Maggie McKay (Host): Sometimes when women experience possible signs of a heart attack, like chest pains, it might be ignored as indigestion, etc. But when it comes to women's heart health, it's not always about chest pain. Joining us today to tell us more is Mary Collins, Director of Cardiac Surgery and Cardiac Specialty Services for the Valley Hospital and Nurse Practitioner.

Welcome to Conversations Like No Other, presented by Valley Health System in Ridgewood, New Jersey. Our podcast goes beyond broad everyday health topics to discuss very real and very specific subjects impacting men, women, and children. We think you'll enjoy our fresh take. I'm Maggie McKay. Thanks for listening.

Welcome, Mary. This is such an important topic and one that I think cannot be discussed enough.

Mary Collins, APN-BC, HN-BC: I agree with you there, Maggie, and thank you so much for having me today.

Host: Absolutely. So don't men experience heart attacks and heart disease more than women or is that right?

Mary Collins, APN-BC, HN-BC: That is a common misnomer. Many times we think of cardiovascular disease as a man's disease. However, cardiovascular disease affects women in a higher percentage than it does men. So it really truly is the number one health concern of women, and we are trying to get that message out so that women can advocate and take care of themselves.

Host: And what effect does smoking have in relation to heart disease?

Mary Collins, APN-BC, HN-BC: Smoking is not good. The different chemicals that are in the different cigarettes cause direct toxins to the interior lining of the coronary vessels. And that can contribute to inflammation and contribute to plaque buildup. So, many times people will think that smoking just affects your lungs, and it certainly does, but it is one of the highest risks that or person will face in terms of cardiovascular disease if they are smoking.

Host: And with family history, I know my mom and dad both had heart attacks. Is, I know, is it just if there's a family history with your mom or your aunt or should you also be worried if your dad had heart disease?

Mary Collins, APN-BC, HN-BC: Yeah, great question. Actually, we look at what we call the first degree relatives. So that's your mother, your father, your sister, your brother. And then we take a look at your aunts and grandparents and uncles also, just to get a full scope of an understanding of your family history. And what we particularly look at is the age that your mother or father had heart disease.

So if your dad had a heart attack before the age of 55 and your mom before the age of 65, we consider that premature coronary artery disease. And those are the people that may carry a genetic predisposition and may be at higher risk of developing cardiovascular disease in the future. So it is the first degree relative, and it is also very important to know the age at which that first degree relative sustained any kind of cardiac issues.

Host: That's interesting, I never heard that age played a factor. That's good to know. Mary, if someone had diabetes or high blood pressure while they were pregnant, are they at an increased risk of heart disease?

Mary Collins, APN-BC, HN-BC: Maggie, that is such an important question. So we find that women, research does tell us that if you developed diabetes during your pregnancy, you are at a higher risk of developing diabetes a little bit later in life. And diabetes certainly is one of the risk factors for having heart disease. And if you've developed hypertension, had any form of pregnancy induced hypertension, preeclampsia, eclampsia, you are at a higher risk of developing hypertension and cardiovascular disease later in life.

So therefore, with that population of women, we want to monitor them starting at an early age. It doesn't mean that they're definitely going to develop heart disease, but we want to monitor that group and teach them about heart healthy lifestyle and things to report, so that they do not go on to develop cardiovascular disease.

Years and years ago, it used to be thought that once you deliver the baby, if you developed the gestational form of diabetes or hypertension, you were fine. But we know now that that is not the case. And with this group of women, we try to be a little bit more aggressive with modifying their risk factors and just following them a little more closely.

Host: What are considered atypical heart attack symptoms or symptoms seen more in women?

Mary Collins, APN-BC, HN-BC: Although women will experience chest pain as men do, they are more likely to experience some subtle forms of discomfort. Some of the symptoms that women experience more often than men are shortness of breath. In fact, the American Heart Association really recently released a paper showing that that shortness of breath was one of the most common symptoms that a woman experienced prior to having her heart attack.

So shortness of breath, nausea, pain in the shoulder, pain in the jaw, things like that, lightheadedness, dizziness, sweating, all of those things we want women to be very cognizant of. We like them to know what their risk factors are, so should they have that kind of symptom, they can advocate for themselves and try to get help early on.

Host: Sometimes I've had shortness of breath for no good reason. And I thought, oh, it's a precursor to a heart attack. And then I think back to Rosie O'Donnell, remember when she had her heart attack and she went on a big bandwagon campaign to let women know what the symptoms are. And I thought, yeah, that's, really a good thing to do, but how do you know the difference?

Mary Collins, APN-BC, HN-BC: The way we like to address it is we like for women to come in and understand what their risks are. So if they are at high risk, if they have hypertension, smoking, their cholesterol level is high, they've had issues during their pregnancy. So understanding what your risk is so that if you do have an unusual symptom, you decide to get that checked out a little bit earlier. So shortness of breath, if that were to come on suddenly to you pick up the phone, call your physician. If you are having real discomfort or chest pain, go to the ER. Call 9 1 1. Go to the ER. Get checked out. Often women sometimes feel embarrassed. Oh, I don't want to bother anybody, you know, if this isn't really something terrible. But you know what? If we're nurses and physicians in the ER and you come in and we can tell you that wasn't a heart attack or anything to do, it makes us happy.

