The Hidden Signs of Heart Disease in Women

[00:00:00] Speaker A: Run toward the unknown. When you're riding the big wheel, you're not alone. [00:00:10] Speaker B: But women sometimes don't believe that they can't have heart disease. And if you think about it, historically, the picture of a person having a heart attack is usually that old white male clutching his chest. [00:00:23] Speaker A: Yes. [00:00:23] Speaker B: But we know that, you know, women are having heart disease, they're having heart attacks. And so that is the first thing that we need to make people aware and patients that women can have heart disease. And so we need to be aware of that so we can take the steps to prevent those things. [00:00:39] Speaker A: Did you know that heart disease is the leading cause of death for women in the United States, with one woman dying every 80 seconds? And over 44% of women are living with some form of cardiovascular disease in our country, and many may not even be aware of it. Today we're having a heart to heart discussion with Dr. Izzy Adenso a a renowned cardiologist specializing in preventive cardiology and women's heart health. Her clinical interests include cardiovascular risk reduction, coronary artery disease and heart disease in women with a specific interest in those with system inflammatory conditions like lupus and rheumatoid arthritis. After watching Dr. Izzy Adenso in action, through interviews, videos, hearing her thought leadership on women's cardiovascular health and understanding her mission, I knew that she was the person for me and that's how I see her. My go to person who I fully trust with my heart. The center point of our health. Her advocacy isn't just by raising awareness and speaking, but includes doing she's in action, making a difference in her work every day and her approach to healthcare. Welcome. Dr. IzziAdenso. I think that I have told you that I have anticipated this podcast and I TR truly believe it is my favorite one of the year. [00:02:02] Speaker B: It's so good to be with you today. Thank you first of all for that really sweet introduction. It's been an honor for me to be able to take care of you and really the what I'm able to do with my patients every day. So it's a service for me and it's so wonderful to hear how you think of me and what I'm able to do for my patients. [00:02:21] Speaker A: Yeah, you're by far one of my favorites out there in riding the big wheel. It's all about everyone's personal and professional journey of life. And, and so you said before that you basically grew up in the world of healthcare, so along the way you found this passion for preventive cardiology, especially helping women understand their heart Health in a deeper way. So what drew you specifically into that focus? [00:02:49] Speaker B: You know, what's interesting is the female patients found me. I would often have a new patient tell me. I came to look for you because I was looking for a female doctor, specifically a female cardiologist, because I wanted someone to listen to me. I wanted someone who understood what life was like as a woman and how I may express symptoms differently or the fact that I want to take a little bit more time talking about how I feel and things outside of medicine and how that may be impacting my health. And so over the time, I found I would get more and more female patients. And then, to be quite honest with you, I started to learn more and more about how women present with cardiovascular disease differently. And the fact that, as you mentioned in your introduction, is that women are. Almost 50% of women have some form of cardiovascular disease and are unaware of it. So I sort of got drawn to women's heart disease that way. [00:03:50] Speaker A: All right, so let's talk about why this topic is so important today and why women should care. So I've had a couple more stats here, and the one was, and I believe that this is a worldwide number that about 200,000 women die a year of heart attacks, which is five times more than breast cancer. Like, that's kind of a big number, I think. And 20% of female deaths in the US and 35% of female deaths worldwide are due to some type of cardiovascular disease. So only half, as we mentioned before, about 44%, are even aware that cardiovascular disease is the number one killer of women. What are some things that people might not know about? Some of those. You know, I'm throwing out some stats and numbers, but what are things that maybe there are some misconceptions people have or thoughts about who gets cardiovascular disease? Anyway? [00:04:55] Speaker B: Yeah, I think your point is, should be well taken, is that first and foremost, women are less likely to believe that they might have cardiovascular disease. There's been several times throughout my career where I've met a patient who had. Who didn't have typical chest pain and maybe presented with a heart attack and couldn't believe that they were there, couldn't believe they were in the hospital, in the emergency room having a cardiac event, or couldn't believe that certain risk factors mattered for them. I think that's the first myth that should be dispelled that women can get cardiovascular disease. We'll be using the term cardiovascular disease and sometimes heart disease. And the only difference is that cardiovascular disease includes heart disease or stroke. So Cardiovascular disease is more comprehensive, but women sometimes don't believe that they can't have heart disease. And if you think about it, historically, the picture of a person having a heart attack is usually that old white male clutching his chest. Yes, but we know that, you know, women are having heart disease, they're having heart attacks. And so that is the first thing that we need to make people aware, both clinicians and patients, that women can have heart disease. And so we need to be aware of that so we can take the steps to prevent those things. [00:06:12] Speaker A: So then every woman could be at some level of risk for cardiovascular disease. What is it that could increase the risk of cardiovascular disease across a woman's lifespan? [00:06:27] Speaker B: That's a great question. First and foremost, there are what we call traditional risk factors for cardiovascular disease. So high blood pressure or hypertension, diabetes, high cholesterol, obesity, physical inactivity, believe it or not, is a risk factor for heart disease. So even if you're slim, but you don't exercise, that is a risk factor for heart disease. And then family history. So if in your family there is a male who had some sort of cardiovascular disease. So again, that's comprehensive at that point. If you have a male who had cardiovascular disease before the age of 55 or women before the age of 65, that is a risk factor for you. And then separately, there are some female specific risk factors, and I don't want to forget to include tobacco use that in and itself is also a risk factor for cardiovascular disease. [00:07:16] Speaker A: All right, so let's kind of package these up a little bit and kind of create the narrative. So I kind of had a few categories that we talked about. So let's get a little bit deeper into each one of these. The first thing you talk about is lifestyle and behavioral things. And you put in there things like smoking that you mentioned, poor sleep. Let's talk about that a little bit. Alcohol, obesity, physical activity. And those are things that you call modifiable. [00:07:49] Speaker B: That's right. So modifiable risk factors are those that we are able to change those that are within our control. Right. That has nothing to do with genetics. And the first one that I wanted to touch on is the poor SLEE sleep. Because I don't think that people realize that poor sleep is tied to increased risk for cardiovascular disease. Right. I don't think we talk about that enough. But one of the things that was recently done is the American Heart association released newest recommendations for a heart healthy life, which is called Life's Essential 8. And what they did is they included sleep in that the importance of proper sleep. We know that if you don't get good sleep, it definitely causes stress to be high and it also increases your cortisol level, which can in turn increase your blood pressure, glucose level, cause a lot of pro inflammatory state in an individual. So it's really