In today’s episode of What the Health, John discusses the severity of cardiovascular disease with Dr. Harmony Reynolds, a volunteer for the American Heart Association focused on women's issues in cardiovascular health. They discuss the increasing prevalence of heart disease, particularly among women. Dr. Reynolds emphasizes the importance of recognizing the signs and symptoms of heart disease, as early diagnosis can be critical. Furthermore, she highlights common misconceptions about heart disease in women and provides practical advice on maintaining heart health. The conversation covers the increasing risk due to lifestyle factors like poor diet and lack of exercise. Important insights are shared about countering these factors and promoting heart health.

00:30 Introduction to Cardiovascular Disease

01:44 The Growing Threat of Heart Disease in Women

01:46 Interview with Dr. Harmony Reynolds on Women's Cardiovascular Health

02:04 Understanding the Perception of Heart Disease in Women

03:24 The Rising Risk of Cardiovascular Disease

03:43 The Impact of Lifestyle Choices on Heart Health

04:59 The Global Impact of Cardiovascular Disease

06:01 The Disproportionate Rise of Heart Disease in Minority Women

06:15 The Connection Between Pregnancy and Heart Disease

07:50 The Importance of Raising Awareness for Women's Heart Health

10:44 The Role of the Medical Community in Heart Health Awareness

16:06 Understanding Heart Attack Symptoms and Prevention

19:37 The Importance of a Healthy Lifestyle for Heart Health

25:42 Addressing Challenges in Raising Heart Health Awareness

31:36 Health Hacks and Final Thoughts

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Connect with the American Heart Association:

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Perhaps the only good news in this cocktail of concern is that there seems to be a growing awareness that heart disease poses a threat, particularly for men. They are usually seen as the prime target for cardiovascular problems, heart attacks, and deaths. Unfortunately, too many don't realize that heart disease is also the number one killer of women.

What's worse is that the problems for women are rising while the awareness seems to be dwindling. Think about this. Nearly 45 percent of women over 20 are living with heart disease according to the American Heart Association. What are the causes and why aren't we more aware of this threat? Our upcoming guests will lay out some of these answers and help us all understand how we can collectively help stem the cardiovascular threat to women.

Welcome to this part of What the Health. Our interview today is going to be with Dr. Harmony Reynolds a volunteer with the American Heart Association and her work among other things with the Heart Association is focused on women's issues in cardiovascular health. Welcome Dr. Reynolds to the program. Thanks for coming on board.

[00:02:04] John Salak: Cardiovascular health disease is reputed to be one of the leading killers, if not the leading cause of death among men and women. But the perception is often that men suffer from cardiovascular health more than women or that it's much less of a threat to women.

Is that accurate, that perception?

[00:02:38] John Salak: Why is that perception out there? Is it sort of a stereotypical thing, from everything from cartoons in the 40s men under stress, to some other reason?

Now, we've come a long way since then. The American Heart Association is now leading in trying to get this message out to women. But that percepts sometimes these old ideas stick.

[00:03:29] Harmony: It is, and unfortunately, it's growing for men as well. We had seen a long decline in the number of cardiovascular deaths in men and women over maybe 50 years. And in the last three or four, that rate is going up again.

[00:03:48] Harmony: I think that it's a set of cardiovascular risk factors that are again on the rise. I think that the long term trend that was downward had to do with less smoking. Better diet overall, better access to care, a general understanding of risk factors, even if they weren't being controlled as well as I would like.

I think people were starting to get the message, but lately, as you said, we've seen a huge rise in obesity and in the accompanying risk factors related to obesity. Plus pregnancy complications are on the rise and that might be something related to heart disease in women over the long run. For whatever reason, the number of deaths from cardiovascular disease is going up, and that's an emergency in my view.

[00:04:43] Harmony: Thank goodness less people are smoking. Now we're seeing vaping as a problem, and that's something that we need to nip in the bud, especially in the younger population. But thank goodness smoking is on the decline because smoking is the biggest risk factor when it's present.

[00:05:06] Harmony: The worldwide numbers are outpacing even the United States. There's been just an explosion of cardiovascular death worldwide, probably because we're getting towards defeating some of the communicable diseases worldwide. And that leaves us vulnerable to cardiovascular disease. I saw a statistic that there had been 2 million deaths from cardiovascular disease in the world 20 years ago, and now we're at 9 million.

