South Asians represent about a quarter of the world's population but account for over 60 percent of the world's heart disease. The highest rates of diabetes and metabolic syndrome. And yet most women in the community have no idea this could be coming for them.

This week I spoke with Dr. Ambreen Mohamed, a cardiologist with a passion for improving cardiovascular health, particularly in South Asian communities. This is a conversation I have wanted to have for a long time, and it is personal. I lost my mother to a massive heart attack over a year ago, and like so many women in our community, her symptoms did not look like what we are taught to recognize.

We talk about why women's heart attack symptoms are so often dismissed, why the research was built on men for decades, and why what we call atypical is actually just different. We get into the genetics that make South Asians uniquely vulnerable, including lipoprotein A, APOB, insulin resistance, visceral fat distribution, and why someone can look healthy on the outside and have significant cardiovascular risk on the inside. We talk about the cultural pressures that make South Asian women put everyone else first, and how chronic stress compounds an already elevated risk.

We also cover what good prevention actually looks like. What to ask your doctor. What markers to check beyond a standard cholesterol panel. How pregnancy history, PMOS, preeclampsia, and early menopause all factor into cardiovascular risk assessment. And what is coming down the pipeline in cardiology that gives Dr. Mohamed genuine excitement.

This is not a doom and gloom conversation. It is an empowering one. Because knowing your risk is the first step to doing something about it.

South Asians make up about 25 percent of the world's population but account for over 60 percent of global heart disease, with the highest rates of diabetes and metabolic syndrome of any ethnicity.

What you'll learn:

• Women's heart attack symptoms are often dismissed because they can present differently from the classic Hollywood version, including fatigue, jaw pain, back pain, nausea, and indigestion rather than crushing chest pain.
• Microvascular disease, disease of the smaller coronary arteries, is more common in women and diabetics and can be missed entirely on standard imaging.
• The skinny fat phenomenon is real: visceral fat, the fat that wraps around organs deep in the body, increases cardiovascular risk even in people who appear slim.
• Early menopause is an independent risk factor for high blood pressure, and the estrogen drop during perimenopause and menopause accelerates cardiovascular risk.
• Sleep apnea is one of the most underdiagnosed contributors to high blood pressure and should be screened for before jumping to medication.
• The foundation of prevention is not supplements or peptides: it is sleep, movement, diet, stress management, and knowing your numbers.

Connect with Dr. Mohamed:

Website

Instagram

TikTok

I mean, I just like to have conversations. So I like to have conversations around you know, obviously like South Asian heart health is really big. talking about sort of the intersection of like perimenopause and menopause is a real cardiovascular inflection point and how we should like, you know, intervene early. I like to talk a little bit about microvascular disease. You know, this all the stuff that like I learn at at Metopause Society, I'm like

Yeah.

Yeah.

Yeah.

There's a big talk about microvascular disease and how we really need to be on top of that. but just like prevention and like maybe talking about like pregnancy and you know, cardiovascular how well is cardiovascular health and stuff. So I have mainly I think most of my listener I have a combination of like just, you know, potential patient listeners, but I have a lot of like healthcare clinicians that follow me too. So people can get CME, they can get CME from listening to some Yeah. From CME.

Yeah, yeah, yeah.

I love that. Well, hopefully we can give them something good to something good to to learn. And it's not just gonna be you know, well, it should be fun conversation too, because I love I love laughing and joking around. So we'll make it fun.

Mm-hmm. Yes, I

Yeah, awesome. Okay, awesome. hey y'all, it's me, Dr. Smeenerman, Gyno Girl. Welcome back to another episode of Gyno Girl Presents Sex, Drugs, and Hormones. Where I'm here to educate so you can advocate for yourself. Today we're gonna talk to we're gonna talk about something that deserves far, far more attention than I think it receives, especially in the South Asian community. South Asians represent about a quarter of the world population and over 67% of the world's heart disease and have the highest rate of diabetes and metabolic syndrome as well.

Yet, you know, most women don't even recognize that this is a a big concern. You know, we have a lot of attention around different cancers, which we should, but the reality is most people don't even realize that heart disease will kill them first, unfortunately. And so we really need to be aware of these symptoms. So, and and all the things that contribute to them and how we can prevent this. So, today I have the amazing Dr. Ambrine Mohammed. She is a cardiologist with a passion for improving cardiovascular health.

Mm.

in all communities, especially centering South Asian communities and voices. today we're going to discuss genetics, lifestyle, menopause, pregnancy, cultural barriers, and why recognizing risk early can really save lives. So thank you, Umbreen, for joining me today.

You're welcome. Thank you for having me. I'm always excited to do these types of you know, sessions, whether it's a podcast or a lecture, whatever, because I feel like the more awareness that is spread, especially within our community. I mean, obviously whether it's men and men or women, but you know, obviously, especially with South Asian women, I just feel like we don't we tend to look after everybody else and we don't look after ourselves yet.

That it'll be broken.

You know, just like you mentioned in your intro, you know, we're at the highest risk of heart disease, not only just because heart disease is a number one killer, you know, of men and women, not only in the US but worldwide, but also it is probably, you know, our our ethnicity is probably at the highest risk of heart disease out of most other ethnicities. So that's a very scary thing to realize. And you talk to, you know, everybody in the community and most people just

don't have the proper education and it makes me very sad. So I've kind of just really invested myself in trying to do as much education as possible over the past year or so. I hope I'm making an impact. I don't know, but I I love to talk to everyone and anybody. Yeah.

Yeah, that's how I found you. You got in front of my Instagram algorithm. So I I I agree with you. I mean, I'm obviously I'm gonna I'm a board sort of out of Open GYN, but I a lot of menopause like I'm a menopause specialist, so a lot of what I do is really, you know, getting on top of cardiovascular prevention for my patients. And, you know, I have a particular vested in

Yeah.

Yeah.

And you know, spreading the word because you know, I lost my poor mother about a year and a half ago from a massive heart attack that you know we all missed, you know, like as and we could talk about you know the a the atypical signs that are atypical for men but more typical for women. But you know, like just you know, someone that had back back pain for, you know, all day that we just assumed was something else. And you know, even myself and my, you know, family full of doctors, you know, thinking that it wasn't. So anyway.

Sorry to hear that.

Yeah.

I also have, you know, sort of a vested interest in, you know, keeping this awareness alive for, you know, for in her memory as well. So

Yeah. I love to hear that and I'm really sorry about your your mom's loss. But you know, it just makes it that much more important to to talk about and have people be aware. Yeah.

Mm-hmm.