So, you need to come in. You need to advocate for yourself and get checked out.

Host: Mary, how does mental health affect a woman's risk for heart disease?

Mary Collins, APN-BC, HN-BC: That's a great question. There's a lot of research regarding mental health, certainly depression. One of the things they talk about with depression is that, many times when people are depressed, they don't get up and do those things that are associated with a heart healthy lifestyle. For instance, eating well, going out and walking, 30 minutes a day, five times a week at least, that they're not sleeping well. So sometimes with depression, the things that come along with it are associated with it more unhealthy heart lifestyle and can lead to cardiovascular disease.

Also anxiety, chronic stress, chronic anxiety. When we are anxious and we are under chronic stress; our body is producing a lot of chemicals, adrenaline, that can increase your heart rate, that vasoconstrict or narrow your heart vessels, and this ultimately can lead to hypertension, which is one of the risk factors for heart disease. And then most recently, is the condition of loneliness and social isolation and how that we're seeing that being associated with heart disease. So, those people that feel that they are without purpose and without a social network are experiencing higher levels of heart disease.

Host: I heard that kind of came to light after the pandemic, right?

Mary Collins, APN-BC, HN-BC: We did see more heart disease during the pandemic. Some of it was that, and then some of it, of course, the COVID virus itself had negative impact with some people on the cardiovascular vessels itself. It also led to hypercoagulability, which, can be detrimental to the blood flow also.

Host: What are the numbers or the guidelines for blood pressure and cholesterol in women?

Mary Collins, APN-BC, HN-BC: They will change a little bit depending on your particular status. Certainly, we want lower numbers in both cholesterol numbers and high blood pressure numbers if you already have heart disease, if you have diabetes, if you've had a heart attack before.

But, in general, 120 over 80 is the gold standard. And when you start getting up into the 130s, we really try to make sure the person takes a look at their salt intake, does appropriate exercise, and does those non pharmacological things that they can do in order to try to keep that blood pressure in check.

Host: Okay, we've got to ask about it because to me it seems like you get a different answer every few years, but is red wine good for you?

Mary Collins, APN-BC, HN-BC: Okay, so a red wine, the great question. So there are some chemicals in red wine such as resveratrol which is one of the polyphenols that can act as an anti inflammatory agent. So, the statement from American College of Cardiology and the American Heart Association is if you don't drink any alcohol or wine, they would suggest that you not start.

However, if you are taking, you know, a glass of wine once in a while, then no more than four ounce glass for women on a daily basis and a little bit more for a man. I believe it might be up to six ounces. The jury is really out. There are some conflicting studies that will say that patients can be benefited by drinking red wine and others that don't because in the alcohol itself that's in the red wine can also have detrimental effects on the heart muscle.

So, that is what they say now. If you don't drink, don't start. You would not start to drink what red wine to say, oh, this is going to be something healthy to to help me. It's bad, right? But if you do very much in moderation and some of those good aspects of the grapes, the resveratrol, can be had in red grapes themselves and even in unsweetened pure grape juice. you can get it that way too.

Host: Yeah. And how do I know if I'm at risk for heart disease? I think you pretty much answered this, but just in a nutshell, what are like the top three risks for heart disease?

Mary Collins, APN-BC, HN-BC: The best way for you to know if you're at risk for heart disease is to make an appointment with our cardiac screening department. You will sit with a nurse practitioner for 45 minutes or so, and she will go over your global risk of having heart disease, including those things that we talk about, that many of the public know; hypertension, diabetes, smoking, inactivity, poor sleep, all of that.

But in addition to that, we'll look at your cancer history, your OBGYN history, your inflammatory disease history, and all of those things that go into your global risk. So, the first thing that I would say to you is make an appointment with our cardiac screening group. It's a free service with a nurse practitioner, and it's just fantastic. So that would be number one. And then you asked me for the top risks that we know. And again, hypertension, smoking, high cholesterol, inactivity; those are the major things that we all know about and they stay true today.

Host: What should younger women say in their twenties and thirties be watchful for?

Mary Collins, APN-BC, HN-BC: So we suggest that at age 20, individuals, women, do get a lipid profile and blood pressure evaluation. And this is the time for them to really adopt that heart healthy lifestyle because these are their childbearing ages. And we want them to be healthy during childbirth and during their pregnancies.

And that is really a very important time for them to learn what a heart healthy lifestyle is and to adopt it and to have at age 20 a lipid profile and also your blood pressure so that you know where you stand and what you need to do to maintain good heart health.

Host: Right. Well, Mary, thank you so much for shedding some light on this important topic, and, what to look for, and we really appreciate your time and sharing your expertise.

Mary Collins, APN-BC, HN-BC: Well, thank you, Maggie. Great questions.

Host: Thank you. That's Mary Collins. For more information about Valley's free heart risk assessment, call 201-447-8125. And for more on today's topic or to be connected with today's guest, please call 201-291-6090 or email valley podcast at valleyhealth.com. If you found this podcast helpful, please share it on your social channels and check out our entire library for topics of interest to you.

I'm Maggie McKay. Thanks for listening to Conversations Like No Other presented by Valley Health System in Ridgewood, New Jersey.