important that we are recommending and advocating for ourselves to get like six to eight hours of sleep throughout the night. [00:08:51] Speaker A: So you know, there are non modifiable things, right? We'll get deeper into it. But on that whole sleep piece, when we think about things that happen through the aging process, I'll bring up the big one, menopause, the big M. Like how do women deal with that poor sleep issue? You know, sometimes I will even be like, it's been kind of funny the past couple weeks. I usually sleep through the night, but I've been waking up like at 3am I can't sleep. I'm tossing, turning, and it's like, oh my gosh. And twice I actually ended up getting up at 4:30 and just staying up, you know, because I just couldn't, couldn't get sleep. But what, what can people actually do? [00:09:34] Speaker B: Exercise certainly helps to decrease menopausal symptoms and will help you to get good sleep. A Mediterranean diet, believe it or not, is also helpful to sort of quiet down some of the menopausal symptoms. And one of the things that we like to tell patients is that your bedroom should be the place for intimacy and for sleep. We shouldn't use the bedroom as a place where we're watching TV because then you're not going to be, it's not going to be a place for you where your body is ready to, into this rest phase and for you to sleep. And then if you're having trouble sleeping, actually the recommendation is that you get up out of the bed, whether you walk around or sit in the chair and then when you're tired again, get back in the bed to sleep. So, so training your body and your mind that this is the place of. [00:10:17] Speaker A: Rest, that is really good advice. You know, a few years ago I think I mentioned this possibly before, but I do not bring my laptop upstairs. It's not allowed. I read before I go to bed. I like to try to go to bed. Like if I can by 9:30, if I'm reading a really good book, I don't even care if I'm up there at nine, right. And I read for an hour or two. And I find that that does help me get that good night of sleep. And it's interesting Because I've been traveling and really busy. And what I have noted is that I'm off my exercise routine. So that could be related to my poor sleep right now. You also mentioned things like environmental and social things like chronic stress, air pollution. But then you even get into things like healthcare access. So how does that contribute to people's well being or not? And what are some of the challenges that you see today? [00:11:19] Speaker B: Yeah, you know, what we're finding is that in the rural areas that patients may not have an access to a cardiologist and their primary care doctor is managing all of their healthcare, and there's nothing wrong with that, is that when people need higher levels of care or specialty care, they can't get it. It is not appropriate that patients have to travel two hours sometimes to be able to get to a cardiologist. [00:11:44] Speaker A: Oh, gosh. [00:11:45] Speaker B: And that is the reality for some places, especially when it comes to pregnancy. And I know we'll talk about that a little bit later, but when women are going through complications related to pregnancy, there are where there's not even an obstetrician. So I think that is one of the things that, I mean, again, my public health hat that I think we need to do better is just make sure that patients have access to equitable care no matter where they are. One thing about cardiology is that there are times we actually need to physically touch, feel the person, listen to their heart, listen to their lungs. But I think that is one thing geography, but then also uninsured. What happens to the uninsured or underinsured individual who needs specialty care or needs care? Unfortunately, there have been patients that I've seen who struggle to get necessary testing simply because they don't have insurance. And financially it's not an out of pocket expense that they can shoulder. And so that's some of the things that we're dealing with. [00:12:42] Speaker A: Oh, God. Okay, that just sounds. That sounds rough. I know we're going to get more into some of these like autoimmune disorders and psychological, neurological issues, genetic and hereditary things. But let's talk about first the connection between preventive medicine, what it is that you focus on, and cardiovascular health. Because when I hear you talk about preventive health, it feels very forward thinking, very proactive rather than being reactive. So for women that are listening right now, can we think about and talk more about everyday things that truly can make a difference in protecting your heart health? [00:13:28] Speaker B: You know, I wanted to start first with just a concept of preventive health, what that, what that means. And we do a Great job in medicine. You know, we've had such advances in therapies and medications, procedures, where, you know, in the past, if someone had a heart attack, they would be committed to the hospital for two months for their recovery. Now they go home within 48 hours. We're really good about treating disease when it has already occurred, but I am of the belief that we can actually focus more on preventing disease. It costs so much financially to the individual, to the health care system, to employers to try to treat disease, then I think it would cost to prevent disease. And so as a preventive cardiologist, my focus is on identifying those risk factors that cause heart disease or cardiovascular disease specific to women, identifying those risk factors that increase a woman's likelihood of having cardiovascular disease, and working with my patients on taking steps to reduce their risk. And when needed, what medications do we need to make sure we're including to try to prevent and or treat those receptors that are there? [00:14:46] Speaker A: Yeah. We'll talk a little bit about my health later. So far, knock on wood, I've stayed away from the medicine. I think one of my things that I find really interesting is the older I get, I hate to say that the more when I go to any type of doctor and they'll say, what medicines are you on? And I say, nothing, the older I get. It's good for you. Am I just getting old or what? But that's my. My thing. Okay, so let's talk about eating. [00:15:16] Speaker B: Okay. [00:15:17] Speaker A: You know, because, like, there's a lot out there around clean eating. The exercise and health are the two big ones. Right. High intensity workouts. So let's really talk about. What does the research say now when we think about eating, I think that the advice you give me is actually pretty straightforward. [00:15:34] Speaker B: Do you want to share with them the advice that I give you? [00:15:36] Speaker A: You tell me. Stay on a Mediterranean diet, Michelle. Just follow the Mediterranean diet. So talk to everyone a little bit. And don't do fad diets. [00:15:44] Speaker B: That's right. [00:15:44] Speaker A: Don't be reading what that guy said is a good thing to do. Just, you know, stick to the basics. So let's talk about that a little bit. [00:15:51] Speaker B: Yeah. You know, two. There are two particular diets that have been shown to be healthy overall, but also good for overall cardiovascular health, and that's the Mediterranean diet and the DASH diet. The DASH is really focused on a low sodium diet and it actually has been shown to be a good treatment for high blood pressure or hypertension retention. The Mediterranean diet I like because again, I have a lot of patients who have Autoimmune diseases. And it's a pro, a low inflammatory diet is the way I like to say it. So it's low in red meat, low in sugars. It's clean food as you said. So it's vegetables and fruits and it's high in fiber. The big thing is avoiding anything that's processed. One of my colleagues says if it comes in a box, it comes through a drive through window. If it comes preheated already, that is not good for you. So that's the way I deliver that message. [00:16:51] Speaker A: Yeah, like I said, very straightforward. So I want to ask you a personal question. If you can take me through like a normal day for you when it comes to eating. So let's see, what did you have for breakfast this morning? [00:17:04] Speaker B: So this morning I actually had oatmeal. And usually when I have oatmeal I will add blueberries. I know you talked