There's more of a shift towards a Western unhealthy diet, towards less exercise, and also, thankfully, we're having less deaths from, let's say, bacterial disease, because antibiotics are more available. But then, as people survive, if they don't have healthy habits, they're vulnerable to heart disease.

[00:06:01] Harmony: Yes, we're seeing a disproportionate rise in women from underrepresented racial minorities like black women and Latina women. And I think that probably parallels a rise in risk factors among these women, especially obesity and hypertension.

[00:06:22] Harmony: We're trying to shine a light on this, that what happens in a pregnancy can reveal a lot about cardiovascular risk. There are adverse pregnancy outcomes, as they're now called, and they range everything from high blood sugar, that gets called gestational diabetes, or maybe doesn't always get a name put on it, but is gestational diabetes, high blood sugar in pregnancy, or high blood pressure in pregnancy.

High blood pressure in pregnancy might be because there was a pre existing high blood pressure problem or a new high blood pressure problem during the pregnancy. If it gets bad towards the end and there are associated findings, let's say, with the kidneys or the blood counts, we call that pre eclampsia.

Even having a small baby is considered an adverse pregnancy outcome or delivering early. And all of these things are associated with a higher risk of cardiovascular disease, not just immediately, But for the woman's entire lifetime. And that risk persists 10, 20 years down the line. Now this is a big problem because women often get lost to care in that time frame after a delivery.

They tend to go to their obstetrician and to think about that aspect of their health, what one of my colleagues, Nanette Wenger, has called bikini medicine. but they don't necessarily check in about general health and certainly not heart health. So we miss an opportunity for prevention there. One of the key messages that we want to get out is that women need preventive care because heart disease is preventable.

It's treatable, but it's also preventable.

Are women more aware of the risk of cardiovascular disease?

But for some reason that messaging has not gotten through in a sustained way. And I'm not sure if that means we need to reach people in new ways, which is why I'm so happy that we are doing this podcast, because I think this is a way to reach a larger demographic. In recent years the American Heart Association does periodic surveys of random women just to see what the understanding is about heart disease, about risk factors, about what you can do.

And in the last 10 years, there's been a huge decline in understanding of heart disease as the leading killer. And sadly, the worst knowledge losses are in the people who are most at risk. Our underrepresented women, black women, Latina women, but also in young women. And that really worries me for the future because we have the ability to do so much for prevention from the early ages. Healthy diet that sticks with us, healthy lifestyle, healthy exercise, and knowing your numbers.

And if people don't recognize heart disease as a threat, then it's a lot harder to think that we're going to do something about it. They also surveyed women about heart attack symptoms, and only about half knew that chest pain is a symptom of heart attack. It's the most common symptom of heart attack, and only about half of women knew that.

Only about half said they would take action and call 911. If they had a symptom, so I'm really worried about the loss of knowledge among our women really the only women who are retaining that knowledge over the last 10 years were white women over 65.

[00:10:28] Harmony: It has. I don't know I'm not sure if people are just getting their information from different sources. I'm not sure what to think about it, it's sort of become if you know you know there's sort of an echo chamber of people who know this and keep saying the same information over and over but we just need new channels, I think.

But there seems to be some connection to doctors not raising awareness for annual checkups with women and saying, Hey, this is something you need to watch, especially given these conditions are your age or something like that.

I'm hearing borderline cholesterol. Maybe this is something we should do when I'm getting second opinions for preventive care. But I'm not hearing what I think we should be hearing, which is your blood pressure is high and we need to treat it. You know, studies show it's not very sexy.

I'm an outpatient cardiologist and, you know, office cardiology is hugely impactful. But sometimes the folks who are in the hospital and dealing with the patients who are at death's door, I think the sort of they've got the corner on the market of reducing the risk of cardiovascular death. But in reality, in the office, if you lower somebody's blood pressure by 10 points, and then you sustain that for 10 years, you save a life.

You save a stroke or a heart attack. And you know, it's sort of set it and forget it. Once you get somebody's blood pressure down with medication, they tend to keep taking it if you educate them properly.