100%. well, let's talk about, I mean, let's go ahead let's go ahead and center the South Asian voice for a minute. And you know, like I re actually I I wrote a book, it's coming out in October called Brown Girls Disease: A Guide to Sexual Health and Empowerment through a South Asian lens. So also my whole book is really about you know sexual dysfunction and all the types of issues that come up for women across the board, but I center sort of South Asian women and all dismissed populations because I think.

Mm.

You know, the term brown girls' disease, as some people might not have known, is we used to be thrown around as a term to describe South Asian women who couldn't tolerate pelvic exams. Like this was a dismissive term that was thrown around in hospitals by medical assistants, by nurses, by doctors, when they would see a South Asian patient with you know what we used to historically always call vaginismous, which is that involuntary design of the public floor.

Mm.

Yeah, yeah, yeah. Yeah.

Which is very common in our community for sure. And it's common in the Muslim population and it's common in South Asians across the board. but I think that like, you know, for me, it was like this dismissive term that I I heard in training and grow, you know, like growing up in OG Wine Land. And it really just shines a light on how we dismiss things that we don't want to understand or we don't want to invest in, or we think that it's the patient's problem, right? Like if we're starting to blame the patient for the issue.

Yeah.

We're not practicing good medicine anymore, right? Like, I mean, obviously we have to take some responsibility, but you can't say that all brown people have this because of their, you know, and just dismiss, right? So anyway, I like to talk about some of this stuff, but you know, when you talk about dismissal, actually, before we talk about why South Asians are particularly at risk, I mean, do you think that this is still the case that, you know, women are less likely to get their first calf? Women are less likely and I think compounding of that would be women of color, but

Yeah.

Yeah. Yeah.

Let's can we talk about some of that? Like why statistically we see less women getting the interventions that we need, the diagnosis that you need.

Yeah. I mean, I I think it kind of I think it kind of starts from, you know, the basics, right? Like I think when you think about how heart attacks have kind of been played out, right? You think about like the big Hollywood type of display of what a heart attack is. Yeah, which is like, you know, and it's the stuff that like we learn in textbooks too, right? Like elephants sitting on your chest.

Yeah. Mm.

Just like porn, right? Like the porn that's what you think that's like, okay, that's what sex is like no.

Literally, literally, literally. This is like, yeah, this is like the the porn version of a heart attack. But it's yeah, but you know, elephant sitting on the chest, you know, crushing chest pain, you know, severely diaphoretic, really sweaty, significantly short of breath, you know, maybe the person vomited, whatever. And it's this big display.

And you know, unfortunately, not everybody is gonna present that way. And I think we've, you know, seen over time that there has been a difference between, and it again, not everybody presents the same way, right? So it also means not every man is gonna present the same way, but it also means not every woman is gonna present the same way. And we actually have seen some differences between how men and women can present. So that's kind of the first thing is that the presentation of symptoms can be

different and you know, whereas in men it might be

We shouldn't call it atypical, like that's what Dr. Jane Morgan, who I had on the podcast, was like we shouldn't label it atypical. We're not looking for it. Yeah. Yeah.

No, no, it's just it, it's just a different type of presentation. So maybe for men, they have more of the classic symptoms. But for women, they can have classic symptoms, but they also can have some different kinds of symptoms. So maybe, you know, over like a period of time, they're starting to feel a lot more fatigued than usual. Maybe instead of the classic chest pain, they're actually having isolated left arm pain, or they're having jaw pain, or they're having neck pain.

Pain, or like you had described, you know, back pain. maybe they are, you know, feeling a ton of indigestion, but it's not necessarily chest pain that they recognize and they feel like maybe it's just due to food intake or something like that. Maybe they're just really nauseous or they're more short of breath, or they can't do the same types of activities that they used to before. And so now think about it when that person then.

goes to, you know, a doctor, a primary care. They go to the emergency room because they're just having these continuous symptoms. but it's not the classic presentation of a heart attack and you can't also categorize them as, you have this or you have that. What do you do with this person, right? And then maybe you even get an EKG and you kind of just see some nonspecific changes and their labs look okay. So then you send them home. And then unfortunately that person

You say society. It's a woman.

Yeah. And then unfortunately that person could end up having an event later on and it would have been something that you missed. So, you know, I see, I see a lot of patients, a lot of female patients, second opinion female patients who, you know, have been around, you know, around kind of the gamut with like going to different people, being dismissed over and over again. And lo and behold, we do some additional testing and we find out that they do have real disease. So

You know, so I just think it's the the atypical presentation. And then I also think like, you know, if you kind of look historically at how heart disease or just in general how different diseases were studied, women weren't always taken into account, right? And so only recently, yeah, exactly. So only until very recently have women started to have more of a presence in research studies, but we just didn't really have that much of a presence before. So if you're, you know, studying.

Yeah. Yeah. Nineteen ninety three, we were yeah.

primarily men and maybe even men within a certain ethnicity. And these are the types of symptoms that you're having. And that's just kind of what you're characterizing as like a generic box of this is how heart disease is supposed to present. And then you have, you know, a female patient that comes in and presents differently, you're not really going to think outside of the box because you really weren't trained to do that.

Right. yeah. So I think, you know, for for a lot of the reasons that I described, I mean, we're just this this is how, you know, people get dismissed. And so I think, you know, I always tell somebody, by the time they come to me, it's not my job to just be like, it's just anxiety. You're coming to me for a reason, right? Like you're coming to me because you feel like something is wrong.

So I'd rather be a little bit more aggressive and a little bit more like, okay, let's just figure out what's going on and find out that there's not anything significant, then God forbid if we miss something and you know, then we're running into real trouble.

No, for sure. And I kind of feel like well, especially if this a lot of this is happening in urgent cares or ERs, like large volumes of patients, like, you know, it's a practice of algorithmic medicine, right? On some level. And so we're not in those algorithms. So we don't get you know so and and truly like, you know, to to practice the most nuanced medicine you need time and you need the structural support that most offices don't have, most hospitals don't have either, or choose not to to use

Yeah, yeah.

Yeah.

Yeah. I also I just want to also add in that like, you know, there's there's a part of it that's being dismissed by the medical society, right? and again, I we don't want to make it seem like this is being done on purpose. A lot of times they just don't know. But also there's a dismissal on the person's own symptoms, right? And so, you know, you might, yeah, you might be a really busy mom at home taking care of three kids and you have a

Yes. Yeah. You can't believe it's your channel. Yeah.

partner who you also have to take care of. And maybe you have elderly parents and maybe you have a business you're running or you're, yeah, or you're, you know, or you're working full time, or maybe you're not working and you're just at home and you have to take care of everything, you know? you a lot of times women are gonna be the people that put themselves last because they have to put everybody else first.

Yeah.