about blueberries in your salad. So I'll add blueberries, almonds, chia seeds, hemp seeds, and then I use almond milk. I, I don't use any whole milk or anything like that. And what I like about that a, it's filling. So fiber is very filling. So it also is very good at controlling your sugar so you don't have these spikes and peaks and dips in your sugar which makes us hangry and fatigued. It doesn't make you crave for more food. You feel full for longer periods of time and then it's healthy. You know, oatmeal has been shown to lower your cholesterol. It's actually a good management for high blood sugar as well. Then usually for lunch I will have, I will say that I tend to not eat very early in the morning. Usually my first meal is running 11 o'. Clock. [00:17:57] Speaker A: Okay. Wow, that's late. [00:17:58] Speaker B: Yeah, yeah. And then for a lunch, which tends to be a late lunch, around 3ish, I'll have sometimes a salad or brown rice, quinoa with protein. The only animal protein I tend to eat is chicken. So I live what I preach which is to really limit or avoid red meat. And then fish is another thing that I eat for my source of protein and tofu actually. And then for dinner in the evenings it'll be brown rice or quinoa or some other whole grain, again with protein and a vegetable. [00:18:32] Speaker A: Okay, that sounds like really delicious. So stay away from the frozen food box. Right. And it doesn't have to be really that difficult. I know it's hard, busy lifestyle to kind of cook at home. But I think today you can actually go out to things like chatgpt and say, give me a 20 minute meal. And it really will. That's healthy. I will tell you that lately I've been eating a little bit more red meat to increase my protein. So what kind of recommendation would you give to women that, you know, maybe you have reduced your red meat? I was really eating no red meat. [00:19:12] Speaker B: Okay. [00:19:13] Speaker A: And I kind of introduced it back. But I do know that my markers have been a little bit different and I've been wondering if that could have an impact. So what is it about red meat that makes it, you know, maybe not as great for us? [00:19:26] Speaker B: Yeah, it's high in fat, it's high in cholesterol. And so that's why I try to get my patients to avoid red meat. We also know that, you know, red meat is associated with some cancers. Right. And so that's another reason I like to steer women or any of my patients away from red meat. We can get a good amount of protein from chicken, fish. I mean, beans is high in protein, but not as much, obviously as some of the other animal proteins, the non red meat meat animal proteins. But then there's also things like tofu, etc, which should increase your protein. And I didn't add that. Some mornings I'll actually have yogurt with blueberries. [00:20:01] Speaker A: Ah, yes. I love yogurt. [00:20:03] Speaker B: And some of those have 18, sometimes 16 to 20 grams of protein in them. [00:20:07] Speaker A: Yeah. So I'll tell you that my doctor, we were talking about my GP who I had since 1994, and I'm crying because he just retired this year. I think you know who he is. He told me years ago because I gave up yogurt and I loved yogurt. He said, michelle, the yogurt's fine. Don't give up the yogurt. And I was so grateful. Right. Because this is when I started to have high cholesterol issues. And I love my yogurt. Can we talk about milk for a second? [00:20:38] Speaker B: Okay. [00:20:39] Speaker A: Because I will tell you that I really don't use a lot of whole milk. I believe that. Like, have you heard of the A2 milk out there? [00:20:49] Speaker B: No, I haven't. [00:20:50] Speaker A: There's this A2 milk that's supposed to be, I don't know, I guess the cows today have this A2 protein, which is the normal protein, and then this other protein. Right. They're like 50, 50, because I guess how we've changed the cows. So I'm a little bit out of my league here. [00:21:07] Speaker B: Interesting. [00:21:07] Speaker A: But I'm just wondering, you Know, is your perspective to avoid milk or is it just in like, should we just be careful the type of milk that we consume? I always buy organic and then I buy this A2 milk. Yeah, I'll try to do grass fed, 100%, something like that. But what's your thought on that? [00:21:28] Speaker B: First of all, I guess I need to read more about the A2 milk because I think. [00:21:31] Speaker A: Yes. [00:21:32] Speaker B: Yeah. More patients are probably going to be coming into the office asking about this. I probably better quickly learn more about that. But the reason I avoid whole milk is just because of the fat. So that. That's why. Yeah. And so I find the almond milk, the. Some folks like the oat milk as well, which is also healthy. I think overall there's also a growing percentage of the population that has become lactose intolerant, especially among African Americans. And so then they end up having a lot of GI distress when they're drinking whole milk. So that's where I usually steer people towards the non fat or lower fat milks which have some nutritional value. And if you're using it for oatmeal or cereal, etc. You don't really miss. It takes some time to get acclimated to it. It certainly did for me. But I haven't had, to be honest with you, whole milk in probably 25 years. [00:22:26] Speaker A: Wow. [00:22:27] Speaker B: Yeah. [00:22:27] Speaker A: Well, in full disclosure, I actually gave up milk and then I introduced this A2 back because there's nothing better than whole milk in a morning latte. [00:22:39] Speaker B: I just have to. [00:22:42] Speaker A: And every morning I have one. Okay, that is my little. That's my cheat. [00:22:46] Speaker B: Yeah. [00:22:47] Speaker A: So, okay, let's now talk about exercise. [00:22:50] Speaker B: Okay. Very important. [00:22:52] Speaker A: You were talking about the importance. And it is finally becoming a thing for women to actually get into strength training. [00:22:58] Speaker B: Yes. [00:22:59] Speaker A: You know, years ago they didn't do that. Right. They're measuring your waist. And I remember there's. Oh gosh, I can't remember. There was a 1960s show on. And I'm looking at these women, it was like supposed to be back in the 60s, and this woman's in a leotard and she's measuring her waist and hips and she would do it every day. Right. And I'm like, oh my goodness. Right. So it was kind of about maybe how thin you were, but not necessarily building the strength training, but being as slender as possible. So let's talk about strength training and the important importance of that in our, in our lives. [00:23:30] Speaker B: Yeah. Well, first of all, I can't even imagine what it was like then if you're Measuring your waist circumference. That sounds very stressful. First of all, I mean, who would want to eat if that's what you're going through every day? But you're right, it's more of a move from slim. I need to lose weight to be slim to fitness. We need to be fit. One of the things for women is that I remember listening to another speaker say this, is that if you just go to the gym and you just watch where the men and the women go, the women usually go up to the treadmill and the men go to the weights. And it's really important because certainly as we age, both men and women, we start to lose muscle mass. But it's really important for women post menopause, it's important to do strength training. It's actually part of the American Heart association recommendations that we do 150 minutes of some sort of moderate intensity exercise. But you also do two days of strength training. [00:24:27] Speaker A: Wow. [00:24:28] Speaker B: Yeah. [00:24:28] Speaker A: I didn't know that that is part of the recommendation. [00:24:31] Speaker B: It definitely is incredible. And I think we focus so much on doing some form of exercise where I'm sweating, where I'm getting my heart rate up. And that's wonderful for cardiopulmonary fitness. But we want strong bodies, strong bones, strong muscles. As we get older, there's a greater risk of falls and fractures and it's really hard to recover from a fracture and it can have really significant complications. So important that we're building in that exercise, strength training. But even the aerobics, 150 minutes in a week, it doesn't matter if you do that 30 minutes, five days a week, or if you do 60 minutes one day, 60, another