And this sort of, to me, seems to reflect back that there's a mindset there that isn't aware of what the actual threat is out in the community. What do you think of that sort of take? And this was off a study, I forget where it was from.

with a heart attack, the more likely there is to be permanent damage and more permanent damage. So it's really an emergency, obviously, if somebody is having chest pain and might be having heart attack. So I'm also very concerned about that. Fewer women were being seen by specialists, fewer women were being admitted for observation of their chest pain in this large ER study.

similar studies showing that there is a bit of a difference. There's a disparity in care for women. It's definitely important. And that's why when I counsel my patients about coming into the emergency room, I will say, I want you to come in and say, my cardiologist told me that I need to come in. And say, I think I'm having a heart attack because you want to focus the physician on the concern.

Sometimes people are afraid to say something like that because it's scary, the idea. You don't want to make it happen by saying it, but of course that's not real, right? That can't happen. So what can happen is that the doc might not be thinking about it in the right way, might not do all the testing you need, and you might still have that worry because your question hasn't been answered.

It seems like there are two parts to the solution. One is to raise awareness, well, maybe three parts. Raise awareness. The second part is proactive treatment. How do women in particular stay healthy or awareness? And maybe, really, how do we Change the focus of a segment of the medical community.

Is that a sort of the three prongs you see? Are there other prongs or pillars? Correcting or alleviating some of this problem.

I've heard a bunch of horror stories about the people who went to doctors who weren't up to speed and weren't doing exactly what they might need to do. So that's why I tell my women to be very specific in asking questions. It can't hurt and it might help.

But even beyond that, what are the steps, critical steps, we need to do to help women proactively address these challenges?

But the pain might not actually be painful. It might just be a discomfort. I have a patient, a favorite patient of mine said, I thought that the heart attack would be so bad that I wouldn't be able to stand it. And because she could stand it, she thought that wasn't it, and she was late in coming in and suffered some damage.

So, heart attack pain doesn't have to be so bad that you can't stand it. It might just be uncomfortable, and it'll generally be in the chest, but it might be outside the chest. It might be in the jaw, the neck, shoulders, arms. back, upper stomach, or in the chest. It might be all of those places or just a few of them.

It might be accompanied by shortness of breath, nausea, vomiting, sweating, or a sense that something is terribly wrong. It could be only those things, you don't have to have the chest discomfort but in general women will have chest discomfort and often one other symptom as well. And if you're not sure, it's best to come in.

If you've had 10 minutes of a symptom, come on into the emergency room, call 911, because that's how you get the most expedited treatment. People who decide they're going to drive themselves run the risk of hurting somebody on the road if they're having a heart attack. And also they're not going to get the same expedited treatment because People generally take you more seriously if you come in by ambulance.

And whenever I tell people the long list of symptoms that might be a heart attack, they tend to get concerned because almost everybody's had one of those things in the last couple of months. And I'll say, all right, if you have the sausage and pepper hero, which you should not be eating because sausage is a preserved meat that's terrible for you, causes cancer too, but let's just say you cheated and you had a sausage and pepper hero and you've got some terrible heartburn after that.

Well, you know what that is. If you've had it before, the next time you have it, you're not going to suddenly think it's a heart attack just because you know that heartburn can. be heart attack symptom, right? But if you're feeling something that you're not familiar with, or it's in a situation that doesn't seem like what you'd expect, then you need to be calling 911 if that symptom is going on for 10 minutes or more.

How long are these symptoms before you should worry? I mean, you should be alert at all times, but if it's a passing twinge versus, Oh, this is something that's going to be extended for five or 10 minutes, that's when concern should raise.

The blood test that's useful in the emergency department is called troponin. It's a very sensitive marker of heart injury and it needs to be checked generally more than once in order to be sure there's been no injury.

[00:19:59] Harmony: The American Heart Association has a framework called Life's Essential Eight, and I usually use my fingers when counting them because it's, that makes it easier for me to remember. So, smoking. Don't smoke. And if you're a smoker, every single cigarette you choose not to pick up reduces your risk. And this is from a worldwide study.

It's exactly true that six cigarettes is less risky than seven is less risky than eight and one is better and none of course is the goal. So no smoking and no nicotine products at all and try not to inhale any smoke of any kind. Next cholesterol. We want to low blood cholesterol because cholesterol is the main component of plaque that blocks arteries and causes heart attack.

