because I talked to experts at Summa Health, you know, about the types of injuries that they see and, you know, take that slow as well. But as you say, just anything. Get moving, get walking, just do something to get that heart rate up, right?

Dr. Brianna French: Yeah. Yeah. And sometimes I tell people, you know, think about what you enjoyed as a kid. You know, because if you don't enjoy the activity that you're doing, you're not going to be motivated to do it.

Host: Totally. Yeah.

Dr. Brianna French: I kind of tell people to focus on adding instead of restricting. So try to add more vegetables, add more fruit, add more fiber, add more lean protein, those foods that we, you know, think are good for us. And, you know, really just small sustainable changes. You know, I think there's the old adage, the best exercise and nutrition plan are the ones that you're going to actually stick with.

Host: Yeah. And I think the key word there that you said was sustainable, right? After the first of the year, you know, we make our New Year's resolutions, but are they sustainable, right?

Dr. Brianna French: Exactly.

Scott Webb: So, maybe are there some

Host: life stages or factors that may prompt women to pay a little closer attention to their heart health?

Dr. Brianna French: Yeah, absolutely. Pregnancy is actually one of the most important, I guess, you could think of it as cardiovascular stress tests women will take. So, conditions that people get during pregnancy like preeclampsia, gestational hypertension, gestational diabetes, preterm delivery, those don't just affect your pregnancy, they actually provide us important clues about, you know, a woman's future cardiovascular risk.

And what many women don't realize is that cardiovascular disease is actually the leading cause of maternal mortality in the United States. And that's actually a big reason why I'm so passionate about educating women early. You know, as a mom myself, I'm going to get a little choked up, that message hits home. You know, I have a young daughter. And when I look at her, I think, you know, every mom deserves a lifetime with her child. And so much of this is preventable. And it's not just about preventing a heart attack or stroke. You know, I want my patients, my fellow moms, to be able to be there, hopefully, you know, maybe grandchildren one day. So, pregnancy's a big one.

Host: Yeah, for sure. And I'm a parent myself and want to be here as long as I can. And, you know, today, through the lens here, we're talking about women, of course, and overlooked signs and symptoms and letting life get in the way of, you know, putting themselves first at least occasionally. So hopefully, we'll have the desired effect here. I just want to finish up here. When women are thinking about the screenings maybe they should ask for and how best to advocate for themselves, what would be your recommendations?

Dr. Brianna French: Yeah, I have a couple. And then, one other thing I want to hit with that last question though is menopause is another big transition to kind of think about that really can affect women and heart disease. So, we see kind of different changes in cholesterol, blood pressure. It's not that menopause itself causes heart disease, but it can be a time when risk factors become more apparent. So, I think, that's another kind of stage in life where women should really pay attention.

Host: Definitely. Yeah. So then, what about the screenings and how women can advocate for themselves? They're busy, they might feel a little dismissed, whatever it might be. You know, when they come into the office, what should they be asking for maybe and why?

Dr. Brianna French: Yeah. As we've been talking about this whole time. So, know your numbers. So, make sure you know your blood pressure, cholesterol, blood sugar. And if you need your doctor to order, you know, basic laboratory tests to know that information, that's really important. Bring up your family history to your doctor, as you had said. One thing that's getting a lot more attention now is kind of a new cholesterol blood test called Lipoprotein(a), or you may have heard of it as Lp(a).

Host: Yeah

Dr. Brianna French: Yeah, it's actually a genetically inherited cholesterol particle, that very significantly increases someone's cardiovascular risk. Unlike traditional cholesterol, it is very largely determined by genetics. So actually, the American College of Cardiology released new guidelines just this past March that recommend everyone, regardless of age, gender, family history, get screened at least once in their lifetime to know if their lipoprotein(a) is elevated. And it really can inform your doctors how aggressive they need to approach prevention.

Another test is a coronary calcium score. That may be appropriate in the right person. It kind of helps us understand whether cholesterol plaque has already started to develop in the arteries. It's not something everyone needs, but it can be kind of a useful tool. So, it's not one-size-fits-all. Kind of how we talked about your age, pregnancy history, family history. Those factors all play in. And never let yourself feel dismissed. You know, whether you're a man or a woman, you know, if you think that something's not right, ask questions. You know your own body better than anyone else.

So, I know sometimes being your own advocate can be difficult, but I'd much rather have a patient that's engaged in their health. And I think the doctor-patient relationship works best when both parties are highly involved.

Host: Yeah, that's well said. Well, I appreciate your time and your expertise today. I'm not the target audience for this podcast, but I think everyone can benefit from your advice.

Dr. Brianna French: You're not off the hook, Scott. Heart disease is still the number one killer in men too. You just get more of the headlines.

Host: Of course, yeah. We tend to have the classic symptoms, especially on television and in movies. But listen, I really appreciate your time and your expertise today. It's great having you here. Hope that this benefits listeners. I hope that they, you know, speak with their providers, advocate for themselves, have a little better understanding of the signs, symptoms, which questions to ask, all that good stuff. So, thank you so much.

Dr. Brianna French: Yes. No, thank you for having me. It's been awesome.

Host: And for more information, go to summahealth.org/heart. And if you enjoyed this episode of Healthy Vitals, we'd love it if you'd leave us a review. Your review helps others find our educational content. I'm Scott Webb. Thanks for listening, and we'll talk again next time.