day, get the rest of it on your last day. I think moving your body every day is something that's important. [00:25:18] Speaker A: You know, I agree with you, but I know that you have reinforced that in me. So even when I don't make it to the gym, and I haven't made it to the gym, like, I'll tell you what I did yesterday. I had a super busy day. I was up at 5am already working and on calls. I had calls all day. I was so exhausted when I got home at 7:00', clock, okay, that's a long day. I put my gym shorts on, I went into. I've got a workout room. I went in there and I just started lifting some weights. Just lighter ones, like 15, 20 pounds. But I made sure I did stuff, I did lunges and I spent like 45 minutes. And then what I do that's the one place I do have a tv. So I put a guilty pleasure show on the time I watch tv. I don't just sit in front of a couch. It's like my motivation to watch this guilty pleasures series is when I'm working out. So I kind of. That's just one of my. [00:26:14] Speaker B: Well, we're on the same spectrum with that. First of all, I've got a room where I've got a stationary bike and usually I'll just take my iPad in there. I went there this morning at 6:30 and that's the time I get to watch the things that I wouldn't normally watch. [00:26:27] Speaker A: Right. [00:26:27] Speaker B: Because you sit there and you're pedaling and next thing you know, 60 minutes have gone by and you've done it. [00:26:31] Speaker A: Right. I know, I completely agree with you. I used to like get on there and then feel like I had to, you know, listen to world news, all this stuff, and I'd be like, it's only been 35 minutes. So now I throw on a guilty pleasure. I'm like, really? We're done. [00:26:49] Speaker B: You know, the advice I give my patients, especially when I feel my patients, is first of all, don't feel like you have to go to a gym. [00:26:55] Speaker A: Yeah, right. [00:26:56] Speaker B: Because that's something that we'd always think that if we weren't going to a gym that maybe we were in exercising. First of all, thank God. One of the things that has come out from the post Covid ever is a lot of online resources for exercise programs. I'm always giving that to my patients. [00:27:11] Speaker A: That's great. [00:27:12] Speaker B: And then the other thing is just making sure that you find a way to do something you enjoy. Right. You don't have to feel like I must go running or I have to be on a treadmill because that's what everybody else does. What is it that you like to do that you know you're going to be consistent at doing? So if you like walking, if you're somebody who likes hiking, some people do pilates, some people do yoga. Pick what you're gonna enjoy doing and just commit to that. [00:27:38] Speaker A: That is like such great advice. Okay, so let's get into some of these non modifiable risks. Let's start with pregnancy because this was a shocker for me on. We talked about some of the risks and some of the things that happen to women during pregnancy. So I'd like for you to talk about your experience, what you know and what happens. [00:28:03] Speaker B: You know, what we know in the field of cardiology is that pregnancy is akin to a stress test for a woman and how well you go through your pregnancy tells us about your risk for cardiovascular disease later on in life. So we look to find out if you have a successful, uneventful pregnancy or if you're one of the patients who has pregnancy related complications such as preeclampsia, which is developing high blood pressure during your pregnancy that wasn't there previously. Eclampsia, which is a more severe form that's actually associated with seizures or just pregnancy early on in pregnancy. Hypertension early on in pregnancy. And that's called gestational hypertension. So any form of hypertension during pregnancy we want to know about. And then also diabetes. Gestational diabetes actually can increase your risk of later developing diabetes or developing heart disease. [00:29:02] Speaker A: Wow. [00:29:03] Speaker B: Yes. [00:29:04] Speaker A: So people might think that those things are a temporary event during that time. And what you're saying is you need to make sure you keep an eye on that. It seems like we were talking about how healthcare today, it's so specialized and not everybody shares, you know, like, meaning an individual. Me, I might not share what's going on with one doctor with another. And unless they're in the same portal, they won't even know. So what advice would you tell women about, you know, their pregnancy if they're like talking to their GP or other doctors? [00:29:42] Speaker B: Yeah. First of all, I think the onus is on us, the clinicians, to educate our patients about the risk for cardiovascular disease later on in life. If you've had any pregnancy related complications, that's number one. Because a woman doesn't know to tell her doctors unless she knows herself. And then as you said, our healthcare system is so fragmented that sometimes we don't even talk to one another unless we're in the same healthcare system. So it's important for both clinicians and our female patients to be educated on those risks. So that if I'm the one who's had a compl. Complicated pregnancy, I'll tell every doctor that I come into after that. I'll tell my primary care physician, I'll tell my obstetrician, I'll tell the vascular doctor if I'm following them. Interesting, because they need to know that if I've had any form of pregnancy related hypertension, I may develop hypertension later on in life or some form of cardiovascular disease. If I've had gestational diabetes, I may develop diabetes later on life or some form of cardiovascular disease. And the same is true for like premature pregnancy, that's actually premature delivery, rather that is also a risk factor. For future cardiovascular events. [00:30:51] Speaker A: Okay, so a lot packed in there and a lot to think about. Now we'll talk about the other side of the spectrum, which is we're gonna go from pregnancy to menopause. [00:31:00] Speaker B: It's never easy for women, is it? [00:31:04] Speaker A: What is that? You know, I had this conversation with one of my friends the other day, and I said, you know, we get to go through pregnancy, which, you know, arguably, though, it's beautiful experience. You know, once it's over, it's over. And then we get to go to menopause. And I'm like, are we just supposed to die? Like, what is the deal? [00:31:23] Speaker B: And it feels like you're dying sometimes when you're going through menopause. [00:31:26] Speaker A: There you go, right? Full spectrum. So, like, what do we know? I know there's a lot that we don't know, but there's been, boy, in recent years, a lot of awareness about menopause and the impact on women's overall health. It's a whole nother thing. Why hormone therapy is not as easy to get for women than men. That's a whole nother podcast and topic. But let's talk about what is it that you do know about the connection of women's cardiovascular health and menopause? [00:32:00] Speaker B: You know, what we know is that women's risk of developing cardiovascular disease tends to be lower than men. Until you reach that menopausal age, then our risk for cardiovascular disease equals that of men. And that's because we don't have estrogen anymore. And there are a lot of changes that happen metabolically for women as we transition to menopause. Higher rates of high blood pressure. In fact, we tend to have higher rates of high blood pressure than men when we're in menopause. The other thing that we know is, you know, we talked about cholesterol. Cholesterol tends to worsen as we go through menopause. So your total cholesterol will increase, triglycerides increase, and then that bad cholesterol, the ldl, that also increases. [00:32:46] Speaker A: Oh, my God. You're talking. [00:32:47] Speaker B: Right? So you're set up. And then we gain weight in menopause. Right. And where do we gain it? Mostly in the abdomen. And that is where it is, like, at greater risk for heart disease in women is when you have a lot of fat around the abdomen. [00:33:01] Speaker A: So all of those things that you mentioned are all the things that have happened to me. LDL is up. And I'll tell you, I recently had my estrogen levels tested. I mean, everything is off the charts. Zero. Right. And I actually. But it took me. It