- 2 days ago
On this month’s Stay Well Health Chat, Nicole Michalik from 92.5 XTU and Marisa Magnatta from 93.3 WMMR sit down with Virtua Health cardiologist Dr. Rozy Dunham to talk about practical ways women can reduce their risk for cardiovascular disease.
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00:00Hi, it's Nicole from 92.5 XTU and Marissa from the Preston and Steve Show.
00:07And we are joined by Rosie Dunham, MD, a board-certified cardiologist caring for adults
00:13with heart conditions. A graduate of Jefferson Medical College of Thomas Jefferson University,
00:20she is particularly interested in caring for women with cardiovascular disease.
00:24And noted as a rare gem by patients who appreciate her personalized approach
00:29to care and attentive management of their needs. Dr. Dunham is praised for her kindness,
00:35her knowledge, and her ability to communicate complex medical information in easily understandable
00:41terms, which is a joy to have you on this virtual Stay Well Health chat with us.
00:46Yes, thank you so much for joining us today.
00:48Thank you so much for having me.
00:50Awesome. Let's dive right in. So obviously, it's super important to know your heart history.
00:56So what steps can we take at any age to improve our cardiac health?
01:02So a lot of times people feel overwhelmed when they think about their family history and
01:07cardiovascular disease that runs in their family. But what's reassuring is that there are a number
01:12of factors that are well within your control to help reduce your risk for cardiovascular disease.
01:17Number one is your diet, what kind of foods you're eating. We encourage everyone to follow a heart
01:24healthy diet, which includes plenty of whole foods, less processed foods, lots of fruits and vegetables,
01:31lean protein, plant-based protein, nuts and seeds, and sort of just a Mediterranean style type diet that can
01:39really help reduce your cardiovascular risk. Another thing that's well within your control is exercise.
01:45The American Heart Association recommends about 150 minutes of exercise per week.
01:52So if you break that down, that's about 30 minutes, five days a week of moderate intensity exercise.
01:58And a lot of times patients ask me, well, what's moderate intensity mean?
02:02It's something where you can keep up the exercise and still keep up a conversational breath
02:07where you're not gasping for air trying to talk.
02:10So something like a brisk walk or biking or water aerobics or even dancing, all of that counts as moderate intensity exercise.
02:23Another thing is getting plenty of restful sleep. The American Heart Association recommends seven to nine hours of sleep
02:29for most adults. Believe it or not, lack of sleep, stress, anxiety, all of that leads to an increase in your cardiovascular risk.
02:37If you smoke, don't quit. And if you don't smoke, don't start. That's a big risk factor. That's under your control.
02:48And then finally, we call it knowing your numbers, your numbers, like your weight, managing a healthy weight,
02:55knowing your blood pressure, maintaining a healthy blood pressure, knowing your blood sugar levels.
03:02There's easy blood tests that your primary care physician can do to assess your blood sugar level
03:07and to tell you whether you're in a healthy range or not.
03:10And finally, your cholesterol numbers, making sure those are all within a healthy range.
03:16Okay, well, knowing your numbers is important.
03:18I assume it's just as important to know your family history if possible, correct?
03:23Oh, 100%.
03:24Although there are some cardiovascular diseases that are truly genetic and are inherited from, you know, parent to child,
03:31there are others that are more familial or inherited.
03:35Traits like a family history of early heart disease.
03:38If you have a family member who's had a heart attack or stroke before the age of 60, that's a risk factor for you.
03:46Any family history of stroke or heart attack can affect your heart health.
03:51Of course, there are also some genetic disorders that if they run in your family, you should know about genetic cardiac disorders,
03:59such as certain types of valve disease, certain types of arrhythmia or abnormal heart rhythms,
04:06and certain types of congestive heart failure can actually be genetic as well.
04:11So it's important to know, you know, what kind of history is in your family.
04:15Very important.
04:17So let's obviously talk about before and after pregnancy.
04:19Obviously, that's huge, right?
04:21And I think a lot of people think cardiovascular issues and they think, like you said, people over 60.
04:26But that's not the case.
04:27That's why it's important to, like, get your blood work and to know your numbers and to live a healthy, well-balanced lifestyle, mental and physical.
04:33But pregnancy, I mean, you're literally growing another human inside you.
04:37It is never ceases to amaze me.
04:40So how does becoming pregnant affect your cardiac health?
04:43So let's talk about women in cardiac health first before we get to pregnancy and cardiac health.
04:51So many women don't know that heart disease is the number one killer of women in the United States.
04:57Not breast cancer, not cervical cancer.
05:01It's cardiac disease.
05:03And then when we, you know, separate that into pregnancy,
05:08cardiovascular disease is the number one cause of mortality in pregnant women.
05:12So pregnancy is definitely an important time in women's lives.
05:17Some people say that pregnancy is the first real stress test for women on their heart because your body's going through such enormous physiologic changes.