And so again, you hear this a lot where it's like they've been dealing with this stuff for a long time, but only until it got to a point where they couldn't take it anymore, where they actually, you know, pushed in the direction of having to do something about it because they just they just weren't going to be able to prioritize their health either. So that's a huge thing that we see, you know, in general in women.

But more particularly, we see that within the South Asian community, because the South Asian community really does prioritize family and you know elder elders and other people aside from the person themselves. And so it makes it even harder for women to be able to advocate for themselves just because of the type of society and culture that you know they're a part of.

Yeah, for sure. And it feels like sort of like by the time you get to be that menopausal female, you're like the matriarch of the family, which, you know, garners a lot of respect and a lot of like, you know, deference, I think. But at the same respect, it also like you're also the one running the show for every like cousin. should I should I marry this person? What's your opinion on this? Like, you know, and and you're doing all the things, you're taking care of, you know, the the grandparents and the kids and the the the side relatives and so

Yeah.

Yeah.

Yeah.

I I think that's a it is a it is attributable to the community involvement and I think, you know, something that we see far more frequently. And I think probably contributes to the people that do have sort of like this chest pain without, you know, any kind of real coronary features, right? Like isn't that more common? The the microvascular disease tends to be a little bit or

Yeah. Yeah. So microvascular disease is basically disease of the smaller vessels of the coronary arteries, right? So if you kind of think about the coronary artery anatomy, we have four main coronary arteries. So we have one specifically that supplies the right side of the heart called the right coronary artery. And then we have the left main, left interior descending left circumflex that primarily supply the left part of the heart. And then they have some branches that kind of go to the back.

Posterior part of the heart that's either supplied by the right or the left. It's so funny. I like go over so many of these like angiograms that like now I'm just like, no, no how to know how to break it down and very, very simply. But and then you start to have offshoots of those, you know, of those main arteries, right? So then you have smaller and smaller and smaller offshoots. So I I think a lot of people don't know, even within the medical community, that when we do something like an angiogram or a

Yeah. Yeah, that's great.

Coronary CTA and we're actually looking at the coronary arteries, we can't see every single offshoot and branch. We can only see arteries that are usually greater than 1.5, I think it's like millimeters or something. So they have to be of a certain type of width or diameter for us to be able to see them. Because the arteries themselves are actually very hard to see by the naked eye, just in general. So we can't see these like teeny teeny little arteries, but just imagine if you know plaque is able to build up.

you know, proximally in one of the major arteries, plaque can absolutely build up in one of the smaller arteries as well. And what can happen oftentimes is, and we've seen this phenomenon especially in women, we can also see it in diabetics, is we can have something called microvascular disease where they have more plaque in the smaller arteries. And if you can't detect that

On imaging, or it's very hard to detect on imaging. And you know, someone is kind of presenting with these chest pain symptoms, but we can't detect like any type of you know coronary artery disease, you're more than likely gonna be like, okay, well, it's probably not anything significant because we couldn't see anything on the angiogram or your stress test or your coronary CTA or whatever.

And so those people can often be really dismissed unless someone is being very vigilant and thinking like, this might be microvascular disease. So they can still have the same types of presentations where they have the chest pain, they have the trouble breathing, they have the, you know, getting fatigued, you know, they have the whatever jaw pain or left arm pain or nausea or whatever the case might be. but again, you know, these symptoms can more often be dismissed if it's not kind of fitting into that picture of what we normally see.

you know, heart disease fit into.

And so if someone was suspecting that, you know, someone that has a lot of, you know, stress in their life and they're f fitting all the other symptoms, but and they have all the symptoms of of angina but not seeing anything in those vessels, what 'cause I know there's some centers that do the studies, but like what kind of workup would they then receive and and how do they go about getting treatment in that respect?

Well, I mean, I think we would just go down the traditional path like we always would. So, you know, whether that be you feel like the patient needs to get a stress test or whether you feel like a lot of you know, actually more often than not, we're doing more coronary CTAs. It's becoming so much more prevalent that I feel like a lot of us are doing you know, more coronary CTAs and we're actually doing stress tests.

but whatever the patient qualifies for, we would just go down that normal path. Eventually, maybe they would even need to get a cath. Let's say they got a coronary CTA, we saw something, you know, a little bit significant, we send them for a cath, whatever the case might be, you'd go down the traditional path. And if you're still not able to find anything, then you kind of reassess, okay, is this patient truly having symptoms? What kind of symptoms are they having? Then you would kind of start, you can start down the medication path, you know, in addition to like, okay, I suspect like that this person.

maybe has microvascular disease, I'm just gonna t I'm gonna treat it like coronary disease. So maybe I'm going if they're having continued chest pain, maybe I'm going to give them something like a beta blocker or I'm gonna give them a, you know, like a nitroglycerin or imdor, isotore, something to be able to help relax their blood vessels and see if that helps with some of their symptoms. And if that actually helps with some of their symptoms,

that's even more of a clue of okay, maybe this is what's actually going on here. So then I would just treat it, you know, as such. So that means that they're on the aspirin, that means that they're on a high intensity statin. That means that we're targeting their LDL to, you know, at least less than 70. And then again, depending on what their risk factors are, you know, that means that if they have to again be on the beta blocker, you know, the IMDR, nitrochlorin, whatever, you know, they're on that medication. And then we just continue to follow them.

Now, some cases may be a little bit more difficult. So maybe we need to get maybe more extensive imaging or have more, you know, testing, stress testing done. So maybe they need to get referred to a center. I don't think every person does because to be honest, you just have to be a little bit more

vigilant of what's going on. I feel like I've treated a lot of, you know, microvascular disease without, you know, formally diagnosing it, but just knowing that patients improved with certain medications and just making sure that that we're very good and aggressive about their medical management and also making sure that we're following their blood work, specifically their cholesterol and things like that, to make sure that we're at optimal

you know, optimal goal. And again, if you're kind of hit against a wall, hitting like a wall and you're like, I this person's just not getting any better. I think at that time you can always, you know, do like a subspecialty referral and see if there's anything else you can offer them.

Yeah, because there's only I think a few centers that do the specialized sort of testing that but but probably right the endpoint is still the same as treating it capacity. well let's go back to the like South Asian experience. you know, I think there's people that don't recognize that when they, you know, for the listeners of mine who treat patients or maybe for the for the people that are listening that you know have a South Asian person in their life, like that the that

Yeah.

Exactly. Yeah. Exactly. Yeah.

Yeah.

some of the qual some of the things that we look for when we're looking at, you know, sort of our parameters for screening and things like that, our BMI. You know, we have different cutoffs right for when we would want to intervene. before we talk about that, like do you think what what do you think is the c like, have you read have you read Doctor Mobine Said's book, Healing from Our History?