was a big effort for me to start a path of being onto some type of hormone therapy. So I'm starting it. The path hasn't been easy. It took me a long time to get there. There are excellent providers, though, through my healthcare provider, which is really good. I know that's not as easy for other women. You know, what would be your advice around? I know you're not a hormone therapy specialist, but like, women, if they are in menopause and they find that their markers are starting to change, like, is there something, you know, maybe they run a panel just to understand maybe what their estrogen and all the other hormones, not just estrogen levels look like. Like, what would you tell women how they can start to understand if menopause is impacting their overall health in a way that could be very negative down the road? [00:34:15] Speaker B: Well, first of all, it's. First of all knowing that perimenopause can last several years. [00:34:19] Speaker A: Yes. [00:34:20] Speaker B: And so letting our female patients know that is that you can be in this perimenopause stage for a few years. And so what does that look like? Maybe you're having less sleep, you're feeling more anxious. Anxiety and palpitations are symptoms of menopause. You notice that you're gaining that weight that you could easily shed before you know. One of the things is that we know more about menopause and we're still learning, but some of the literature from earlier on was we've learned more, I will say, about menopause and what in the cardiovascular risk. [00:34:59] Speaker A: Okay. [00:35:00] Speaker B: Earlier on, we thought that any woman who was on menopausal hormone therapy was at high risk for cardiovascular risk, disease. And what we found is that there's really a certain segment and we need to look at each woman individually. So what is your overall cardiovascular risk? Are you somebody who doesn't have any family history of heart disease? Maybe you don't have any of those traditional risk factors we talked about. Maybe you yourself have never had a heart attack or a blood clot in the lungs, and you're a little bit lower risk versus a person who's had a heart attack, maybe who's had clotting disorders. You know, then you're at higher risk of having some sort of cardiovascular event if you're on menopausal hormone therapy. We also know that menopause, menopause can be very disruptive to your lifestyle. We talked about fatigue and lack of sleep and brain fog and things like that, and that menopausal hormone therapy has been helpful to try to control some of those symptoms. So while we don't recommend menopausal hormone therapy to prevent prevent cardiovascular disease, it is recommended to treat menopausal symptoms. So, hot flashes, etc. And when you consult with the physician who is well versed on treatment and understanding your risk, then you have a more comprehensive discussion about whether or not you are a right candidate for menopausal hormone therapy. So it's not a be all, end all or that no one's a candidate. It's really an individualized therapy. [00:36:29] Speaker A: All right, so I want to get into an area that you're a specialist in, which is autoimmune disorders. And there's two in particular that you have figured out the connection between them and cardiovascular health, and that's lupus and rheumatoid arthritis. So tell us a bit about what you've learned, why we should care, and what someone can do about it. [00:36:53] Speaker B: Yeah. You know, I first became interested in this field, and actually now it has a name. It's called cardioreumatology. [00:37:00] Speaker A: Wow. [00:37:01] Speaker B: There are some places that have centers. Yeah. And some of us who are so interested in it that there's a group of us that meet once a month and that includes some international colleagues, rheumatologists and cardiologists to talk about these specific patients and how we can appropriately treat them. So I became interested because rheumatoid arthritis and lupus affect more women than men, first and foremost, and lupus especially affects more black women than any other ethnicity or race. We know that the systemic inflammation, so that it occurs throughout the entire body when you're in acute flare of lupus or rheumatoid arthritis, is actually associated with increased risk for cardiovascular disease. [00:37:43] Speaker A: Wow. [00:37:44] Speaker B: In fact, it's important to understand that the plaque that forms in the artery, that's actually part of an inflammatory process. Some of the medications that we use to treat rheumatoid arthritis or lupus can sometimes have a negative effect on your cardiovascular risk. So that's why it's important to work with a physician who understands if you have these conditions. Well, how do I interpret this when it comes to my individual risk for cardiovascular disease? Am I different than someone who doesn't have these? And you are. You are different. How do I treat your lupus and rheumatoid arthritis? Even if some of these medications like prednisone, which can increase blood pressure, cause swelling, and can increase your cholesterol, but you need it to prevent yourself from having a flare. Well, so how do I work with you to make sure that your rheumatologist is treating you, but I'm also decreasing your risk for cardiovascular disease. So I think first and foremost, we all need to understand that there is an association, that some of the treatments can increase your risk, but some of the treatment actually reduces your risk. And that we need to work with specialists in both fields to make sure that we're controlling both so that you can have a healthy, long life. [00:39:02] Speaker A: Wow. It gets complicated. Yeah, I mean, complicated fast. But so what you're saying is, you know, and I did have this experience with my mother, just in transparency, she has rheumatoid arthritis and we were finding that one of the medicines that she was on was having a negative impact on her and on her cardiovascular health. And it went for years. And truly she's off of it, all of it. And she just takes in arthritis, prescription strength, like a Tylenol type thing, you know, but for rheumatoid arthritis, and she finds that she's feeling better and her markers are looking better. So it's kind of interesting. Medicine is fantastic. It's amazing what it can do for us, but we have to know how to use it. [00:39:50] Speaker B: Right. And it's fast changing. It's fast changing. You know, I think especially when we're talking about these two disease processes, they occur a lot more in younger women and, you know, because the risk for heart disease is higher in people who have lupus or rheumatoid arthritis. I've had patients who present to the emergency room with chest pain and no one can believe they're having a heart attack. But actually, chest pain or heart attack is the number one presentation, the cardiovascular presentation for somebody with lupus. And they tend to have it much earlier on, as early as age 35. They can have a heart attack. [00:40:25] Speaker A: Oh, my gosh. [00:40:26] Speaker B: Yeah. So it's really important that young women are educated about their risk of cardiovascular disease. When you're, when you have some of these inflammatory conditions, don't just blow it off. That's right. [00:40:38] Speaker A: Think you've got. [00:40:39] Speaker B: Yeah, that's right. Because you're young. [00:40:42] Speaker A: Okay. So we're going to get more into that when we talk about symptoms. Let's discuss something I know that is also really important in your thinking, which is the link between, you know, between stress and this emotional well being. You talk about this link between emotional health and cardiovascular health. When I think about women and our natural caretaking instinct. Right. I think I shared with you that I Feel like it's part of our evolution. It's just who we are. And then when I think about me and where I am in my life, you know, I've got children, although they're getting older, it's, you know, and kind of out on their own, it seems like it's almost. They need you more. I now caretake for my mom and I've got an elderly dad. I've got a career and I travel with it and work really hard. So how do you help your patients, like, recognize and manage this connection between their stress and everything going on in their life and by all of their caretaking and