05:27Your heart is working twice as hard.
05:29During pregnancy, your blood volume doubles and your cardiac output doubles.
05:35So your heart is really working twice as hard during pregnancy than when you're not pregnant.
05:40So all of these things can either uncover an underlying existing cardiac condition if you didn't know you had one,
05:47or it can actually cause certain cardiac conditions.
05:51So pregnancy is a time to be hypervigilant, hyperaware of any changes, any symptoms that you're having,
05:57and, you know, bring them to the attention of your doctor.
06:01Well, so that sounds really important.
06:03And you are sharing with us how important it is to be prepared if you are pregnant or planning on getting pregnant,
06:09starting a family, whatever it might be.
06:11What are some of these symptoms to look out for?
06:14So, again, you should know your family history before getting pregnant.
06:18Know what you're at risk for so your doctor can screen you for those things.
06:22Once you are pregnant, you know, it's hard to separate some of the symptoms of cardiac disease
06:28from some of the normal symptoms of pregnancy.
06:31So those symptoms can be chest discomfort, shortness of breath, swelling in the ankles, palpitations.
06:38All of these things are also normal with pregnancy.
06:41But at the same time, you shouldn't blow them off.
06:44You should take them seriously if you're really concerned about any of those above symptoms.
06:48They deserve a workup, a medical workup.
06:55You know, pregnancy can bring out some pretty serious cardiac conditions like pregnancy-induced high blood pressure,
07:01which can lead to something called preeclampsia,
07:05which is high blood pressure with evidence of kidney damage or liver damage.
07:09There's also gestational diabetes.
07:11Going back to knowing your numbers, you know,
07:14your OB-GYN will probably check your blood sugars throughout your pregnancy
07:17to know if you're developing gestational diabetes.
07:21And then finally, there are rare forms of heart failure
07:23that can also be related to pregnancy, as well as arrhythmias.
07:29So palpitations, shortness of breath, all this stuff should not be ignored,
07:33even if you think it's just a normal sign of pregnancy.
07:36Another example of what women have to go through every month.
07:43I'm just like, we should be wearing capes.
07:46My God, especially mothers.
07:49That's a great thing.
07:49Hey, I worked through it three times.
07:51I've had three kids.
07:52Yeah, I mean, it's just that we could do a whole series on the fact that men should get on their hands and knees
07:59and thank God they don't have to do what women do.
08:01All right, you mentioned preeclampsia and high blood pressure.
08:04What can these conditions, can these conditions signal anything after pregnancy?
08:10Absolutely.
08:11So anytime I see any adult patient, even if they're past menopause, I ask about their OB history.
08:18If you've ever, if you have a history of preeclampsia or eclampsia during your previous pregnancies,
08:23if you have a history of gestational diabetes during your pregnancies long ago,
08:27if you have a history of preterm birth, premature birth with any of your babies,
08:33all of those things put you at higher risk later in life for things like high blood pressure, diabetes,
08:40cardiovascular disease compared to another woman who didn't have any of those complications during her pregnancy.
08:47So absolutely, it's important to know your OBGYN history.
08:52Were all the pregnancies healthy or were your pregnancies complicated by any of these factors?
08:57Because that will affect your health later in life.
09:00I'm excited that you brought up menopause and it sounds like such a funny...
09:03Wow, way to be excited.
09:05Because I feel like people are talking about it more.
09:08Yes, finally.
09:09I feel like our entire lifetime, we never heard it.
09:11And suddenly, maybe it's, you know, a social media revolution or whatever it might be.
09:16But people are out there and talking about menopause.
09:18So can you share with us about cardiac health after menopause?
09:23So menopause is the hot topic right now.
09:25Everyone is talking about it.
09:27But everyone wants to know what they can do for their symptoms of menopause.
09:32The unfortunate part is there is a real lack of data when it comes to cardiovascular disease.
09:38Go figure.
09:40Go figure.
09:41Exactly.
09:42There's a lack of data regarding hormone replacement therapy and as well as menopause.
09:47But some of the things we do know, I'm going to just sort of summarize the data we do have
09:52and what we can tell from looking back on the data retrospectively.
09:56One, we do know that estrogen and estradiol levels drop during menopause.
10:02So what does that mean?
10:03Less estrogen means your blood pressure goes up.
10:06Less estrogen means your cholesterol profile changes.
10:09The good cholesterol goes down while the bad cholesterol goes up.
10:13There's also a decrease in women's metabolism when their estrogen drops,
10:18which means you lose lean muscle mass and you gain adipose tissue or fat tissue.
10:24And you also, women will also tend to gain weight around the midsection or belly area,
10:32which is called truncal obesity, which is a risk factor for heart disease.
10:37So a drop in estrogen level can cause all these other effects,
10:40which will impact your cardiovascular health downstream.