No, I I f actually follow him on social media. I think he's really great and inspirational. I haven't I haven't read his book though. No. Yeah.

it's really good actually. Yeah, I hit him on a podcast too last year. But yeah, he you know, just talking about his own experience and how, you know, the studies that he's done on sort of like the genetic changes that happened over time from, you know, the starvation endured famines and I mean it makes sense if you think about sort of, you know, people that like

nice, yeah.

Yeah.

groups of people that have endured suffering and how like you know and and like really traumatic suffering whether or not it's you know genocide or you know issues around I mean word blank word of right now you know this where people start you know start what is it called starvation like

Ha ha ha ha it's okay. It's okay. Yeah.

Famine? Yeah, it's okay. I was like, I don't I don't know where she's going with this.

Real life brain fog. Real real life brain fog in in the making. Say your par Save your perimetapossal without saying your parametapal. yeah, salmon, yes. And so I think that and then that leads to all the genetic changes. So can we talk a little bit about that and how you see patients that present maybe differently or how how you would treat a patient a little more aggressively or what your cutoffs are in the South Asian population?

It's like I think she's talking about famine and so maybe that

Yeah, I mean, so you know, I think just in general, a lot of people are very unaware as to how high risk South Asian populations could be. So just like you alluded to before, just in terms of numbers, we're almost a quarter of the world's population. So like almost 25% of the world's population is South Asian, and we have multiple countries that kind of encompass South Asia. So it's not just India and Pakistan, we have Bangladesh and Nepal and you know, all of these countries.

Think seven or eight countries that encompass South Asia. And then you're not just having the people that live there, you're also having, you know, other South Asians that have then, you know, migrated to other parts of the world, right? So it's quite a large population. And we might not only, but we are maybe a quarter of the world's population. But in terms of heart disease, we have like over 60% of you know South Asians that have some form of heart disease.

Or could be prone to heart disease. And so those numbers are actually quite, you know, quite staggering. And so then people, you know, think, okay.

And I think Pakistan is number one in diabetes, right? Number one. Yes, we got one.

Yeah. I wouldn't be surprised. Yeah. Yeah. I know. I wouldn't be surprised. But but then you kind of think about like why, right? So, you know, a lot of people, if you start to ask them, well, why do you think South Asians are, you know, at a higher risk of heart disease? And they're start they're gonna start to throw out, you know, different things. And they're not wrong, right? Like, so it's gonna be, the diet is absolutely terrible. Okay, diet goes into lifestyle. That is, you know, that is a part of it. it's because, you know.

Yeah.

most of the people are pre-diabetic or diabetic. Okay, that goes into, you know, a part of it as well. it's because their cholesterol is high. it's actually also because of, you know, the history of, you know, famines over, you know, multiple year span that have eventually, you know, caused changes to our genetic profile that have led us to more being more susceptible to things like diabetes and high cholesterol and visceral fat distribution and all of those things.

And the truth is that there's just multiple, there's multiple factors. So I, yeah, exactly. So I kind of like to put it into two buckets. You have like the genetics part of it, and then you have like the lifestyle part of it. And each of those things contributes. So when you think of genetics, you think of things like, you know, diabetes and pre-diabetes, right? So basically higher levels of insulin resistance. You think about things like abnormal cholesterol profile. So it's not just, you know, getting a traditional

It's probably all of it. Yeah.

Cholesterol profile and looking at someone's LDL and being like, it's a little high, like they might be, you know, more susceptible. No, that that actually is not the case. so a lot of times South Asians can actually have very normal LDL levels or just slightly above normal, and it's not anything significant. It could just be passed off as not a big deal. But then you start to hear their family history, and you know, mom had a heart attack at 50, dad had a heart attack at 45.

You know, uncle had, you know, some type of bypass surgery at, you know, the age of 50. So you start to see that their family history, and then everybody has diabetes on both sides of the family. So you start to see, okay, family history is, you know, a thing. And then you get some advanced lipid markers. So what are those advanced lipid markers? So, you know, one of the things that tend to be more elevated in the South Asian population is something called lipoprotein A or LP little A.

So actually, LP litolae is a genetic marker that basically makes the LDL or your cholesterol stickier. And so if it makes it stickier, you could actually be more predisposed to developing heart disease at earlier ages or at more aggressive, kind of in a in a more aggressive way. So that could increase your risk of heart attack, it could increase your risk of stroke. It could actually, you know, increase your risk of valvular disease, specifically aortic valve disease as well, peripheral arterial disease as well.

And so, but you don't see that in a general cholesterol profile, right? So you would have no idea that this person is susceptible because you you're not looking for it. and then the other thing would be something called APOB or Apolipoprotein B. And so basically it is a surrogate for athrogenic particles. So there's one APOB that's attached to every LDL particle. So the higher the APOB, the more of you know the susceptibility to.

to to potentially developing plaque or heart disease. So that can also be elevated as well. And so again, not in a general cholesterol profile. And what are some other things? You know, again, we are very much more susceptible to insulin resistance or higher levels of insulin resistance. So

We can have higher blood sugars, we can have you know, higher hemoglobin A1Cs, and obviously then it just a greater disposition to diabetes. We can also have visceral.

Poly poly polyendocrine metabolic ovarian syndrome, or formerly learned as PCOS. There's one in four South Asians have PMOS versus one

Yes. Yes, yes, yes, exactly.

Exactly. Yeah. We can have more visceral fat distribution. So that's not just the fat that sits right under the skin. That's the fat that's more deep inside your body that can wrap around your organs and is known to be more metabolically active, which can you know increase again in levels of insulin resistance. It can increase inflammation. and these can all lead to increased you know, risks of heart disease.

And so you hear of the skinny fat phenomenon, you know, thin on the outside, fat on the inside. That's kind of where that comes from. It's more of that like abdominal distribution or mid-abdominal distribution of fat. And so, you know, you may look skinny, but you might have a higher predisposition of having that type of fat distribution, which then increases your risk of heart disease. So those are some of the genetic kind of predispositions. And then you have like the lifestyle bucket. Okay, what's in the lifestyle bucket?

We talked about diet. So, you know, eating a lot more refined carbs, cooking with, you know, heavier oils, eating a lot more sweets. Like that's kind of a very, very rich, you know, South Asian diet. And I've gotten pushback for this, you know, like when I posted a couple of things on, you know, South Asian diet, I got a lot of pushback, you know,

From the community because people are very passionate. You know, our people are very passionate about their food, including me. I love, you know, I love my Rasmalaya and my biryani and my Korma. Yeah, like Nahari and Halva Pur. I love it all, but we can't, we can't think that like eating that kind of food on a daily basis is serving us when we're already genetically predisposed as it is. And so it's important for us to understand that we can have a, you know, a great diet.