seemingly well being that they may be creating an issue for themselves down the line? [00:41:49] Speaker B: Yeah, well, you know, stress and anxiety are associated with cardiovascular disease. I always tell my patients who come to see me, maybe they're having palpitations, they feel like their heart's racing, they feel like they're having panic attacks. Your body can't tell the difference whether somebody is chasing you down the block or if mentally you're under such stress that you feel like you're at this high intensity level of stress and you're just. Your heart's racing all the time. One of the things that is important is that once we understand that that connection exists is that we find ways to reduce our stress. As I tell my patients, there's always going to be some trigger. [00:42:31] Speaker A: Yeah. [00:42:32] Speaker B: How do we manage it? Right. How do we manage it? Because sometimes it'll come out of left field. Sometimes there's a chronic level of stress. It may be your job, as you said, sometimes for someone you may be taking care of an ill parent. Where some of us are in that sandwich phase. We're taking care of children as well as taking care of taking care of parents as well. Stress is associated with high cortisol levels, poor sleep. When we're stressed, we don't exercise. Right. So there goes a risk factor for cardiovascular disease. When our cortisol level is high, we gain weight, especially around the abdomen. We're not able to make those healthy choices. Right. So you're not going to eat healthy. I will fully confess that I'm a stress eater. So when I am stressed, I will do the late night eating or I'll. You won't find me eating oatmeal if I'm stressed out. That's not gonna calm me. [00:43:20] Speaker A: I think I caught you on a good day. [00:43:22] Speaker B: Yes, yes. I did the treadmill and I had oatmeal today. The stationary bike, rather. But it's important to Understand that not only does it affect our blood pressure, it affects our heart rate. It causes a pro inflammatory state that can affect your biomarkers, like your cortisol, your blood sugars. I actually had a friend who wore one of those continuous glucose monitors and found that when they were in a stressful period, their blood sugar would spike. [00:43:49] Speaker A: Wow. [00:43:50] Speaker B: So finding ways, whether it's exercise, meditation, mindfulness, some people like journaling, some people like prayer or whatever it is, how can you incorporate that in your weekly and or daily life to try to keep your stress at a manageable level, if it exists. [00:44:11] Speaker A: So how do you define and how do you practice mindfulness? [00:44:17] Speaker B: Well, I'll tell you. Last weekend I was at Chateau Ilan. I took a couple of days off and I just went on my own, just to get away. Went on a nice nature walk. So I think it's like those type of things is finding time to take care of yourself. We work hard and especially as women, as you said, we take care of everyone else but ourselves. We are always last. We give to our family, we give to our jobs, we give to our children, we give to our friends. And oh, yes, now it's my turn. But then, by then, you're spent, you're exhausted, maybe you're sick. You're ignoring your symptoms because you've got some of these other obligations. So carving out that time intentionally. I'm not perfect, but I have an accountability partner and one of my colleagues who will tell me what she's done for exercise or what we can do, maybe on a weekly basis, meet up and go for a walk. I also like to listen to, even when I'm at work, in between patients, I actually have some meditation background, very soft music playing in the office. So that sort of keeps me even. Keel. [00:45:26] Speaker A: Oh, that's great. So I love this idea of having an accountability partner. That's really fantastic. You and I had talked about something that kind of makes me sad. This broken heart syndrome. Let's talk about that. Because you're talking about how that's a real thing and what do we do about it? What does it mean? How can you recognize if you have it? And then what can people do about it? [00:45:54] Speaker B: Yeah. So I think almost all of us can probably recount a story that if we don't know someone personally, we've heard of someone else who maybe their spouse suddenly became ill or died and they died the next day, or they were in a very stressful situation and they collapsed or passed out, etc. Ended up in the hospital, found to Maybe have had a heart attack, et cetera. But broken heart syndrome is a period of acute stress. So whether it's emotional or even physical stress that causes this surge of adrenaline to the heart and can actually cause damage and stress to the heart muscle. And when women have. And women will have this more than men. Some men will have it, but it's much, much more common in women than it is in men. And it feels like you're having a heart attack. [00:46:44] Speaker A: Oh, wow. [00:46:45] Speaker B: It's that pronounced. You feel like you're having severe chest pain. You can't breathe, you'll start sweating. I've had people collapse. And we actually, in the medical community cannot tell the difference between broken heart syndrome and a heart attack until we've actually done a procedure called a coronary angiogram, where we look at your arteries and prove that there's no blockages in the arteries. [00:47:06] Speaker A: Oh, my goodness. [00:47:07] Speaker B: That's how much it looks like a heart attack. Even the electrocardiogram looks the same as if the person's having a heart attack. [00:47:13] Speaker A: Wow. So how do people, like. I mean, it's so easier said than done, right, to be able to say that you could manage that. [00:47:23] Speaker B: Yeah. Well, the hard thing is that you can't prevent it because it's usually an acute stressful episode. Right. It's not that you've got this high level of ongoing chronic stress. The good thing is that for people who do have broken heart syndrome, most of them recover heart function within a month. [00:47:44] Speaker A: Yeah. [00:47:44] Speaker B: So that's very good. [00:47:45] Speaker A: That's good news. [00:47:46] Speaker B: It is very good. Is that you do recover from that. Most individuals, we do have good medications as well to treat. If you do develop broken heart syndrome. I think, again, it's recognizing that this is an entity. So let's say you. You suffer extreme stress and you're at home and you feel bad. You think you're just mourning. There may be something more going on, and it's important that you seek care. [00:48:11] Speaker A: Okay, Good advice. Okay. I want to talk about some of the. What I'm calling the scary stuff. Although what we talked about, symptoms and things to watch out for. Now you were talking about this. Broken heart syndrome may present itself as a heart attack. Panic attacks can also do that. So what is it? You know, I think it could cause people to maybe not go to the emergency room if they think they're having a panic attack. So what is it that we should be paying attention to? And what would be some symptoms that women would have that should maybe keep them on alert or say you Know what? Maybe you should go to the hospital right now. [00:48:55] Speaker B: Yeah. You know, that study that looked at women's awareness of cardiovascular disease as a leading cause of death also looked at symptoms, and they found that women didn't recognize symptoms as well for cardiovascular disease, especially younger women. And the scary part about that is that our younger women are more. They are actually the growing part of our female population that is experiencing, yes, heart attacks, actually in cardiovascular disease. So first and foremost, I think a lot of my patients will come in. One of the reasons they come in is they say that I understand that women can present differently. So that word is getting out. But it is important to understand that the most common symptom of heart disease, or a heart attack specifically, is chest pain. Regardless. So it's, it's not that we just present differently. Women still do get chest pain. So if you get chest pain, don't ignore it. One of the things that I also educate my female patients and other clinicians whenever I'm out giving talks is it's not just chest pain. Women are usually not likely to use the word chest pain or the phrase chest