An OB-GYN’s Insight on Heart Health and Hormones

As an OB-GYN for the past 25 years, I feel as though I’m on the frontline of health care providers who can identify women at risk for heart disease. When you go to see your OB-GYN for your yearly exam, you can start to learn what your risk factors are for the No. 1 killer of women. Many women only see their OB-GYN during the first 50 years of their life, so knowing who is at risk can be lifesaving.

Once thought to be a man’s disease, heart disease is the No. 1 killer of women. It accounts for more deaths than all forms of female cancer combined, including breast, lung and ovarian cancer.

It’s hard to believe that a woman dies every 80 seconds from a heart attack or stroke and that more than two-thirds won’t feel a single symptom. If there’s a take-home message, it’s that 80 percent of the causes of heart disease can be prevented.

Since “a woman is not a small man,” as Dr. Nanette Wenger – a leading cardiologist in women and heart disease – suggests, we need to look at the less traditional and natural hormonal cycles affecting women that increase their risk.

Pregnancy is the first “stress test” a woman experiences. Pregnancy complications such as hypertension of pregnancy (pre-eclampsia), preterm labor, a small-for-gestational-age baby and gestational diabetes can uncover early predictions of cardiovascular risk. Once the pregnancy is over, the disease of the blood vessels continues after pregnancy, so these complications and concerns persist. A detailed pregnancy history is important in accessing your risk of cardiac disease and must be conveyed to your health care providers to monitor these risks.

Menopause is another natural hormonal cycle that continues the conversation of heart disease risk. Prior to going into menopause, the hormone estrogen has a positive and healthy effect on blood vessels and blood flow. Once you enter menopause, estrogen levels plummet and you experience hormonal and physical chaos happening at the same time. The decrease in estrogen levels during menopause may increase risk of heart disease but doesn’t cause cardiovascular disease. Hormone replacement therapy isn’t recommended to treat or prevent heart disease but can be used to treat other disruptive symptoms of menopause, including hot flashes, night sweats, insomnia and mood changes.

Other unexpected body changes occurring during menopause include increases in blood pressure and an increase in LDL, or bad cholesterol, and triglyceride levels. Menopause should make women pay more attention to healthy aging and decreasing our mortality.

A Canadian study showed women with unsuccessful fertility treatments were at increased risk of heart disease compared to the general population. Those women who had successful fertility treatments had a decrease in cardiovascular disease. This finding helps continue the conversation between your fertility specialist and other health care providers to identify unsuspecting risk factors for heart disease.

Other medical conditions common in women that increase the risk of heart disease include, systemic autoimmune diseases including rheumatoid arthritis, Lupus, and Psoriasis. Depression and it’s association of high risk behaviors including drugs and cigarette smoking put this group of woman at risk.

I want to encourage awareness and action to women of all ages. My advice for women in their 20s to 40s is that you’re never too young to form healthy habits to lower your risk of heart disease. Here are some simple lifestyle habits to adopt:

• Eat a heart-healthy diet including fruits, veggies, whole grains, low-fat dairy products, fish and chicken.
• Avoid high-sodium foods, sugar, processed meats and foods made with partially hydrogenated vegetable oil.
• Exercise 30 minutes on most days of the week or 150 minutes/week.
• Maintain a healthy weight with a BMI less than 30, and keep your blood pressure, cholesterol and blood sugar numbers at normal levels.
• Don’t smoke or use tobacco, and avoid secondhand smoke.
• Get regular health screenings and understand your family health history.
• Get quality sleep and manage your stress.

There aren’t guidelines like we have for mammograms, pap smears, colonoscopies and bone densities for heart disease screening in women. It is my hope that heart disease screening begin for women at 40 years old. Since 80 percent of heart disease can be prevented, I look forward to the day when heart disease in women will be eliminated through awareness and action. A woman’s early health habits can impact her heart health in later years and transition to menopause, which ultimately promotes healthy aging and wellness.