10:43We also know that after menopause, plaque buildup in the arteries is accelerated in women,
10:52even more so than men of the same age.
10:55So something in the drop in estrogen actually accelerates blockage buildup in the arteries of the heart.
11:03So that's something that women should know.
11:05So there were a lot of studies done in the 90s, many, many, many moons ago,
11:11looking at hormone replacement therapy.
11:14And with some of the initial studies, they saw that cardiovascular risk,
11:18when giving hormone replacement, actually reduced in younger patients.
11:22So then the Women's Health Initiative came out in the 90s,
11:25where they looked at older women, over 65, who are more than 10 years out from menopause.
11:30And they found that risk was actually higher for cardiovascular disease and clot.
11:35Now, looking at all of that data retrospectively,
11:39what we can say is that hormone replacement therapy may actually reduce cardiac risk
11:44if given early, before the age of 60, and if given within the first 10 years of menopause.
11:50Giving hormone replacement later, 10 years after menopause or after the age of 65,
11:56not only is it not a benefit, but it may increase your cardiac risk.
11:59But if given early, it may actually reduce your cardiac risk.
12:04Now, there's no official recommendation to give hormone replacement therapy
12:08for the purpose of reducing your cardiac risk.
12:11But if you need hormone replacement therapy for other symptoms,
12:15like hot flashes and other menopausal symptoms,
12:19then it's probably safest to give it early and at a younger age.
12:26So interesting.
12:26What are the differences between women and men when it comes to cardiovascular health later in life?
12:31I know, personally, I've read a lot about how symptoms of, God forbid, like a heart attack
12:37are so different in women than they are in men.
12:40And I think that that's really important to know.
12:41So that's just something that I knew, but obviously you're the expert.
12:44Is there anything else that we should really be aware of as differences?
12:47Well, that's impressive that you know that because a lot of women are not aware
12:51that symptoms are different in women than men.
12:54And actually, back in 2004, the American Heart Association launched the Go Red for Women campaign,
12:59which is why I'm wearing red today.
13:02Nice.
13:02It's to raise awareness of heart disease in women because even women don't realize at what high risk
13:08they are and they often ignore their own symptoms.
13:11So it's true.
13:13Women's symptoms are very different from men's.
13:15The classic symptom you read about is the elephant sitting on the chest.
13:20Women don't often get that.
13:21Women can have symptoms as vague as fatigue, just feeling overwhelmingly tired, shortness of breath,
13:29nausea, jaw pain rather than chest pain, sweating, getting sweats for no reason.
13:37Those can all be symptoms of a heart attack and should not be ignored.
13:42One of my really good friends from college, she was actually just here.
13:45She lives in South Carolina now, but her mom is 78 and just had a massive heart attack.
13:50And that's where her symptoms, she kind of fell off.
13:53She was a little nauseous.
13:54She also has diabetes.
13:55And that was another thing that we learned is that a lot of times with diabetes patients,
13:59especially in women, that heart disease could be like a silent killer because of your neuropathy,
14:03you don't necessarily feel it the same.
14:05So also another important fact that like, you got to talk to your doctor.
14:09You got to get your numbers checked.
14:11You got to know your family history.
14:13You're absolutely right.
14:14I had a patient many years ago whose only symptom was actually a sore throat.
14:19Yeah.
14:20And she came to the ER and she's like, my throat's sore.
14:23It just won't stop.
14:24And lo and behold, she was having a heart attack.
14:26So you really, you know, women know their own bodies and if something isn't right,
14:31they need to bring it to their doctor's attention.
14:33Um, we're so used to taking care of everyone else.
14:36We're so used to ignoring our own symptoms and putting it on the back burner,
14:40but we really need to put our health forward because, and first, because, you know, again,
14:46cardiovascular disease is the number one killer of women in the, in the United States.
14:50Well, thank you for bringing up Go Red for Women.
14:52Um, I've been an advocate and a part of the, uh, program for a while.
14:57And I brought Nicole in last year.
14:58I helped her team last year.
15:00Same reason because women need to remember to help yourself and to help each other.
15:04And we need to remind each other.
15:05So, um, Dr. Dunham, thank you so much for joining us.
15:09And we are so excited for, um, this new information.
15:13Um, share it with your friends because there's somebody out there who can help.
15:16And keep staying tuned to these Virtua Stay Well Health Chats because we have some of the most
15:22brilliant minds, brilliant minds in medicine.
15:25We're so honored to be able to talk to you and get all this information.
15:29So thank you so much.
15:30Oh, you're so welcome.
15:31And you're right.
15:32We have a great team of doctors here at Virtua.
15:33We have a great team of female doctors who know what it's like to talk to other women
15:38about their symptoms, about menopause, pregnancy, post-menopause, all of the good stuff.
15:43So, yes.
15:44If you need more information or would like to request a consultation, visit Virtua.org
15:49slash heart consult.
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