pain. They'll say chest pressure, chest heaviness, chest tightness. [00:50:07] Speaker A: Wow. [00:50:07] Speaker B: So a woman will come into the emergency room and the doctor will ask, are you having any chest pain? She'll say, no. But her EKG in her lab is showing she's having a heart attack. Because in her mind, it's not chest pain. It just. It feels like discomfort. So a lot of times I'll ask my female patients, have you had any chest discomfort, any abnormal sensation in your chest? So that's still the number one symptom. [00:50:29] Speaker A: Okay. [00:50:30] Speaker B: But women are more likely to have what we call non cardiac symptoms. We used to call them atypical symptoms, but we know they're not atypical, they're just non cardiac. So sometimes women will feel nauseous, they'll feel short of breath, break out in the sweat with minimal activity. You're just going up the stairs. You haven't run a marathon. Fatigue. I had a woman who was in her late 60s, early 70s, and she took care of herself. She noticed that when she would make her bed, she would get tired. Very atypical for her. That's not normal. And sure enough, we proceeded with stress testing, found out she did have a blockage and needed to have a stent placed. So those are the primary symptoms. The chest pain, fatigue, nausea, profound sweating, shortness of breath, and before I forget, the scapula pain. So sometimes some women, their symptom is just pain in the shoulder blade. [00:51:27] Speaker A: Oh. [00:51:30] Speaker B: Yeah. [00:51:31] Speaker A: Okay. So don't confuse this pain in the shoulder blade, which maybe I've been getting these days with, like, frozen shoulder or something. [00:51:38] Speaker B: Well, it can be. It's funny you should mention. Yeah, it's funny you should mention frozen shoulder because that. Something that is very common in the peri. In the postmenopausal state because of low estrogen. Yeah. And so I think it's. I think the important thing is noticing what's normal and not normal for you. I mean, I have shoulder pain as well, so I know that that is if that occurs. I know what that is. But if I am out jogging and suddenly I break out in a sweat when I could usually run a mile, then that's different for me. Yeah. [00:52:07] Speaker A: Okay. And the one alarming thing that you brought up to me is that what you're saying is this is not an older woman's disease. And so people of all ages. Women of all ages. The other startling piece of information I think, that you brought forward is that there's a greater proportion of younger people now coming or expressing cardiovascular disease than in the past. Do we know why? [00:52:36] Speaker B: Yeah, we do. You know, one thing that we're finding is that younger people and women actually have those risk factors for cardiovascular disease. So where type 2 diabetes used to be a disease of older people, in the type one was the young children who were born with diabetes. Maybe their pancreas wasn't working. We see that type 2 diabetes is actually occurring in young individuals because they're obese, because they're unhealthy, because they're not exercising, because they're not eating a healthy diet. So those are the things that we're seeing in younger women. And in fact, in that age group, 25 to 36 years old, they are actually at greatest risk because, yes, they're. They're unaware about their cardiovascular risk. And that's the fastest growing proportion of women is experiencing cardiovascular disease. [00:53:24] Speaker A: Oh, that makes me sad. Okay, so having that awareness, bringing this message out, I think is very critical. [00:53:32] Speaker B: Yes, absolutely. [00:53:33] Speaker A: Okay, so preventive health question. A little bit of stuff. When I go to my physical. So my regular doctor, I go to you every year as well. You know, my physician, I mentioned how many years I went to him and he read something. He shamed me in one of my reports because he said. Well, first of all, he said to me, yeah, because I travel, I run a business. I think I told you. I'm up seeing my dad a lot. I tend to change my appointments around, and he said, I kind of think you're on, like, the every other year plan. I'm like, really? He said, you kind of get your physical almost every year, but sometimes it's 18 months, sometimes it's every other year. I'm like, oh, my God. And then he really shamed me when I read in one of his reports, I've asked the patient at least five times to schedule a colonoscopy. I went, oh, my gosh. Like, I was like, holy mackerel. So he always runs an EKG for me, right. Because I know that I have hypercholesteremia. There are things that I look out for. But what is it that women in particular, you know, can do to just start on the path of wellness and get that baseline or, like, and then how do they get it? [00:54:46] Speaker B: Yes. Yeah. Well, I think, first of all, I am of the belief that I think an annual physical is important for the longest time, even. I myself didn't have a doctorate, so I have a primary care, who I see every year. But I think it's that opportunity to just talk with somebody about how it's a check in, just like we would take our car in for a check in. How am I doing? Is there anything else that I need to be doing differently? Is there anything that we need to be checking for? We talked about that transition to menopause. Anything that we need to be checking for right about now that would be important for us to start treating or for me to focus on lifestyle and diet a little bit better. So routinely at each visit with the primary care doctor, and if, you know, if you see your other physicians, if you don't have a primary care clinician, getting your laboratory testing, so checking your sugar, checking your blood counts, make sure you're not anemic, checking your cholesterol every single year, that's for sure. We do also checking in on your weight. So every one of us should be getting weight when we go in for a visit, because then sometimes as we transition to menopause or just live a very stressful life, the weight starts to slowly creep up. You know, you're changing clothes, maybe you're using elastic waistband. You don't realize it, but, you know, it's that external individual to remind you you weigh 10 pounds more than you did last year. Or the flip side, which I love to do, is you've been doing so good, you've lost 10 to 15 pounds since last year. So those, I think, would be the basic things. And then if you've never had a Lipoprotein A level checked, I think that's important. We recommend it once in a lifetime. And that should be done as well because it does advise you about your cardiovascular risk. Okay. [00:56:28] Speaker A: So I actually have an order in my inbox to have my lipoprotein A done, which I assure you will be done within the next week. So let's talk about one of the things that, you know, high cholesterol may not necessarily mean that your going to have cardiac events. [00:56:48] Speaker B: That's true. [00:56:48] Speaker A: Right. And one of the things that I did, and I know a lot of people might not even know about it because I don't think it's covered under healthcare, which is that calcium cardiac score, but it can be really a helpful indicator. So talk about that a little because I actually came to you and we had that discussion and I had it done and I'm getting ready to have that one done again too. Unless I did, I can't remember what I do and don't do. But I'm sure that the portal will tell me what does it mean and when should someone consider doing that. [00:57:21] Speaker B: So the calcium scan, and this is the way some women may hear about this is they've heard about somebody getting a calcium scan or their clinician will recommend a calcium scan. And so it is a CT scan that just says scans the heart and the lungs and it's looking for evidence of calcified plaque. And it has a really informative for us in the medical community because we know that it shows us that there may or may not be evidence of plaque, which is atherosclerosis, and that the more calcium there is, it actually educates us or advises us about an individual's risk for cardiovascular disease. So if you have zero calcium, that's great. You're a lower risk risk unless you have some of those other conditions like hereditary cholesterol or maybe family family history of heart disease, or you're a smoker or you're