Yeah, I love Crunchy.

Full of flavor, but it doesn't always have to be that type of heavy food all the time. And that's very, that's a very hard and sensitive subject to talk about to a lot of people. and so, and then we also have, you know, cultural pressures too, right? So we think about chronic stress. And we kind of alluded to this a little bit before, but like in women specifically, they are the matriarch. They are, you know, kind of the head of the family a lot of times. They're

Yes.

They have a lot on their shoulders, a lot of stress that they're dealing with. And maybe they have, you know, mental health issues that they haven't been able to tap into because they're dealing with everybody else's problems. And so they're putting everybody.

And that's a culture we don't believe in mental health issues.

Which is a whole nother, which is a whole nother subject, but you know, they're putting everybody else's problems, you know, before theirs because they feel they need to. So they're ignoring themselves, you know, completely. And that can actually add to more stress. And what does stress do to the body? We know stress for the body isn't good. It can increase your insulin resistance, it can increase your blood pressure numbers, it can have an impact on your cholesterol, it can increase inflammatory markers. All of these things can actually lead to an increased risk of heart disease.

Over a period of time, you're actually doing damage to your body physically if it's under that much stress. So we just know that, you know, cultural pressure, you know, also has a a lot to do with it too. We also know that, you know, our traditionally, our you know, maybe our parents and aunts and uncles, like we have a very sedentary type of lifestyle, right? We're not we're not this like active, super active community. Maybe things are changing now, and I hope so, and I hope it continues to change for the better, but

Let it

I think in our generation. Yeah.

We know that like people love to sit around, drink their chai, you know, for hours and hours and hours and talk and you know, gup gups up and all of this stuff. But you know, what they don't want to do is they don't want to go to the gym, they don't want to walk outside, they don't want to do, you know, they don't want to ride their bike or go for a jog, they don't want to do more activity. It's just not built into the culture.

Yeah, yeah.

and then also the types of jobs that we have. A lot of them, you know, a lot of people, especially back home, have more, you know, IT related jobs or sitting jobs where they're just sitting for long periods of time. So it's just kind of ingrained to just not do as much movement.

So these are just some of the things that, you know, basically if you kind of take lifestyle plus you take, you know, you take your genetic susceptibility, you put it together, it's kind of a recipe. I don't want to say it's a recipe for disaster, but you're not dealing with good. Yeah. And then on top of that, then you try to educate people and then they just get mad at you that, like, well, you're just basic, well, one, they listen, the amount of like, the amount of like.

It's hard. Mm-hmm.

They don't believe you either. Listen.

Crap that I've gotten like online. I'm like, I'm a I'm a heart, like you don't understand. Like I see this stuff every single day. So you can fight me all you want to, but then I just I see it every day. One. And then two, it's just always like, well, you're just giving us doom and gloom. Like, well, I guess we're just all doomed. And I don't want people to think that, like, you know, just because we have a higher susceptibility, that's the whole point, right? Yes, we have a higher susceptibility. I want to educate you.

Yeah.

Right and

We have to act on it, yeah.

And then I want to empower you so that you can do something about it. Because if you do something about it now, especially even at our age, you know, but even the younger folks, like the twenty year olds and the thirty year olds, you know, like I want them to feel empowered enough so that they can make a change so they don't have an event down the line and they could potentially save their life.

Absolutely. Absolutely. Yeah, I totally agree with you. And this is, you know, sort of on what I talk when I talk to the communities, I say the same. And so and you know, just thinking even like, you know, from my perspective as someone that, you know, deals with hormone health and you know, reproductive health and and how we know, like, you know, even you know, I think that we've changed sort of the the risk assessments for women across the board, but

Yeah.

You know, looking at, you know, how what what's what happened in your pregnancy? Like I'm always asking like, why do you care? So I'm like, I care because this is a risk assessment, right? Like doing a PMOS is a risk assessment, whether or not you had pre-eclampsia in your pregnancy is a risk assessment. It makes it, you know, we would be much more aggressive with these patients. And so can we talk a little bit about the new screening guidelines when it comes to, you know, how we screen for, you know, the prev to to be more aggressive with prevention.

Yeah.

and looking at some of these parameters and and the other thing is we know that South Asian women in general like end up with earlier menopause, right? And they're gonna get that estrogen deprived state earlier on average forty seven, you know, forty six, forty seven

Yeah.

Yeah, so I mean, if we kind of just you know, if we kind of just looked at women in general, you know, we talked or alluded to earlier how, you know, women's symptoms and things like that can be, you know, easily dismissed. And now unfortunately, right, being a woman, we have to deal with all of these things like hormones and pregnancy and you know, all the complications that can come around pregnancy.

And a lot of that stuff, unfortunately, can also, you know, as a byproduct, increase your risk of heart disease. Now, traditionally, actually, women tend to get heart disease a little bit later in life than men because we have a protective hormone, mainly estrogen, that's protecting us from ha developing significant impacts of heart disease earlier on, right? And so around

Our age, the peramenopause era, and then going into menopause, we start to see that shift. So, what do women start to see? They actually start to see changes in their cholesterol, they can see changes in their fat distribution, they can start to see increases in their blood pressure, in addition to the other changes, sometimes increase in inflammatory markers, and increase in insulin resistance. And so this all of these things, and I mean, I've kind of just been touching on this the whole entire time, but

What do all of these things do? They actually can all actually increase your risk of developing heart disease, plaque in the arteries that can develop or increase your risk of heart disease down the line. And so, you know, we're not we I guess maybe before really weren't paying as much attention to women a lot earlier on. I actually think now, I mean, you kind of you touched, yeah, but I mean you touched on it before that like, you know, you're asking women about their

Pregnancy history and not just that, but any complications and all of those things. Now, you know, in my position, we're usually not talking about that stuff. However, if we know that these are all risk factors, like things like preeclampsia, PCOS, or formerly known as PCOS, which is what is it now? PM PMOS? Yeah, PMOS. I gotta get with the the new program too.

Noise. Yeah.

But you know, that is an increased risk factor. you know, when you like how you know, your postpartum history is, you know, that can be a risk factor. you know, did you have a preterm delivery? That could be, you know, a risk factor. did you have gestational diabetes or did you have high blood pressure? That could be a risk factor. So we have to talk about these things because this can then by, you know.

Again, on top of everything else that you're dealing with, this can further increase your risk. And so we need to be able to understand that history. So I think we're kind of pushing for more aggressive screening earlier on. So that again, the whole point is prevention, right? Like just like we said, we want to prevent events from happening later on.