And something that people don't always know is that a plaque of any size can break and cause heart attack. That's what causes heart attack. There can be a plaque. It's, the analogy I like to use is that it's a lot like a raw egg. It's got a thin shell and a bunch of gooey stuff inside. And if the shell breaks, because eggs are fragile, then it, the stuff oozes out and it makes a big mess.

So in this case, the flowing blood will contact the interior of that plaque and a blood clot will form. That's what causes heart attack and stroke. That does not need to be an artery that was badly blocked beforehand. And stress tests are only meant to find 80 85 percent narrowing or more. So you could have a stress test one day and have a quiet plaque that's, let's say, 40 percent narrowing.

And the next day, if that plaque decides to act up, that person could have a heart attack. Stress test is not going to be a good screen name. So, we want to lower cholesterol. And that's a lot that, when we lower cholesterol a lot and when we manage all the risk factors, it winds up being a lot like hard boiling the egg.

It's totally different inside, less fragile, even though it's the same size. How do we lower blood cholesterol? Mostly by lowering saturated fat in the diet. Unsaturated fat is in a lot of different foods. It's in red meats, butter, cheese, desserts, baked goods, fried foods, chips. Let's see, what else am I forgetting?

sausage. I'm probably forgetting a long list of saturated fat foods. Oh, you know what has saturated fat that I've learned is something we've got to watch for is coconut oil. It's an all saturated fat, probably worse than butter in that regard. So I just ask people to read the labels. If you're not sure, read the label on the food.

And if it's high in saturated fat, try and find a replacement. And I've gotten very good at creating swaps for people. If you've been eating this, try to eat that. And there are a lot of things online that will help you with that. So that's cholesterol. Next one, blood sugar. We want to control diabetes if it's present and try and stay away from diabetes.

And that's generally done by cutting back on sugar. It's a huge amount of added sugar in the American diet. We want to try and get rid of that. Next one, blood pressure. A normal blood pressure is 115 over 75. If your blood pressure is over 130 for the top number, the systolic, when the heart beats, or over 85 for the bottom number in between beats, and certainly if it's over 140 over 90, you're going to want medication for that.

Lifestyle measures can also be effective. Reducing salt, increasing exercise just generally eating more fiber and more vegetables may be healthy, but you've got to know your numbers. And don't be so quick to discount a blood pressure that's high in the office just because you're nervous. We can go and check blood pressure at home then, or check in a pharmacy when things are calm and quiet and you're under your own control.

Because if blood pressure continues to be high, you really should get treated. Let's see. All right. We had smoking, cholesterol, blood sugar, blood pressure. Okay. Healthy weight. It's useful to check your body mass index, which is just an index of weight to height. It's available online. We want that to be less than 25.

Exercise. We are looking for 20 minutes of at least moderate intensity exercise every day. at least six days a week. The more exercise, the better. So if you can't get to 20 minutes because you can't get to a gym, no problem. Just get up, go walking for five minutes, put a song on, dance for five minutes dance to one song or two songs, anything that, especially when people are really sedentary, every little bit you do counts.

And I recently learned that something that's called VILPA, Vigorous Intermittent Lifestyle Physical Activity, is also very protective. So what that's go up the stairs and get something on the second floor or I'm in New York, you know, run up the subway stairs or run down one block just brush for the bus.

Those little bits, those little like exercise snacks are also protective and that's separate from the moderate stuff.

I'm sorry. I didn't mean to interrupt you. Go ahead.

[00:24:33] John Salak: on exercise.

You can get pretty tired. So I've got a solution for everything. And if you try, you can do it. Then we're at, okay. Sleep. We want to get eight hours of sleep a night. Most of us, the more, the better get tested for sleep apnea. If you snore or if people are worried you have it, then you might go ahead and get tested.

And the last thing is diet and diet is its whole healthy, its own discussion, but lots of vegetables and fruit fish at least a couple of times a week, something in the legume family, nuts, lentils, beans, chickpeas and olive oil, whole grains when you have grains. And not much else.

[00:25:38] Harmony: Oh yes, that's true.