a diabetic, then your risk is still a little bit high even with a zero calcium score. But if you have calcium in the arteries, it tells me that that process of plaque deposit has already started. And then actually we know that individuals who have coronary artery calcium score of 300 or higher, that's equivalent to somebody who's already had a heart attack or stroke. [00:58:40] Speaker A: Oh my goodness. [00:58:41] Speaker B: It actually is. [00:58:42] Speaker A: Wow. So it's good to get a baseline. And this isn't something that has to be done every year. [00:58:47] Speaker B: No, in fact, we don't recommend it's repeated unless for Some reason you've had a zero calcium score. Then if you want to understand your risk in the future, then you can repeat that in three to five years, as long as you're not on a cholesterol pill. But once you have calcium, we know what to do here. It's time to start treatment. [00:59:04] Speaker A: Okay, Understood. So, for the record, I was at zero. It's been four years. You gave me the two thumbs up to get another one, and I'm counting on zero yet again. All right, so setting yourself up for success, to own our own cardiovascular health journey. You talked about getting a baseline. We talked about this lipoprotein A, the little A, I think it's called, something like your calcium cardiac score, having a good physician. Is there anything else? Like, should every woman have a cardiologist? You know, what are your thoughts on that? [00:59:43] Speaker B: Yeah, you know, I mean, I'm somewhat biased because I'm a preventive cardiologist, so I do see people before they develop any disease. You know, I don't want to take away from some of our primary care colleagues who do a phenomenal job at taking care of patients, and they see a higher volume than we do. Right. They come to us either because they sought care on their own and want to talk about prevention or want additional help with managing their risk factors, or they're referred by their clinician. So every woman may not necessarily need to see a preventive cardiologist, but I think every woman would benefit from having a discussion with their clinician, whether it's a primary care clinician or a cardiologist, about cardiovascular risk. What is my cardiovascular risk? That would be a perfect question to ask at a visit. What is my cardiovascular risk? What do I need to do to minimize my risk within my control through lifestyle? And then when do I need to look into this again in the future, should I see my primary care and they can take over and do these testing, or do I need to check back in with you because I've got a family history or because I have an elevated lipoprotein A. [01:00:56] Speaker A: So one of the challenging things is finding a good provider, be it a gp, your gynecologist, a cardiologist. I have relied on my GP to help me with my referrals and all of my extensive research that I do, as you know. And he retired, and so I felt a little bit lost, although he gave me a referral to another gp, which was great. But how can people find a good healthcare provider? And what are the things that you would recommend for them? Like to look For. [01:01:30] Speaker B: Yeah, well, you know, thank God for the power of the Internet. It used to be just word of mouth and you would have to rely on the recommendation that your clinic. But now patients seek out their own clinicians on their own. You look up their reviews, right? You look to see how others have received care when they visited them. So I think when they're asking friends or family, I do get a lot of referrals just from family members or from friends who they refer their friend to come and see me. So I think that is still a good, a tried and true method because you can ask somebody, do you. You trust this person? Would you send another family member to this doctor? I think the other thing, though is making sure that you're doing your own due diligence is that when you finally found someone, you don't have to feel like you're committed to them unless the relationship is right. And what I mean by that is that when I am working with patients, and that's what it is, I'm working with you to either improve your health or to help maintain good cardiovascular health. So my goal is that I am here to listen to you. I want to know what your concerns are. I want to know what's important to you, and then I want to make sure I'm able to advocate and fight for you. That when I suggest something is because we're going to talk about the risk and benefits and I'm here to hear how you feel about both of them. And then to make sure that when you go to that visit, you feel heard, you feel that someone's on your side, you feel like someone's advocating for you and that you feel that this is a safe place for you to share. However you feel that's what you should be looking for in that clinician. It's a relationship. It's a bidirectional relationship. I get as much joy taking care of my patients as I'm hoping that I provide to them. [01:03:25] Speaker A: Oh, gosh, you definitely do. And I can tell you that if I did not live in Atlanta, I would want to move here just for what you said. No, it's the truth. So it's like finding that right fit. I love everything that you do. So let's talk about two things. One is like, how can women get more information? Like, what are some resources that they can go to to understand more about their cardiovascular health? If they just want to understand more. [01:03:56] Speaker B: Yeah. So one of the great resources is cardiosmart.org, org which is a patient centered website that is developed by the American College of Cardiology and has a lot of information about different health conditions and symptoms, et cetera. Another one that would probably absolutely advocate for is womenheart.org full disclosure. I happen to be on their board of directors, and that's because I believe in their mission, which is they are very interested in increasing awareness of cardiovascular disease in women, advocating for better care and research, and then going out into the community and empowering women to be ambassadors to others who are surviving, whether some sort of cardiovascular event. So I think those are the top two that I would recommend. [01:04:44] Speaker A: In closing, if there would be one message or one thing or something that you would want women to, literally or figuratively, like, take to heart to remember our conversation today. What might that be? [01:05:00] Speaker B: I think, first of all, understanding that heart disease is not just a disease of men, we need to really bust that myth for sure, because I think we do women a disservice by not educating them and making them aware about their risk for cardiovascular disease. So it is a disease of all. And that there are certain periods in a woman's lifetime where you may be at a higher risk for cardiovascular disease based on the stage of life or conditions that you may have experienced, and ensuring that you work with your physician to manage those risk factors if they do exist, and then from the prevention standpoint, understanding what you can do on your own in your everyday life to prevent the development of cardiovascular disease if you don't have it yet. [01:05:55] Speaker A: Well, thank you. Thank you for being here today. Thank you for what you do, your service, your work. I love everything you do. And I'm honored that you came here to spend your time talking to everyone here about how they can improve their cardiovascular health. Thank you so much. [01:06:14] Speaker B: Well, thank you. Thank you for giving me this opportunity and this platform. And thank you for what you're doing today and what you do with your podcast to get the word out. And I think this is some information that is just going to be well received by women. They're going to hopefully tell their family members, their children, their mothers. So thank you for doing this. It's. It's just a blessing to be able to do this with you. [01:06:41] Speaker A: Hey, it's Michelle. Thank you so much for listening today. If you enjoy our podcast and know someone who you believe would make a great guest, I would love to hear from you. Feel free to connect with me on LinkedIn and let's talk. I'd love to hear your feedback. And as always, always may it inspire you in your own personal and professional journey of life.