So if we're gonna, if we're gonna do that, then we have to live by that and we have to be able to screen these people early on. So if I have female patients, I'm making sure that they're staying on top of their blood pressure, I'm making sure that they're staying on top of their cholesterol, I'm making sure that they have a family history of heart disease that you know we're we're staying on top of that, that maybe we're getting advanced markers if we need to, that you know, especially before they're pregnant and especially after they've given birth.

We don't just, you know, they're okay, fine. Well, they're done with the pregnancy, no big deal. No, now you have to really watch them closely because sometimes they can develop, you know, things like high blood pressure and diabetes after. And we want to make sure that we're keeping, you know, a close eye on them. And so you really just can't, you just can't let things go. you know, especially the very simple things that are very easy to let go, right? Like blood pressure is something that is very easy to just lose track of. And especially if you're younger.

You're like, I don't, you know, whatever. Like I just had this event. I had a baby. It was a little bit high. No big deal. Like I don't have to, you know, watch over it before. But no, you're actually more susceptible to having higher blood pressure, you know, later on down the line. You're more susceptible to having gestational hypertension again if that occurs again. And so we really just have to make sure that we're on top of making sure that these patients are monitoring, you know, being monitored as much as possible.

Yeah, and I think there was a study I just read this week that they looked at some databases in the UK that that women who had early per menopause had a elevated risk of high blood pressure later on and it was like an independent like early perimenopause was or early menopause was an independent risk factor for high blood pressure. So I mean talk a little bit about you know what you talk to patients about if they have if this is just white coat hypertension or

Yeah.

Like how often would you have them screening and because I think there's more data to suggest that like white cold hyperatention isn't like necessarily just a benign thing either.

Yeah, well, I I this whole white coat hypertension thing I think is so interesting, right? Because a lot of people's blood pressure is naturally gonna go up if they go to the doctor's office, right? They're stressed, they're scared, you know, they maybe they're scared that they're gonna hear bad news. They just had a cup of coffee, they were running late for their appointment, whatever. There's a lot of factors that can go into that. So I say, okay, fine, your blood pressure is a little bit elevated at the office.

Yeah. Yeah.

I'm not going to take that to mean everything because one number is not something that you treat. And I can't tell you how many times I've seen, you know, patients after, and they're yeah, I was diagnosed with hypertension. And I'm like, how? And they were like, my blood pressure was high in the office one. So the doctor started me on X, Y, and Z. And I'm like, we need to get more data. So I'm a very like, I love data. I like to collect data and be able to say, like, okay, what is actually happening in the real world? And the only way

Yeah. Yeah.

For us to be able to do that is for patients to be able to be diligent about checking their blood pressure at home. So I put them on a program. So if you are suspected of having even, you know, mildly elevated blood pressure at one point in the office, let's say, then I'll be like, we're gonna get you a home blood pressure cuff, get it off of Amazon, get it from a local pharmacy, whatever, they're easily available now. And then I'm gonna have you start checking your blood pressure every day. Usually I'll have to have them do it for about like a two to three, two to four week period.

And then I'll do a blood pressure check with them.

I'm having them keep a, you know, in their in the notes app in their diary, I'm sorry, in the the notes app in their phone, or if they can just write it on a piece of paper and then they can either send it into us or we can just discuss it, you know, discuss the log on their next visit. And I want them to do it, you know, first thing in the morning before coffee, before activity, and just log your blood pressure and get used to doing that for a few days at a time because usually the more realistic numbers that we're gonna get are in the comfort of somebody's own home, right? Like again, there's less factors.

That are involved there than it would be in the office where there's other things that are going on that could naturally elevate the blood pressure, but it doesn't necessarily mean this person has hypertension. And so once we've accumulated the data, then we can discuss: okay, what's happening on average, what's happening here? Did you just have one or two isolated numbers? Okay. Or are we kind of naturally seeing a trend where your blood pressure is elevated?

And you don't have a history of it. Now we have to kind of discuss how we're gonna go from there. Is this something where maybe over a couple month period we're just gonna monitor it? And I'm gonna have you, you know, we're gonna get you on an exercise regimen, we're gonna make sure that you're watching your diet, your salt intake, what kind of foods are you taking in? How well are you sleeping at night? You know, all of those things. And then if I feel like despite that, and despite them checking their blood pressure, it's not getting any better, okay. Now we have to start talking about, you know, we gotta the next thing is gonna be medication.

Another important thing to add also is the factors that can also lead to high blood pressure. So, you know, I think obviously medication is great, we all use it, but it doesn't always need to be used as like a first-line thing. You always want to get to the root causes to why something could be happening. And one of the most under, you know, un underdiagnosed conditions that actually actually can lead to high blood pressure is sleep apnea.

Sleep apnea is one of the most underdiagnosed conditions that people have. And usually when I try to screen people for it, you know, one of the first things that they say is, Well, I sleep fine at night. And I'm like, Well, that's fine, but you might you might not be aware that you actually have it. And that actually can be a huge contributor to high blood pressure. and then the other thing is overweight and obesity, right? So somebody's just weight in and of itself can, you know, create higher blood pressure. So oftentimes when patients start to lose weight, or you know, recently we have.

many patients that are on GLP one medications and they're doing great on it, we start to see that their blood pressure comes down. So it's really just kind of addressing, not only treating the numbers in and of themselves, but can we get to the bottom of why this may be happening and can we address that as well?

Okay, great. okay, so you know, obviously I I treat menopause and I use a lot of menopausal hormonal therapy and you're a cardiologist who does a lot of pr you know prevention. So I'm gonna put I'm gonna put a gun to your head and tell you ask because I know you know, we know the guidelines that it's not for primary prevention of heart disease, right? but it you know, prevention for you know it's pro protective for your bone health and prevention of osteoporosis and invasive motor symptoms and you know, genital urinary health, the guidelines. But like, you know.

Yeah.

Yeah.

Yeah.

You're a cardiologist, like tell me, do you think that there is room to say that this could be used for breath?

I mean, I honestly wish that I could give you a different answer, but I just still feel like we don't have enough supportive data to say that we can use it as a primary preventative measure. We just don't, you know. Can we see improvements after patients have been on hormone replacement therapy? Absolutely, we can see improvements in their blood pressure and we can see improvements in their

Mm. Yeah.