[00:25:51] Harmony: You bet. think a huge challenge is availability of healthy food. There are many food deserts. It can be hard to get great vegetables. It can be hard to get great fish. People find, they're expensive. And that's something I think that we need to change through public policy, but for now, I'm happy to know that there are food pantries available, and they often have fresh vegetables.

And also, there's a, people sense a lack of time when thinking about preparation of vegetables, but you know, microwave vegetables are great. I get boxed microwave vegetables to have with my family during the week because like many of your listeners, I'm busy and it can be hard to prep things, but the frozen vegetables really have the nutrients that we're looking for and it's totally fine to pop them in the microwave and make sure you get a serving during the day.

And I think easy snacks also, easy, healthy snacks, are not as widely available as I would like. And that makes it tough for people on the go. There's also tons of misinformation. I mentioned coconut oil earlier, and before that it was Oh, I can't even remember, but there was some other misinformation campaign.

You know, this gets touted as a health food when in fact it's unhealthy and has the risk of raising cholesterol. So you just really want to try and get good quality information

They were the sides of basketballs. And I remember that being one of the first health myths. And so workers would be going into work with two or three brand muffins and a cup of black coffee. I'm sure it didn't do them much good.

Are their misconceptions that people have in dealing with heart health? And it's not just whether or not there are challenges, I'm doing something that isn't working. Are there other misconceptions out there that people just need to become aware of so at least maybe they get on a pathway to learning more?

You know, I think that people expect a heart attack to feel like it looks in the movies on men and for women it really may not be that way.

Another misconception is that heart disease in women needs to look exactly like it looks in men. There is definitely the type of blocked artery heart disease in women that there is in men. There's congestive heart failure can be very similar in women than men, but there can be some differences. For example, my area of research is in heart attack with open arteries or chest pain with open arteries.

And sometimes even physicians fail to recognize that if the arteries are not badly clogged, that doesn't mean that you're in the clear. There's a whole set of problems that are caused by things other than blocked arteries, like small artery disease or artery spasm that cause true cardiac chest pain in women.

And the pathogenesis, the mechanism, is just a little bit different than it is in men. So that worries me because I think some people get a pat on the head and get told, oh, you're fine, you know, your chest pain is for something else. It's stress. And it's not stress.

[00:29:51] Harmony: Absolutely. You can just put in your search engine, American Heart Association. You can put in heart disease risk factors, go red for women know your numbers, life's essential eight. These are all key search terms that should get you high quality information through the American Heart Association or the NHLBI Heart Truth Program and others.

[00:30:20] Harmony: I am the chair of the Committee on Women and Underrepresented Populations at the American Heart Association with special focus on trying to improve health equity for women and underrepresented populations through research.

So thank you very much for joining us today, Dr. Reynolds.

Signing up is easy and free. Just visit us at WellWellUSA. com, go to Milton's Discounts in the top menu bar, and the sign up form will appear. Signing up will take seconds, but the benefits can last for years. Okay. By now, we all realize that heart disease is deadly serious for everyone. Thankfully, it's a threat we can conquer.

Awareness of the causes and symptoms are key, along with a commitment to respond quickly to attacks. Start by recognizing if you're in a high risk group, either because of genetic or congenital conditions, or because you're overweight, inactive, smoke or drink heavily. If it's a lifestyle issue, work to change it.

Recognizing the symptoms of heart disease is also critical. And these include chest pains, chest tightness, chest pressure, chest discomfort, shortness of breath, pain in the neck, jaw, throat, upper belly, or back, numbness, weakness, or coldness in arms or legs, dizziness, fatigue, or fainting, irregular heartbeats that feel rapid, pounding, or fluttering, swollen legs.

Ankles or feet, all of these could indicate you're facing heart disease. Now, admittedly, these symptoms may not be related to cardiovascular problems, but if you have them, it is worth going over them with a medical professional. More specifically, don't wait. Seek emergency medical care if you experience chest 10 minutes combined with a shortness of breath or fainting.

Ultimately, have a heart. For yourself and your loved ones by protecting yourself..

Well that's it for this episode of What the Health. We want to thank Dr. Harmony Reynolds, who, among other things, works with the American Heart Association on raising awareness of cardiovascular issues for women. The American Heart Association is also a great source of information on all related heart issues.

Just visit heart. org to learn more. That's heart. org. Again, I'm Thanks for listening. And please come back soon for more of our programming.