You know, in their cholesterol and all of those things, but we can't say that there's not like a direct correlation between this person is on hormone replacement therapy and then f you know, they have had like a reduction in plaque, which is never usually happens anyways, or you know, they had decreased events, you know, down the line. So I think unless we and I know that that is like you're like, don't give me the textbook answer, but like I feel like I kind of have to, because we really just don't have that type of data out there. Does it mean

That I don't think that people can benefit because I think in the right population, when patients really need it, it can just make a world of difference. And I also think that we're seeing that, you know, and you know this a lot better than I do, that hormone replacement therapy for really long time got a really bad rep, right? Just because of much older studies that were done. And I think we're starting to see that that's just not

That's just not as much as the case anymore. Is it the right thing for every single person? No. But that's why we have people like you who are experts in this who can say, like, hey, I think that this is the right thing for you. And as a byproduct, if we can see, you know, decrease in risk factors for heart disease because of it, I think that's fantastic. but yeah, we you you still won't catch any of us saying that, you know, do this and everything is gonna be fine. Your heart's gonna be okay. I wish we could say that.

I know. Yeah. I know. Well the surgery. Well what what are you excited about that's coming down the pipeline in cardiology? Like the new medications or you know, new treatment strategies, you know what are you getting to?

Ha ha

Yeah.

Yeah, I mean, I think that that's such a good question because I feel like cardiology is like one of and obviously I'm biased because I'm a cardiologist, but I feel like there's so much budding research within cardiology, right? That you know, there is so much to get excited about. And I think one of the biggest things is AI. And I know a lot of people have this like love-hate relationship with AI. I think one of the cool aspects is how AI can be involved with imaging. And now we have different imaging use

with AI. Specifically, I'm very familiar with AI use in coronary CTAs and how that's completely changed the game and how we can actually just look at plaque composition and you know, plaque deposition and all of this kind of stuff.

just at a much different level, like a more at a cellular level than we were ever able to look at it with a traditional coronary CTA. So just even with my experience over the past couple of years, like seeing these studies and reading these studies, I am just completely like, wow. I mean, this is, I don't think I ever would have thought about, you know, something like that. And now that I've like seen it practiced so much, I actually recently got a coronary CTA myself. I was lucky enough to do that.

and so I just saw like the application of this type of AI analysis, and I was like totally mind-blown. I think the other, you know, cool thing is like wearables, right? So again, love-hate relationship with wearables, but there's a lot of wearables now that are detecting arrhythmias like AFib, and they're detecting even high blood pressure. And we have some FDA-approved devices like you know, the Apple Watch and other types of devices that can actually detect these things.

How good they are, I think the verdict is still out there. I don't think they're a hundred percent there, but it the technology has gotten a lot better and patients just want more data, right? Just like we want more data, patients want more data too. And I think that type of data that can be useful for us.

is is actually you know gonna be great. So I think it's just these like emerging technologies that is awesome. And then, you know, of course, like the traditional stuff, right? We're still learning a lot about heart failure, especially things like heart failure with preserved ejection fraction and how to treat it. Like before that was like the disease that we were just like, what the hell do we give these people? Blood pressure medicine? Like we don't know what to do with them. And now we actually have really supportive guidelines around things that can actually you know help you know with these patients. So

I just think it's always really exciting. And to be honest, there's so many like sub-specialties and sub-sub specialties that are like coming out too, right? Like before it was just your traditional interventional and electrophysiology and imaging, and that was it, and heart failure. And now it's like cardio oncology and sports cardiology. And maybe one day there'll be South Asian, you know, specific cardiology. Like, who knows? Right. Because it's

Yeah.

I there's two centers in the country, right? Like the we have one in

There's even, I think there's even more. There's a San Francisco. Yeah. I think there's like one in Texas. There might be one in the Boston area. but at any rate, I just feel like, you know, more and more people want to be able to take care, you know, of their heart. And especially in the South Asian community, if we can have more and more of an impact. I hope to be a voice that continues to advocate for our community and I hope to continue to.

more. I there's Bay Area in Chicago.

I'm hoping.

be able to, you know, help, you know, with physicians like yourself so that we can build the support system for a community and really be able to push the word out there to get screened and get treated and get seen and and not be scared, you know, like if if if more community members were able to see people like us who look like them, maybe they wouldn't be as scared to be able to get the help that they need, you know?

Sure. Yeah, no, for sure. I think that's great. Actually, speaking of coronary C D, I actually tried to get one of those studies and look for the CT the coronary C T with the A. And they could I couldn't get my heart rate down enough to like isn't that weird? Like definition they didn't want to give me any metoprolol because they're like, your blood pressure's so low anyway, we're not gonna I mean I didn't ha it wasn't like anything formal, it like, you know

Yeah.

Yeah, yeah.

Mm.

Yeah, yeah, yeah.

The rep had come to my office and was Why don't you try to get one yourself? So I so I was like, Yeah, I'm South Asian. I should totally do this. And then they couldn't like, so then I had talked to a nurse beforehand, and she was like, Okay, you're just gonna take this little bit of metoprolol. And I went and then they couldn't get my heart rate down enough. And I was like, I didn't think I was anxious, you know, and I hadn't had caffeine. So it was just weird because then they gave me like IV metropolol and they were giving me nitro. And I was like, What is going on? And then my

Yeah.

Ambreen Mohamed (48:55.926)

Yeah. Yeah.

My cardiologist brother in law was like, Just stop. What are you doing?

Yeah, no, I I actually had I had the same problem. So I got mine done at a conference. It was our cardio like our national cardiology conference, and it was like the first of its kind where they actually did like a mob mobile cardiac CT. They've never done that before. And I was lucky enough to get it on like the last day of the conference or whatever on Sunday before I was leaving. But I wasn't prepped because I didn't know. I was on a wait list. So I ate that morning.

yeah,

Yeah.

Yeah.

Okay. Yeah. Yeah.

I had caffeine. I didn't prep with metopol. Like I did everything that you were not supposed to do. And I had my true the same thing. Like so I was on the table and they had already given me some Mitoprolol and my heart rate still wasn't coming down. And and they noticed that every less less less than 60. Yeah, for us to be able to get like ideal images, because it's EKG gate and image acquisitions. So if your heart rate is a little bit higher, the image quality isn't going to be as good.

fifty or something like that, fifty and sixty.

Yeah.

So they they noticed that any time that someone was asking me a question and I like started to talk, my heart rate was going up. So they basically were like, we're just not gonna talk to you anymore. We're gonna give you a little bit more mitoprolol, zip it, and then let's see if we're able to do this. And so finally it came down. and then also the other thing was I was terrified of like nitro, right? Because like I know what nitro does. And I and again, same like you, my blood pressure was also lower, and I'm like scared of symptoms and very sensitive. And so I was like,

Yes.

Yeah. Yeah.

I I just the whole time I was like, my God, the nitro and I had built it up so much. And then we did the test. I didn't think I got it. And then at the end I was like, ha ha, you guys didn't give me nitro. You forgot. And they were like, No, we we slipped it in. We slipped it in right before the test. You just didn't even know. And I was like, Really? So it was like

Yeah.

My God. I was so mad. was like, what is going on? I'm not even an anxious person, I don't think, you know.

man. Yeah, sometimes people just need like y you don't realize

They didn't give me the contrast, do you know? At least I didn't get the contrast.

and the contrast was like another thing. Have you ever gotten contrast before?

Yeah. well I have I have when I had over a lot of PE when I was pregnant a long time ago, but yeah.

yeah, that's like the craziest sensation. That was the weirdest. That was the weirdest part of the whole test. Cause that was just like I was not expecting that at all. Yeah, it was crazy. But yeah, it's I think I I wish, you know, we talk about it a lot. I wish more people would be able to get it. it's just not right now, it's just not guideline based for everybody because I have a lot of people that ask for it. so unless you have an indication for it, we can't just like give it to you.

Yeah.

Yeah, yeah.

there are a lot of companies out there, these AI based, you know, AI-based companies, startup companies, and a lot of radiology centers that offer them at cash price, but it's it's not inexpensive. You know what I mean? So, and you don't technically need it, but the more that we're screening people.

Yeah. I mean it doesn't change. I don't know how much it changes like if you're having some you know, doing the things like how

It yeah, the only time it'll like really change is if we actually see something significant, right? Because then at that point I'm gonna be like, okay, you're not having symptoms, but we see this significant thing. We can't not look at it. So then I'll, you know, we'll refer them for cath and yeah. but a lot of times, yeah, it doesn't change management, but it is kind of nice to know if you have something going on. So I don't know, kind of on the fence.

Yeah.

Yeah, yeah.

Yeah. Yeah. And I know. I might try again, but my brother was like, just stop. And he was like, okay.

No, I'm listen, I'm I'm a curious George just like you. Even though I practice this day in and day out, I I wanted to know. And it was being offered to us for free. So I was like, dude, screw it. This is my only chance I'm getting it done. Yeah.

Yeah. I know the the rep was like, We'll give you a discount and da da da da you know 'cause you so much, Umbreen, for being here today. Do you have so I do this thing at the end, like we I'll call it my my husband jokes that the my listeners are vagilantes. So we do like a vagilante verdict, which is like what's your hot take? What's the one thing that you want listeners to to to walk away with in terms of like

Yeah.

Anything prevention or advocacy or whatever.

Please don't skip out on your health. Like take it seriously. Like you take your job, like you take taking care of your kids, like you take taking care of your family, you know, whatever it is, don't skip out on your health because you never want to get to the point where it's too late. And unfortunately, being on the other side of that, where I see patients where they have had catastrophic events.

Yeah.

and then you hear about, well, I never really went to the doctor before, I didn't get this checked until now, or I had no idea. I just wish that people took prevention, you know, more seriously. I'm not saying that it's always easy. I understand a lot of people have barriers and all of those things, but if you really prioritize your health, like you prioritize other things in your life, I I do think that those things make a difference. And simple things too, like you know, don't don't discount like things like getting good sleep.

Mm.

You know, eating well, moving your body, dealing with your stress, like these small things over time compound and actually make a huge difference. You have no idea. Sometimes people want us to like have this like miracle as to like this is, you know, but I'm like, it's all foundational. And if we do find something, yeah, literally okay, that's like another

Do have any medicine, right? Like

Conversation for another day, my thoughts on longevity medicine.

If heart attacks are the number one killer people and you're a cardio like you're a you're a longevityist. Yeah.

Sorry, like you're not like your supplement and your peptides and all of this stuff is not going to save your life. Like we have to be very realistic about this. And I swear I could talk about that. So many thoughts on longevity medicine. But next podcast, yeah, hot takes on longevity medicine. But but honestly, but honestly, it's just prevention. It's it's prevention, taking care of your health.

Next next podcast. We'll have a longevity medicine from a real cardiologist who prevents who prevents heart disease.

Making sure that you, you know are really good at keep good about keeping up with your preventative care, getting screened, you know, once a year, checking your blood pressure, knowing your family history, and then the foundational stuff, making sure you're eating good food, you know, making sure that you're moving your body every day or almost every day and just taking care of your mind, getting good sleep, all of these things are going to make a huge impact and potentially could save your life.

Yeah, a hundred percent. I think the stress is the hardest part for people to really Yeah. Yeah, I know. It's like I can't reduce my stress.

I know. It's hard for us too. Listen, I mean, like, you know, we talk. Yeah, no, it but you yeah, but like, you know, I I'll give you an example. Like for me, like I I work out and it's working out, of course, like there's phys, there's obviously physical benefits, but a lot for me is like mental clarity.

It's great, I know. Yeah, me too.

Two, right? And I, you know, sometimes I'm so stressed out. Like I I'm like, what the hell? And then I like notice, like, wait, I didn't I didn't get my workout in. And then I work out. I have to push myself to go do it. But then it's like the benefits after. I'm like, thank God I did that. I have more energy. I feel better. I have more mental clarity. I don't feel as stressed out about this thing. So I just think, you know, we all kind of have to prioritize the things sometimes that are the hardest to prioritize, but can have the most benefit, you know, for us. Yeah. Yeah.

Yeah.

Yeah. That's probably the only reason I still run, even though I don't think there's like a you know, is just for my brain and my mental sanity.

Yeah, I'm a runner too. I'm actually training for a half, half marathon, later this year. So it's like my first half. So I've I'm like on this like strict schedule and I'm telling you like every day I'm making excuses and then I'm like, no, no.

Yeah. I know. Yeah. Well I I'm a retired marathonic person. I don't do them anymore. Spiny.

No good well at least you did them at one point. That's good, you know? Yeah. Yeah.

No. but it's yeah. that's great. Well, I mean, thank you so much, green for being on the podcast. This has been so informative. I really love when I talk to cardiologists about this stuff because this is again like this is longevity medicine. Like this is how we can really do something. And so as someone that does provide like, you know, midlife care, like this is something that I am trying to stay abreast of because I'm a guy. I'm everyone's like, Why are you doing this? You're a gynecologist. I'm like, No, but I'm like, you know, I I

You're welcome.

It's more intertwined than we think. Yeah. We need to know. Yeah. Yeah. Thank you so much for having me. And I I loved having this conversation and I hope that we can have more to come. This is great.

Yeah. Yeah.

So thank you so much. Yeah, of course.

Yeah, a hundred percent. Well, thanks everyone for listening. Gyneur Girl Presents Sex, Drugs, and Hormones. I'm Dr. Smear Rahman. Guyno Girl, remember I'm here to educate so you could advocate for yourself. Please join me next week.